Introduction: Preterm delivery remains the major cause of newborn infants’ morbidity and mortality globally and more so in low-income countries like Eritrea. Research has shown that the provision of Kangaroo mother care (KMC) can contribute to a reduction in morbidity and mortality among newborn infants. However, there is limited research on the practice of KMC in Eritrea. Methods: A mixed methods approach was adopted in a phenomenographic study to collect the data. Eleven participants with work experience of at least two years were recruited from the Specialised Neonatal Intensive Care Unit (SNICU) at Orotta Paediatric Hospital (OPH), Asmara, Eritrea. Data were collected via individual interviews and observations. Results: The results showed that participants had no prior KMC training and education. In addition, staff had limited knowledge and mixed attitudes about KMC practice. There were also no KMC guidelines and protocols. Furthermore, space was not adequate for full KMC practice except for implementation of the kangaroo position. The researcher’s observation confirmed similar evidence of a lack of availability of a KMC ward and lack of protocols and guidelines. Limited interaction and communication about KMC between participants and parents was also observed. Some of the most common hindrances to KMC practice were the perception that KMC increased staff work load and that it was time consuming. In addition, lack of regular KMC training for staff, lack of a convenient setup and too few staff members were among the hindrances. One staff members also perceived that KMC practice was not culturally accepted. 15 Conclusion: The results of this study showed that there were no proper KMC guidelines and protocols in the ward. In addition, only the kangaroo position was practiced, not the full KMC protocol. Furthermore, staff had limited knowledge and mixed attitudes. The observation component of the research highlighted the lack of space and KMC protocols and guidelines as key limitations for delivering KMC. Therefore, it is recommended that a programme to improve staff knowledge be implemented, that evidence-based KMC guidelines and polices be made available, that the KMC ward be expanded, and that health education about KMC practice be brought to the population through mass media

Includes bibliographical references. / There is paucity of evidence to guide case-finding strategies in field trials of new tuberculosis vaccines conducted in young children. To investigate case-finding and case detection methods for tuberculosis in tuberculosis field trials conducted in young children.

Includes bibliographical references. / Innate cells such as macrophages, monocytes, myeloid dendritic cells and granulocytes recognise mycobacteria and initiate immune responses such as phagocytosis, cytokine production and expression of maturation markers. The type and magnitude of innate responses to mycobacteria may determine the subsequent adaptive responses generated. Our aims were to determine maturational changes in innate immune responses to mycobacteria over the first 9 months of life, and to assess effects of genetic variations in toll-like receptors on host responses to mycobacteria. This knowledge is important for designing rational strategies for vaccination against tuberculosis.

We tested the hypothesis that a lower frequency and profile of specific T cells induced by BCG vaccination at birth is associated with subsequent risk of developing tuberculosis.

Includes bibliographical references. / BCG is the only vaccine against tuberculosis and has been used for over 90 years. BCG efficacy is variable, especially in countries with high TB prevalence, where over a million deaths due to tuberculosis, are still reported annually. New TB vaccines are under development to either replace or boost the BCG vaccine. However, our understanding of the immune response required for protection against TB disease, remains inadequate. Identification of a protective immune response is only possible in a clinical trial of an efficacious vaccine, allowing comparison of vaccine-induced immune responses in protected and unprotected individuals. In the absence of such a vaccine, as is the case with TB, we can only explore biomarkers of risk of disease. The most commonly measured outcomes of anti-mycobacterial immunity in clinical trials, specific Th1 cells, are typically thought to be protective in TB. However, to date, human mycobacteria-specific Th1 responses have not correlated with risk of TB disease. New approaches are urgently required to identify other factors at play in conferring protection against TB. In this thesis, we explored BCG-specific cytotoxic T cells as candidate correlates of risk of TB disease in BCG-vaccinated infants. We hypothesized that reduced production of cytotoxic molecules by T cells in response to BCG are associated with risk of developing TB disease. We designed a case/control study nested within a large trial of newborn BCG-vaccination.Blood was collected at 10 weeks and infants, were followed up for two years.We compared outcomes in infants ultimately diagnosed with TB (at risk of TB disease) and two groups of healthy infants (not at risk of TB disease), the first group had household contact with TB cases, the second group were randomly selected from the community, which is endemic for TB. Amongst these groups, we designated a training and a test cohort to allow validation of candidate correlates of risk of TB.

Globally and in South Africa, university students’ knowledge of sexual and reproductive health (SRH) is low. This study was conducted in response to the dearth of information about the sexual and reproductive health knowledge of postgraduate students. Research conducted to explore the SRH knowledge of undergraduate students suggests that the level of SRH knowledge among undergraduate students is low. The aim of this study was to determine the SRH knowledge of postgraduate students at University of Cape Town (UCT), in South Africa. A cross sectional survey design was utilized, using an adapted and pretested online questionnaire. All postgraduate students enrolled in the first semester of 2017 (9444) were invited to anonymously complete the online survey. Four hundred and six (406) students completed the online survey, of whom 293 were female and 107 males. The age range of respondents was between 18 years and 57 years, with the median age for both male and female respondents being 24 years. Six survey responses were excluded from the statistical analysis because of incomplete data. Post graduate students from the African continent comprised 90.75% of the respondents. Most respondents were white (51.50%) from both Africa and abroad. The results indicated that respondents knew about sexually transmitted infections, and human immunodeficiency virus (HIV) & acquired immune deficiency syndrome (AIDS). Female respondents were more aware of breast examination, and the role of Papanicolaou smear (Pap smear) in SRH. Almost half of the respondents in this study (49%) stated that they had no need for more information about contraceptives. Lecturers were identified as one of the top five sources of information across faculties, which could suggest that the university environment provides students with important SRH-related information. Most postgraduate students had knowledge of sexual and reproductive health with regards to contraception, Pap smear, clinical breast examination, STIs, HIV and AIDS. Further research should focus on the relationship between SRH knowledge and usage among this population. As university lecturers were identified as an important source of information across faculties, the University should consider the incorporation of SRH education in the broader curriculum and as an integral component of student health services.

Includes bibliographical references (leaves 106-112). / Measures of the severity of metabolic acidosis (base excess) and of the severity of the underlying acid-base derangements (levels of lactate, chloride, albumin, and strong ion gap) have been used to differentiate survivors from nonsurvivors in various types of adult critical illness, including states of severe hamodynamic compromise following cardiac surgery on cardiopulmonary bypass (CPB) and in septic shock. prognostic studies of acid-base data for critically ill children in the settings of post-operative cardiogenci shock and septic shock are relatively scarce. It has been suggested that hyperchloraemia migh be a benign phenomenon that should not prompt escalation of therapy. Although it is recognised that hypoalbuminaemia is associated with adverse outcome, and obscrues the extent of underlying metabolic acidosis, the significance of 'unmeasured' anions estimated from the strong ion gap remains controversial. It has been suggested that the admission lactate level is strongly predictive of paediatric intensive care unit (PICU) outcome in both shock states, but it is not known whether calculation of the lactate: pyruvate ratio would add prognostic value in children with either post-operative cardiogenic, or septic shock.

In the United States, childhood and adolescent obesity is a problem of growing concern. With nearly 17% of children between the ages of two and 19 years classified as obese, healthcare providers, clinical scientists, and program managers must collaborate to reduce the prevalence of obesity. Obese children are more likely to be obese adults, who are at an increased risk to develop type two diabetes and cardiovascular disease, compared to non-obese individuals. Children are classified as obese based on body composition. CDC, WHO, and IOTF have developed definitions to classify the weight status of children; however, these definitions are based on reference populations' data rather than physiological ideal growth and development. Physicians and scientists measure body composition with a variety of direct and indirect techniques. Although there are advantages and disadvantages to each method, there is no database to compare the measurements to determine whether the child has an increased risk for developing a disease based on his or her weight status. While the current literature debates the use of one definition or measurement tool over another, there is a need for longitudinal studies to establish a true definition for obesity and healthy model of child growth and development from birth to adulthood. This review summaries the current arguments and provides suggestions for further research to increase the understanding of obesity in children and adolescents.

The optimal model to support adolescent sexual health is the concurrent use of hormonal birth control and condoms. This dual protection approach prioritizes protection against unplanned pregnancy as well as sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). In order to explore individual, interpersonal and structural factors that influence adolescent protection use, multivariate Chi-squared Automatic Interaction Detector (CHAID) analysis was completed with a national sample of adolescents (n=2320) from the 2002 Canadian Youth, Sexual Health, and HIV/AIDS Study. CHAID is a decision tree method which assesses interactions between significant independent variables to optimize prediction of the dependent variable (i.e. safer-sex protection method). Among adolescent females, the following factors were associated with dual protection use: high condom intentions; having lived with both biological parents; having accessed a medical professional or media as the primary source of HIV/AIDS information; having utilized a medical professional as the primary source of sexual health information; having never had unwanted sex; having not consumed alcohol and/or drugs before sex; frequent sexual activity; having identified a medical professional as the primary source of STD advice; having been tested for STDs; and having supported the importance of talking about condoms with a partner. Among adolescent males, dual protection was associated with: high condom intentions; frequent sexual activity; the belief that both partners are responsible for condom use; having been born in Canada; having noted uncertain or high levels of religiosity; having been older than 14 at first sexual intercourse; having been able to speak with their father about sex; having accessed a medical professional or media as the primary source of HIV/AIDS information; and having reported a peer group that did not use tobacco. The results indicate that structural factors, in concert with individual and interpersonal factors, play a vital role in understanding adolescent safer-sex practices. Policy and practice implications include revisions to sexual health curricula, sexual health service accessibility for all adolescents, and targeted prevention programming for adolescents at highest risk. Further research into the sexual health of male adolescents and the influence of structural factors on sexual health among diverse samples should be prioritized.

The optimal model to support adolescent sexual health is the concurrent use of hormonal birth control and condoms. This dual protection approach prioritizes protection against unplanned pregnancy as well as sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). In order to explore individual, interpersonal and structural factors that influence adolescent protection use, multivariate Chi-squared Automatic Interaction Detector (CHAID) analysis was completed with a national sample of adolescents (n=2320) from the 2002 Canadian Youth, Sexual Health, and HIV/AIDS Study. CHAID is a decision tree method which assesses interactions between significant independent variables to optimize prediction of the dependent variable (i.e. safer-sex protection method). Among adolescent females, the following factors were associated with dual protection use: high condom intentions; having lived with both biological parents; having accessed a medical professional or media as the primary source of HIV/AIDS information; having utilized a medical professional as the primary source of sexual health information; having never had unwanted sex; having not consumed alcohol and/or drugs before sex; frequent sexual activity; having identified a medical professional as the primary source of STD advice; having been tested for STDs; and having supported the importance of talking about condoms with a partner. Among adolescent males, dual protection was associated with: high condom intentions; frequent sexual activity; the belief that both partners are responsible for condom use; having been born in Canada; having noted uncertain or high levels of religiosity; having been older than 14 at first sexual intercourse; having been able to speak with their father about sex; having accessed a medical professional or media as the primary source of HIV/AIDS information; and having reported a peer group that did not use tobacco. The results indicate that structural factors, in concert with individual and interpersonal factors, play a vital role in understanding adolescent safer-sex practices. Policy and practice implications include revisions to sexual health curricula, sexual health service accessibility for all adolescents, and targeted prevention programming for adolescents at highest risk. Further research into the sexual health of male adolescents and the influence of structural factors on sexual health among diverse samples should be prioritized.