Magister Public Health - MPH / The Zambia Demographic Health Survey reports that 81% of the population of Mansa District, Zambia lives in extreme poverty. Eleven percent (11%) of this population is estimated to be HIV positive. Many of this HIV positive population were the primary breadwinners in their households prior to the onset of AIDS. The majority of them are cared for by family members (PCGs) with limited training. Home Based Care programmes provide care and support to patients at their homes. However, this support does not extend to the caregivers. This explorative study investigated the psychological, social and informational needs of primary caregivers of AIDS patients in Mansa District, Zambia. It was envisaged that the findings of the study would assist home-based care organizations to provide comprehensive support and care to the primary caregivers, in addition to patients. Methods A qualitative research approach was chosen to gain an in-depth understanding of healthrelated experiences of caregivers while taking into consideration the context within which this phenomenon takes place. Twenty-six caregivers who provide basic care and support to family members who had advanced HIV-disease were recruited into the study. All AIDS patients in the study were former breadwinners of their households. Purposive, maximum variation sampling was used to select non-homogeneous cases of family caregivers, who provided services to AIDS patients within their homes. It was envisaged that such a heterogeneous sample would provide wide variations in experiences, and this would contribute to the range of issues pertaining to caregiver needs being covered. Three Focus group discussions were conducted, audio-tape recorded and transcribed. Findings The findings of the study highlight that caregivers have the following psychological needs: reciprocated sympathy and appreciation from society and their patients, stress coping mechanisms, and the capacity to display patience despite unreasonable demands made by the patients for whom they are caring. The study highlights that caregivers face numerous challenges in dealing with conflicting relationships and in handling stigma and discrimination, and that they are in need of a strong social support network. It also emphasizes that many of the primary caregivers lack adequate information about social services organizations that can assist them with training. The training will enable those (PCGs) to provide care in a manner that does not compromise the safety of the patients or themselves, as well as give them opportunities for education and skills development for income generation that will make it possible for them to provide for the upkeep of the family. Conclusions Home-based care workers are best placed to support PCGs at home. The training of such home-based workers should be extended to take in consideration the specific needs of these caregivers. In addition, the role of primary caregivers should be acknowledged in national HIV/AIDS strategies.

Thesis (MPH.) -- University of Limpopo, 2016 / Background: The purpose of the study was to find out if hand hygiene was being done according to World Health Organization hand hygiene Guideline. It was hoped that the study would benefit all health care workers through making recommendations aimed at improving hand hygiene compliance. Purpose: The aim of the study was to assess hand hygiene practices among healthcare workers in Nyangabgwe Hospital, Francistown, Botswana Methods: Quantitative, Cross-sectional study, using a self-administered Questionnaire to collect data on 280 participants. The questionnaire consisted of three (3) sections: socio-demographic profile; attitudes of HCWs and practice of healthcare on hand hygiene. For attitude questions Three (3) point Likert scale was used. The sampled Healthcare workers were stratified. The results were analysed using SPSS version 24.0. The descriptive statistical method was used to analyse frequencies, correlations and means. The chi-squared was used to analyse cross tabulation between variables and association with significance level at (p < = 0.05). Results: The results shows that 260 participants aged between 20- 60years responded to the questionnaire. The majority of participants had good knowledge of hand hygiene and younger participants practiced hand hygiene more than older ones (p<.05). Barriers to hand hygiene were significant and included lack of time, negative attitude, but not lack of knowledge. Conclusion: The study highlighted the practices of hand hygiene among health care workers and the status of hand hygiene resources in the hospital which have a negative impact on hand hygiene practices demonstrated that compliance with hand hygiene compliance among health care workers remains unacceptably low, despite xiv the irrefutable scientific evidence that hands are the most common vehicle for transmission of pathogens Keywords: Hand hygiene, Health care workers, Hand hygiene practices, Health care associated infection, Resources.

Thesis (MPH.) -- University of Limpopo, 2015 / Background: The revised Infant and Young Child Feeding Policy (IYCFP) 2013 encourages HIV-positive mothers to also exclusively breastfeed for six months, and to continue breastfeeding for a year with introduction of appropriate complementary feeding, while their children receive antiretroviral treatment. The aim of this study was to determine knowledge and practices of the Primary Health Care Workers (PHCWs) related to the implementation of the revised IYCFP 2013 in the Blouberg Municipality of Capricorn District, Limpopo Province. Methods: A quantitative descriptive study was conducted on 103 PHCWs. The questionnaire was closed ended. The questionnaire was developed based on the contents of the revised IYCFP 2013. A simple random sampling technique was used to sample nurses irrespective of the category. Data were analyzed through SPSS Software v23.0. Results: Most participants were females (91.3%), category were Professional Nurses (44.7%), aged between 31 and 40 years (44.7%) and also mostly worked for >10 years (56.3%). The results revealed that 97.1% of the participants have good knowledge about infant and young child feeding, 68% of participants were not trained on the revised IYCFP 2013, resulting to only 32% of participants having a good practice of this policy. Also 44.7% of the participants reported that they were not aware if clinics had a copy of this policy. The results further revealed that 92.2% of the participants reported that clinics still receive, keep and issue infant formula to HIV positive mothers, which maybe the reason the dieticians still receive requests for Infant Formulas to be delivered to HIV-positive mothers. Conclusion: There is a need for monitoring and evaluation to ensure availability and vi implementation of the revised IYCFP 2013; and also the need for in-service training on this policy in order to improve the capacity to implement the revised IYCFP 2013. Key Concepts Revised IYCFP 2013; knowledge; practice; implementation; PHCWs; infant and young child feeding.

PHD (Health Sciences) / Department of Advanced Nursing Sciences

Department of Advanced Nursing Science / MCur / This study was carried out to assess the use of protective clothing among health care workers in selected hospitals of Vhembe District in Limpopo Province, South Africa. Protective clothing is the corner stone of health care facilities and it remains the most cost effective measure which is currently available in public health intervention. Although personal protective clothing is one of the best lines of protection against hazardous exposures, many healthcare workers either shun this protective apparel or do not wear it in an appropriate manner at the appropriate time. The purpose of the study was to assess the use of protective clothing of health care workers in selected hospitals of the Vhembe District, in the Limpopo province of South Africa. The study followed a quantitative approach using a cross-sectional design. The population comprised of all health care workers in purposefully selected hospitals and the sample was 205 health care workers who were 21 years and older. A questionnaire was selfdesigned in English, translated into Tshi-Venda, Se-Sotho and Xi-Tsonga languages. Data was collected by the researcher in selected hospitals of Vhembe District. The statistical package for social sciences (SPSS version 25) was used to analyse the collected data. Validity and reliability were ensured. Permission to conduct research was obtained from the University of Venda Higher Degree Committee, Department of Health in Limpopo Province for Ethical Clearance, and the institutions where the study was conducted. The use of protective clothing among health care workers was found to be relatively low (8, 3%) probably due to unavailability of protective clothing in the hospitals, allergic reactions and ignorance. Lack of knowledge regarding the use of protective clothing could also explain the low yield of the detected cases for not using protective clothing while on duty in this study. Based on the findings, the study conclusions and recommendations were that all health care workers should follow the stipulated policy on protective clothing and periodic awareness campaigns to be held to conscientise workers on the importance of wearing personal protective clothing. / NRF

Thesis (MPH.) -- University of Limpopo, 2019 / Background: Tuberculosis still continues to be a global public health problem and leads to many deaths. In an effective TB control strategy, TB patients are allocated to community care workers who provide care to these patients in their homes. It is important to understand the experiences of community care workers in order to strengthen TB control in the country. Objective(s): The purpose of this study was to explore lived experiences of community care workers of supporting patients taking Tuberculosis treatment. Methods: The design of the study was phenomenological, exploratory, descriptive, and contextual. The study site was Hlogotlou area in Limpopo Province. The target population was all community care workers supporting patients on Tuberculosis treatment. Purposive sampling was used with a sample of 13 participants, which was determined by the saturation of data. Semi-structured interviews were conducted using an interview guide and all sessions were audio recorded. The data were analysed using Interpretative Phenomenological Analysis. Results: The results highlighted certain challenges met by community care workers. Patients thought that community care workers are there to kill them with treatment, they had mood swings during treatment and this caused them to use vulgar words and become aggressive to their community care workers. Most community care workers did not have enough information about Tuberculosis. This made it difficult for them to support patients on tuberculosis treatment. Conclusions: A good relationship with patients enhances treatment compliance. The researcher recommends that intensive training about tuberculosis should be provided to community care workers.

Bakgrund: Diabetes drabbar allt fler människor och utgör ett hot mot folkhälsan. Följdsjukdomar som fotkomplikationer är vanliga. Fotsår resulterar i sänkt livskvalitet för personen som drabbas och ger ökade samhällskostnader. Regelbunden fotundersökning förebygger fotsår och utgör en rekommenderad intervention. Trots existerande riktlinjer är det skillnader i genomförandet av fotundersökningen vilket skapar ojämlik vård. I ett projekt har ett formulär baserat på riktlinjerna för fotundersökning utarbetats med syfte att underlätta och säkerställa en årlig fotundersökning med grund i evidens. Syfte: Att utvärdera vårdpersonals erfarenheter av att arbeta enligt ett formulär för strukturerad fotundersökning hos patienter med diabetes. Metod: Kvalitativ innehållsanalys utifrån Graneheim och Lundman. Studien är en del av ett projekt ” Optimerat omhändertagande av personer med diabetes och fotkomplikation” med Västra Götalandsregionen som forskningshuvudman. Semistrukturerade intervjuer genomför dessom fokusgruppintervjuer samt som enskilda intervjuer. Totalt inkluderades åtta informanter av olika yrkestillhörighet vilka intervjuades angående sina erfarenheter av formuläret i kliniskpraxis. Resultat: Formuläret underlättade arbetet vid fotundersökningen genom ökad tydlighet, struktur och överblick. Formuläret kunde bidra till att likrikta fotundersökningen eftersom skillnader i arbetssätt synliggjordes. Vid fotsår upplevdes riskkategorierna som motsägelsefulla. Osäkerhet framkom angående definitioner av exempelvis förhårdnader och svårläkta sår. Förhoppningarna var att ett införande i digitalt journalsystem skulle underlätta dokumentationen och synliggöra fotundersökningen, med ökad tillgänglighet för alla berörda. Slutsats: Formuläret fungerar väl som stöd och beslutsunderlag i det preventiva arbetet med fotundersökningen och kan komma att bidra till likriktning av fotundersökningen enligt gällanderiktlinjer och därmed bidra till en säkrare och mer jämlik vård. / Background: Diabetes is a growing threat to public health. Secondary diseases like footcomplications are common. Foot ulcers affect individual’s quality of life and are a great cost to society. Regular foot examination prevents foot ulcers and is a recommended intervention. Despite existing guidelines there are differences in the execution of the foot exam which causes care inequality. A structured foot exam form based on the guidelines was developed in a project. The aim was to facilitate the foot exam and contribute to a uniform execution. Aim: To assess health care workers experiences of working with a structured foot exam form for patients with diabetes Method: Qualitative content analysis based on Graneheim and Lundman. The study is part of a larger project entitled “Optimized care of persons with diabetes and foot complications” with Västra Götalands region as responsible authority. Semi structured interviews were held in a focus group and individually with eight informants of different professions who were interviewed regarding their experiences of working with the form in clinical practice. Results: Experiences of working with the form were that it simplified the foot exam by giving itan overview and clear structure. Using the form made apparent differences in work routines between individuals. It was believed that by implementing the form routinely that it would contribute to a more uniform execution. When the patient had foot ulcers the risk categories were perceived as contradictory. There was an uncertainty about the definition of for example chronic ulcers and callosities. The hope was that the future digital format would simplify documentation and elucidate the foot exam as well as contribute to accessibility for all concerned. Conclusion: The foot exam form works well as a support during the preventative foot exam, gives a basis for decision making and could contribute to a uniform, safer foot exam with more care equality that is consistent with the current guidelines.

Denna studie hade som syfte att beskriva hur vårdbiträden inom äldreboende och hemtjänst upplever sin psykosociala arbetsmiljö under coronapandemin. Detta genom frågeställningarna: Hur upplever vårdbiträden att deras arbetsinnehåll har påverkats av pandemin? Hur har vårdbiträdenas samarbete påverkats av pandemin? Vilka andra faktorer i den psykosociala arbetsmiljön har vårdbiträdena uppmärksammat i samband med pandemin? Studien genomfördes med en kvalitativ ansats och semistrukturerade intervjuer med fyra vårdbiträden inom äldreomsorgen. Som analysverktyg användes Karasek och Theorells (1990) krav-kontroll-stödmodell. I resultatet framkom att den största inverkan på vårdbiträdenas psykosociala arbetsmiljö under pandemin var samhällets förändrade rekommendationer och restriktioner avseende skyddsutrustning och att förhindra smittspridning. Detta påverkade hela deras arbetssituation på flera olika sätt genom högre krav och mindre kontroll i arbetet. Stödet i arbetet i form av kollegialt stöd, visade sig vara betydelsefullt för den psykosociala arbetsmiljön under pandemin.

A dramatic and historic evolution has occurred as mental health care has shifted from institutional-based care to community-based care. Framed by the social exchange theory, the purpose of this study was to identify the correlation of the leadership style of supervisors in residential care facilities with the organizational citizenship behavior of the residential care workers. The research questions focused on the correlation between the leadership styles and organizational citizenship behavior (OCB) with a secondary focus specifically on transformational leadership. Residential care workers in 3 states working in 65 facilities within a single organization completed 2 surveys: the Multifactor Leadership Questionnaire and the Organizational Citizenship Behavior Checklist. Forty-nine completed surveys were returned. The transactional leadership style was correlated to OCB in 2 defining subfactors: contingency reward r(42)=.424, p < .001 and management by exception/active r(42)=.417, p <.001. The transformational leadership style was correlated to OCB in 4 defining subfactors: idealized behaviors r(42)=.388, p <.001, instrumental motivation r(42)=.417, p <.001, idealized influence r(42)=.395, p <.001, and individual consideration r(42)=.371, p <.005. These findings have not been previously reported in mental health residential care settings. The generalizability of this study is limited by sample size and scope, because the employees come from facilities within a single corporate organization. Residential care is part of the overall positive social change in care of the mentally ill, by offering the mentally ill the opportunity of an enhanced, community-based life. This study begins the process of ensuring that sufficient evidence-based knowledge and scholarly practitioners are available to lead work that benefits this vulnerable population; additional study is recommended.

Influenza is a preventable infectious disease, against which vaccination is the primary means of protection. Health care workers (HCW) are among the most vulnerable to the illness and are likely to be sources of infection transmission while caring for patients. Circumstantial evidence suggests higher rates of vaccination coverage by HCW will coincide with a lower incidence of influenza transmission, yet a gap remains in the literature regarding governing health agencies' (i.e., licensing boards, medical and nursing associations) influence on the influenza vaccination practices of their constituents. Moreover, discrepancies exist between governing health agencies' and the National Vaccine Advisory Committee's recommendations on mandatory influenza vaccination for HCW. The main purpose of this quantitative cross-sectional study was to explore the relationship between influenza vaccination uptake by HCW and guidance from governing health agencies to vaccinate. The health belief model and social cognitive theory were used to identify the most influential determinant for HCW to vaccinate against influenza. The sample consisted of 388 HCW who provided direct patient care at the same hospital. Data were analyzed using Fisher's exact test. Study findings suggest that a workplace mandate for influenza vaccination has an influence on HCW uptake of the vaccine and that governing agencies' lack of uniformity on the matter has minimal impact on their constituents' beliefs and behavior. It is recommended that a universal policy be adopted for health agencies' implementation of an influenza vaccine mandate, which could lead to positive social change by supporting preventive self-care practices, minimizing spread of the disease to workers and patients, and maintaining workplace productivity.