Magister Public Health - MPH (Public Health)

Permanent URI for this collectionhttps://hdl.handle.net/10566/11948

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Cash transfers and child health: understanding the barriers and facilitators to early application and receipt of the child support grant in Langa Township, Cape Town
(University of the Western Cape, 2026) Maxhakana, Inathi
The Child Support Grant (CSG) is increasingly a social protection instrument of choice aimed at alleviating child poverty and malnutrition in South Africa, with over 13 million children as beneficiaries of the Child Support Grant (CSG). Timely receipt of the grant, within the first three months of birth, is needed for the CSG to be protective against stunting(Aguero et al., 2006). Late application for the Child Support Grant (CSG) remains a significant issue, even 25 years after the grant's establishment. Despite national uptake rates consistently hovering around 80%, take up for children younger than 1 is still low at less than 50%, with the majority of mothers still applying for the CSG late after delivery. This study aimed to explore the reasons behind this late application and understand the contributing factors. The study employed a qualitative exploratory approach to conduct interviews and focus group discussions with 30 mothers/primary caregivers who are 18 years and above with children under 6 years, who have applied and received CSG. . Fifteen in-depth interviews and 2 Focus Group Discussions (FGDs) were conducted to gain a greater understanding, at individual and community level. The age of mothers was stratified according to different age groups (18-24; 2531; 32-38; 39-45;>45). These mothers/primary caregivers were sampled from a longitudinal birth cohort study that ran for 6 years (2016 to 2022) in Langa, Western Cape. The data were analysed using thematic content analysis, and used to formulate themes.
Understanding reasons for treatment defaulting among mental health patients at a district hospital in Mossel Bay, South Africa
(University of the Western Cape, 2025) Jacobs, Heinerich Elroy
The number of patients who received a selective serotonin re-uptake inhibitor within the Mossel Bay Sub-District in the last four years (2020 – 2023) ranged from 2500 – 3500 annually. In 2020, the number of patients on mental health treatment within the Sub-District was 3510, and it decreased to 2500 in 2023, mostly because of treatment defaults. This statistic shows that there is a significant need for intervention in the mental health sphere within the Mossel Bay District. Treatment default by mental health care users is a challenge in the Mossel Bay area and this study sought to understand the reasons for treatment defaulting at Mossel Bay Hospital, Western Cape Province, South Africa.
The prevalence and risk factors associated with pulmonary arterial hypertension among HIV-infected individuals in a tertiary hospital in Durban
(University of the Western Cape, 2025) Gwala, Thembelihle Roseline
Human Immunodeficiency Virus (HIV) infection continues to be a major global public health burden and a risk factor for developing pulmonary arterial hypertension (PAH). Africa carries the largest burden of HIV globally. However, data summarizing the epidemiology of PAH remains unclear. The lungs are often affected by disorders associated with HIV-infection. HIV-infected individuals are at an increased risk of developing PAH and dying from the condition compared to the general population. This study aims to determine the prevalence of PAH, and the risk factors associated with it in individuals living with HIV in a healthcare facility in Durban between 2022 and 2023
Implementing the ideal hospital programme in two rural district hospitals in the West Coast District, Western Cape Province, South Africa: A qualitative study of staff perspectives
(University of the Western Cape, 2025) Cillié, Johanna Jacomina
South Africa's constitution guarantees the right to health and embeds regulations to ensure the delivery of quality healthcare. The National Ministry of Health proposed the National Health Insurance (NHI) Bill in 2012 to support universal health coverage. The National Department of Health established the Office of Health Standards Compliance in 2013 to enforce compliance with the National Core Standards and to provide high-quality healthcare, even though the National Core Standards were promulgated only in 2015. Inspection tools based on the National Core Standards were finalized only in 2018. The Ideal Hospital Programme was introduced in 2018 with its own set of tools to enhance hospital service delivery and to prepare for the implementation of NHI and compliance with the Office of Health Standards Compliance assessments. The COVID-19 pandemic disrupted the Ideal Hospital Programme, resulting in slow progress and poor assessment results. None of the seven district hospitals in the Western Cape's West Coast District met the requirements of the Ideal Hospital Programme during the 2023-24 self-assessments, with outcomes for all seven district hospitals being unsatisfactory, highlighting implementation and sustainability challenges. Concerns about sustainability and the lack of research to support learning and improvement for the Ideal Hospital Programme were raised in a workshop held in June 2024. This situation prompted a research examination of the Ideal Hospital Programme's current state in the West Coast District of the Western Cape and the experiences of staff implementing the programme.
Assessment of knowledge, attitudes, and practices of contraceptive use among college students at a tertiary institution in Harare, Zimbabwe
(University of the Western Cape, 2025) Mutirikwi, Givemore
Contraceptive utilization among young adults remains a cornerstone of sexual and reproductive health and rights (SRHR). In Zimbabwe, young adults—including university students—remain vulnerable to unintended pregnancies and sexually transmitted infections due to persistent gaps in contraceptive knowledge, misconceptions, and barriers to access. Understanding contraceptive knowledge, attitudes, and practices (KAP) within university settings is therefore essential for informing targeted reproductive health interventions. This study assessed contraceptive KAP and associated determinants among students at the University of Zimbabwe, with emphasis on predictors of optimal contraceptive behaviour.
Factors associated with precancerous cervical lesions in HIV-positive women: a retrospective cross-sectional study at a clinic in Eswatini
(University of the Western Cape, 2025) Matsenjwa, Gcinekile
Women living with HIV (WLHIV) are at increased risk of developing precancerous cervical lesions due to immunosuppression and persistent high-risk human papillomavirus (HPV) infection. Cervical cancer remains the fourth most common cancer among women globally, with a disproportionate burden in sub-Saharan Africa. Eswatini faces a dual burden of high HIV prevalence and cervical cancer incidence, yet screening uptake remains low. Limited research has examined the relationship between antiretroviral therapy (ART), immune status, and precancerous cervical lesions among WLHIV in the country. This study aimed to determine the prevalence of precancerous cervical lesions and identify associated factors among WLHIV attending a clinic in Mbabane, Eswatini
Barriers in implementing quality improvement initiatives amongst health care workers at a regional hospital, eSwatini
(University of the Western Cape, 2025) Ngwenya Juliet Siphiwe
The quality and safety of healthcare depend on the capacity of healthcare professionals to continuously implement quality improvement (QI) processes in service delivery. However, QI initiatives often fail to be fully integrated into daily practice due to barriers that hinder effective implementation. This sought to identify and describe factors influencing the uptake and implementation of quality standards among healthcare workers, with the goal of informing strategies to close the gap between expected and actual performance. A descriptive cross-sectional study was conducted at Raleigh Fitkin Memorial Hospital (RFMH), a regional hospital in Manzini, eSwatini guided by the Theoretical Domains Framework (TDF). A stratified systematic sampling method with proportional allocation was used to select 134 healthcare workers across medical, nursing, and allied cadres. Data were collected through a validated self-administered questionnaire distributed both electronically and in hard copy. The instrument contained structured Likert-scale items and open-ended questions assessing individual, organisational, and contextual barriers to QI implementation. Data were analysed using excel to generate descriptive statistics, supported by qualitative thematic insights from open-ended responses. From the findings, it was revealed that although most participants understood QI concepts and recognised their importance, practical application remained imperfect. For example, 77.8% of respondents reported clarity of roles, and the belief in QI’s value was strong, with 90.4% acknowledging its positive impact. Moreover, organisational endorsement of QI was relatively high (83.7%), but financial limitations (21.5%) and moderate self-efficacy (60%) hindered effective implementation. Major barriers included insufficient resources, weak day-to-day management support, inadequate training, low confidence in QI delivery, and limited peer collaboration. Staff thus believed QI enhances patient outcomes but felt constrained by poor organisational systems and perceived lack of active management engagement. The study concludes that, for these barriers to be addressed, it requires a stronger leadership engagement, adequate resourcing, continuous in-service training, and the integration of QI activities into routine hospital operations. Strengthening mentorship, communication, and feedback mechanisms is also essential for sustaining QI practices.
An exploration of the challenges hindering implementation of learning programmes at special care centres
(University of the Western Cape, 2024) Emmanuel, Anthea; Carelse, Shernaaz
The high demand for special care centres for children with severe to profound intellectual disabilities (CSPID) in the Cape Metropole, led to several special care centres (SCCs) emerging in recent years. However, implementing the learning programmes (LPs) in SCCs pose problems regarding the quality of care and the well-being of CSPID. This qualitative case study aimed to understand the challenges that hinder the implementation of LPs provided by special care centres for CSPID. Using a combination of an exploratory and descriptive design, a developmental perspective was employed to investigate this phenomenon. The study population was transversal outreach teams (educational psychologists, physiotherapists [psysio], occupational therapists [OT], speech-language therapists, and learning support educators), programme implementers, caregivers and centre managers, who form a multidisciplinary team employed at special care centres in the Cape Metropole, the study setting. Purposive sampling was used to select 31 participants. Three focus groups were conducted with three to six participants per group, involving caregivers, programme implementers and CSPID teams while individual semi-structured interviews were conducted with the managers of the selected SCCs in the Metropole. Thematic analysis was conducted to develop themes and sub- themes. Ethics approval was obtained from the Humanities and Social Sciences Research Ethics Committee at the University of the Western Cape, and permission to conduct the study was granted from the Western Cape Department of Education and the selected SCCs.
Exploring the experiences of supply chain managers involved in antiretroviral medicines in Zimbabwe during the COVID19 pandemic.
(University of the Western Cape, 2024) Chitsike, Tinei
Background: HIV and AIDS remain a major public health problem globally, in sub-Saharan Africa and particularly in Zimbabwe. The efficient supply of medicines, including Anti-Retroviral (ARVs), is essential to HIV treatment and care during a public health emergency. The COVID19 pandemic exposed vulnerabilities within public health supply chains that manifested in shortages of medicines, medical supplies, and equipment. Aim and objectives: This study explored the experiences of supply chain managers involved in managing ARVs in Zimbabwe during the COVID19 pandemic. It describes the successes, challenges and lessons learnt in managing ARV supply chains in Zimbabwe during the pandemic. Methodology: This was an exploratory, descriptive, qualitative study. In-depth interviews were conducted on a heterogenous, purposively selected sample of ten supply chain managers drawn from Ministry of Health and Child Care (MoHCC) and health development partners involved in forecasting, supply planning, procurement, warehousing, and distribution of ARVs in Zimbabwe. Only central and provincial level supply chain managers were included in the study, given the limited scope, time frame and resources available for the research. The interviews were conducted on Microsoft Teams using a semi-structured interview guide.
Primary caregivers’ experiences of caring for their child post cardiac intervention: An exploratory study
(University of the Western Cape, 2022) Ennos, Fathima B. R
Children in developing countries are now receiving both surgical and catheter-based interventions for the repair of congenital heart defects. Despite the technically advanced treatment options and improved survival rates of children with congenital heart defects, little is known about the experiences and challenges of primary caregivers whilst taking care of their child after a cardiac intervention in South Africa. This exploratory, descriptive study used a qualitative research approach to describe some of the key experiences of eight primary caregivers as they took care of their child in their home environment following a cardiac interventional procedure. The interventional procedures being referred to are both interventional cardiac catheterisation and cardiac surgery procedures. A purposive sample of eight primary caregivers from the tertiary level hospital in Kwa-Zulu Natal, South Africa was selected. Data was collected telephonically through semistructured interviews. Thematic analysis was used to analyse the data and basic statistical analysis of sociodemographic data of participants was conducted. Data was presented both quantitatively and qualitatively in the form of tables, concepts maps, word clouds, participants quotes. In terms of ethics, interviewees participated voluntarily and informed consent was sought from each interviewee and they were informed of their rights to not participate or to stop participating at any time, without any negative consequences to them, their child and the services they would receive from the hospital in the future. Verbal informed consent was sought prior to telephonic interviews and all participant information was kept confidential. The study revealed a number of challenges which primary caregivers described as encumbering the quality of the care they could provide for their child at home. These included poor living conditions, multiple roles as the person running the home, lacking adequate finances to meet the basic needs of the child (like food and clothes) as well as their lack of access to clean water, electricity and proper sanitation.
A preliminary assessment of a framework for the allocation of comprehensive primary dental services
(University of the Western Cape, 2010) Antunes Do Nascimento, Denise
Background: The author of this dissertation has developed a first version of a Dental Resource Allocation Framework (DRAF). The aim of the DRAF is to help improve equity of access to primary dental services by providing health teams and managers of the Brazilian Family Health Programme with a tool to guide the allocation human resources according to primary dental care needs, and therefore to assist them to meet the Family Health Programme targets for improving equity of access to its services. The DRAF comprises three inter-related components: a diagnostic classification tool, a timeframe for primary dental services, and dental team members of the Brazilian Family Health Programme. Aim: The aim of this study was to produce a preliminary assessment of the DRAF by determining its face validity, testing reliability and usability of its diagnostic classification tool, and to produce a set of preliminary recommendations on the viability of the DRAF before it is released for use within the Family Health Programme. Method: Primary care dentists assisted with the preliminary assessment of the DRAF. They participated in three assessment phases. Phase 1 involved distributing the first version of DRAF to dentists for them to determine its face validity in three sessions of consensus group. Across the three sessions, they made changes within each component of the DRAF until a second version was produced at the end of the third session. Phase 2 involved providing dentists with calibration training on the diagnostic classifications and then applying the 5-level diagnostic classification tool by performing clinical examinations in a sample of the Family Health Programme users.
An exploration of how general practitioners, working in seven Black townships in Cape Town, South Africa, perceive their role in strengthening the district health system
(University of the Western Cape, 2025) Mdlekeza, Nozuko Arizona
Despite the recognition of general practitioners’ (GPs) role within the health system, and more recently their role in implementing the National Health Insurance (NHI) in South Africa, very little is known about township GPs’ role, motivation and experiences and their contribution to strengthening the district health system (DHS). The aim of this study was to better understand private GP’s perceived roles in primary healthcare provision within the DHS, investigate their reasons for choosing the medical profession and explore their experiences of being a private GP in Cape Town’s black townships. A qualitative exploratory study was conducted amongst 12 township GPs who provided consent. The exploratory study examined their experiences, to better understand their histories, motivations and socio-cultural work contexts. In-depth interviews were conducted using a semi-structured interview guide consisting of open-ended questions, with interviews conducted face-to-face for approximately an hour per participant. Interviews were recorded with consent and collected data was analysed using thematic coding analysis (TCA). The participants, who had rural and township upbringing obtained positive role modelling from their local GPs, hospital doctors and peers who were medical students. Parental guidance also influenced their choice of profession. These influencers changed their trajectory towards medicine during their secondary schooling. The GPs perceived their role in the DHS as providers of quality primary healthcare in low socioeconomic areas burdened by high morbidity and mortality. They emphasized offering quality medication which the public sector cannot offer, thereby preventing mortality in vulnerable communities. Additionally, they viewed themselves as facilitators and advocates, who support patients and connect them to appropriate public or private clinics and hospitals, or to other sectors like police or social services. Ensuring continuity of care for optimal results was also highlighted as a significant feature in their practices as they established good relationships with their clients, referring them accordingly while working in co-ordination with other actors for their wellbeing. The GPs noted that the absence of language barriers (enabled by their fluency in vernacular) enhanced quality service delivery and clinical outcomes in the townships. They also emphasized cultural understanding as key to strengthening doctor-patient relationships and were supportive of traditional healing as it was embedded in the community. Health promotion in the form of health education on disease management and prevention, was cited as central to their work to enable patients to take control of their health, improve it and that of their families plus the broader community.
An exploration of how general practitioners, working in seven black townships in Cape Town, South Africa, perceive their role in strengthening the district health system
(University of the Western Cape, 2025) Mdlekeza, Nozuko Arizona
Despite the recognition of general practitioners’ (GPs) role within the health system, and more recently their role in implementing the National Health Insurance (NHI) in South Africa, very little is known about township GPs’ role, motivation and experiences and their contribution to strengthening the district health system (DHS). The aim of this study was to better understand private GP’s perceived roles in primary healthcare provision within the DHS, investigate their reasons for choosing the medical profession and explore their experiences of being a private GP in Cape Town’s black townships. A qualitative exploratory study was conducted amongst 12 township GPs who provided consent. The exploratory study examined their experiences, to better understand their histories, motivations and socio-cultural work contexts. In-depth interviews were conducted using a semi-structured interview guide consisting of open-ended questions, with interviews conducted face-to-face for approximately an hour per participant. Interviews were recorded with consent and collected data was analysed using thematic coding analysis (TCA). The participants, who had rural and township upbringing obtained positive role modelling from their local GPs, hospital doctors and peers who were medical students. Parental guidance also influenced their choice of profession. These influencers changed their trajectory towards medicine during their secondary schooling. The GPs perceived their role in the DHS as providers of quality primary healthcare in low socioeconomic areas burdened by high morbidity and mortality. They emphasized offering quality medication which the public sector cannot offer, thereby preventing mortality in vulnerable communities. Additionally, they viewed themselves as facilitators and advocates, who support patients and connect them to appropriate public or private clinics and hospitals, or to other sectors like police or social services. Ensuring continuity of care for optimal results was also highlighted as a significant feature in their practices as they established good relationships with their clients, referring them accordingly while working in co-ordination with other actors for their wellbeing. The GPs noted that the absence of language barriers (enabled by their fluency in vernacular) enhanced quality service delivery and clinical outcomes in the townships. They also emphasized cultural understanding as key to strengthening doctor-patient relationships and were supportive of traditional healing as it was embedded in the community. Health promotion in the form of health education on disease management and prevention, was cited as central to their work to enable patients to take control of their health, improve it and that of their families plus the broader community.
Factors associated with the practice of mixing commercial milk formula with commercial infant cereal during preparation of milk feeds: In a rural South African community
(University of the Western Cape, 2024) Zingani, Nosihle
Background: Breastfeeding is a critical factor in reducing the risk of childhood acute illnesses, and lack thereof results in increased risk of morbidity and mortality. In South Africa, exclusive breastfeeding rate for the first six months is at 24%, with the majority of infants being fed through mixed feeding practices that include commercial infant cereals. Research done in the Eastern Cape indicates that more than 70% of these infants are given their milk formula feeds mixed with a commercial infant cereal. There are a number of harms associated with formula feeding, and in particular mixed feeding. Consequently, there is a need to improve infant feeding practices and reduce early introduction of cereals but, it is necessary to first understand why caretakers have adopted this feeding practice as well as what contributes to uptake of this practice in rural communities in the Eastern Cape. Study aim: To investigate what leads to the practice of mixing commercial milk formula with commercial infant cereal during preparation of milk feeds in Elliotdale in the Eastern Cape. Objectives: 1) To understand key role players’ perceptions and views on the practice of mixing commercial milk formula with commercial infant cereal, 2) to identify contributing factors to the practice of mixing commercial milk formula with commercial infant cereal and 3) to identify potential solutions to promote good infant feeding practices in the Elliotdale community.
South African policy analysis on respectful maternal care
(University of the Western Cape, 2024) Gormley, Stephanie
Every woman has the right to receive respectful maternal care (RMC), which includes high quality of care that is dignified, respectful and free of violence and discrimination. Addressing disrespectful maternal care requires interventions at multiple levels including policy. The purpose of this study was to determine the extent to which current policy addresses RMC in South Africa, and identify any potential gaps therein. The study was conducted through a desk-based review of policy documents, accessed through internet search engines, academic portals, and requests from governmental and other public healthcare agencies. Each policy document was assessed for relevance to the study and then analysed using a framework of analysis. The key policy documents related to maternal care in South Africa, in varying levels of detail, address the rights related to providing RMC. While there are some gaps in the policy, all rights related to RMC are addressed to some extent across the range of policy documents reviewed. This however has not deterred violation of these rights. This thesis discusses the disparity between what policy says and what appears to be implemented, it highlights some of the potential gaps in South African policy on offering RMC and some of the perceived strengths of South African policy related to RMC.
Factors associated with the loss to follow-up and mortality among adolescents and young people receiving antiretroviral therapy in Lesotho
(University of the Western Cape, 2024) Pompong, Pheello Daniel
Background: Globally, it was estimated that about 3.2 million adolescents and young people (AYP) aged 15-24 years were living with human immunodeficiency virus (HIV) in 2022. The loss to follow-up (LTFU), challenges with retention to HIV care, and mortality among adolescents and young people living with HIV are prevalent in sub-Saharan Africa. Factors such as lack of support from the health system, school environments, and caregivers, as well as behavioural and emotional issues associated with adolescence, affect adherence and retention in care among adolescents living with HIV. The HIV programme in Lesotho is making efforts to provide accessible HIV treatment services to people living with HIV. However, the recent national antiretroviral therapy (ART) cohort analysis showed a suboptimal retention rate among adolescents and young people living with HIV aged 15-24 years initiated on HIV treatment. Aim: To determine factors associated with the LTFU and mortality among adolescents and young people living with HIV aged 15-24 years receiving antiretroviral therapy in Lesotho.
Exploring the barriers to optimal implementation of monitoring and evaluation of school oral health programmes amongst oral health professionals, within a Sub-District of the Cape Metropole
(University of the Western Cape, 2025) Martin, Tamsyn Leigh
Dental caries is a major Public Health concern among school children worldwide, with a prevalence of 90% in South Africa. Untreated caries can result in pain, infection, and absenteeism, adversely affecting academic performance in school children. In response, South African education and health departments have implemented comprehensive policies for oral health prevention. Although Public Oral Hygienists are essential in providing oral health preventative services, the effectiveness of these programmes are often diminished by insufficient Monitoring and Evaluation (M&E) both globally and in South Africa. Aim This research study aimed to explore barriers which hinder the optimal implementation of Monitoring and Evaluation of School Oral Health Programmes amongst Oral Health Professionals, within a Sub-District of the Cape Metropole .
An exploration into the key role players’ experiences and perceptions of the Community Based Rehabilitation programme in the Klipfontein Mitchells Plain Substructure, Western Cape
(University of the Western Cape, 2024) Davids, Sadiqa
The Community Based Rehabilitation (CBR) programme was formally adopted via the Integrated National Disability White Paper (Republic of South Africa, 1997) and National Department of Health’s Rehabilitation Policy of 2000. It was incorporated into the Western Cape Government Department of Health’s (WCGDOH) 2030 health care plan as a strategy to improve access of health services to persons with disabilities. Existing literature on the impact of the implementation of CBR globally and particularly within South Africa has found value in CBR for improving the overall health of persons with disabilities (Chappell and Johannsmeier, 2009; Mannan et al., 2012; Thomas & Thomas, 2002). The CBR programme implementation is ten years old within the Western Cape. The study aimed to develop an understanding of CBR implementation in the Klipfontein Mitchells Plain Substructure (KPMSS) and the various factors influencing implementation and sustainability of the programme from the experiences and perceptions of the key role players. The researcher will be reporting on the findings that emerged within the study. They include the History of CBR, the RCWs role, Recruitment, Training, Integration into the formal health system, Challenges within the working environment and Community support and/or acceptance. A qualitative, exploratory design was employed which included all key role players of the CBR programme in the KMPSS, Western Cape
Exploring the experiences of supply chain managers involved in antiretroviral medicines in Zimbabwe during the COVID19 pandemic
(University of the Western Cape, 2024) Chitsike, Tinei
Background: HIV and AIDS remain a major public health problem globally, in sub-Saharan Africa and particularly in Zimbabwe. The efficient supply of medicines, including Anti-Retroviral (ARVs), is essential to HIV treatment and care during a public health emergency. The COVID19 pandemic exposed vulnerabilities within public health supply chains that manifested in shortages of medicines, medical supplies, and equipment. Aim and objectives: This study explored the experiences of supply chain managers involved in managing ARVs in Zimbabwe during the COVID19 pandemic. It describes the successes, challenges and lessons learnt in managing ARV supply chains in Zimbabwe during the pandemic. Methodology: This was an exploratory, descriptive, qualitative study. In-depth interviews were conducted on a heterogenous, purposively selected sample of ten supply chain managers drawn from Ministry of Health and Child Care (MoHCC) and health development partners involved in forecasting, supply planning, procurement, warehousing, and distribution of ARVs in Zimbabwe. Only central and provincial level supply chain managers were included in the study, given the limited scope, time frame and resources available for the research. The interviews were conducted on Microsoft Teams using a semi-structured interview guide. Audio recordings of interviews were transcribed before the data was coded and analysed. Manual thematic coding was used for data analysis which involved assigning codes and identification of emerging and global themes.
A comparative study of the relationship between sociodemographic factors and physical activity levels among black urban and rural adults
(University of the Western Cape, 2024) Allen, Wilfred;
Introduction: The health benefits of engaging in physical activity (PA) in the prevention and control of non-communicable diseases are well established. A physically inactive lifestyle places individuals at risk for premature complications in health, as well as early onset and progression of non-communicable disease. Aim: The aim of the study is to investigate the relationship between sociodemographic factors and physical activity levels among black urban adult South Africans residing in Langa, Western Cape, and black rural adult South Africans residing in Mt Frere, Eastern Cape. Methods: A quantitative, descriptive, cross-sectional and comparative study design was employed. This study was an analysis of secondary data from the Prospective Urban Rural Epidemiology (PURE) cohort study, comprising black South African adults, males and females aged between 35 and 70 years in the urban setting of Langa in the Western Cape (n = 661), and the rural setting of Mt Frere in the Eastern Cape (n = 699). A p-value of less than 0.05 was used to indicate statistical significance. Ethics clearance to conduct the study was obtained from the Biomedical Research Ethics Committee (BMREC) at the University of the Western Cape (BM23/3/13).

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