Ethiopia adopted a new strategy called integrated community case management to address common childhood illness (ICCM). This strategy has been introduced in some rural districts of Bale zone. It has multiple functions, involving assessment of sick children at community health post levels. Despite this, the efficacy of this strategy has not been investigated. Aim: This study aimed to assess the level of ICCM service utilisation and factors influencing this at health posts in Agarfa district. METHODS: Cross sectional and phenomenological methodologies were employed in this study. Data were collected from 401 mothers using questionnaires and 29 participants using in-depth interviews. Quantitative data were analysed using both descriptive and inferential statistical approaches. Thematic analysis was used for the qualitative data. RESULT: The utilsation of ICCM services is limited among caregivers in rural communities. There is a range of factors responsible for the limited utilisation. Examples of these include absence of health extension workers at health posts, caregivers’ negative perception of ICCM service, socio-cultural factors, level of education and household finance. The most common childhood illnesses noted were diarrhoea, followed by fever and cough. Caregivers seek help from HEWs at health posts two or more days after idenfying signs and symptoms of these illnesses. CONCLUSION: Behavioural messages to address prevailing negative attitudes and socio-economic barriers to accessing health care would help improve uptake of ICCM services / Health Studies / M. A. (Public Health)

The aim of this study was to assess the dietary intake, diet-related knowledge and metabolic control in children with Type 1 Diabetes Mellitus between the ages of 6-10 years attending the Paediatric Diabetic Clinics at Grey’s Hospital, Pietermaritzburg and Inkosi Albert Luthuli Central Hospital, Durban, KwaZulu-Natal. This was a cross sectional observational study that was carried out in a total of 30 subjects out of a possible 35 subjects that qualified for inclusion in the study from both the Grey’s Hospital clinic (n=8) and IALCH clinic (n=22). The dietary intake was assessed in a total of 25 subjects using a three day dietary record (n=20) and a 24 hour recall of the third day of the record (n=16). Diet-related knowledge was assessed using a multiple choice questionnaire. Metabolic control was assessed using the most recent HbA1c and the mean HbA1c results over the previous 12 months from the date of data collection. Height and weight measurements were also carried out. Information on socioeconomic status and education status of the caregivers was obtained from 22 caregivers through follow-up phone calls. All measurements except for dietary intake were obtained from all subjects participating in the study. The mean percentage contribution of macronutrients to total energy was very similar to the International Society for Pediatric and Adolescent Diabetes (ISPAD) Consensus Guidelines (2002). The mean percentage contribution of macronutrients to total energy from the 3 day dietary records and the 24 hour recalls were as follows: carbohydrate (52% and 49%); sucrose (2% and 2%); protein (16% and 17%); fat (32% and 34%). Micronutrient intake was adequate for all micronutrients except for calcium and vitamin D which showed low intakes. The mean diet-related knowledge score for the sample was 67% with significantly higher scores in children older than 8 years of age. The latest HbA1c for the sample was 9.7% and the mean HbA1c over the previous 12 months from the date of data collection was 9.6%. There was a significant positive correlation between age of the participant and the latest HbA1c (r = 0.473; p=0.008) and a significant negative correlation between the education level of the caregivers and the latest HbA1c (r = - 0.578; p=0.005) and the mean HbA1c over 12 months (r = - 0.496; p=0.019). Significant differences were found between African and Indian children respectively for HbA1c, with higher values in African children. There was no correlation between BMI for age and latest HbA1c (r = 0.203, p=0.282) or mean HbA1c over 12 months (r = 0.101, p=0.594). Z score for BMI for age was also not correlated with latest HbA1c (r = 0.045, p=0.814) or mean HbA1c over 12 months (r = - 0.012, p=0.951). Children from the Grey’s Hospital Clinic were found to have higher HbA1c values (p=0.001) and lower diet-related knowledge scores as compared to the children from the IALCH Clinic (p=0.038). It should be noted that the ethnic and racial composition of the children attending these two clinics differed. In conclusion the macronutrient intake in this sample was found to be similar to the ISPAD Consensus Guidelines (2002) while calcium and vitamin D intakes were low. Overall this sample displayed good diet-related knowledge while metabolic control was found to be poor. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2007.

The aim of this study was to describe mothers’ knowledge, attitudes and practices regarding malaria in children under five years old. A descriptive cross-sectional study design was used. A structured questionnaire was administered by face-to-face interviews during data collection. The study population of this research composed of mothers of children under five years old suffering from malaria in Thyolo district. Economic-demographic characteristics that were significantly associated with mothers’ knowledge were age (p=0.018), formal education (p=0.001), income (p=0.005), and type of a house (p=0.002). Sources of malaria information that were significantly associated with mothers’ knowledge included television (p=0.004), radio (p=o.005), and posters (p=o.00019). Treatment-seeking behaviour was significantly associated with education (p=0.017). Treatment prior to hospitalisation was significantly associated with mothers’ education (p=0.0001), number of children that passed away (p=0.015), distance to the health facility (p=0.013), lack of money (p=0.019), and time taken at the hospital to get treatment (p=0.016). Recommendations were made to improve mothers’ malaria knowledge for further research / Health Studies / M.A. (Public Health)

This non-experimental, descriptive, quantitative survey attempted to evaluate IMCI implementation in the eThekwini district of KwaZulu -Natal. The study focused on IMCI implementation by IMCI trained registered nurses, health facility support and follow-up and supervision. The research population comprised of all IMCI trained registered nurses working in health facilities in the eThekwini district. The convenient sample consisted of 40 research subjects. Data was collected by means of an interview schedule and a checklist, and analysed using Microsoft Excel 2007. Findings of the study revealed that many of the IMCI trained registered nurses were unable to assess, classify and treat the sick child comprehensively and consistently. The recommended follow-up visit at six weeks after completion of IMCI training, and lack of on-going supervision remains an area of concern. Recommendations were that district or clinic supervisors can enhance the skills of IMCI trained registered nurses through recommended follow-up visits and on-going supervision and the provision of updated IMCI chart booklets. / Health Studies / M.A. (Public Health)

MSCPNT / Department of Nutrition / Objectives: The study objectives were to determine demographic and environmental factors that can affect nutritional status of children receiving CSG, to assess the nutritional knowledge of caregivers, to determine the proportion of CSG spent on food and to determine the nutritional quality of food bought from CSG. Design: Cross-sectional descriptive with an analytical component Subjects: PCG of children under the age of 5 receiving CSG in Mogalakwena Municipality. 189 caregiver-child pairs were interviewed, in their households. Methods: Data collected by the interviewer included demographic data, Use of CSG, nutritional knowledge and the HHFI and anthropometric measurements were done by a 3rd year Nutrition student. Results: About 36.5% of participants were in the age 26-35 years, 75.7% were unmarried, 84.1% were unemployed and 72% had no matric. Mean age for children studied was 2.84±1.33, 77.8% of participants stayed in a household of more than 5 people. In terms of types of housing, 56% had formal houses, 55% had access to pit latrines and 52.9% used communal taps to access water, 41.3% used electricity for energy while 23.3% used wood to stretch the availability of electricity. Mean CSG received was R386.22 ±R208.75. Majority of participants (56.1%) indicated that CSG supports the whole family and 64.6% of the families depended solely on CSG for survival, while 27% of families had elderly people receiving pension grant which was supplementing the CSG. The CSG was used for different items, majority of families used 94.2% of the money for food at a mean of R171.55±159.25, followed by toiletry (71.6%) at a mean R61.89±69.24, then clothing (68.9%) at a mean of R70.77±97.14. Stokvel was also mentioned as one of the items contributed for by CSG, 32.3% of participants used more than R50.00 for stokvel. Different food items were purchased using CSG, 80.5 % of the money was used to purchase starchy food, mealie meal being the highest commodity at 43.7%. Offal (35.8%) was the highest protein source purchased followed by poultry at 26.4% and soya soup at 20%. Potatoes (19.6%) were mentioned as the most purchased vegetable, followed by cabbage (14.8%). There was a 53.5% of prevalence of stunting, of this 19.6% of children were severely xiii stunted, 5.3% underweight, and 32.3% of wasting. There were 22.1 % of PCG who were overweight and 12.1% were obese. The PCG BMI was negatively associated with WAZ (r= -0.48, p=0.515). There was a positive association between PCG BMI and HAZ (r=0.103, p=0.158), however when caregivers BMI was correlated to BAZ the association was strongly negatively significant (r=0.206, p=0.004). Most PCG received nutrition education from relatives, 71.1% were never educated on nutrition, 57.9% of children were fed 3X/ day. Conclusion: It is apparent from the study that malnutrition, precisely stunting is still a problem in South Africa, however this does not disregard the impact that CSG has on the lives of the poor. It affords the families to access basic needs in the household such as food, toiletry, electricity and even stokvel. The role of nutritionists/ dieticians is paramount in helping mothers to choose healthier economic food for the children in order to curb the burden of malnutrition. / NRF

PhD (Health Sciences) / Department of Advanced Nursing Science / Background: Family-centred approaches to Prevention of Mother-to-Child Transmission (PMTCT) interventions present an important direction for sustainability and prevention of pediatric infections while improving overall family health. Despite numerous opportunities to sustain and expand the existing PMTCT interventions, Mother-to-Child Transmission (MTCT) still occurs. This is evidenced by the number of under-five children who are admitted in hospital being infected by the Human Immunodeficiency Virus (HIV) between the ages of 6 weeks to 18 months, whereas the Polymerase Chain Reaction (PCR) results was non-reactive at six weeks. Purpose: The purpose of this study was to develop a strategy to enhance family-centered interventions for PMTCT sustainability in the selected districts of Limpopo Province, South Africa. Phase 1: The study was conducted in phases. In Phase 1, which was empirical, the following objectives: to explore the risks that contribute to MTCT between the ages of 6 weeks and 18 months; to explore the perceptions of family members regarding family support in PMTCT interventions; and to explore the factors that affect the provision of family support in PMTCT interventions. Phase 2: was development of the strategy and validation of the strategy. Methods: The exploratory sequential mixed method was used to conduct the study, where qualitative data were collected and analyzed first; followed by collecting, analyzing and interpreting the quantitative data. The population comprised the following groups: mothers of babies between 6 weeks and 18 months who are living with HIV/AIDS, family members were represented by male partners, grandmothers or mother’s in_-law and health care professionals working at the PHC Heath Centers v or clinics rendering PMTCT services. In the qualitative design, participants were selected by non-probability purposive sampling and data were collected through one-to-one interview and focus group discussions. Data were analyzed utilizing the open-coding method. In the quantitative design, participants were selected by using simple random sampling and data were collected by means of self-administered survey questionnaires with structured close-and open-ended questions. The population were midwives from Capricorn, Mopani and Vhembe districts PHC clinic. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), Version 22 and descriptive statistics. In Phase 2, findings from the data were used to develop an intervention strategy. The strategy was developed through the use of Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis. The developed strategy was validated by using a quantitative design. / NRF

This explorative, descriptive quantitative survey attempted to determine whether the reduced number of consultations and admissions of sick children less than five years in Emfuleni sub- district clinics is due to the utilisation of the IMCI strategy or other health services. The research population comprised of all the mothers/caretakers of children less than five years who utilised the clinics and those who consulted the private medical doctor. The convenient sample consisted of 169 candidates. Data was collected by means of a questionnaire and analysed using the SAS/Basic computer statistical software package. Findings of the study revealed a need to address the major concern about the waiting time and operational times in all the three clinics. Recommendations were made that staff allocation procedures and policies be reviewed in order to abate long waiting periods at the clinics where children with childhood illnesses are treated. / Health Studies / M.A. (Health Studies)

This explorative, descriptive quantitative survey attempted to determine whether the reduced number of consultations and admissions of sick children less than five years in Emfuleni sub- district clinics is due to the utilisation of the IMCI strategy or other health services. The research population comprised of all the mothers/caretakers of children less than five years who utilised the clinics and those who consulted the private medical doctor. The convenient sample consisted of 169 candidates. Data was collected by means of a questionnaire and analysed using the SAS/Basic computer statistical software package. Findings of the study revealed a need to address the major concern about the waiting time and operational times in all the three clinics. Recommendations were made that staff allocation procedures and policies be reviewed in order to abate long waiting periods at the clinics where children with childhood illnesses are treated. / Health Studies / M.A. (Health Studies)