Introduction and background: Peer pressure and sexual coercion are driving adolescents to engage in early sexual activity. Adolescent risk behaviour that involves unsafe sexual practices remains a major concern for nurses, because it negates all progressive efforts to prevent the incidence of amongst others, unplanned pregnancies, sexually transmitted infections (Lansford, Dodge, Fontaine, Bates & Pettit, 2014:1742), unsafe abortions and childbirth complications (Fantasia, 2011:48; Van de Bongardt, De Graaf, Reitz & Dekovi? 2014:388). Emotional immaturity and vulnerability predispose adolescents to making irresponsible decisions regarding sexual activity with dire consequences, which is considered to be a worldwide concern (De Vries. Eggers, Jinabhai, Meyer-Witz & Sathiparsad, 2014:1087). Making such irresponsible decisions is also attributed to limited knowledge and information on Sexual Reproductive Health (SRH). Despite various initiatives specifically implementing targeted adolescent intervention programmes aimed at reducing the consequences of sex, such as HIV and adolescent pregnancies (Panday, Makiwane, Ranchod & Letsoalo, 2009:14), many South African adolescents are still having unprotected sex (Reddy et al., 2008:30; Rutherford, 2008:276) and even multiple sex partners (Ha, Kim, Christopher, Caruthers & Dishion, 2016:709; Mah & Shelton, 2011:2). Advanced approaches are required to assist adolescents to resist peer pressure and coercion and to not participate in sex for the sake of pleasing friends and peers. Purpose of the study: The aim of this study was twofold: firstly, to explore how peer pressure and coercion to sexual activity manifested among adolescents in Tshwane District, Gauteng Province, South Africa and, secondly, to develop a nursing theory for anticipatory guidance of adolescents to resist peer pressure and coercion to sexual activity. The Research Ethics Committee recommended the provision of an educational intervention with the aim of delaying the initiation of early sex, prevention of sexually transmitted infections, HIV and building the self-esteem of all the adolescent participants in the interviews. Methodology: A constructivist grounded theory was used to concurrently collect and analyse data (Coyne & Cowley, 2006:508; Moghaddam, 2006:53) to develop a nursing theory. The initial sampling involved 10 adolescents and nine nurses, followed by theoretical sampling of five health professionals working in clinics and health-related settings, who were interviewed. Constant comparative analysis was employed to analyse the data. Results: The study revealed parental incapability and ineffective parenting compounded by the non-conducive clinic environment making it difficult for adolescents to visit clinics for health information. Adolescents mistrust their parents and nurses. Five concepts emerged, namely: substituting for parental shortcomings; addressing negative peer pressure vulnerability of adolescents; addressing risk behaviour vulnerability; optimising nurse-adolescent interaction and enabling responsible decision making. Conclusion: SRH information is very important and adolescents should be provided with such information to help them make responsible choices in order to resist peer pressure. Thus, their health and well-being will improve, leading to a better future without suffering the consequences of early sexual activity. Recommendations: The anticipatory guidance could be applied in other settings outside the traditional clinic environment to provide more adolescents with valuable information. Other interested community volunteers could be trained to help with the provision of support to adolescents in the absence of their parents or guardians. / Thesis (PhD)--University of Pretoria, 2017. / Nursing Science / PhD / Unrestricted

Background: Nosocomial bloodstream infections constitute a significant public health problem and may be an important cause of morbidity and mortality in patients who are hospitalized. The presence of living microorganisms in the blood of a patient is usually indicative of a serious invasive infection requiring antimicrobial therapy. Mortality associated with bloodstream infections may range from 20 to 50% and depends on several factors, including pathogen and host factors. Many septic episodes are nosocomial and may be due to microorganisms with increased antimicrobial resistance. Aim: This study describes the microbiological profile of the organisms, and their resistance to antibiotics, causing bloodstream infections in patients in a tertiary hospital in Limpopo between 2004 to 2006 and 2014 to 2016. Methods: This was a retrospective laboratory-based serial cross-sectional study of 219 cultures in 2004 to 2006 73 of which were positive and 1095 cultures in 2014 to 2016 298 of which were positive. Data, including patient demographics (age, gender), microbial species (as recorded in the blood culture reports) and the antibiograms of isolated microorganisms, was collected and analysed. Results: 371 blood culture results which were culture positive were analysed. Coagulase negative staphylococci 190 (51.2%), Acinetobacter baumannii 14 (4%), Klebsiella pneumonia 44 (11.9%), Enterococcus spp 23 (6.2%). Enterobacter spp 19 (5.1%), Staphylococcus aureus 21 (7.3%), and Escherichia coli 14 (3.8%) were predominant. The constitution of bacteria cultures isolated where gram status was known, was gram-positive 262 (70.6%) and gram-negative 106 (28.6%). Among the S. aureus isolates, extended-spectrum beta lactamase (ESBL) positivity was 27 (7.3%). The microorganisms exhibited a level of resistance against the following antimicrobials: (colistin, imipenem, linezolid, meropenem and vancomycin). Conclusions: There was an increase in the numbers of tests, and hence the numbers of isolates, between the two study periods. The study demonstrated that there was a less than 3% drug resistance level, against antibiotics tested for, in both time periods. There was no clinically significant change in the resistance levels between the first and second study periods. / Dissertation (MSc)--University of Pretoria, 2017. / School of Health Systems and Public Health (SHSPH) / MSc / Unrestricted

South Africa has one of the world’s worst Tuberculosis (TB) epidemics. Several interventions were instituted by the Department of Health to manage TB and, regrettably, people still die from the disease. The community Health nurses provide care to people diagnosed with TB in facilities that have low staffing ratios with increased workload and responsibilities. Objective: This paper explores and describes the experiences of community health nurses working in a TB work environment. Method: A qualitative, descriptive, phenomenological approach was used to investigate the experiences of community health nurses in the TB work environment. A purposive sampling was used and consisted of twenty nurses. Unstructured interviews were conducted at an urban clinic, a semi-urban clinic and a rural clinic to gather data. The researcher followed the steps of the Colaizzi process of data analysis. Findings: Four themes were identified and discussed. These themes include fear of being infected with TB, control of infection, defaulting TB treatment, and screening services. Themes were supported with literature during discussion. Conclusion: The study concluded that the participants’ fear of contracting TB was attributed to delayed diagnosis of TB patients, the patients’ ignorance regarding TB transmission and community health nurses with chronic diseases and interacting with undiagnosed TB patients. Compromised TB infection control measures, such as failure to wear protective masks, was revealed by several participants. Recommendations for the Community Nursing Management and Nursing Education have been clearly described. / Dissertation (MCur Nursing Science)--University of Pretoria, 2017. / Nursing Science / MCur Nursing Science / Unrestricted

Introduction: The National Department of Health in South Africa piloted ward-based primary health care outreach services in 2011. The service is part of Primary Health care (PHC) re-engineering and it is provided by a team that includes community health care workers. Aim: The aim of this study was to explore the perceptions of ward-based community health care workers (CHWs) regarding primary health care outreach services in Tshwane sub-district. Research method: A qualitative ethnographic design was followed to explore the perceptions of CHWs. A purposive sampling method was used and data collected by means of interviews. Unstructured face to face interviews and reviews of site documents were used to generate data. Data was analysed using thematic analysis. Findings: The four main themes were revealed as: household activities performed by CHWs, working conditions, benefits to the community, and acknowledgement by the Department of Health. The findings included dissatisfaction of the CHWs with their current working conditions, especially the need to be full-time workers, earning a living wage in the form of a salary, not a stipend, and the aspiration to development by furthering their careers. Despite this dissatisfaction, the findings further revealed appreciation of the service by communities and reduction of the workload at clinics. It was recommended that the Department of Health recognise the service of CHWs in the form of permanent employment and formalise the career paths of CHWs. Furthermore, it was recommended that clinic staff members begin to portray positive working relationships and attitudes towards CHWs. Conclusion: Despite the dissatisfaction among the CHWs, the communities and health facilities are benefiting from this service. / Dissertation (MCur Nursing Science)--University of Pretoria, 2017. / Nursing Science / MCur Nursing Science / Unrestricted

The inclusion of women in mining and the growing number of women working underground in South Africa are by no means indicative of a woman-friendly and gender equal work environment. The impact of the hazardous underground mining environment on women’s health has been well documented. However, occupational health and safety legislation and regulations do not specifically address women’s health concerns, and guidelines to address and incorporate women’s health concerns into their onsite Occupational Health Services (OHS) do not exist. Consequently, women’s health concerns are often considered to be non-work related and are therefore excluded from the services offered by onsite OHS centres. Thus, this study aimed to: 1) explore and describe women’s health concerns of underground coalmine workers, and 2) formulate guidelines to address women mineworkers’ health concerns in the mine’s OHS programme. A case study research design was followed. The study was conducted in two phases. In the first phase, the researcher explored the women’s health concerns of mineworkers, the perceptions of the professional nurses working at the OHS centre on women’s health at a selected mine, and the mine managers’ expectations regarding the implementation of the guidelines to address women’s health concerns. Primary data was collected by means of semi-structured interviews. Data analysis lead to the development of a set of initial statements that were further developed as guidelines in phase 2 of the study. In the second phase of the study, the researcher used an E-Delphi technique and an online platform with support from University of Pretoria’s Learning and Management system. The online platform was used to facilitate discussions among a sample of occupational health and safety experts on the draft guidelines. The E-Delphi process was implemented in four stages: preparatory, exploratory, consensus and verification phases. Eight guidelines were formulated to respond to the women’s health concerns at the coalmine. The guidelines related to the following aspects: 1) enabling a supportive organisational environment wherein women mineworkers can function to their full potential; 2) effective measures for controlling hazardous environments that could affect women mineworkers; 3) a ‘fit for work and fit for life’ work environment for women underground coalmine workers; 4) supportive structures that facilitate a conducive environment in which women underground coalmine workers can express their health concerns; 5) processes that uphold women underground mineworkers’ human dignity and adhere to the human rights framework for non-discrimination against women; 6) procedures needed to adhere to safety procedures in reporting accidents and injuries; 7) measures to enhance accessibility, availability and relevant on-site health care services to promote women mineworkers’ health and wellbeing, and 8) methods to capture the needs, inspiration of hope and resilience of women underground coalmine workers. Substantial effort is needed to improve the safety of and quality of healthcare for women mineworkers. Implementing the guidelines could advance attainment of this goal, both for women and men at the selected coalmine. When women’s human rights are upheld, women and men benefit, together with positive outcomes for productivity. / Thesis (PhD)--University of Pretoria, 2017. / Nursing Science / PhD / Unrestricted

This study investigates the causal relationships, both long run and short run between the Industrial Index 25 and some macroeconomic variables in South Africa. Quarterly data from all the variables was collected from 1995 Q3 (September) to 2015 Q2 (June). Included in the set of macroeconomic variables used in this study are gross domestic product (GDP), inflation (CPI), prime rates and exchange rates. Statistical techniques applied in order to analyse the relationship between stock returns and macroeconomic variables include Augmented Dickey Fuller (ADF) unit root tests, correlation analysis, Johansen cointegration test, Vector error correction (VECM) and Granger causality tests in a multivariate framework. Results show that inflation significantly increases stock prices, hence investors get some inflationary compensation. Interest rates are shown to have a negative relationship between, suggestive of the substitution between stocks and interest bearing securities when interest rates increase. On the other hand, exchange rates have a positive effect on the INDI25, whilst there is no relationship between INDI 25 and GDP. Two error correction terms were obtained from the VECM. Whilst the first one was insignificant and failed to indicate any long -run relationship, the other term was significant, indicating short term adjustments and the presence of a long run relationship from GDP, CPI, prime rates and exchange rates to INDI 25. Results from Granger causality showed only univariate causality from INDI 25 to prime rates. / Dissertation (MCom)--University of Pretoria, 2017. / Financial Management / MCom / Unrestricted

Past studies have reported various occupational risks to municipal solid waste handlers (MSWHs). However, no generic framework has been developed for assessing the risks. Therefore, this thesis’ aim sought to develop a framework that local government structures can use for such purposes. To accomplish this task, the following objectives were formulated. The first objective was to review available literature regarding human health risks associated with municipal solid waste management operations. The PubMed literature search was used to identify relevant articles, published in the years 1995-2014. Also, references of potential articles were assessed to identify additional papers that conformed to the criteria for inclusion. 379 studies were found but only 72 met the concerned criteria. Methodological shortcomings such as usage of cross-sectional designs, small sample sizes, not enrolling reference groups, enrolling smaller reference groups, and not controlling possible confounders, were the major limitations of the studies. The proposed framework encourages local government structures to engage in or utilise methodologically sound studies that can yield valid and reliable findings. The second thesis objective determined the workplace hazards of MSWHs. Exposure assessments were done on various workplace hazards. Findings show that MSWHs are occupationally exposed to bioaerosols, chemicals, infectious material, physical and mechanical hazards. In light of the higher summer exposures of MSWHs to ultra-violet radiation and the reported health complaints, the study recommended: i) waste collection to be done at night or early morning and ii) regular breaks, rest and rehydration of MSWHs with oral fluids. A publication to disseminate these findings was made in an accredited open access journal. The findings partly constitute phase 1’ output 1 in the framework. The third thesis’ objective assessed the risky job actions of MSWHs. Postural measurements were performed using the Rapid Upper Limbs Assessment method. The findings indicate that MSWHs use unsafe work postures when performing the bin lifting, carrying and emptying tasks. The study recommended: i) mechanisation of refuse bin collection, where feasible, ii) training MSWHs on safe working postures and iii) supervision of waste collection tasks. Also, under phase 1’s output 1, the framework stresses the need to examine ergonomic risks of waste collection services. The findings on objective 3 were disseminated in form of a publication. Objectives 4-7 sought to develop, validate, refine and compile a framework for assessing occupational health risks of MSWHs. An SWOT analysis of available human and environmental risk assessment frameworks was done and the findings were used as a base for the draft framework. The developed draft framework validated and revised through iteration workshops in small, medium and large local government structures. This thesis proves that Mr Ncube is conversant with the nature and purpose of this relevant investigation. From his thesis Mr Ncube has published 3 articles in peer reviewed journals. / Thesis (PhD)--University of Pretoria, 2017. / School of Health Systems and Public Health (SHSPH) / PhD / Unrestricted

Introduction: Childhood obesity and dental caries (DC) have increased worldwide and are continuing to pose challenges to public health. The increasing risk of obesity for children is of particular concern because research has suggested that childhood obesity predicts adult obesity. Children experiencing DC early in their lives have a much greater probability of subsequent caries in their permanent dentitions and adulthood. Studies have reported a strong association between the nutritional intake and DC and reported a direct link between DC, sugar consumption and obesity. Objectives: to assess the association between dental caries (DC), the Body Mass Index (BMI) and diet among grade six learners at selected primary schools in Tshwane West District. Methods: A cross-sectional analytical study of grade six learners was carried out in Tshwane. The data collection consisted of a questionnaire, clinical oral examination and anthropometric measurements. All clinical data was collected by a single calibrated examiner. A validated questionnaire was used to collect the demographic data and the type of diet consumed. The SPSS version 23 software was used for analysis. Descriptive statistics, Chi-Square test to test for significance for categorical data and logistic regression analysis were used to determine statistical significance. Results: The response rate was 83% (440) and of these 53% were male. The mean age of the participants was 11.8yrs. The majority of the participant’s fathers (71%) and 50% of mothers were employed. The DC prevalence was 43% with a mean DMFT score of 1.19 (SD= ±1.79). The PUFA score was zero. Less than half (47%) of the participants reported to brush their teeth twice daily. The majority (71%) claimed to drink between one and one and a half glasses of sugar-sweetened beverages (SSBs) with 67% eating between one and three sweets per day. While most of the participants reported having a balanced meal at supper, a third reported eating junk food. The majority (71%) of participants had a BMI score that was within the normal range with 19% being overweight. There were no significant associations between the mean DMFT, BMI scores and the SES of the participants. Conclusion: The DMFT was low, but the decayed component was relatively high. The PUFA score was zero. Most participants were classified as having a “normal” BMI with almost a quarter being classified “overweight”. There were no significant associations between the DMFT and the mean BMI scores and SES of the learners. More than half of the participants were from a medium SES and had a slightly high DMFT score than their counterparts. Less than half reported to brush their teeth daily, most of them had a balanced diet at supper. / Dissertation (MChD)--University of Pretoria, 2017. / Community Dentistry / MChD / Unrestricted

There is paucity of information on whether exposure to emissions from a cement factory has pulmonary ill effects on communities residing close to these factories. This study investigated the association of exposure to cement dust and respiratory health effects in a community located near a cement factory. A cross-sectional study, followed by panel study, was conducted in Freedom Compound, a community bordering a cement factory in Chilanga, Zambia and, as control, Bauleni, located 18 km from the cement plant. In the cross-sectional phase, a modified American Thoracic Society questionnaire was administered to 225 and 198 respondents aged 15–59 years to capture symptoms of mucous membrane irritations and respiratory symptoms. For the panel phase, 118 participants were randomly sub-sampled from those participating in the cross-sectional study and followed up for three climatic seasons (cold dry, hot dry and rainy season). In this phase, exposure to cement dust, measured as ambient PM2.5 and PM10 concentrations in both communities and respiratory symptoms together with lung function indices were recorded daily for each participant for 14 consecutive days in each of the seasons. Descriptive statistics and generalized estimating equations (GEE) regression models were used in the analysis. A p-value < 0.05 was considered as statistically significant. A higher proportion of respondents in Freedom, compared to Bauleni, reported signs of mucous membrane irritations: 78.2% vs. 49.9%, 66.9% vs. 29.4% and 73.7% vs. 53.3% for eye, nasal and sinus irritations respectively (p value < 0.001). Respondents from Freedom Compound had higher odds of experiencing the irritations; adjusted odds ratio (OR) 2.50 (95% CI: [1.65, 3.79]), 4.36 (95% CI [2.96, 6.55]) and 1.94 (95% CI [1.19, 3.18]) for eye, nose and sinus mucous irritations respectively. Similarly, respiratory symptoms and diseases were more likely reported in Freedom compared to Bauleni: 5.64 (95% CI [3.63, 8.67]); 3.30 (95% CI [2.04, 5.3), 1.60 (95% CI [1.01, 2.54]); 5.76 (95% CI [2.00, 16.07]); and 5.22 (95% CI [1.75, 15.47]) times more likely to suffer from cough, phlegm production, wheeze, asthma and pneumonia respectively. Mean seasonal concentrations of PM2.5 and PM10 ranges were 2.39 - 24.93 ?g/m3 and 7.03 - 68.28 ?g/m3 respectively for Freedom while PM2.5 and PM10 for Bauleni ranged from 1.69 - 6.03 ?g/m3 and 2.26 - 8.86 ?g/m3 respectively. Overall, the mean FEV1 and FVC predicted percentage for Freedom was six and four percentage points lower than the control. A systematic review revealed that the majority of studies conducted in communities used mostly cross-sectional study design. Most studies reported higher levels of PM2.5 and PM10 in the exposed compared to the controls and demonstrated either a statistically significant difference in the prevalence of respiratory symptoms and reduced pulmonary functions or some degree of association. This review shows that despite showing some degree of association between exposure to cement dust and respiratory ill health, the existing evidence is insufficient to draw firm conclusion mainly because the studies were of low quality. These findings add to existing evidence that there an association between exposure to cement dust emitted from a cement plant and respiratory ill health. Future research, including characterization of air pollutant and source apportionments is required to determine whether the observed excessive respiratory symptoms and lower FEV1 and FVC among participants in the exposed community are due to cement dust emitted from the cement plant. / Thesis (PhD)--University of Pretoria, 2017. / School of Health Systems and Public Health (SHSPH) / PhD / Unrestricted

Triage allows for patients with life-threatening conditions to be identified and managed first, increasing the waiting times of patients presenting with non-critical conditions. The latter then perceive triage as negative. Even though triage is meant to save lives and improve patient satisfaction, frustrated and dissatisfied patients remain a concern in the selected emergency department of a referral hospital in Botswana. The aim of the study was to explore strategies to enhance patient-centred triage in an emergency department in Botswana. A qualitative descriptive phenomenographic study was done. Data were collected through semi-structured face-to-face interviews with 10 participants (patients) who were triaged in the emergency department. Data was analysed by the healthcare professionals involved in triage. Three categories of description namely environment, nursing staff and waiting times were identified. Based on the findings the healthcare professionals collaboratively planned strategies and outcome spaces to move towards patient-centred triage. Patients were given an opportunity to voice their experiences in triage. Sharing the data obtained from patients with healthcare professionals during the data analysis process was regarded as vital, as it would raise awareness of the way in which patients experienced triage. Being included in the data analysis process, the healthcare professionals understood of the way in which patients’ experience triage and therefore were able to collaboratively plan strategies to move towards patient-centred triage and improve patients’ satisfaction. / Dissertation (MCur Nursing Science)--University of Pretoria, 2018. / Nursing Science / MCur Nursing Science / Unrestricted