Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Child mortality is a worldwide problem and, according to the World Health Organization (WHO), 8,1 million children under the age of five years die each year. The Millennium Development Goals focus on the worldwide reduction in child mortality by two-thirds between 2000 and 2015. Several studies show that worldwide Community Integrated Management of Childhood Illness (CIMCI) interventions by community care workers (CCWs) have a positive effect on child health. The goal of this study was to determine the factors influencing CIMCI in the rural areas of the West Coast District in the Western Cape of South Africa. The objectives for this study were to determine the factors influencing CIMCI carried out in rural areas by the CCWs, which were identified as: • having working hours that are adequate for such a comprehensive service package; • being adequately trained; • having adequate knowledge of the “16 Key Family Practices” of CIMCI; • having equipment that is adequate for the execution of their daily duties; • being able to cope with the challenges of working in rural and remote areas; and • receiving adequate supervision and support related to CIMCI. A descriptive, non-experimental exploratory research design with a quantitative approach was applied. The target population (N = 270) consisted of CCWs who are funded by the Provincial Government of the Western Cape (PGWC) in the West Coast District. For this study a response rate of 257 (95,18%) was obtained. Data was collected personally by the researcher with a self-administered questionnaire. The data was analysed with the assistance of a statistician and are presented in histograms and frequency tables. The participants were tested on their knowledge of CIMCI, and more than half of them achieved an average score that was not satisfactory. Statistically significant correlations were found between the participants’ total score achieved and highest school grade passed (p < 0. 01); their level of Expanded Public Works Programme (EPWP) training (p < 0.01); their attendance of the CIMCI five-day course (p < 0.00); and if they had done a refresher course on CIMCI (p < 0.00). The total score was also shown by the Mann-Whitney U test (p < 0.01) to have a direct relationship with whether they had received any health-related training after school. The conclusion that can be drawn is that the higher the level of education of the CCWs, the better their knowledge of CIMCI. This could also improve their work performance. The recommendations arising from this study include that CIMCI training should be standardised to ensure that the CCWs have adequate knowledge. The current policy on community-based services (CBS) of the Provincial Government Western Cape Department of Health should also be standardised to ensure adequate working hours, training, equipment and supervision, and to take into consideration the challenges of working in rural areas. In conclusion, should these recommendations be implemented, CIMCI will have a huge, positive impact on child morbidity and mortality. CCWs will be ensured adequate working hours in relation to their workload, and will receive adequate training, equipment and supervision. This will reduce the challenges CCWs face and strengthen their services in rural areas. / AFRIKAANSE OPSOMMING: Kindersterftes is wêreldwyd ’n probleem en volgens die Wêreldgesondheidsorganisasie sterf 8,1 miljoen kinders onder die ouderdom van vyf jaar elke jaar. Die Millenniumontwikkelings-doelwitte fokus daarop om kindersterftes tussen 2000 en 2015 met twee-derdes te verminder. Verskeie studies toon dat intervensies deur middel van Gemeenskapsgeïntegreerde Bestuur van Kindersiektes deur gemeenskapsorgwerkers die wêreld oor ’n positiewe effek op kindergesondheid het. Die doel van hierdie studie was om die faktore te bepaal wat Gemeenskapsgeïntegreerde Bestuur van Kindersiektes in die landelike gebiede van die Weskusdistrik in die Wes-Kaap van Suid-Afrika beïnvloed. Die doelwitte vir hierdie studie was om die faktore te bepaal wat beïnvloed hoe Gemeenskapsgeïntegreerde Bestuur van Kindersiektes in die landelike gebiede deur gemeenskapsorgwerkers uitgevoer word, wat soos volg uiteengesit is: • werksure wat voldoende is vir die omvattende pakket dienste wat aangebied word; • dat hulle voldoende opgelei is; • dat hulle voldoende kennis het van die “16 Sleutel Familiepraktyke” van Gemeenskapsgeïntegreerde Bestuur van Kindersiektes; • dat hulle die nodige toerusting besit wat voldoende is vir die uitvoer van hulle daaglikse pligte; • dat hulle raad weet met die uitdagings van werk in landelike en afgeleë gebiede; en • dat hulle voldoende toesig en ondersteuning met betrekking tot Gemeenskapsgeïntegreerde Bestuur van Kindersiektes ontvang. ’n Beskrywende, nie-eksperimentele verkennende navorsingsontwerp met ’n kwantitatiewe benadering is gebruik. Die teikenbevolking (N = 270) het bestaan uit gemeenskapsorgwerkers wat deur die Provinsiale Regering van die Wes-Kaap in die Weskusdistrik befonds word. Vir hierdie studie is ’n responstempo van 257 (95,18%) verkry. Die data is persoonlik deur die navorser deur middel van ’n selftoepastoets ingesamel. Die data is met behulp van ’n statistikus geanaliseer en word deur middel van histogramme en frekwensietabelle voorgestel. Die deelnemers is getoets op grond van hulle kennis van Gemeenskapsgeïntegreerde Bestuur van Kindersiektes, en meer as die helfte het ’n gemiddelde telling behaal wat nie bevredigend is nie. Statisties beduidende korrelasies is verkry tussen die deelnemers se totale telling en die hoogste skoolgraad behaal (p < 0.01); hulle vlak van Expanded Public Works Programme (EPWP) opleiding (p < 0.01); hulle bywoning van die vyfdaagse Gemeenskapsgeïntegreerde Bestuur van Kindersiektes kursus (p < 0.00); en of hulle ’n opknappingskursus oor Gemeenskapsgeïntegreerde Bestuur van Kindersiektes gedoen het (p < 0.00). Die totale telling is deur die Mann-Whitney U-toets (p < 0.01) gewys om ’n direkte verwantskap te hê met of hulle enige gesondheidsverwante opleiding ná skool ondergaan het. Die gevolgtrekking is dat hoe hoër die gemeenskapsorgwerkers se vlak van opvoeding, hoe beter hulle kennis van Gemeenskapsgeïntegreerde Bestuur van Kindersiektes. Dit sou ook hulle werkverrigting kon verbeter. Die aanbevelings wat uit hierdie studie spruit, sluit in dat Gemeenskapsgeïntegreerde Bestuur van Kindersiektes-opleiding gestandaardiseer moet word om te verseker dat gemeenskapsorgwerkrs voldoende kennis het. Die huidige beleid van die Provinsiale Regering van die Wes-Kaap oor gemeenskapsgebaseerde dienste moet ook gestandaardiseer word om te verseker dat hulle toereikende werksure, opleiding, toerusting en toesig het, en om die uitdagings van werk in landelike gebiede in ag te neem. Ter afsluiting: sou hierdie aanbevelings geïmplementeer word, sal Gemeenskapsgeïntegreerde Bestuur van Kindersiektes ‘n groot, positiewe impak op kindermorbiditeit en kindersterftes hê. Gemeenskapsorgwerkers sal van voldoende werksure met betrekking tot hulle werklas verseker wees, en sal voldoende opleiding, toerusting en toesig ontvang. Dit sal die uitdagings verminder waarvoor hulle te staan kom en hulle dienste in landelike gebiede versterk.

Thesis (MScSportSc)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: Numerous studies have shown that coronary artery disease (CAD) has its origin in childhood. Several risk factors that increase a person's risk for the development of CAD are prevalent amongst children. South African statistics concerning the prevalence of these risk factors are limited. Research has shown that early intervention to eliminate risk factors can decrease the risk for the development of CAD. The purpose of this study was to determine the prevalence of certain coronary risk factors amongst children aged 11 to 13 years in certain Western Cape schools. Certain selected factors were tested. These included obesity, lack of physical activity, hypertension, low physical fitness (V02max), a family history associated with an increased risk, exposure to cigarette smoke, prevalence of diabetes mellitus and an unhealthy diet. The sample consisted out of 288 children and was made up by 154 boys and 134 girls. Certain anthropometrical measurements (stature, weight, skinfoids, waist and hip circumferences) were taken. Activity levels, family history, exposure to cigarette smoke, prevalence of diabetes mellitus and diet, were measured by means of questionnaires. Physical fitness (V02max) was tested with a three-minute step-test. A sphygmomanometer was used to measure blood pressure. Depending on the circumference of the child's arm, a paediatric or adult size cuff was used. The results of the study showed that 22.01% of the boys and 59.7% of the girls had a percentage body fat so high that it was considered a coronary risk factor. Physical fitness levels were considered risk factors in 2.6% of the boys and 9% of the girls. A very high percentage of the children tested had a family history associated with an increased risk for the development of CAD (73.38% of the boys and 78.36% of the girls). Systolic hypertension was prevalent among 22.01% of the boys and 23.13% of the girls. Diastolic hypertension was only prevalent among 5.19% of the boys and 5.97% of the girls. Low activity levels were considered a risk factor in 31.17% of the boys and 39.55% of the girls. Out of all the subjects, 32.47% of the boys and 37.31% of the girls were exposed to cigarette smoke on a daily basis. The results of this study shows that certain coronary risk factors are quite common amongst children. Prevention programmes that focuses on elimination of coronary risk factors, such as hypertension, inactivity and obesity, is essential for the prevention of subsequent coronary artery disease in adults. / AFRIKAANSE OPSOMMING: Verskeie studies het al bewys dat koronêre hartvatsiekte (KHS) reeds sy ontstaan het in kinders van baie jong ouderdomme. Verskeie risikofaktore wat tot die latere ontstaan van KHS lei kom ook onder jong kinders voor. Statistiek ten opsigte van die voorkoms van hierdie risikofaktore onder kinders in Suid-Afrika is egter baie beperk. Verskeie navorsing toon dat vroeë intervensie kan lei tot "n verlaging in risiko vir die ontwikkeling van KHS op "n latere stadium. Die doel van die studie was om die voorkoms van sekere koronêre risikofaktore in kinders in Suid-Afrika te ondersoek. Sekere risikofaktore is ondersoek, dit het ingesluit, obesiteit, lae fisieke aktiwitietsvlakke, hipertensie, lae fisieke fiksheid (V02maks), 'n familie geskiedenis wat geassosieer word met "n verhoogte risiko, blootstelling aan sigaret rook, die voorkoms van diabetes mellitus en "n swak dieet. Die steekproef het bestaan uit 288 kinders waarvan 134 meisies en 154 seuns was. Verskeie antropometriese meetings (lengte, massa, velvoue, middel- en heup omtrekmates) is geneem. Aktiwiteitsvlakke, familiegeskiedenis, blootstelling aan sigarette rook, voorkoms van diabetes mellitus en dieet is deur middel van vraelyste vasgestel. Fisieke fiksheid (V02maks) is deur middel van "n drie-minuut-opstaptoets vasgestel. Bloeddruk is met "n sfigmomanometer gemeet. Afhangend van die omtrek van die kind se arm is "n pediatries- of volwasse-grootte drukband gebruik. Persentasie liggaamsvet was by 22.01% van die seuns en 59.7% van die meisies so hoog dat dit as "n risikofaktor beskou kan word. Fisieke fiksheidsvlakke kan by 2.6% van die seuns en 9% van die meisies as "n risikofaktor beskou word. "n Baie hoë persentasie van die kinders het "n familiegeskiedenis gehad wat geassosieer word met "n verhoogde risiko vir die ontwikkeling van KHS (73.38% van die seuns en 78.36% van die meisies). Sistoliese hipertensie het onder 22.01% van die seuns en 23.13% van die meisies voorgekom. Diastoliese hipertensie het baie minder voorgekom as sistoliese hipertensie (5.19% van die seuns en 5.97% van die meisies). Lae aktiwiteitsvlakke het onder 31.17% van die seuns en 39.55% van die meisies voorgekom. 'n Redelike hoë persentasie van die kinders word daagliks aan sigaretrook van hulouers of oppassers blootgestel (32.47% van die seuns en 37.31% van die meisies.) Die resultate van die studie dui aan dat daar 'n redelike hoë voorkoms van sekere koronêre risikofaktore onder kinders is. Ondersoek moet ingestel word na moontlike, goed gestruktureerde intervensieprogramme.