Lymphatic filariasis (LF) is a parasitic disease affecting more than 120 million people; over a billion persons live at risk for infection. Filariasis does not kill, but rather disables; making it an important public health -and socio-economic issue facing developing' countries. In 1998, the Global Programme to Eliminate LF (GPELF) was created to eliminate LF by 2020 using mass drug administration (MDA) requiring the entire eligible population living in endemic areas to take treatment once a year for 4-6 years. Challenges to elimination include: (I) convincing asymptomatic persons to comply; (2) maintaining high levels of compliance; (3) managing adverse reactions. Research on compliance has focused on associated factors rather than on influences. GPELF recognises the relevance of this information to its success and has called for increased research on individual motivations. This study aims to make an original contribution to existing research by describing the reasons people comply with treatment within the context of Alor District. By using theoretical perspectives from social dilemma theory and health promotion theories, the research examines how various elements may influence a person to cooperate and consume LF treatment. Research methods include a preliminary quantitative survey (2004) (n=336) and in depth interviews (2005) (n=43) with compliers and non-compliers in Alor District, Indonesia. Analysis of results shows non-health related factors are the strongest reported influences on compliance; namely emotions, coercion, power, hierarchy and norms. Lay beliefs about disease reveal complex interpretations which do not necessarily predict compliance. The research demonstrates the complexities of interventions in societies undergoing transition from traditionally-based towards increased development. Research recommendations include re-evaluating present theoretical reasoning behind GPELF-recommended social mobilisation to include group interaction and cooperation, which have shown to be more appropriate in encouraging compliance. Furthermore, this research recommends wider use and promotion of non-health related benefits to LF treatment.

Drawing on both qualitative and quantitative data, the thesis describes and explains both the current patterns of natural protection against pregnancy and the use of modern contraception in the period following childbirth in two populations, one rural and one urban, in Bangladesh. First, quantitative data gathered through demographic surveillance systems of the International Centre for Diarrhoeal Disease Research, Bangladesh are used to explore the patterns and differentials in breastfeeding, postpartum amenorrhoea and risk of pregnancy in the months following birth in the two study populations. Next, the surveillance data are used to describe the patterns of adoption of contraception in relation to time postpartum, breastfeeding and menstrual status for the two study populations. Extensive use is made of life table methods, hazard models and logistic regression techniques in these analyses. Qualitative data gathered through in-depth interviews with users of contraception are then used to identify key themes of understanding that influence women's behaviour, including contraceptive uptake, in the period following childbirth. The current knowledge, attitudes and practices of family planning providers in the two study populations are next described using qualitative data collected through a series of in-depth interviews and group discussions. Findings from the quantitative and qualitative analyses are then integrated in order firstly, to explain the current patterns and recent trends in contraceptive use and lactational protection against pregnancy following childbirth, and secondly to explore their potential implications for birth intervals and fertility. Finally, important issues are identified and recommendations made for improvements to postpartum family planning programme approaches in Bangladesh.

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For children growing up today in the developing world, acute respiratory infection (ARI) is the 'Captain of the men of death'. The World Health Organisation estimate that 4.3 million young children die every year from ARI making it the largest single cause of death. Given the magnitude of this problem, relatively little research has been carried out in developing countries. In keeping with this observation, ARI was known to be a major cause of childhood mortality and morbidity in The Gambia but little was known about their epidemiology or aetiology. Suitable methods for their treatment or prevention had not been investigated. A one year community based longitudinal study was undertaken in a rural area of The Gambia in which approximately 500 young children were monitored for signs of acute lower respiratory infection (ALRI). An attempt was made to determine the incidence of ALRI in this community, all identified episodes of ALRI were investigated in order to try to establish the cause of the infection; the association between a number of possible risk factors with ALRI incidence was explored; and two different regimens of antibiotic treatment were compared. A survey was made of the knowledge, attitudes and practices of mothers with respect to acute respiratory infections in their children. The study documented very high incidence rates of ALRI among children in the study villages. The use of simple clinical criteria for the diagnosis of ALRI, which could be taught to health workers, was investigated and the most valid criteria for this community identified. Preliminary evidence suggests that bacterial infections are important causes of community acquired ALRI. These infections responsed well to a 5 day course of an inexpensive, oral antibiotic (cotrimoxazole) which was well tolerated. An important clinical overlap between ALRI and malaria was suggested by the study data. Widespread recognition of fast breathing was found among rural mothers and valid traditional concepts of difficulty breathing discovered.

The psychological response of 64 women identified as CF carriers and their partners who received a negative test result were assessed together with selected controls on 4 further occasions: 10 on receiving the carrier's positive test result; 2) on receiving the partner's negative test result; 3) six weeks later; 4) six weeks after delivery. Knowledge of the genetics of CF and attitude to having been screened were measured by self-administered questionnaire. Compared to control subjects, carriers showed a significant increase in generalised psychological disturbance attributed specifically to symptoms of anxiety and depression during the period awaiting their partner's test result but returned to control levels on receipt of a partner's negative test result. Although there was no significant difference in generalised psychological disturbance between partners and their selected controls, partners did become significantly more anxious and manifested signs of inadequacy while awaiting their own test result. All four groups were well informed about the genetics of CF and the significance of being a gene carrier, although 23% of carriers felt information given at the booking clinic was insufficient. 20% of carriers felt regret or ambivalence about having been screened. There was a consensus that screening should be routinely offered to pregnant women but should also be made available in family planning clinics and GP centres. Results showed that the implications for midwifery practice focus on 3 areas of care: information giving; counselling; and emotional support.

The aim of this study was to examine the role of oral health promotion in oral health policy. Oral health promotion was defined as: 'Any action to protect or enhance oral health, including legal, fiscal, educational and social measures'. The study examined such actions within the four policy areas of sugar consumption, oral hygiene, fluoride exposure and visits to a dentist. In order to increase understanding of the application of policy work in dentistry a comparative perspective was taken. Two northern European countries, the United Kingdom and Denmark were chosen for the analysis as countries with similar patterns of dental disease. Due to the novelty and complexity of the research area, a rather comprehensive and thorough analysis of existing documents and scientific literature was conducted and presented as part of the thesis. This includes a review of policy literature as well as a comparative analysis of dental health, dental health services, dental manpower and structure and organisation of dental health education in the two countries. In addition data were collected using qualitative, specialised elite interview techniques. The study population comprised 39 Danish and 19 British experts. The interviews were tape-recorded and comprehensive notes were taken during all interviews. The comparative analysis using Leichter's health policy framework was based on tapes and notes from all 58 interviews and also on information gained from the document and literature analysis. The results showed differences both between the two countries and between the four policy areas in terms of what the policies were and the way in which they had developed.

There is some evidence to suggest that socialisation to alcohol develops from an early age. However, in contrast to the considerable literature pertaining to adolescent alcohol-related beliefs and behaviours, little is known about the early development of knowledge in relation to young children. This research therefore set out to trace the early development of alcohol cognitions in children aged 5 ½-6 ½, 7 ½ - 8 ½ and 9 ½-10 ½ years. This exercise took as its methodological basis, the classic investigation by Jahoda and Cramond (1972), consisting of a series of game-like activities designed to elicit the knowledge, attitudes and the behaviour of young children with regard to alcohol. These activities were adapted and updated. In addition, children were tested with vignettes. These were designed to investigate their understanding of adult motives for drinking. Children's knowledge of and attitudes towards tobacco smoking were also examined. Eight participating schools were selected from two regions of Britain - Edinburgh in Scotland and Birmingham in England. Within each area, these schools were selected according to their religious affiliation - Roman Catholic or non-Denominational - and then within these two categories they were further differentiated according to the socio-economic status of their catchment area - middle class or working class. A total of 238 children were tested. It can be concluded that children develop an awareness of alcohol from an early age, and that this awareness commonly consists of rather simplistic and negative stereotypical ideas about alcohol. The implications of these findings for future initiatives are discussed.

The work in this thesis describes the effects of an informal education programme for children attending the paediatric diabetic clinic at the Royal Hospital for Sick Children, Edinburgh. This paediatric clinic was introduced in the early 1950s to provide an appropriate service for children and by the early 1980s the children within the clinic, which was staffed by a motivated team including a diabetes nurse specialist, paediatric dietitian, paediatrician and adult physician for adolescents, had reasonably good diabetic control compared with other specialist clinics. A recent survey of the clinic, however, identified problems, including difficulties teaching about diabetes, limited dietitian time and little time to discuss stress-related problems. To address these issues, a 2 year randomised cross-over trial was devised to determine whether an informal education programme (Diabetic Club) could improve knowledge about diabetes, reduce stress in diabetic families and thereby improve diabetic control. Forty-eight of 92 families with children less than 13 years on 1st October 1985 volunteered for the study and were randomised to groups A and B. Those families who elected not to participate were significantly older, and had had diabetes for longer, but their diabetic control was similar to the participants. Group A attended the Diabetic Club for 10 afternoons of education in the first year while Group B continued at the routine clinic (5 visits per year). For the second year Group A returned to the clinic, Group B attended the Club. The education programme covered all aspects of diabetes care based on small group teaching and semi-structured discussion groups for parents and children.

The thesis is about the social organisation of employment. This is analysed through an examination of women's professional careers, specifically in a single profession - that of pharmacy. Standard theories of women's employment place the social divisions of employment at the forefront of analysis, and this is particularly so in accounts of professional employment, where the highly structured nature of professional careers is the object of explanation. Nonetheless, such explanations are deficient in the way in which they locate gender in employment processes. It will be argued that the standard accounts retain a theoretical division between social and employment structures which contributes to the reification of job structure, and to a narrow view of the social relations of employment. Theorists have stressed the gender construction of employment, and processes of de-skilling and segregation to explain women's careers. This has led to problems in dealing with the complexity and substance of professional women's employment and, particularly, to difficulties accounting for processes of change as increasing numbers of women enter male-dominated professions. The social organisation of employment has been analysed as a particular influence on jobs rather than as a general statement of employment relations. Labour markets have been seen as rigid and constraining structures somehow distinct from the social relations that produce them. In the profession of pharmacy, for example, the increasing entry of women can only be understood as a unified process of changing employment and social relations, in which the movement of groups through the career structure is the same process generating that structure. It will be argued that employment divisions in pharmacy reflect the structuring of employment in relation to household finance. The generation of such divisions is seen as the product of integrated social and employment relations, in which, if it is to be routinely reproduced, job organisation must accommodate the requirements of incumbents.

The aim of this study was to examine and describe the nature and content of communication in profound mental handicap. The developmental level of people with profound mental handicap and their limited behavioural repertoire suggests that the normal development of emotional and social communication in infancy offers an appropriate model for the processes underlying their communication. By revealing what is shared in the two populations insight might be also be gained into the robust elements of normal communication, i.e. those elements operating in both populations. The investigation was divided into two studies. In Study 1 interactions between 12 children (aged 8-18 years) with profound mental and multiple handicaps and their caregivers (mothers and nurses) were described. Study 2 compared the communicative involvement of six young people with profound mental handicap (aged 14-26 years) when with three groups of adults who were differentiated by their personal knowledge of the young person and their previous experience in the field of profound mental handicap. The two studies revealed that, beneath the apparent chaos and disorder, an ordered system of emotional communication is operating in children and young people with profound mental handicap, in common with similar observations in normal early development. The implications of these findings for the development of personal communication and relationships in children and young people with profound handicaps and the contribution of this knowledge to the understanding of the normal development of early communication are discussed. Possible therapeutic applications are also considered, proposing that close attention should be paid to the fundamental aspects of human behaviour which are shared in the general and profoundly mentally handicapped populations, influencing the practices which help children with profound mental handicap to move forward and out into the community of other human beings.