Situation analysis of an informal settlement in the Vaal Triangle

Abstract

The United Nations Children's Fund (UNICEF) has indicated that urban poverty is found primarily in squatter settlements. At present one in seven (13,5 per cent) of all South African households live in informal settlements. The major research question is to what extent the interlocking micro-mechanisms identified by UNICEF as causes of malnutrition influence the nutrition and health of residents in an informal settlement in the Vaal Triangle. This question will be tested empirically against the UNICEF framework of immediate, underlying and basic causes of malnutrition. Pre-tested questionnaires were administered to 340 randomly selected care-givers. A previously validated quantified food frequency questionnaire was administered by trained enumerators as the test measurement, and 24-hour recall as the reference measurement, for dietary intake and food consumption patterns. The data were statistically analysed for means and standard deviations. The great majority of the respondents (nine out of ten) live in corrugated iron shacks, and overcrowding is common; 32 per cent live in two rooms or fewer, 44 per cent in three to four rooms and 24 per cent in more than four rooms. Thirty-one per cent of the households consisted of six or more members, 19 per cent of five members, 22 per cent of four members and 28 per cent of three or fewer members. The unemployment rate was 94 per cent for respondents and 80 per cent for their partners. Two-thirds of care-givers (69 per cent) have an income below R500 per month. The main health problems that were observed were chronic coughing (44 per cent) and headaches (54 per cent). The causes of these were not established. Diets were poor and consisted overwhelmingly of refined carbohydrates. The top 10 food items consumed were: stiff and soft maize meal porridge, brewed rooibos and leaf tea, coffee, mabela, white bread, crumbly maize porridge, carbonated cold drink and mageu. The daily intakes (mean and standard deviation) of various nutrients were: 4550 ± 1993 kJ energy, 20 ± 9 g protein, 21 ± 21 g fat and 182 ± 78 g carbohydrates. The results indicate that this is a poverty-stricken community with chronic household food insecurity and compromised nutrition. It is hoped that the knowledge gained from this survey will improve the planning and implementation of sustainable community-based interventions to promote urban household food security and combat nutrition-related diseases.

1. Introduction

Globally, data on trends in rural and urban nutritional status are scarce. Surprisingly little research has been conducted on urban poverty, food insecurity and malnutrition. This omission may be because of the prevalence of poverty in the rural areas of the developing world. Alternatively, this gap in the research might reflect lack of awareness of growing urban problems (Haddad et al., 2001: 1). The United Nations Children's Fund (UNICEF) has indicated that urban poverty is primarily found in squatter settlements and slum areas (UNICEF, 1998: 4). Empirical data for this claim are however limited. At present, 66 per cent of the South African population (28 million people) are urbanised. Most have been obliged to live in informal settlements because of the shortfall in permanent housing for Africans. About 13,5 per cent of all South African households live in informal housing (Cunnan & Maharaj, 2000: 668). A large proportion of households do not have health-care facilities nearby. Approximately 25 per cent of urban households do not have access to piped water and 48 per cent do not have basic sanitation. In South Africa urbanisation has been identified as central to the environmental factors which affect health, as apartheid and the poverty it generated among blacks are the primary cause of urban and rural health problems in South Africa. Apart from discriminatory legislation, other factors that contribute to squatting include structural violence, low wages and unemployment. The inhabitants of the informal settlements live in structures that offer only partial shelter against the elements (Mabin, 1988: 93; Arendse, 1992: 53; Mathee & von Schirnding, 1995: 8; Cunnan & Maharaj, 2000: 669).

Although dramatic progress has been made in some areas of nutrition in recent years, 790 million people in the developing world and 34 million in developed countries are still undernourished and do not have enough to eat. Reducing hunger and malnutrition will continue to remain a challenge, as the International Model for Policy Analysis of Commodities and Trade (IMPACT) projects that malnutrition will persist in 2020 and beyond (Flores, 2001: 1; Pinstrup-Andersen & Babinard, 2001: 11; Underwood, 2001: 53). New information confirms that nutrition has improved globally, but that nevertheless nutritional status is deteriorating in several countries, especially in Africa. Hunger and low intake of the major micronutrients remains widespread despite rapidly declining world food prices during the past 20 years (Pinstrup-Andersen & Babinard, 2001: 9).

This research project focused on malnutrition among dwellers in an informal settlement in the Vaal Triangle, South Africa. The Vaal Triangle is an industrial area situated approximately 70 km south of Johannesburg and has a population of 794 599. Of these, 48 per cent are unemployed and 46 per cent of households live in poverty (McIlrath & Slabbert, 2003). The major research question remains to what extent the food, nutrition and health of the dwellers in an informal settlement in the Vaal Triangle are influenced by the micro-mechanisms of potential resources, insufficient household food security, inadequate maternal and child care, insufficient health services and unhealthy environment, inadequate dietary intake and disease. These are the components of a framework created by UNICEF (see Figure 1) to portray the immediate, underlying and basic causes of malnutrition (UNICEF, 1990). In this article we draw a demographic and health profile of the dwellers in an informal settlement of 1 261 households in the Vaal Triangle. It is hoped that the knowledge gained from this survey will inform policy and ultimately assist in reducing poverty, strengthening the fight against disease, raising nutritional literacy and accelerating urban development, and thus contribute to the national health plan for improving health care for all South Africans.

Figure 1 Immediate, underlying and basic causes of malnutrition Source: UNICEF (1990;)

2. Methods

2.1 Planning

A number of variables were investigated in this integrated nutrition research project. Before the project was launched, a multimethodological research process was followed, to facilitate planning. The planning process consisted of three steps: analysing the available scientific literature, writing the research proposal and holding a strategic round-table participatory planning workshop with all stakeholders. At this workshop one informal settlement was identified as suitable for a pilot study for the larger project, taking into consideration the size of the settlement (1 261 households) and its geographical position. The location was mapped to identify all the households by street and household number. The methodology for the baseline survey will be described in this article.

Before the baseline survey, introductory visits were made to the informal settlement for observation. The municipal councillors who provided information regarding the number of houses in the area and street maps accompanied the researchers. Households were visited to observe their general living conditions, the environment, the types of housing, the roads and services (water, electricity, waste management and clinics). After the exploratory visits, a planning meeting was held with the whole community to obtain consent for the project to be undertaken.

2.2 Ethical considerations

The ethics committee of the Vaal University of Technology approved the study. The protocol was submitted in accordance with the existing policy for research in the institution.

2.3 Sample strategy

The female care-givers of households were targeted to complete the questionnaires. These were the women responsible for looking after the children in the household: in the first instance the mother, and in the absence of the mother, the person who looked after the children, a grandmother or other member of the family, or a stepmother or guardian. Three hundred and forty households were randomly selected for the baseline survey. A total of 315 questionnaires had to be completed by the care-givers of the households so as to obtain a representative sample of 25 per cent of the population of the informal settlement. The additional 25 households were selected to make provision for possible drop-outs during the project.

2.4 Data enumerators

Eight data enumerators were recruited as fieldworkers. A training manual was developed and an intensive workshop conducted for training the field workers, so as to ensure a high standard of research. Various participatory methods were used in the training, including case studies and role-playing, and communication skills were developed.

2.5 Questionnaires

In the baseline survey various questionnaires were used to investigate the following variables:

•	demographic data such as the age, gender, home language and education levels of the household members
•	physical and infrastructure data such as the residence setting, number of household members, number of rooms, number of rooms used for sleeping, water storage, fuel usage, household pests and perceptions of environmental sanitation services
•	socio-economic data such as health, food, food procurement, food processing and preparation, employment status, household assets, environmental sanitation and caring practices
•	dietary intake and food consumption patterns.

A socio-demographic and health questionnaire was compiled in English and tested for reliability.

The validated quantified food frequency questionnaire (QFFQ) (MacIntyre, 1998: 200) was used in this study to obtain quantitative and descriptive information about the respondents' usual food consumption patterns and dietary intake. To verify intake, all subjects completed these questionnaires in individual interviews with the assistance of field workers. Food models were simultaneously used to determine portion sizes and to explain food items to the subjects. A 24-hour recall questionnaire was drawn up and tested for reliability and served as a reference measure for the QFFQ.

2.6 Statistical analyses

Demographic, socio-economic and health data were captured onto a spreadsheet. A well-trained and committed data capturer was assigned for this and a qualified statistician was consulted for analysis and interpretation of data output. The data were analysed using the Statistical Package for Social Sciences (SPSS) and descriptive statistics (frequencies, means, standard deviations and confidence intervals) were obtained.

The dietary intake and food consumption data were analysed by a qualified dietitian. Means and standard deviations were calculated for food and nutrient intake.

3. Results

3.1 Characteristics of the respondents

The results in Table 1 indicated that the great majority of respondents were the mothers of families; mothers were present in 76 per cent of the households. Two per cent of the respondents were 20 years old or younger; 22 per cent were aged between 21 and 30 years; 26 per cent between 31 and 40 years; 23 per cent between 41 and 50 years; while 28 per cent were over 50 years of age. Two-thirds (68 per cent) of the respondents were Sotho-speaking. Education levels were low, and only 28 per cent had attended high school or college. Over half the households are female-headed, single-parent households (56 per cent), 24 per cent of the households are headed by other care-givers with no mothers present, and in only 20 per cent of households were both parents present.

Table 1 Demographic data on the sample

Variable	Number	Per cent of total
Age
< 21 years	7	2,0
21–30 years	79	22,1
31–40 years	92	25,8
41–50 years	83	23,2
51–60 years	60	16,8
61–70 years	27	7,6
> 70 years	9	2,5
Educational level
None	83	23,2
Primary school	173	48,5
Secondary school	98	27,4
College	3	0,8
Home language
Sotho	242	67,8
Zulu	50	14,0
Xhosa	34	9,5
Afrikaans	21	5,9
Other	10	2,8
Number of people in household
≤ 3	97	27,2
4	76	21,3
5	66	18,5
≥ 6	118	33,0
Number of children in household
None	88	24,6
1	79	22,1
2	55	15,4
3	20	5,6
4	8	2,2
5	3	0,8
Time lived in the informal settlement
< 1 year	9	2,5
1–5 years	31	8,7
> 5 years	317	88,8
Type of house
Brick	16	4,5
Clay	16	4,5
Corrugated iron shack	321	89,9
Other	4	1,1
Number of rooms
≤ 2 rooms	115	32,2
3–4 rooms	148	41,5
> 4 rooms	94	26,3
Permanent residents	316	88,5
Total	357	100,0

3.2 Living conditions

The results showed that 90 per cent of the respondents lived in corrugated iron shacks. There was widespread overcrowding; 32 per cent of the respondents lived in two rooms or fewer, 42 per cent in three to four rooms and 26 per cent in more than four rooms. The average size of household was 4,9. In 33 per cent of the households there were six or more members, 19 per cent consisted of five members, 21 per cent of four members and 27 per cent of three or fewer members. Just under 90 per cent of the respondents resided in the informal settlement permanently and had been residing there for more than 5 years.

3.3 Water and environment

The socio-economic indicators of the sample are set out in Table 2. All the households had access to clean, safe water, mains electricity and water-borne sewerage. During 2001 the local government had supplied each shack with an outside toilet with tap and basin, and a meter for pre-paid electricity.

Table 2 Socio-economic indicators of the sample

Variable	Number	Per cent of total
Tap outside house in yard
Toilet facilities
Flush/sewage	348	97,5
Other	9	2,5
Access to electricity	357	100,0
Waste removal facilities	20	5,6
Gravel road in front of house	315	88,2
Tarred road in front of house	42	11,8
Pests	325	91,0
Mice/rats	190	53,2
Cockroaches	12	3,4
Mice/rats and ants	18	5,0
Mice/rats and ants and cockroaches	49	13,7
Mice/rats and cockroaches	56	15,7
Respondents'employment status	20	5,8
Looking for a job	181	50,7
Period of unemployment > 3 years	211	59,1
Partner's employment status	71	19,9
Total household income per month (in rand)
< 500	152	42,6
501–1 000	56	15,7
1 001–1 500	6	1,7
1 501–2 000	5	1,4
2 001–2 500	1	0,3
> 2 500	1	0,3
Do not know	136	38,1
Number of people who contribute to household income
1	129	36,1
2	127	35,6
> 2	101	28,3
Family member responsible for household expenditure
Father	57	16,0
Mother	244	68,3
Other	56	15,7
Total	357	100,0

3.4 Health

The major health problems experienced by the care-givers, as reported in Table 3, were chronic coughing (42 per cent) and headaches (50 per cent). Twenty-eight per cent reported the death of a child under five during the previous five years, of which 35 per cent were stillbirths.

Table 3 History of chronic diseases and early childhood deaths in family

Variable	Number	Per cent of total
Skeletal disease	112	31,5
Chronic cough	149	42,0
Heart disease	77	21,7
Chest disease	84	23,7
Gastrointestinal tract abnormalities	60	16,9
Genital abnormalities	52	14,6
Mental disorders	25	7,0
Headaches	179	50,4
Bad hearing	6	1,6
Bad eyesight	32	9,0
Disabled	9	2,5
Operations	80	24,2
Chronic medication	109	32,1
High blood pressure medication	32	9,0
Death of child under 5 during past 5 years	98	27,7
Age of death
Stillborn	34	34,8
0–7 days	4	4,1
1 week–3 months	10	10,2
4–12 months	12	12,2
13–24 months	3	3,1
24–60 months	35	35,6
Total	355	100,0

The results in Table 4 indicate that 72 per cent of the respondents had never smoked and the same proportion did not drink alcohol.

Table 4 Smoking and drinking patterns

Variable	Number	Per cent of total
Respondent's smoking history
Yes	54	15,2
No, never smoked	255	71,8
No, stopped smoking	46	13,0
Partner's smoking history
Yes	117	33,0
No	238	67,0
Respondent's snuff usage history
Yes	92	25,9
No, never used	238	67,1
No, stopped using	25	7,0
Respondent's alcohol consumption
Yes	97	27,3
No	258	72,7
Frequency of alcohol consumption
Never	258	72,7
Every day	6	1,7
Once a week	22	6,2
Occasionally	69	19,4
Type of alcohol consumption
None	258	72,7
Commercial beer/cider	26	7,3
Home-brewed beer	37	10,4
Spirits	5	1,4
Wine	29	8,2
Total	355	100,0

The results in Table 5 indicate that 75 per cent of households visited the mobile clinic which comes to the informal settlement three days a week. Most visited the health facilities on foot.

Table 5 Health facilities in the informal settlement

Variable	Number	Per cent of total
Type of health facility visited
None	13	3,7
Private doctor	12	3,4
Clinic	266	74,9
Hospital	6	1,7
Other	58	16,4
Access to health facilities
On foot	283	79,7
Other (taxi, train, bus, own transport)	72	20,3
Total	355	100,0

3.5 Dietary intake and food consumption patterns

Eight out of ten households indicated that they eat more than one meal per day; 56 per cent eat twice daily and 23 per cent three times a day, but their diet is inadequate. Both the QFFQ and the 24-hour recall questionnaire indicated intakes for all nutrients except carbohydrates, which were below estimated average requirements. Carbohydrates dominated the diet, and maize meal porridge was the only food item regularly consumed in all the households (Table 6). Table 7 shows that the ten most frequently consumed foods (with their average daily intake in brackets) were stiff maize meal porridge (345 g), soft maize meal porridge (124 g), brewed rooibos tea (80 ml), brewed tea (79 ml), brewed coffee (76 ml), mabela porridge (74 g), white bread (73 g), crumbly maize porridge (63 g), carbonated cold drink (52 ml) and mageu (51 g). The only protein sources included among the top twenty foods on the list were soya beans (in 11th place) and chicken and vegetable stew (in 13th place), with mean daily intakes of 51 g and 45 g, respectively. Few (one-quarter or less) of the respondents consumed these protein-rich foods.

Table 6 Analysis of food questionnaires and 24-hour recall: mean daily intakes of the mothers or care-givers in the household

Nutrient and unit of measure	Questionnaire (409 respondents) (mean ± SD)	24-hour recall (mean ± SD)	Estimated average requirements*
Energy (kJ)	3 839,8 ± 430,4	4 550,1 ± 1 993,0	10 093
Total protein (g)	24,5 ± 22,7	19.7 ± 9,3	46
Total fat (g)	26,9 ± 31,4	20,9 ± 20,8
Cholesterol (mg)	84,8 ± 115,8	55,8 ± 117,9
Carbohydrates (g)	135,2 ± 94,6	182,4 ± 77,9	100
Calcium (mg)	116,2 ± 165,0	150,1 ± 176,7	580
Iron (mg)	3,54 ± 4,73	3,79 ± 2,04	8,1
Magnesium (mg)	135,9 ± 103,2	194,7 ± 93,5	265
Zinc (mg)	2,9 ± 2,65	3,8 ± 2,4	6,8
Copper (mg)	0,39 ± 0,42	0,41 ± 0,29
Chromium (mcg)	14,3 ± 23,3	14,7 ± 19,8
Selenium (mcg)	10,27 ± 16,57	8,27 ± 13,15	45
Iodine (mcg)	11,28 ± 16,31	8,97 ± 18,12	95
Vitamin A (RE) (mcg)	210,64 ± 452,49	175,91 ± 617,28	500
Thiamine (mg)	0,56 ± 0,51	0,72 ± 0,32	0,9
Riboflavin (mg)	0,32 ± 0,51	0,35 ± 0,36	0,9
Niacin (mg)	4,58 ± 6,66	4,93 ± 4,08	11
Vitamin B6 (mg)	0,30 ± 0,50	0,34 ± 0,23	1,1
Folate (mcg)	64,19 ± 87,64	85,13 ± 125,11	320
Vitamin B12 (mcg)	1,33 ± 2,76	1,19 ± 3,17	2,0
Pantothenate (mg)	1,67 ± 2,19	1,78 ± 1,65
Biotin (mcg)	10,52 ± 10,35	14,62 ± 25,30
Vitamin C (mg)	13,4 ± 25,7	14,32 ± 14,87	60
Vitamin D (mcg)	1,45 ± 2,09	0,73 ± 1,84
Vitamin E (mg)	7,42 ± 10,38	4,56 ± 7,33	12
*Estimated average requirement for females aged 19–50 years.

Table 7 Twenty food items most frequently consumed, as reported in response to the food questionnaire

Food item	Mean daily intake (grams per person)	Number of respondents who consume the item each day
Maize meal porridge, stiff	345	409
Maize meal porridge, soft	124	202
Tea, rooibos, brewed	80	35
Tea, brewed	79	335
Coffee, brewed	76	38
Maltabella	74	177
Bread, white	73	38
Maize meal porridge, crumbly	63	72
Cold drink, carbonated	52	52
Mageu (fermented maize drink)	51	88
Soya beans	51	19
Potato, boiled with skin	47	47
Stewed chicken with vegetables	45	25
Potato, boiled without skin	31	28
Cold drink, squash	31	264
Oats	30	12
Soup (powder)	29	19
Samp	28	98
Spinach, buttered	23	126
Cabbage, potato and onion	21	138

3.6 Income levels and procurement patterns

The unemployment rate was 94 per cent for respondents and 80 per cent for their partners. Nearly half the households (43 per cent) had an income of below R500 per month (Table 2).

Table 8 indicates that most households shopped for food monthly (62 per cent), and shopped mainly at spaza or tuck shops in the area (56 per cent). A significant minority spent less than R50 per week on food (38 per cent). In most households the mother was responsible for household expenditure (68 per cent) as well as for food procurement decisions (84 per cent), food preparation (82 per cent) and feeding the children (80 per cent).

Table 8 Food procurement and preparation patterns of the sample

Variable	Number	Per cent of total
Frequency of shopping for food
Every day	27	7,6
Once a week	63	17,6
Once a month	220	61,6
When money is available	14	3,9
Never	11	3,1
Donations	22	6,2
Where is food most commonly bought?
Spaza shop	198	55,5
Street vendor	2	0,6
Supermarket	62	17,4
Spaza shop, street vendor and supermarket	27	7,6
Spaza shop and street vendor	33	9,2
Spaza shop and supermarket	10	2,8
Street vendor and supermarket	2	0,6
Other	23	6,5
Weekly expenditure on food (in rand)
0–50	136	38,1
51–100	72	20,2
> 100	47	13,4
Do not know	101	28,3
Household member responsible for food preparation
Mother	292	81,8
Other	65	18,2
Household member responsible for food procurement decisions
Mother	299	83,8
Other	58	16,2
Household member responsible for feeding the children
Mother	284	79,6
Other	73	20,4
Number of meals served per day in the household
1	59	16,5
2	199	55,7
3	81	22,7
> 3	4	1,1
No specific meal times	14	3,9
Where is most of the food consumed?
Home	312	87,4
Other	45	12,6

3.7 Household assets

The study found that 58 per cent of the households owned a radio and 47 per cent a television set. While 19 per cent owned an electric stove, 4 per cent a gas stove and 8 per cent a coal stove, three-quarters of all households used a primus or paraffin stove for cooking. One-quarter had a refrigerator and 12 per cent a freezer. This study did not explore other household assets.

4. Discussion

This study was conducted to determine the demographic and health profile, as well as the dietary intake and food consumption patterns, of the residents in an informal settlement in the Vaal Triangle. To achieve this, respondents in the randomly selected sample were requested to complete quantitative and qualitative questionnaires, which were then statistically analysed.

The results gave indications of the prevalence of poverty in this community. They lived in sub-standard housing. Ninety per cent of the households resided in a non-permanent structure, generally a corrugated iron shack, and had been staying like this for more than five years. Although the average household size was 4,9 people, the houses were small and only 26 per cent of all the houses had four or more rooms. The respondents complained of rodent infestation (53 per cent), damp (31 per cent), cold (10 per cent) and rust (7 per cent).

The socio-economic status of these people was poor. Only 6 per cent of the respondents and 20 per cent of their spouses were employed. The majority of the respondents had been without a job for more than three years (59 per cent), and 10 per cent were 60 years and older. Over half the households (58 per cent) had an income of less than R1 000 per month, an indication of poverty.

Household food security was also a problem in this community. Most of the respondents indicated that they bought food only once a month (62 per cent) and food was procured mostly from the local spaza or tuck shop in the area (56 per cent). Most of the households (58 per cent) spent less than R100 on food per week. Given that the average household size was 4,9 people, these families must have spent less than R2,90 per person per day on food. This is equivalent to a half loaf of bread or half a litre of milk. The mother was generally responsible for the food procurement decisions (84 per cent), food preparation (82 per cent) and feeding the children (80 per cent).

Dietary intake and nutritional status was also compromised as these households consumed a carbohydrate-based diet and the intake of all nutrients was deficient, except for carbohydrates.

The health status of the respondents was compromised as well. Although few respondents smoked (15 per cent) or drank alcohol, the area in which they live suffers the highest pollution in the country, waste removal is almost non-existent and the area is very dusty, with gravel roads predominating (88 per cent). Although the respondents had access to clean, safe water and toilet facilities, electricity was expensive and most could not afford to use electricity for cooking. Most of the food was prepared on primuses and paraffin stoves.

Although most (75 per cent) households made use of the mobile clinic for preventative and curative medical care, this facility is only available three days per week. The nearest hospital was five kilometres away from the informal settlement and residents walked to the health facilities (80 per cent) because they could not afford public transport. The most prevalent diseases in this area were chronic coughing (42 per cent) and headaches (50 per cent). Antenatal and paediatric care seemed a problem, as 28 per cent of the households in the sample had experienced the death of a child under five during the past five years. Of these, 35 per cent were stillbirths, an indication of poor maternal health and antenatal care.

5. Conclusions and recommendations

The findings of this study confirm that poverty, malnutrition and chronic household food insecurity were major problems in this community and correspond with the shifts in poverty and under-nutrition from rural to urban areas described by Haddad et al. (2001: 1). In South Africa under-nutrition continues to be the most serious nutritional problem facing children. This form of malnutrition is caused by poor food intake and also by increased infections in young children. The underlying causes are household food insecurity, inadequate care for the vulnerable groups such as maternal and child care, insufficient essential human services including health, education, water and environmental sanitation and housing (UNICEF, 1984: 4; FAO, 1998: 2).

The results of this study will form the basis for planning and implementing sustainable community-based intervention projects to promote public health nutrition in the Vaal Triangle. The focus of all intervention studies should be to reduce urban poverty, malnutrition and household food insecurity. However, it is impossible to undertake all the proposed strategies at once. The strategies have to be prioritised and phased in according to the community's priorities, needs, affordability and sustainability. Community approval and participation must be ensured for all the proposed activities. It is important to address the underlying causes of the inadequate food consumption. This can be achieved through economic development and income growth by promoting entrepreneurial activities for job creation in this community.

Simultaneous training programmes, aiming to provide skills, should be implemented to support the effectiveness and sustainability of the community-based interventions. Because most of the important functions in the household are performed by the mother and a great majority of these women are unemployed (94 per cent), the focus for skills training programmes should be to equip the mothers with the skills necessary for uplifting their livelihood and improving the community infrastructure. Awareness creation of good health and hygiene practices will improve the wellness of the local community. Women can benefit from the knowledge of health practices in an underprivileged area and can in turn improve the quality of life in their community by means of enhancement of early childcare and education opportunities.

In addition, public health control measures, including immunisation, control of infections, education and the support for practice of personal hygiene and sanitation, need to be promoted in collaboration with the local authorities. This is a huge undertaking and researchers must take caution when planning and preparing the project protocols.

Additional information

Notes on contributors

Rajab Rutengwe

1Respectively, Head of Department, Lecturer, Senior Lecturer and Research Fellow, Department of Hospitality and Tourism, Vaal University of Technology. We acknowledge the Departments of Education and Health in the Vaal Triangle, the Sedibeng local council and the Eatonside community for their cooperation in the project so far; the Vaal University of Technology and the National Research Foundation for funding the project; and Michelle Wright (research assistant) and Verena Nolan (statistician) for their valuable assistance.