OpenUCT is the open access institutional repository of the University of Cape Town (UCT). It preserves and makes UCT scholarly outputs digitally and freely available, including theses and dissertations, journal articles, book chapters, technical and research reports, as well as open educational resources.
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Open Access
Fairness in water consumption experiments: understanding burden-sharing preferences and conservation beliefs
(2026) Ghoor, Imaan; Visser, Martine
The increasing impacts of climate change have intensified water insecurity, posing significant challenges for major cities in developing countries. Cape Town, South Africa, experienced its most severe drought in four centuries, highlighting the vulnerability of urban water systems to prolonged shortages. Although the city has since recovered, concerns regarding long-term water security persist. Addressing these challenges necessitates a comprehensive approach that integrates both demand and supply management strategies. A critical component of effective policy design is an understanding of public preferences regarding the distribution of responsibility for water conservation, ensuring that burden-sharing mechanisms are both equitable and sustainable. This study is among the first to apply experimental methods to examine equity preferences for urban water conservation in a developing country, bridging a gap in the literature. Using a sample of 315 Cape Town residents, the study investigates how beliefs, policy preferences, and how cultural theory of risk shape fairness and burden-sharing preferences for water use. Key findings show that low-endowment players favoured principles that minimised individual contributions, such as the equal water use principle. High-endowment players demonstrated more complex patterns, with preferences influenced by education and policy attitudes. Burden-sharing principles did not significantly influence high- endowment players contributions in the first stage of the experiment. Similarly, the cultural theory of risk principles did not significantly impact contributions in the first stage of the experiment but emerged as important determinants of preferences in the second stage, with individualism and egalitarianism playing key roles. The study highlights the need for water conservation policies that reflect socioeconomic diversity and fairness norms to foster cooperation and equity.
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Open Access
A descriptive study assessing the effectiveness of patient blood management initiatives at a tertiary level hospital in South Africa by comparing the utilisation of iron therapy (oral and intravenous) to packed red blood cell transfusions over a 10-Year period
(2026) Corin, Chadwin Frederick; Louw, Vernon
Iron deficiency anaemia (IDA) remains a significant public health challenge in low- and middle-income countries (LMICs) like South Africa, where progress towards the World Health Assembly's 2030 target of reducing anaemia by 50% among women of reproductive age is insufficient. Patient Blood Management (PBM) initiatives, implemented at Groote Schuur Hospital (GSH) in 2018, aimed especially to optimise red cell mass and reduce reliance on packed red blood cell (pRBC) transfusions through enhanced utilisation of iron therapies. This study evaluates PBM's effectiveness by analysing expenditure trends on oral and intravenous (IV) iron therapies compared to pRBC transfusions over the 2013–2022 period. Methods: This retrospective cohort study used GSH pharmacy and Western Cape Blood Service (WCBS) data, covering April 2013 to March 2023, segmented into pre-PBM (2013–2017) and post-PBM (2018–2022) periods. Expenditure on the available oral iron (Ferrous Sulphate tablets, Ferrous Gluconate syrup), IV iron (Iron Hydroxide Dextran), and pRBC transfusions was adjusted to 2022 constant USD values using South Africa's Consumer Price Index (CPI) and 2022 Purchasing Power Parity (PPP) factor of 7.23. Expenditure per 1 000 patient encounters and cost differentials per annum were calculated. Statistical analyses included Wilcoxon Rank-Sum, Mann-Kendall, Wilcoxon signed-rank tests, bootstrap methods (10 000 resamples) for 95% confidence intervals, sensitivity analyses excluding 2020 data and segmented interrupted time-series models. Results: Since the initiation of PBM initiatives, iron therapy utilisation increased, with median annual expenditure per 1 000 patient encounters rising by 74.4% for oral iron therapy (from $16 to $28; Wilcoxon p=0.056; 95% CI: $0 to $21), 302.2% for IV iron therapy (from $25 to $99; p=0.008; 95% CI: $29 to $145), and 222% for combined iron therapy (from $41 to $131; p=0.008; 95% CI: $40 to $162). In contrast, median annual expenditure per 1 000 patient encounters on pRBC rose by only 3.2% (from $7 270 to $7 499; Wilcoxon p=0.548; 95% CI: $- 665 to $1 474), below the 11.4% acquisition cost increase (Wilcoxon signed-rank p=0.652), 2 potentially indicating reduced transfusion reliance. Cost differentials per annum showed an additional $90 for combined iron therapy, offset by $600 in pRBC savings, yielding a net savings of $510 (R3 680) per 1 000 patient encounters, with potential annual savings exceeding $305 400 (R2 208 042) at GSH. Sensitivity analyses excluding 2020 data (due to potential confounding effects of the COVID19 pandemic) showed trends remained directionally consistent (p≤0.176). Conclusions: PBM increased iron therapy utilisation, reduced pRBC reliance, and achieved cost savings, positioning it as a more affordable strategy for IDA management in South Africa and LMICs. Clinical outcome studies are needed to further validate these findings.
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Open Access
Enhanced LiDAR Odometry and mapping in outdoor environments
(2026) Dhunny, Zaheer; Verrinder, Robyn; Amayo, Paul
3D mapping is an essential component of autonomous navigation, yet challenges remain in scenarios involving sudden and aggressive motion. This thesis investigates the effects of abrupt changes in pitch and roll on LiDAR-based 3D maps. Experiments were conducted using a Clearpath Husky UGV at the University of Cape Town's Old Zoo, a challenging 2-hectare site featuring dense vegetation, semi-structured ruins, and unstructured terrain. The UGV was fitted with a stereo ZED 2i camera system, an IMU, and Velodyne HDL-32E. The second dataset used is the Newer College Dataset (NCD) and was collected using an Ouster OS1-64 LiDAR with a 6-axis IMU. The Ouster LiDAR was held by a person walking through the campus and was abruptly rotated to cause high linear and angular accelerations. FAST-LIO2 is an accurate and real-time LiDAR-inertial odometry algorithm and is the main algorithm used for this thesis. An ablation study was conducted to compare the different deskewing methods (sensor-based and modeling methods). Due to the slow speed of the Husky, the rough terrain and unstructured environment had no significant effects on the 3D map. No deskewing methods were even required, which shows an accurate 3D map can be built using a relatively slow-moving robot with a high-frequency LiDAR. In contrast, the aggressive motions of the NCD led to mapping inaccuracies for LiDAR-only systems. This highlights the importance of motion compensation techniques involving an IMU.
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Open Access
Quality of care and outcome of patients with pregnancy-induced hypertension: a retrospective observational study before and during the COVID-19 pandemic along the Wesfleur-New Somerset Hospital Axis, Cape Town, South Africa
(2026) Fakir, Abdul Waaghied; Ras, Tasleem
Background: The COVID-19 pandemic disrupted global healthcare systems and may have affected care for non-COVID conditions like pregnancy-induced hypertension (PIH), which is a leading cause of maternal and perinatal deaths. This study aimed to evaluate the quality of care and outcomes for PIH patients along a single district-level referral pathway in Cape Town, South Africa, during the pandemic. Methods: A retrospective clinical study of clinical records was conducted on all 57 PIH cases identified over six months (January to June 2021) at Wesfleur and New Somerset Hospitals. We assessed the quality of care using the Donabedian framework, which includes structure, process, and outcomes. Analysis focused on demographics, adherence to clinical protocols, and maternal and foetal outcomes. We then compared these against pre-pandemic benchmarks. Statistical analyses included descriptive statistics, chi-square tests, and exploratory multivariate logistic regression. Results: The prevalence of PIH was 9.7%. Process indicators showed resilient care, with 100% adherence to clinical monitoring and referral protocols. This was a substantive improvement from the 66.1% compliance before the pandemic. Maternal complication rates were low, with eclampsia and HELLP syndrome both at 1.75%. However, rates of foetal distress were high at 23.0%, and preterm delivery was at 16.0%. Within the constraints of the sample size, multivariate analysis suggested un-booked status was a strong, independent predictor of maternal complications (aOR=4.3, p=0.010), while late antenatal booking predicted foetal distress (OR=2.9, p=0.022). The cohort showed high rates of modifiable risk factors, including smoking at 38.5% and obesity at 42.0%. Conclusion: This facility-level audit indicates that, within this specific pathway, adherence to essential PIH management protocols leads to low maternal complication rates. However, the consistently high adverse perinatal outcomes, related to late antenatal care seeking, highlight a significant gap in early intervention. These findings emphasise the need for early antenatal booking and strengthening community-oriented interventions to overcome patient-related barriers to care during public health emergencies.
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Open Access
Hepatitis B virus infection and vaccine coverage among children living with HIV, HIV-exposed uninfected, and HIV-unexposed uninfected children in the Western Cape, South Africa
(2026) Collins, Courteney Jade; Amponsah-Dacosta, Edina; Copelyn, Julie
Introduction: Limited evidence on the burden of hepatitis B virus (HBV) infection among children living with HIV (CLWH), HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HUU) children hinders progress towards eliminating hepatitis B as a public health threat in South Africa. Methods: This study used secondary data and archived sera (N= 671) obtained from children <13 years old presenting at health facilities in the Western Cape, South Africa. Hepatitis B vaccine coverage was assessed using vaccination records for doses 1 to 3 by 12 months of age. Timely uptake of the hepatitis B vaccine was calculated as the difference between the actual and expected date of vaccine receipt, defined as 4 days before and up to 28 days after the recommended age. The prevalence of HBV infection was determined based on the presence of HBsAg within each subgroup. Logistic regression analysis was performed to assess factors influencing incomplete and delayed vaccination. Results: Coverage with all three doses by 12 months of age was 86.7% (13/15), 77.0% (57/74), and 80.9% (263/325) for CLWH, HEU, and HUU, respectively (p=0.645). Hepatitis B vaccine coverage decreased across all subgroups as the dosing schedule progressed from doses 1 to 3. Across the strata, the highest proportion of participants with delayed uptake for the third dose of hepatitis B vaccine was noted among CLWH at 23.1% (3/13), followed by 21.6% (58/269) among HUU and 15.3% (9/59) among HEU children (p= 0.540). The median delay in vaccination for dose 3 was highest among CLWH (11.3 weeks) compared to HUU (6.7 weeks) (p= 0.368). HBV infection was detected in 1.4% (1/74) of HEU and 0.3% (1/328) of HUU children, while no cases were observed among CLWH. Factors associated with completing the three-dose hepatitis B vaccine series included crèche attendance, low-to-middle socio-economic status (SES), timely uptake of dose 1, participant's age (in months), and HIV exposure status. For the third dose, crèche attendance reduced the likelihood of delayed uptake by 69%, while a monthly increase in the participant's age was associated with a 2% increase in delayed uptake in the multivariable model. Conclusion: Our findings highlight disparities in timely hepatitis B vaccine uptake and coverage, emphasizing the need for targeted interventions ensuring timely vaccine uptake among HIV- exposed children.