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.

Background: Intellectual Disability (ID) is important and has a major impact on life, quality of life, mental illness, economic and educational well-being. Little research has taken place in Africa about ID. One of the key challenges is to identify appropriate, useful, and free screening tools that might identify those at risk of ID both for clinical purposes and for prevalence studies. One tool that has been used to investigate the broad category of 'disability' (which includes ID) is the Ten Questions Questionnaire (TQQ). The TQQ has given some rates of 'disability' in lowand middle-income countries (LMICS) in the order of 10-25%. However, no further dissection of ID within the broader category of 'disability' has been performed given that the TQQ was not developed with ID in mind. The Wessex Behavioural Schedule (WBS) is a UK screening tool for functional ability for adults with ID, and therefore seemed an appropriate candidate instrument to evaluate for potential use in Africa. However no psychometric data for the tool were available and no clinical cut-off scores for ID had ever been developed. A broader project using the WBS in Khayelitsha, a township area in Cape Town, South Africa, generated a prevalence rate of 19% 'disability'. The purpose of this study was to explore the psychometric properties of WBS to determine its suitability for use in children and adolescents in a South African setting, and to generate clinical cut-offs to define ID. Methods: The study consisted of a secondary analysis of the data from the broader Khayelitsha prevalence study, which was a cluster randomized door-to-door household survey in Khayelitsha using the WBS. Firstly, data were used to evaluate the internal consistency and to perform factor analysis of the WBS. Secondly, the Minimal Difference Perceived 75% of time (MDP75) approach was used on a subset of 100 randomly selected participants to generate an intellectual disability cut-off score for the WBS. Results: Data were available on 452 children and adolescents aged 5-18 years. The mean age was 10.3 (SD 3.9), 54% were female, over 90% were in school, and 53% had a mother as primary carer. The WBS had good internal consistency (alpha = 0.80) and all items appeared to be worthy of retention. Exploratory factor analysis suggested the WBS to be a multidimensional scale composed of four subscales: conceptual abilities, practical skills, sensory abilities and continence. Even though four expert raters were used for the MDP75 calculation, inter-rater reliability was low-58% (Fleiss kappa = 0.08). It was therefore not deemed appropriate to proceed to further analysis to determine the MDP75 and cut-off values for the WBS. Possible reasons for low inter-rater reliability suggested by the raters included age-based expectations, inclusion of physical disabilities, limited information to make a diagnosis of ID contained in the WBS, and the need to take environmental factors into consideration. Conclusion: The good internal consistency and factor analysis structure of the WBS was encouraging, but the low inter-rater reliability brought into question the usefulness of the WBS in a child and adolescent age group. Whilst the WBS may remain useful in an adult age range, we recommend that a more developmentally-sensitive measure be sought or developed as a screening tool for ID. Keywords: Wessex Behavioural Schedule, children and adolescents, intellectual disability, Khayelitsha

Bibliography: leaves 106-112. / The primary aim of this dissertation was to gain an understanding of the psychopathology present in the perpetrator of Munchausen Syndrome by Proxy (MSP), exploring Jureidini's (1999) notion that this behaviour can be explained as the perpetrator engaging in a form of pathological play. A systematic literature review regarding MSP, with particular foci on psychopathology in perpetrators of MSP and the notion of pathological play was conducted. The notion that MSP is a form of pathological play was critically evaluated through the use of clinical case material. Two cases were selected, both of which met the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) diagnostic criteria for MSP, based on the assessment of a child psychiatrist with expertise in this area. The case material was analysed through the generation of common themes and identification of repetitive patterns which were then systematically analysed and compared with the findings cited in the literature review, with particular reference to MSP as a form of pathological play. Jureidini's (1999) theoretical statement was analysed in the light of the available evidence and the theoretical basis was then revised. Aspects explained by the theory were presented. Aspects not explained by the theory were rejected. Object Relations Theory was proposed as an alternative to understanding the psychopathology present in a perpetrator of MSP.

Includes abstract. Includes bibliographical references.

Includes bibliographical references. / This study documents hearing parents' experiences of the impact of deafness on raising their deaf children during the preschool years. It focuses on their experience of health services for their child. The study population of 20 children was drawn from parents with children under 6 years of age diagnosed with moderate to profound loss of hearing at the Developmental Ciinic, Red Cross Chiidren’s Hospital, Rondebosch; Cape Town. Data was collected from 2 sources, namely a semi-structured interview, which was analysed for themes, and a questionnaire, which measures parental stress, communication difficuities, and experience of professional support.

Includes abstract. Includes bibliographical references.

Includes abstract. Includes bibliographical references (leaves 334-373).

Bibliography: leaves 68-75.