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The objectives of this study were to determine what the Tumbuka people of northern Malawi consider to be the most dangerous childhood diseases, to explore their perceptions about the aetiology, prevention and treatment of these diseases, and to determine how such perceptions have changed over the years. The study was done in Chisinde and surrounding villages in western Rumphi District, northern Malawi. Although a household questionnaire was used to collect some quantitative data, the major data collection methods comprised participant observation, in-depth interviews with mothers with children under five and old men and women, and key informant interviews with traditional healers, traditional birth attendants, village headmen, health surveillance assistants and clinical officers. Informants in this study mentioned chikhoso chamoto, diarrhoea, malaria, measles, and conjunctivitis as the most dangerous childhood diseases in the area. Old men and women added that in the past smallpox was also a dangerous disease that affected both children and adults. Apart from measles and smallpox, community-based health workers and those at the local health centre also mentioned the same list of diseases as the most dangerous diseases prevalent among under-five children. Though health workers and informants mentioned the same diseases, the informants' perspectives about the aetiology and prevention of these diseases and the way they sought treatment during childhood illness episodes, in some cases, differed significantly from those of biomedicine. For example, while health workers said that the signs and symptoms presented by a child suffering from "chikhoso chamoto" were those of either kwashiorkor or marasmus, both young and elderly informants said that a child could contract this illness through contact with a person who had been involved in sexual intercourse. Biomedically, diarrhoea is caused by the ingestion of pathogenic agents, which are transmitted through, among other factors, drinking contaminated water and eating contaminated foods. While young men and women subscribed to this biomedical view, at the same time, just like old men and women, they also believed that if a breastfeeding mother has sexual intercourse, sperms will contaminate her breast milk and, once a child feeds on this milk, he or she will develop diarrhoea. They, in addition, associated diarrhoea with the process of teething and other infections, such as malaria and measles. In malaria-endemic areas such as Malawi, the occurrence of convulsions, splenomegaly and anaemia in children under five may be biomedically attributed to malaria. However, most informants in this study perceived these conditions as separate disease entities caused by, among other factors, witchcraft and the infringement of Tumbuka taboos relating to food, sexual intercourse and funerals. Splenomegaly and convulsions were also perceived as hereditary diseases. Such Tumbuka perceptions about the aetiology of childhood diseases also influenced their ideas about prevention and the seeking of therapy during illness episodes. Apart from measles, other childhood vaccine-preventable diseases (i.e. tetanus, diphtheria, tuberculosis, pertussis and poliomyelitis) were not mentioned, presumably because they are no longer occurring on a significant scale, which is an indication of the success of vaccination programmes. This study reveals that there is no outright rejection of vaccination services in the study area. Some mothers, though, felt pressured to go for vaccination services as they believed that non-vaccinated children were refused biomedical treatment at the local health centres when they fell ill. While young women with children under five mentioned vaccination as a preventative measure against diseases such as measles, they also mentioned other indigenous forms of 'vaccination', which included the adherence to societal taboos, the wearing of amulets, the rubbing of protective medicines into incisions, isolation of children under five (e.g. a newly born child is kept in the house, amongst other things, to protect him or her against people who are ritually considered hot because of sexual intercourse) who are susceptible to disease or those posing a threat to cause disease in children under five. For example, since diarrhoea is perceived to be caused by, among other things, a child feeding on breast milk contaminated with sperms, informants said that there is a strong need for couples to observe postpartum sexual intercourse. A couple with newly delivered twins is isolated from the village because of the belief that children will swell if they came into contact with them. Local methods of disease prevention seem therefore to depend on what is perceived to be the cause of the illness and the decision to adopt specific preventive measures depends on, among other factors, the diagnosis of the cause and of who is vulnerable. The therapy-seeking process is a hierarchical movement within and between aetiologies; at the same time, it is not a random process, but an ordered process of choices in response to negative feedback, and subject to a number of factors, such as the aetiology of the disease, distance, social costs, cost of the therapeutic intervention, availability of medicines, etc. The movement between systems (i.e. from traditional medicine to biomedicine and vice-versa) during illness episodes depends on a number of factors, including previous experiences of significant others (i.e. those close to the patient), perceptions about the chances of getting healed, the decisions of the therapy management group, etc. For example, febrile illness in children under five may be treated using herbs or antipyretics bought from the local grocery shops. When the situation worsens (e.g. accompanied by convulsions), a herbalist will be consulted or the child may be taken to the local health centre. The local health centre refers such cases to the district hospital for treatment. Because of the rapidity with which the condition worsens, informants said that sometimes such children are believed to be bewitched, hence while biomedical treatment is sought, at the same time diviners are also consulted. The therapeutic strategies people resort to during illness episodes are appropriate rational decisions, based on prevailing circumstances, knowledge, resources and outcomes. Boundaries between the different therapeutic options are not rigid, as people move from one form of therapy to another and from one mode of classification to another. Lastly, perceptions about childhood diseases have changed over the years. Old men and women mostly attribute childhood illnesses to the infringement of taboos (e.g. on . sexual intercourse), witchcraft and other supernatural forces. While young men and women also subscribe to these perceptions, they have at the same time also appropriated the biomedical disease explanatory models. These biomedical models were learnt at school, acquired during health education sessions conducted by health workers in the communities as well as during under-five clinics, and health education programmes conducted on the national radio station. Younger people, more frequently than older people, thus move within and between aetiological models in the manner described above.

This research study endeavoured to explore and describe the experiences of women who participated in the Prevention of Mother-To-Child Transmission (PMTCT) of HIV Programme. Data relating to evaluation of the PMTCT Programme in the piloted sites compiled by other researchers in the Department of Health focus on the process, progress and extent of service implementation. There appears to be a dearth of information available from women participants in the PMTCT Programme. The objectives of the study were to: · Explore and describe postnatal women’s experiences of the PMTCT Programme offered in the East London Hospital Complex. · Propose recommendations into the existing guidelines for midwives who implement the PMTCT Programme in the health services to ensure optimal implementation of this programme. The research population included postnatal women who participated in the PMTCT of HIV Programme at the East London Hospital Complex (Frere site). Permission to conduct the research was obtained from the Eastern Cape Department of Health Ethics Committee, Chief Executive Officer of the hospital complex and the Advanced Degrees Committee and Human Ethics Committee at the Nelson Mandela Metropolitan University. The research study was qualitative, exploratory, descriptive and contextual in design. Data collection was carried out by face-to-face semi-structured interviews with postnatal women at the East London Hospital Complex (Frere site). The tape-recorded interviews were transcribed verbatim with the aid of field notes. Data analysis was done according to Tesch’s method of data analysis (in De Vos et al, 2000:343). Themes were identified from the transcriptions and finalised after consensus discussions with an independent coder who was experienced in qualitative research. Literature control, guided by the themes identified in the interviews, was carried out to compare and verify the findings of the study. Three major themes with sub-themes were identified during data analysis. The major themes were identified as follows: · The participants expressed feelings of being devastated by the results that confirmed their HIV positive status. · The participants expressed a thirst for knowledge on how to live with the diagnosis and on how to continue with the PMTCT Programme. · The physical environment where counselling and testing were done, as well as the practical arrangements, were not conducive to the full implementation of the PMTCT Programme at the antenatal clinic. Conclusions were drawn and recommendations were made in the form of additional guidelines for midwives implementing the PMTCT Programme in the antenatal clinic health services. Guidelines for further midwifery-related research were formulated.

The purpose of the present research is to investigate whether or not chronically ill children are victims of child abuse more frequently than healthy children. The gender of the child and of the parent will also be examined for differences in the treatment children receive.

Thesis (M.Med. (Paediatrics and Child Health)) -- University of Limpopo, 2022 / Introduction: Pleural empyema in children is associated with high morbidity and high mortality. Staphylococcus aureus has been shown to be the most common causative organism in developing countries. Study design: This study applied a retrospective quantitative descriptive study design. Study population: The population of the study is comprised of children (between 1 years and 13 years) admitted to Pietersburg Provincial Hospital with pleural empyema from January 2016 until December 2020. Objectives: The study aimed to determine the causative organisms of pleural empyema, the treatment outcomes, and the relationship between pleural empyema, TB, and HIV infection. Data collection: The National Health Laboratory Services database was used to identify patients who had pleural empyema. A self-generated data collection tool was used to obtain secondary data related to all patients who met the operational definition of pleural empyema during the defined time period. Results: Eleven participants met inclusion criteria. The mean age of participants was 42 months with 43.8 standard deviation and 64% were males and females were 36% . Of these participants, 40% cultured S. Aureus in the pleural fluid, 10% Streptococcus pneumoniae, 30% were sterile and 20% cultured other organisms such as Klebsiella pneumoniae and Haemophilus influenzae. Cloxacillin was the most prescribed antibiotic. Intercostal drainage was inserted in 91% of the participants of which 18% were successful, no further surgical intervention needed,73% had thoracotomy and VATS was offered to 91% of participants and it was followed by thoracotomy. Fibrinolytics were not offered to the participants in this study. The majority of patients, 55%, were discharged back to their peripheral hospitals and 27% of them died. PCV immunisation status of the children was not documented hence the relationship between pleural empyema and PCV immunisation could not be established. There was a positive correlation between age of patients with pleural empyema and ICU length of stay (r=89%; p=0,01) while another strong correlation was depicted between HIV status and hospital length of stay (r=88%, p=0,019). Results further show a positive association between outcome and surgery intervention offered (Chi=7,00; p=0,02). Conclusion: Our study showed that S. aureus is the leading cause of pleural empyema, with a predominance of thoracocentesis and thoracotomy offered as surgical interventions.

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. (Health Studies)

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Homoeopathy, Durban University of Technology, 2009. / INTRODUCTION The aim of this study was to evaluate the efficacy of homoeopathic simillimum in the treatment of attention-deficit/hyperactivity disorder (AD/HD) in schoolgoing children aged 6-11 years. AD/HD affects approximately 3-5% of children worldwide. It is thus a highly prevalent childhood disorder characterised by hyperactivity, impulsivity and restlessness. There are 3 subtypes of the condition, namely combined type, predominantly inattentive type and predominantly hyperactive-impulsive type (DSM-IV-TR, 2000 pg 90). OBJECTIVE The objective of the study was to determine the efficacy of homoeopathic simillimum in the treatment of this disorder, and thus promote homoeopathy as a safe alternative to conventional AD/HD treatments. METHODOLOGY The study was conducted as a double-blind placebo-controlled study. The sample group consisted of 30 participants. There was an experimental group of 16, which was compared to a placebo control group of 14. Participants were recruited from the greater Durban area. They had to satisfy clear inclusion and exclusion criteria. Participants and parents/guardians were required to attend 3 consultations with the researcher at The Homoeopathic Day Clinic over a 2-month period. The ADHD Rating Scale-IV Home and School Versions (Appendices B and C) had to be completed by the participant’s parent/guardian and teacher respectively. One was filled in at the initial consultation to serve as a baseline reading, and thereafter, every month. Remedies were dispensed at the first 2 consultations and these remedies were decided upon after thorough case-taking, use of Radar 9.0 Homoeopathic Software and discussion with 1 of 2 selected clinicians. Those on placebo were given free treatment at the end of the study. RESULTS Statistical analysis was conducted on the ADHD Rating Scales-IV Home and School Versions (Appendices B and C), completed by the parent/guardian and teacher respectively. Improvement was based on a decrease in the rating scale score. On analysis, the results (Table 4.8, 4.9 and 4.10) showed no statistically significant effect of treatment (i.e. no difference between treatment and placebo group), but across the whole trial and within each group (particularly the treatment group) subjects had significant reductions in symptoms (i.e. the reductions in symptoms were large enough that there was less than 5% chance that they were random fluctuations/effects). This was seen in both the treatment and placebo groups, as indicated by Table 4.11, 4.12 and 4.13, but more significant reductions were seen in the treatment group, indicated by Table 4.14. As discussed in Chapter 5, this by no means rules out the efficacy of homoeopathic simillimum for the treatment of AD/HD. CONCLUSIONS A large number of parents, teachers and doctors are seeking a safe, effective way to treat this highly prevalent disorder (Soreff & Chang, 2008) and, although the study did not satisfy the hypothesis that homoeopathic simillimum is an effective treatment for AD/HD in schoolgoing children, it did aid in creating awareness of the use of homoeopathy as a treatment option for this condition and highlighted the need for more extensive research to be undertaken for this treatment option. It is the researcher’s opinion that larger, longer duration studies, employing quantitative analysis, as well as qualitative analysis would yield more significant results.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of technology, Durban, South Africa, 2016. / INTRODUCTION: The utilization of complementary and alternative medicine (CAM) in the treatment of paediatric patients is increasing, especially the utilization of chiropractic treatment for children. However controversy exists regarding the reasons why parents may or may not choose to utilize chiropractic treatment for children. Parents are the gatekeepers to care as they consent to all treatment that is given to their children. Parents that have a lack of knowledge and understanding regarding chiropractic, as well as a negative perception regarding chiropractic treatment for children may be reluctant to choose chiropractic treatment as a treatment option. Both positive and negative opinions regarding chiropractic treatment have been identified in other populations in South Africa which emphasizes the need to explore the way parents feel about chiropractic treatment for children. A lack of knowledge and understanding of CAM has been identified as a reason for underutilization. Insight into the status of knowledge, understanding and perception of parents regarding chiropractic treatment for paediatric patients in the Durban Metropolitan Area equips the profession to better understand how parents view chiropractic treatment for children. AIMS AND OBJECTIVES: The main aim of this research was to explore and describe the knowledge, understanding and perception of parents regarding chiropractic treatment for paediatric patients. The outcomes of such a study can provide useful information which can serve as a baseline from which education and chiropractic treatment awareness can be built, as well as dispelling any misconceptions and myths regarding chiropractic treatment for children. RESEARCH DESIGN: An explorative, descriptive, qualitative research design was followed in this research. This research design was chosen in order to evaluate the knowledge, understanding and perception of parents regarding the utilization of chiropractic treatment for paediatric patients, within the Durban Metropolitan area. RESEARCH METHODOLOGY: Semi-structured interviews were conducted with participants of the Durban Metropolitan Area in order to determine the current knowledge, understanding and perception of parents regarding chiropractic treatment for paediatric patients within this area. Interviews were conducted with the participants until saturation was met, after which an additional five interviews were conducted. A total of 13 interviews were analyzed. The data was transcribed and coded by the researcher as well as a co-coder. NVivo software was utilized for the coding process. RESULTS: It was found that the participants had a lack of knowledge and understanding regarding chiropractic treatment for children. The participants felt that this lack of knowledge and understanding of chiropractic treatment for children left them unsure, resulting in the non-use of this form of treatment for their children. The participants were however not opposed to the utilization of chiropractic treatment for children; they felt fear and concern regarding chiropractic treatment as they felt they were uneducated regarding the outcome of the treatment, what the treatment would involve and the reasons why chiropractic treatment should be utilized for children. The participants mentioned that if they had increased knowledge and understanding they would feel more comfortable in utilizing chiropractic treatment for their children. The participants felt that they did not have the resources to learn more about chiropractic treatment and they showed interest in learning more about chiropractic treatment for children. Recommendations were made for further research and for the chiropractic profession regarding increasing the knowledge and understanding of parents regarding chiropractic treatment. / M