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 (Microbiology) / Department of Microbiology / Globally, one in ten child deaths before the age of 5 years is due to diarrheal disease, causing almost 800,000 mortalities worldwide, which mostly occur in Sub-Saharan Africa and South Asia. Eighty-eight percent (88%) of diarrheal deaths worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene. Unsanitary environments and poor hygiene practices allow diarrhea causing pathogens including viruses, bacteria and parasites to spread more easily. Norovirus (NoV) are now considered the most common cause of outbreaks of nonbacterial gastroenteritis. However, the factors which control the genetic diversity, the sources of sporadic NoV infections, the transmission and persistence of infection are poorly understood. Limited data are available for NoVs strains in South Africa, especially in rural and peri-urban areas. Despite the excessive burden of diarrhea disease in developing countries, NoVs outbreaks have been to date mostly reported in developed countries. Given that the contribution of the various pathogens to diarrhea may differ substantially between regions depending on local meteorological, geographic, and socio-economic conditions, there is a need to investigate intensively the role of viral agents associated with diarrhea in different settings in Africa continent. How would poor living conditions in rural setting impact the prevalence and genetic characteristics of Norovirus strains circulating Limpopo province is the research question of this study. ix To determine the prevalence and genetic diversity of NoVs strains circulating in the rural communities in the Limpopo Province, South Africa and investigate the genetic relationship between NoVs strains, a cross-sectional study was performed on human stools collected from rural communities. We used qualitative variables of poor living environmental conditions including type of water used at the household of child’s parent or guardian, use of toilet seat, presence of livestock at the household and parent employment status to assess possible environmental risk factors of NoV infection within the study area. Prior to this prospective study, we conducted a systematic review of the PubMed and EMBASE databases for published articles of Human NoVs in Africa between 1990 and 2013 in order to assess the contribution of Human NoVs to diarrhoeal diseases in Africa. This review provides a picture of Human NoVs studies in Africa and reveals that unreported sporadic gastroenteritis cases of Human NoVs are common in Africa. Most are community-associated infections reported from urban settings. Possible environmental transmission routes have been documented. Combined environmental and clinical studies are required for targeted actions to control transmission of Human NoVs in Africa. Between July 2014 and April 2015, outpatient children under 5 years of age from rural communities of Vhembe district, South Africa, were enrolled for the study. A total of 303 stool specimens were collected from those with diarrhea (n=253) and without (n=50) diarrhea. NoVs were identified using real-time one-step RT-PCR. Nucleotide sequencing methods were performed to genotype the strains. Phylogenetic analyses x were performed to compare identified NoVs genotypes to the worldwide circulating strains. One hundred and four (41.1%) NoVs were detected. NoV detection rates in symptomatic and asymptomatic children (OR = 1.24; 95% CI 0.66 – 2.33) were not significantly different. Comparison of the median CT values for NoV in symptomatic and asymptomatic children revealed significant statistical difference of estimated GII viral load from both groups, with a much higher viral burden in symptomatic children to our knowledge this is the first study reporting on the differences in estimated viral load of GII and GI NoV positive cases and controls. The study findings may have implications for the diagnosis of NoV disease and future vaccine development, which may only need to consider GII as the genogroup associated with diarrhea in the South African population. Sequence analyses demonstrated multiple NoV genotypes identified in rural communities of Vhembe district. The most prevalent NoV genotypes were GII.4 Sydney 2012 variants (n=7) among the capsid genotypes, GII.Pe (n=9) among the polymerase genotypes and GII.Pe/GII.4 Sydney 2012 (n=8) putative recombinants among the RdRp/Capsid genotypes. Two unassigned GII.4 variants and an unusual RdRp genotype GII.P15 were found. With note, the rare GII.P15 identified in this study, has a common ancestor with GII.P15 strain from Japan previously reported as GII / untypeable recombinant strain implicated in a gastroenteritis outbreak. To our knowledge this is the first report of this unusual genotype in the African continent. Though not proven predictive of diarrhea disease in this study, the high detection rate of NoV reflects the substantial exposure of children from rural communities to enteric xi pathogens possibly. However in this study no risk factor has been found between NoV positive and qualitative environmental variables of poor living conditions in rural setting. The results also suggest that the difference between asymptomatic and symptomatic children with NoV may be at the level of the viral load of NoV genogroups involved. The findings highlighted NoV genetic diversity and revealed continuous pandemic spread and predominance of GII.Pe/GII.4 Sydney 2012, indicative of increased NoV activity. An unusual RdRp genotype GII.P15 and two unassigned GII.4 variants were also identified from rural settings of the Vhembe district/South Africa. NoV surveillance / NRF

MA (Psychology) / Department of Psychology / The aim of the study was to explore the psycho-social experiences of children living with vertically transmitted HIV/AIDS in Messina Hospital, South Africa. The study utilised the qualitative approach, in particular the exploratory research design. The population of the study comprised both male and female children between the ages of 12-17 years, who are receiving care and support at Fountain of Hope Clinic in Messina Hospital. Non-probability sampling, in particular its sub-type, purposive sampling, was used to select the children who participated in the study. Eleven participants (11) were interviewed, and the sample size of the study was guided by data saturation during data collection. Semi-structured, open-ended face to face interviews were used to collect data. In order to analyse data, the researcher adopted thematic content analysis, following Tech’s eight steps of qualitative data analysis. Three main themes emerged from the raw data, namely living with HIV/AIDS infection; challenges of living with HIV/AIDS infection; and coping with HIV/AIDS. Sub-themes emerged from the main themes. Ethical considerations were observed and trustworthiness was ensured in the study. The study results were analysed and recommendations based on the results were formulated to enhance the experiences of children living with vertically transmitted HIV/AIDS. / NRF

Department of Microbiology / PhD (Microbiology) / Human herpes virus type 8 (HHV-8), also known as Kaposi’s sarcoma associated herpes virus (KSHV), is the etiologic agent of Kaposi’s sarcoma (KS), and AIDS related Kaposi’s sarcoma (AIDS-KS). HHV-8 which is a member of the Herpesviridae family, exhibits extensive genetic diversity globally. In endemic regions, infection with HHV-8 occurs very early on in life, which is an indication of both environmental and vertical routes of transmission. The advent of HIV leads to the classification of an AIDS-KS defining condition in HIV infections. This suggests that in regions where HIV and HHV-8 are endemic, KS may become common in a mature HIV epidemic. Just like the prevalence of HIV in Northern South Africa is generally high as in most regions of the country, as the HIV epidemic matures in South Africa, it is important to understand the burden and distribution of HHV-8 infection, and the likely genotypes infecting the population. The main objective of the thesis was to establish the epidemiology and infecting genotypes of HHV-8 in Northern South Africa (Limpopo Province), where no data exists. First, a systematic review of the literature was carried out for the entire African continent to determine the seroprevalence and genotype distribution of HHV-8 in all African countries (n=53). In this review, Sudan and South Sudan were considered as one country. Articles were searched using the PRISMA guideline and exported using an article grid. More than two-thirds (64%) of the studies reported on seroprevalence, 29.3% on genotypes; and 9.5% were on both seroprevalence and genotypes. About 45% (24/53) of the African countries had data on HHV-8 seroprevalence exclusively, and more than half (53%) had data on either seroprevalence or genotypes. Almost half (47%) of the countries had no data on HHV-8 infection. There was high heterogeneity in the types of tests and interpretation algorithms used in determining HHV-8 seropositivity across the different studies. Generally, seroprevalence ranged from 2.0% in a group of young children in Eritrea to 100% in a small group of individuals with KS in the Central Africa Republic and a larger group of KS in individuals in Morocco. Approximately, 16% of all the studies reported on children. The difference in seroprevalence across the African region was not significant (95% CI, X2 =0.86; p =0.35), although specifically, a relatively significant ETTA MASHU ELIZABETH, PHD IN MICROBIOLOGY|UNIVERSITY OF VENDA, 2019|VIII level of infection was observed in HIV-infected children. About 38% of the countries had data on K1 genotypes A, A5, B, C, F and Z which occurred at frequencies of 5.3%, 26.3%, 42.1%, 18.4%, 5.3% and 2.6% respectively. Twenty-three percent of the countries had data for K15 genotypes, whereas genotypes P, M and N occurred at frequencies of 52.2%, 39.1% and 8.7% respectively. Data on HHV-8 inter-genotype recombinant is scanty. Our finding suggests that HHV-8 is endemic on the entire African continent, and in HIV endemic regions, but there is need for a harmonized testing protocol for better understanding of HHV-8 seropositivity. HHV-8 genotype A5 and B for K1 gene and genotype P and M for K15 gene are the most predominant genotypes in Africa. The review, for the first time, has provided information on HHV-8 burden on the entire African continent, and suggests that vaccine development efforts for Africa should focus on genotypes B and P. The second component of the investigation focused on the burden of HHV-8 in an HIV population in Northern South Africa (Limpopo Province). Plasma from 3501 HIV infected individuals from 5 districts in Limpopo Province were assessed for antibodies to both the lytic antigen (ORFK8.1) and the latent antigen (ORF73). The distribution of infection was analyzed based on demographic, socioeconomic, and immunological parameters. Statistical inferences for significant differences were determined by Chisquare at a confidence interval of 95%. P-values less than 0.05 were considered significant. About 19.0% of the study population was positive for antibodies to either the lytic or latent antigens or both. Prevalence of antibodies to the lytic antigen was significantly higher than prevalence of antibodies to the latent antigen (17.3% vs 4.1%; p=0.0001). Significant differences were observed for age groups, racial population groups, districts and year of sample collection (p=<0.0001, p=<0.0001, p=<0.0001 and p=0.0385) respectively. Associations were found between both antigens in comparison to the different variables such as age group, racial population groups and districts (R2 value ranging between 0.886 and 1.0). The burden of HHV-8 has now been established for the first time in Northern South Africa. The third aspect of the investigation was a meta-analysis of HHV-8 seroprevalence in Southern Africa in order to understand the impact of geographical location (urban vs rural) on infection. The analysis revealed a significant association between urban settings and HHV-8 infection (p=0.0001). ETTA MASHU ELIZABETH, PHD IN MICROBIOLOGY|UNIVERSITY OF VENDA, 2019|IX The fourth component of the thesis examined the detection of HHV-8 antigen through polymerase chain reaction (PCR) in 534 participants in HIV infected and HIV noninfected populations. A selection of mouthwash DNA samples were subjected to Next Generation Sequencing (NGS) for subsequent genotype inference. Mouth wash samples were obtained from each consenting individual before eating or smoking, and their DNA was purified. A 233bp fragment of the ORF26 gene of HHV-8 was amplified by PCR. HHV-8 was detected in 150 of the 534 participants (28.1%). A significant difference in detection was observed for gender, HIV status, district and the level of education (p=0,0003; p=0.0094; p=0.0002 and p=0.0095) respectively. Consensus sequences were derived from NGS reads for 13 samples. The genotyping results revealed that genotype Q, B, E and N are the genotypes predominant in the study population. As such no mixed infections were detected. Therefore, from the investigations foregoing have demonstrated for the first time the following: (1) HHV-8 is endemic in the entire African continent, which suggest a coendemicity in regions already endemic for HIV; (2) HHV-8 is endemic in Northern South Africa; (3) Urban settings in Southern Africa are associated with high HHV-8 infection; (4) HHV-8 genotypes Q, B, E and N may be predominant in Northern South Africa, with B and P common on the entire African continent. Hence, studies should focus on the generation of full length HHV-8 genomes of the common genotypes to support the selection of genes for vaccine design and development. / NRF

MPH / Department of Public Health / Autism spectrum disorder (ASD) is a life-long neurodevelopmental disorder, which does not affect the child only but the caregiver more. ASD characterized by impairments in social interactions, communication and repetitive behaviour. Therefore, caring for a child diagnosed with ASD can be a very challenging experience for caregiver especially when knowledge about the condition is limited. The aim of the study was to explore experiences of caregivers for children diagnosed with ASD in the Ehlanzeni District, Mpumalanga Province. The study adopted a qualitative approach, wherein data was collected using face-to-face semi-structured interviews, in which an interview guide was used. Participants were selected purposively from the three different schools and data was analysed using thematic content analysis. Twelve (12) participants were interviewed for the study. The caregivers’ children were aged 5-12 years. Ethical considerations and measures to ensure trustworthiness were adhered to throughout the study. The study findings indicated that caregivers for children diagnosed with ASD experienced psychological stress, social isolation and stigma, financial burden, lack of family support, services for children with ASD were perceived not to be accessible and available. The findings also indicated that there is limited knowledge of ASD amongst caregivers, health professionals and the community at large. Therefore, more awareness campaigns need to be done on ASD to increase knowledge on the condition. Furthermore, the study recommends that support groups for caregivers of children diagnosed with ASD should be formed and that information regarding a range of inexpensive interventions and educational programs should be made available for caregivers and their children, as well as continuous dissemination of information amongst caregivers. However, limited statistical information on ASD is available on the South African context. / NRF

PhD (Psychology) / Department of Psychology / The aim of the study was to develop a conceptualized model that will enhance language acquisition of children between 0 and 3 years. Language is a use of words and symbol to convey message, or communication. Generally, from birth to the age of four months children express their needs through crying and are soothed by the sound of voices or by low rhythmic sounds. When adults talk to children, children later imitate adult’s tongue movements and start to make sounds, coos and gurgles. Providing children with developmental stimulation and exposing them to learning opportunities increases their cognitive and social-emotional skills/abilities. Strategies to enhance language development are fundamental in children and can reduce many literacy related problems in later childhood. The objectives of the study are: to describe activities done by caregivers to influence language development; to identify factors that influence language development; to describe the importance of language development and to explain the disorders that are associated with language development. This study was qualitative in nature and it utilised an explorative design. This research design enabled the researcher to investigate the nature of acquisition comprehensively as well as the development of language and other factors that are related to it. The study was conducted at Vhembe District Municipality. Three villages were selected, namely Tshikuwi, Tshirolwe and HaMatsa villages, which are found in Makhado Municipality under Limpopo Province, South Africa. Purposive sampling was used to sample participants for the study. The individuals selected were those judged to have certain special characteristics as well as the ability to provide in-depth information for the purpose of the study. Thirty participants were selected to participate in the study. The semi-structured face to face interview and the interview guide with open-ended questions were used for data collection. Pre-testing of the interview guide was done to check if the guide would produce the expected results, three women from three different villages were selected for pretesting. All questions in the interview guide were addressed during data collection. Collected data were transcribed and analysed using thematic content analysis. The study adhered to the following research ethics: informed consent, anonymity, confidentiality, voluntary participation, no harm to the participants and dissemination of results. The study revealed that language is an important tool which is used to convey information from one person to the other. The findings indicate that language helps children to communicate and relate with other people. Language was also explained as a tool which is used to educate children, either at school or at home. The study shows that when children are learning language, they will also be stimulating their reasoning, thinking and problem-solving skills. In addition, it was also indicated that cognitive development reduces problems such as poor language development, a low self-esteem and isolation. The findings of this study show that there are a number of activities that can be used by caregivers and parents to foster the development of language in children. Those activities include, communicating with a child, reading of books, watching TV, naming of objects and explaining meaning of words. The study also identified several environmental factors that can be used to foster the development of language in children. The following environmental factors were identified in the study: communication, parental level of education, home socioeconomic status, caregiver’s personality and the availability of other children in the family. Lastly, the findings show that there are many disorders that may affect the development of language in children. The language disorders that the study identified include expressive language disorder, dyslexia, and inability to understand spoken. However, the study also reveals that these disorders may be treated. The findings of this study lead to the development of a conceptualized model to facilitate language acquisition in children between 0 and 3 years was developed. The meaning of one concept, namely reinforcement was explained in detail, in order for users of the model to understand its operational definition in the model. Reinforcement was explained because it has a diversity of meanings. The model enabled the researcher to create a link between research and what is happening in a society. Model validation was done to verify if the developed model relates to practical life, research and language development. The model for this study was validated for its applicability and usability. The drafted model was given to psychologists, speech therapists and parent to determine its usability and applicability. Keywords: language, language acquisition, language development model, language disorders. / NRF

Includes bibliographical references (leaves 149-190) / Abstract in English and Afrikaans / This study aimed to determine whether classroom climate or school climate is a greater predictor of emotional intelligence in South African primary school learners from Durban, KwaZulu-Natal, as well as which factors promote and which inhibit its development. A purposive sample of 119 primary school learners from six classes in two government schools in Durban was obtained. The learners assessed their classroom climate with the My Class Inventory (short form) (MCI-SF), and their emotional intelligence with the Trait Emotional Intelligence Questionnaire (Child Short Form) (TEIQue-CSF). The six teachers assessed the school climate with the School Level Environment Questionnaire (SLEQ). Results suggest that classroom climate is a predictor of emotional intelligence while school climate is not; that satisfaction and cohesiveness positively correlate with emotional intelligence levels, and friction, competitiveness, and difficulty negatively correlate with emotional intelligence levels. The identified relationship between classroom climate factors and emotional intelligence warrants further research into the topic. / M.A. (Psychology) / Hierdie studie het ten doel gehad om te bepaal of klaskamerklimaat of skoolklimaat 'n groter voorspeller van emosionele intelligensie by Suid-Afrikaanse laerskool leerlinge van Durban, Kwazulu-Natal is, asook watter faktore die ontwikkeling bevorder en watter die ontwikkeling daarvan belemmer. 'n Doelgerigte steekproef van 119 laerskool leerlinge van ses klasse in twee regering skole in Durban is verkry. Die leerlinge het hulle klasklimaat beoordeel met behulp van die ‘My Class Inventory (short form) (MCI-SF)’, en hulle emosionele intelligensie met die ‘Trait Emotional Intelligence Questionnaire (Child Short Form) (TEIQue-CSF)’. Die ses onderwysers het die skoolklimaat beoordeel met die ‘School Level Environment Questionnaire (SLEQ)’.. Resultate dui daarop dat klasklimaat 'n voorspeller van emosionele intelligensie is terwyl skoolklimaat nie is nie; dat tevredenheid en samehorigheid positief korreleer met emosionele intelligensievlakke, en wrywing, mededingendheid en probleme negatief korreleer met emosionele intelligensievlakke. Die geïdentifiseerde verwantskap tussen klimaatfaktore in die klaskamer en emosionele intelligensie regverdig verdere navorsing oor die onderwerp. / Psychology

Measles is a highly contagious virus that can affect the entire population if an effective immunisation programme is not in place. This study was aimed at determining the measles immunisation coverage and the dropout rate among children aged between 6 months and 14 years and at assessing factors associated with caregivers’ knowledge and perception of, and attitude towards the measles immunisation programme. Between 14 May 2018 and 31 July 2018, a descriptive, cross-sectional study design was conducted using simple random sampling to sample 381 caregivers of children at nine public health facilities at Tshwane Sub-district 2, Hammanskraal town. Data were collected by means of a structured questionnaire and observational checklist, and analysed using IBM SPSS version 23.0. Overall, the measles immunization coverage was 95.8% (365/381) and the MCV1-MCV2 dropout rate was 4.1%. The association between educational level and employment status (correlation coefficient=0.157**, p=0.0002), measles knowledge (correlation coefficient=-0.244**, p=0.000), immunization importance (correlation coefficient=-0.194**, p=0.000) and measles vaccine schedule (correlation coefficient=-0.138**, p=0.007) were found to be significant at p<0.05. The findings in this study revealed that caregivers’ positive attitude towards, and knowledge of measles immunisation programme resulted in high measles immunisation coverage and low dropout rate. It is recommended that continuous positive immunisation education about the benefits and importance be emphasized in order to increase immunisation uptake. / Health Studies / M. P. H.

This thesis focuses on the development of Gestalt guidelines for alternative caregivers to enhance attachment with the traumatised child. The researcher made use of the intervention research process, consisting of six phases. For the purpose of this study of limited scope, the intervention research process was completed up to step one of the fourth phase. The target group in this study was alternative caregivers of traumatised children where attachment difficulties existed. `Alternative caregivers' refers to people who provide care to these children, either on a voluntary basis or professionally. Focus groups, field notes and observation were used as data collection method, and Creswell's spiral was used to analyse data. Not all aspects regarding attachment were covered in this study and only relevant Gestalt principles were discussed. Gestalt guidelines with an observational system were finally developed. The views of the respondents, those of experts and a literature review were incorporated into the guidelines, as well as some functional elements of existing treatments. / Practical Theology / M. Diac. (Play Therapy)

This thesis focuses on the development of Gestalt guidelines for alternative caregivers to enhance attachment with the traumatised child. The researcher made use of the intervention research process, consisting of six phases. For the purpose of this study of limited scope, the intervention research process was completed up to step one of the fourth phase. The target group in this study was alternative caregivers of traumatised children where attachment difficulties existed. `Alternative caregivers' refers to people who provide care to these children, either on a voluntary basis or professionally. Focus groups, field notes and observation were used as data collection method, and Creswell's spiral was used to analyse data. Not all aspects regarding attachment were covered in this study and only relevant Gestalt principles were discussed. Gestalt guidelines with an observational system were finally developed. The views of the respondents, those of experts and a literature review were incorporated into the guidelines, as well as some functional elements of existing treatments. / Philosophy, Practical and Systematic Theology / M. Diac. (Play Therapy)