Maylene Shung-King

University of Cape Town | UCT · Health Policy and Systems Division, School of Public Health

The social determinants of health (SDH), such as access to income, education, housing and healthcare, strongly shape the occurrence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) at the household, community and national levels. The SDH are systemic factors that privilege some more than others and result in poverty and inequitable...

Background: Maternal and child health is a priority for most governments, especially those in low and middle-income countries (LMICs), due to high mortality rates. The combination of individual and social actions designed to gain political commitment, policy support and social acceptance for health goals are influenced by the interplay between the...

High sugar intake contributes to diet-related excess weight and obesity and is a key determinant for noncommunicable diseases (NCDs) in low- and middle-income countries (LMICs). The World Health Organization (WHO) gives specific advice on limiting sugar intake in adults and children. Yet, to what extent have policy ideas on sugar intake reduction o...

Rates of obesity and related non-communicable diseases are on the rise in sub-Saharan Africa, associated with sub-optimal diet and physical inactivity. Implementing evidence-based interventions targeting determinants of unhealthy eating and physical inactivity in children and adolescents’ immediate environments is critical to the fight against obes...

This case study describes the impact of the COVID-19 epidemic on child health in the Western Cape and the subsequent response. It draws on multiple data sources: routine data, case examples, experiential evidence from practitioners and a series of advocacy briefs that examine the impact of COVID-19 on children in the Western Cape. About 12 000 chil...

In the initial phases of the COVID-19 epidemic in South Africa, children experienced relative neglect, as they were deemed to be at low risk for contracting and spreading COVID-19 infection. Overwhelmed by adult infections, the health system responded slowly to children’s complex needs brought about by the epidemic. This in-depth case study outline...

Non-communicable diseases (NCDs) contribute significantly to global mortality and are of particular concern in growing urban populations of low- and-middle income countries (LMICs). Physical inactivity is a key NCD determinant and requires urgent addressing. Laudable global and regional efforts to promote physical activity are being made, but the l...

Non-communicable diseases (NCDs) are the leading cause of death globally. Despite significant global policy development for addressing NCDs, the extent to which global policies find expression in low-and-middle income countries’ (LMIC) policies, designed to mitigate against NCDs, is unclear. This protocol is part of a portfolio of projects within t...

Physical inactivity is increasing in low- and middle-income countries (LMICs), where noncommunicable diseases (NCDs), urbanisation and sedentary living are rapidly growing in tandem. Increasing active living requires the participation of multiple sectors, yet it is unclear whether physical activity (PA)-relevant sectors in LMICs are prioritising PA...

Noncommunicable diseases contribute the greatest to global mortality. Unhealthy diet—a prominent risk factor—is intricately linked to urban built and food environments and requires intersectoral efforts to address. Framings of the noncommunicable disease problem and proposed solutions within global and African regional diet-related policy documents...

This is the first in a series of advocacy briefs that outlines the emerging impacts of COVID-19 on children in the Western Cape and motivates for greater prioritisation of children in South Africa’s response and recovery plans, as even in this well resourced province children are being left behind.

The COVID-19 pandemic has had a direct and profound affect on children, even though they are less likely to spread the virus and are at lower risk of infection and serious complications than adults. Yet the primary focus on adult COVID-19 care has meant that children's specific needs were not adequately recognised, planned for or addressed in the h...

The opening and closing of schools during the COVID-19 pandemic has been a highly contested issue. Responses call for a balancing act between minimizing the disruption to children’s education while also keeping children, educators and the broader school community as safe as possible. While schools have the education of learners as their primary man...

This special issue presents a set of seven Health Policy Analysis (HPA) papers that offer new perspectives on health policy decision-making and implementation. They present primary empirical work from four countries in Asia and Africa, as well as reviews of literature about a wider range of low- and middle-income country (LMIC) experience.

Background As part of health system strengthening in South Africa (2012–2017) a new district health manager, taking a bottom-up approach, developed a suite of innovations to improve the processes of monthly district management team meetings, and the practices of managers and NGO partners attending them. Understanding capacity as a property of the h...

At the time of writing, it is unclear how the COVID-19 pandemic will play out in rapidly urbanising regions of the world. In these regions, the realities of large overcrowded informal settlements, a high burden of infectious and non-communicable diseases, as well as malnutrition and precarity of livelihoods, have raised added concerns about the pot...

Background: The persistence of high maternal mortality and consistent failure in low-and middle-income countries to achieve global targets such as Millennium Development Goal five (MDG 5) is usually explained from epidemiological, interventional and health systems perspectives. The role of policy elites and their interests remains inadequately expl...

Introduction Document analysis is commonly used in health policy analysis (HPA) studies, but the purpose and rigour of application is unclear. This review explored the application and utility of document analysis in HPA studies conducted in low-and-middle income countries (LMICs), intending to derive lessons for strengthening this methodology. Met...

Background In South Africa (SA), clinics and community health centres are the predominant primary level health care facilities in the public health sector. As part of legislated health governance requirements, clinic committees (referring to those for clinics and community health centres) were established to provide management oversight and bring t...

Intersectionality is a useful lens to understand how inequities in health develop and are experienced. Intersectionality is both a theory and methodological approach that demonstrates how overlaying social stratifiers (e.g. gender, ableness, sexual orientation and identity) can result in mutually enforced vulnerabilities that render some groups at...

Background Non-communicable diseases (NCDs) are the leading cause of death globally. While upstream approaches to tackle NCD risk factors of poor quality diets and physical inactivity have been trialled in high income countries (HICs), there is little evidence from low and middle-income countries (LMICs) that bear a disproportionate NCD burden. Sub...

Background: The prevalence of uncorrected refractive error among school-age children is on the rise with detrimental effect on academic performance and socio-economic status of those affected. School vision screening programmes appear to be an effective way of identifying children with uncorrected refractive errors so early intervention can be mad...

Background As part of health system strengthening in South Africa (2012- 2017) a new district health manager, taking a bottom-up approach to developing managerial capacity, developed a suite of innovations to improve the processes and practices of managers and NGO partners in monthly district management team meetings. Using a systems perspective on...

Background As part of health system strengthening in South Africa (2012- 2017) a new district health manager, taking a bottom-up approach to developing management capacity, developed a suite of innovations to improve the processes and practices of managers and NGO partners in monthly district management team meetings. Understanding capacity as a pr...

Background In South Africa (SA), clinics and community health centres are the predominant primary level health care facilities in the public health sector. As part of legislated health governance requirements, clinic committees (referring to those for clinics and community health centres) were established to provide management oversight and bring t...

This chapter identifies the principles that should inform the development of a child- and adolescent-centred health care system at district level. It recognises the need for a 'whole systems' approach to ensure that child health is adequately prioritised and resourced. This means that child health is not just the responsibility of child specific pr...

This introductory chapter of the 2020 South African Child Gauge outlines South Africa's commitments to uphold children’s right to health; assesses recent trends in children and adolescents' health status; care arrangements, living conditions and access to health care services, and calls for early and sustained investment in young children and adole...

The South African Child Gauge is published annually by the Children's Institute, University of Cape Town, to monitor progress towards realising children's rights. This issue focuses attention on child and adolescent health-reflecting on progress and setting an agenda for 2030 to ensure that South Africa's children not only survive but reach their f...

There is widespread concern regarding the size and capacity of the paediatric nursing workforce, which is an important contributor to improved health outcomes for South Africa's (SA) children. As reliable information on the size of the paediatric nursing workforce and associated training activity was not readily available, a small, exploratory stud...

Background This study sought to identify, as far as possible, the extent of the specialist children’s nursing workforce in five selected African countries. Strengthening children’s nursing training has been recommended as a primary strategy to reduce the under-five mortality rate in African nations. However, information about the extent of the spec...

Aim To investigate how acceptable and feasible a school-based contraceptive clinic (SBCC) would be in a low-income South African community. Background Teenage pregnancy is an important issue in South Africa, with significant health and social consequences. Issues regarding lack of confidentiality in an intimate community, unwelcoming health worker...

Background: The importance of strong and transformative leadership is recognised as essential to the building of resilient and responsive health systems. In this regard, Sustainable Development Goals (SDG) 5 prioritises a current gap, by calling for women's full and effective participation and equal opportunities for leadership, including in the he...

Background: The importance of strong and transformative leadership is recognised as essential to the building of resilient and responsive health systems. In this regard, Sustainable Development Goals (SDG) 5 prioritises a current gap, by calling for women's full and effective participation and equal opportunities for leadership, including in the h...

This position paper summarises the current knowledge on the epidemiology, diagnosis and management of women of childbearing age with rheumatic heart disease (RHD) in Africa, as well as the available data on their use of reproductive health services. The aim is to provide guidance to health professionals on aspects of sexual and reproductive health...

The Oliver Tambo Fellowship Programme is convened by the School of Public Health and Family Medicine, University of Cape Town, South Africa. It is a health leadership training programme with a post-graduate Diploma at its core, supplemented by management seminars, mentorship and alumni networking. An external evaluation was conducted in 2015 for th...

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Background Child and adolescent mental health in Africa remains largely neglected. Quick and cost-effective ways for early detection may aid early intervention. The Strengths and Difficulties Questionnaire (SDQ) is globally used to screen for mental health problems, but little is known about its use in Africa. We set out to perform a scoping review...

When new evidence comes to light, it compels us to contemplate the implications of such evidence for health policy and practice. This article examines recent research evidence on the prevalence of asymptomatic rheumatic heart disease (RHD) in South Africa and considers the implications for the Integrated School Health Programme (ISHP). RHD is still...

Working paper examining the relationship between co-payment and moral hazard in the context of an NHI

The discrepancy between policy and practice has been a subject of concern and fascination to academics, policy makers, implementers and users alike. Scientists are regarded as thinkers, practitioners as doers and policy makers as bureaucrats [1] yet practitioners expect to receive clear guidance on how to act. The administrative function of authori...

In Africa, screening for asymptomatic rheumatic heart disease (RHD) has been conducted in single communities using non-standardised echocardiographic criteria. The use of different diagnostic criteria has led to widely variable estimates of the prevalence of RHD in the same communities. Randomly selected school pupils, from 4 to 24 years of age in...

South Africa: reflections on the past and reflections on the past and reflections on the past and reflections on the past and reflections on the past and reflections on the past and reflections on the past and prospects for the future prospects for the future prospects for the future prospects for the future prospects for the future prospects for t...

To address problems of inadequate public health services, escalating private healthcare costs and widening health inequalities, the South Africa (SA) Government has launched a bold new proposal to introduce a universal, comprehensive and integrated system for all SAs; National Health Insurance. Though attention has been devoted to the economics of...

The Cochrane Column (in the International Journal of Epidemiology) highlights Cochrane Reviews relevant to public health to stimulate debate about the review findings, their application, or methodological aspects that the reviews raise. In this issue, we look at a review summarising interventions to prevent obesity in children. Anel Schoonees from...

In this article, I explore the South African 2003 National School Health Policy (NSHP) and the revised 2012 Integrated School Health Policy (ISHP). I examine whether the shortcomings in the development, content and implementation of the 2003 NSHP, and the context in which it was implemented, have been addressed adequately in the 2012 ISHP. The shor...

Disclaimer This HEU working paper is a report presenting results of a literature review in preliminary form and has been disseminated to stimulate discussion and to contribute to public debates about universal health coverage. The analysis and conclusions are those of the author. i Acknowledgements Thank you to Professor Diane McIntyre for her guid...

The availability of cause-specific mortality data for children in South Africa is limited. Hospital-based data have the potential to contribute to understanding of the causation of childhood death in South Africa. The objectives of the study were to gain insights into the causes of death in a South African children's hospital. Prospective, descript...

Children have special protection under the South African constitution, including the right to safety, health and an environment conducive to their wellbeing and optimal development. Yet, firearms contribute significantly to the high incidence of deaths and injuries among South African children and in young males in their late teens. This case study...

C hildren's right to health care is expressed in two sections of the South African Constitution. Section 27 accords "the right to have access to health care services for all South Africans". Section 28 (1) (c), which is that portion of the Bill of Rights dealing specifically with children's rights, states that children have "the right to basic heal...

This investigation studied the use of the full blood count (FBC) in a general medical inpatient ward at Groote Schuur Hospital. To determine the relative frequency of the reasons for which FBCs were requested (clinically indicated v. routine) and how they influenced patient management. One hundred and sixty-five consecutive general medical inpatien...

The health system in South Africa has to date been fragmented and centralised. The priority of the new government is to establish an integrated and decentralised district health system of which a key element is the development of district health and management information systems (H & MIS). This paper presents experiences from two projects in the W...