CHAPTER 1.2: METHODOLOGY
1.2.1 STUDY AREA
This study was undertaken in the Hlabisa sub-district,a deep rural area and one of four sub-districts of the Hlabisa magisterial district. This site was selected as it wasfairly easily accessible,yet preserved its rural nature because of the intervening game reserve;
was relatively safe from crime and political unrest;and had strong community support for research activities. In addition, the establishmentof an international research Centre in the Mpukunyoni sub-district provided scientific and financial support to local research studies.
Hlabisa is situated in the northern part of the province of KwaZulu-Natal (KZN), about 300km north-east of Durban on the Indian Ocean coast of South Africa. A map showing the location of the district in South Africa and the four sub-districts is provided in
Appendix 1.2.1. Hlabisa is approximately 50 x 70km in aerial extent and according to the 1996 Census had a population of 198179 (Curtis et al,2002), who are largely Zulu- speaking. A major national road, the N2 runs through the eastern half of the district, linking the major port and commercial towns of Durban, Richards Bay and Empangeni to Swaziland and Mozambique. There are large sugar farms and eucalyptus plantations along the N2.The district is home to a relatively poor populace who rely largely on income from subsistence fanning,migrant labour,pension remittances and casual labour.
Key reproductive health issues are HIV, sexuallytransmitted infections,poor pregnancy outcome and high fertility. Just before the survey commenced, the incidence of HIV in women, aged 15 to 30 years,attending antenatal clinics in Hlabisa,was reported to be 12% in 1997 (Abdool Karim, 1997). The prevalence of HIV amongst women attending
1997 and it was estimated that a quarter of women in Hlabisa in the age range 15 to 49 years, were infected with at least one STI on any given day (Wilkinson et al, 1999).
Wilkinson and Sach (1999) placed the infant mortality rate in the Hlabisa District at 53 per 1000 total births.Whist the fertility rate for the Hlabisa district was not known,the fertility rate for KZN Province was reported to be 4.3 in 1991 (Erasmus, 1994) and 3.3 in 1998 (Department of Health etal,2002). A teenage birth rate for KZN of 15.3 was
reported in 1994 (Erasmus, 1994) and 16.7%ofKZNteenagers interviewed in the 1998 SADHS had been pregnant (Department of Health et al, 2002).
The Hlabisa sub-district, where the survey was conducted, is separated from the rest of the district and the main transport routes by the Hluhluwe and Umfolozi Game Reserves. Itlies to the north of the game reserves and is characterised by hilly undulating terrain and savannah like vegetation.Giraffe,zebras,impala,buffalo, warthog,rhino and elephant are commonly encountered on the way to Hlabisa sub-district. Ithas a sub- tropical climate, with summer rainfall and average summer temperatures of 28 to 30 degrees centigrade and winter temperatures between 16 and 25 degrees. Only 7% of households had piped water in 1996 and 25% had access to public taps (Curtis etal, 2002). Most households obtained water from rivers and dams (Curtis etal,2002). Only 3% of households had flush toilet systems with the majority (66%) having access to pit latrines,and 29% having no sanitation system (Curtis et al,2002). Typical rural
homesteads (kraals) are sparsely scattered across the sub-district. Some modem style houses are also to be found, usually close to the Hlabisa village. The further one moves from the village, the more scattered the homesteads become. Most homes are electrified, on a card system basis,and most roads are gravel or dirt.
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The Hlabisa sub-district is governed by a traditional tribal authority system,typical of rural areas ofKZN,and a chief, Inkosi M.Hlabisa was the local traditional leader. At the time ofthe survey, it was estimated, from aerial photographs to be comprised of 2088 homesteads, with an estimated population of 20000 people. A detailed mapping exercise undertaken subsequent to this study places the population at 2316 homesteads, a
population of 16124, and an average number of people per household of7 (F Tanser,GIS Specialist,Africa Centre for Population Studies and Reproductive Health, pers. comm., September 1998). Figures from the 1996 Census released after the survey was conducted placed the population of the sub-district at 21425 with an average household size for the whole district of7.5(Curtis et al,2002). Most households comprise extended families.
The sub-district was further divided into 13 isigodi or wards, each of which was governed by an induna (headman),responsible for the allocation of tribal land and the maintenance of a local census of those living within the isigodi. The thirteen isigodi were: Qunwane, Madondo, Khalokazi, Emajikeni,Mabundeni, Hlambanyathi, Matshamnyama, Macekeni, Mabhokweni, Makopini,Empembeni,Amabhokisi,and Stezi. The boundaries of the isigodi can rarely be delineated by the induna or people living within the isigodi. A Council ofIzindunais chaired by the Chief of Hlabisa,and he serves on the KZN Council of Traditional Leaders (Abdool Karim, 1996).
At the time of the study,the only health facility in the area was a 400-bed district hospital, the Hlabisa Hospital,situated close to the Hlabisa village in the Lutheran Mission area.Services provided by the hospital included medicine,basic surgery, obstetrics and paediatrics (Abdool Karim, 1996). In addition, 3 primary care mobile clinics serviced the area. Community health workers provide a health service to those
who do not have access to the mobile clinics or the hospital. The location of the hospital can be seen on the map provided in Appendix 1.2.1.There were eight primary schools and four secondary schools.