Cholera remains a threat to public health in many developing countries, including Mozambique. Although the disease is easily preventable by practices of hygiene and sanitation, cases are reported in the country every year, as for example in the Lago district in 2015. This qualitative research project set out to explore in what ways the promotion of hygiene and sanitation practices on district level in Mozambique is carried out. Therefore, actors, messages and channels involved in these communication processes were explored via a field study in Lago and a review of relevant literature. Subsequently, the results of the field study and literature review were analysed by applying the concepts of one-way and two-way communication which are part of public relations theory. This analytical framework allowed the researchers to fill a gap identified in the existing literature about hygiene and sanitation promotion, which did not seem to include communication theories linked to public relation practices when it came to hygiene and sanitation promotion in developing countries as a method to prevent cholera. It has been found that the one-way communication approach towards the public was successful in handling the recent cholera outbreak of 2015, however, the approach is not substantial and should be improved into a two-way communication approach, which would allow the local population to express their needs in hygiene and sanitation, as well as their capabilities to implement change in these matters. Simultaneously, a lack of resources within the district authorities involved in hygiene and sanitation promotion seems to encourage one-way communication towards the public from their side, as two-way communication would demand further resources for research into the above mentioned needs and capabilities of communities.

published_or_final_version / Criminology / Master / Master of Social Sciences

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Water-borne infections have been a menace in many countries around the globe, claiming millions of lives. Cholera in particular has spread to all continents and now on its seventh epidemic. Although control measures have been continually developed through sanitation, vaccination and rehydration, the infection still devastates populations whenever there is an outbreak. In this research work, mathematical models for cholera transmission dynamics with focus on the impact of sanitation and hygiene, metapopulation spread, optimal control and biological control using a bacteriophage specific for pathogenic Vibrio cholerae are constructed and analysed. Vital analyses for the models are precisely given as well as numerical results depicting long term behaviour and the evolution of populations over time. The results of our analysis indicate that; improved sanitation and hand-hygiene are vital in reducing cholera infections; the spread of disease across metapopulations characterised by exchange of individuals and no cross community infection is associated with synchronous fluctuation of populations in both adjacent communities; during control of cholera, the control measures/efforts ought to be optimal especially at the beginning of the epidemic where the outbreak is often explosive in nature; and biological control if well implemented would avert many potential infections by lowering the concentration of pathogenic vibrios in the aquatic environment to values lower than the infectious dose. / AFRIKAANSE OPSOMMING: Water-infeksies is ’n bedreiging in baie lande regoor die wêreld en eis miljoene lewens. Cholera in die besonder, het op sy sewende epidemie na alle kontinente versprei. Hoewel beheermaatreëls voortdurend ontwikkel word deur middel van higiëne, inentings en rehidrasie, vernietig die infeksie steeds bevolkings wanneer daar ’n uitbraak voorkom. In hierdie navorsingswerk, word wiskundige modelle vir cholera-oordrag dinamika met die fokus op die impak van higiëne, metabevolking verspreiding, optimale beheer en biologiese beheer met behulp van ’n bakteriofaag spesifiek vir patogene Vibrio cholerae gebou en ontleed. Noodsaaklike ontledings vir die modelle is gegee sowel as numeriese resultate wat die langtermyn gedrag uitbeeld en die ontwikkeling van die bevolking oor tyd. Die resultate van ons ontleding dui daarop dat; verbeterde higiëne is noodsaaklik in die vermindering van cholera infeksies; die verspreiding van die siekte oor metapopulaties gekenmerk deur die uitruil van individue en geen kruis gemeenskap infeksie wat verband houmet sinchrone skommeling van bevolkings in beide aangrensende gemeenskappe; tydens die beheer van cholera,behoort die beheermaatreëls/pogings optimaal te wees veral aan die begin van die epidemie waar die uitbreking dikwels plofbaar in die natuur is; en biologiese beheer, indien dit goed geïmplementeer word, kan baie potensiële infeksies voorkom deur ’n vermindering in die konsentrasie van patogene vibrio in die water tot waardes laer as die aansteeklike dosis.

D. Tech. (Department of Chemistry, Faculty of Applied and Computer Sciences), Vaal University of Technology. / Cholera is a waterborne disease caused by toxigenic strains of Vibrio cholerae. The spread of cholera in developing countries has largely been imputed to the unavailability of proper water treatment and sanitary infrastructure as well as poor hygiene. In order to prevent the contraction and spread of cholera the use of solar disinfection (SODIS) to treat water in waterborne endemic communities has been recommended by the World Health Organization (WHO). SODIS is a water sterilizing method that relies on natural sunlight to improve the microbiological quality of water. During SODIS the culturability of the water contaminating microorganisms is inactivated by the ultraviolet component of solar radiation. The success of SODIS treatment of water in alleviating the risks associated with the contraction of waterborne diseases such as cholera has been attributed to the effectiveness, with which the water is treated, simple application as well as low cost of materials required. Currently SODIS research has been dominated by studies geared towards understanding how the microbial inactivation occurs, enhancement of the disinfection process and health impact assessments. However, little to no research has been directed towards exploring the role played by the immune system following the consumption of the solar irradiated water pathogens such as V. cholerae. SODIS of microorganisms in water results in immunologically important microbial states and components that could induce an immune reaction or response. In view of the role of dendritic cells in shaping an immune response, the effect that solar irradiated V. cholerae in water has on the immunochemistry of the dendritic cells in vitro was investigated. Prior to the stimulation of the dendritic cells with the solar irradiated cultures of V. cholerae, the first objective required an evaluation on the impact that solar irradiation has on the production and secretion of the cholera toxin by V. cholerae in water. The results from this evaluation showed that solar ultraviolet radiation was incapable of inducing the secretion of the cholera toxin. Furthermore, there was extensive DNA degradation in the solar irradiated cultures of V. cholerae. The second objective was to investigate the ability for solar irradiated cultures of V. cholerae in water to induce the phenotypic maturation of immature dendritic cells in vitro. In order to achieve this objective, solar and non-solar irradiated, chemically/ heat inactivated and phosphate buffered saline (PBS) prepared cultures of V. cholerae as well as lipopolysaccharide (LPS) and cholera toxin-β (CTB) subunit were each used to stimulate immature dendritic cells. After 48 hours of stimulation the dendritic cells were assessed for the expression of CD54, CD80, CD83, CD86, MHC-I and MHC-II on their cell membrane. The results showed an increase in the expression of all the maturation phenotypic markers with CD54, CD86 and MHC-I being the most prominent ones on the surface of the dendritic cells stimulated with solar irradiated cultures of V. cholerae. The third objective was to assess the profile of the cytokines and chemokines secreted by the dendritic cells following their stimulation with solar and non-solar irradiated, chemically/heat inactivated and PBS prepared cultures of V. cholerae as well as LPS and CTB subunit. After 48 hours of dendritic cell stimulation the tissue culture media from each treatment was quantitatively and qualitatively analysed for the presence of interleukin (IL)-1α, IL-1β, IL-6, IL-7, IL-10, IL-12p40, IL-12p70, IL-15, IL-23, IL-27, macrophage inflammatory protein (MIP)-1α, MIP-1β, MIP-2, Regulated on Activation, Normal T cell Expressed and Secreted (RANTES) and tumor necrosis factor (TNF)-α. The analysis revealed that solar irradiated cultures of V. cholerae induced dendritic cells to secrete significant levels of pro-inflammatory cytokines in comparison to the unstimulated dendritic cells. Furthermore the profile of the cytokines and chemokines secreted by the dendritic cells in response to the solar irradiated cultures of V. cholerae in water was similar to that required to induce a T- helper (Th) Th2 immune response. The fourth objective was to assess the expression of the toll like receptor (tlr) genes by the dendritic cells following their stimulation with solar and non-solar irradiated, chemically/heat inactivated and PBS prepared cultures of V. cholerae as well as LPS and CTB subunit. After 48 hours of stimulation total RNA was extracted from the dendritic cells and subjected to real time quantitative polymerase chain reaction (RT qPCR) assay for tlr 1, 2, 3, 4, 5, 6, 9, 11, 12 and 13. The results showed no significant increase or decrease in the expression of most tlr genes in comparison to the unstimulated dendritic cells. This observation is synonyms with dendritic cell maturation. Taken together these findings show that solar irradiated cultures of V. cholerae were able to induce the maturation of immature dendritic cells in vitro. Furthermore dendritic cells stimulated with solar irradiated cultures of V. cholerae produced pro-inflammatory cytokines and chemokines. The results from this study suggests that the consumption of SODIS treated could provide immunological benefits.

The aim of this study was to identify and describe the viability of using cell phones to conduct rapid assessments, pass key health messages and conduct monitoring and evaluation in complex emergencies. The study setting was in a cholera outbreak response situation in Mogadishu, the capital of war torn Somalia. Qantitative, descriptive research was conducted to determine the feasibility. Data collection was done using structured questionnaires, self-response mailed questionnaires as well as follow-up telephone interviews. Three groups of respondents participated in the study. The respondent groups included 383 internally displaced persons (IDPs), 5 water, sanitation and hygiene (WASH) specialists and 5 specialists from 5 mobile phone providers in Mogadishu. The study showed that there is good potential for an effective, cost efficient and scalable short message service (SMS) based public health education platform in Somalia. The study has also come up with recommendations on key considerations to ensure viability of the Public health education platform. It is envisaged that the recommended platform shall increase speed, access, spontaneity, coverage and reduced cost per capita, a combination of which form the hallmark of a good emergency health response. Ultimately this effort shall contribute to improved health, reduced suffering and reduced deaths in fragile humanitarian contexts. / Health Studies / M. (Public Health)

The aim of this study was to identify and describe the viability of using cell phones to conduct rapid assessments, pass key health messages and conduct monitoring and evaluation in complex emergencies. The study setting was in a cholera outbreak response situation in Mogadishu, the capital of war torn Somalia. Qantitative, descriptive research was conducted to determine the feasibility. Data collection was done using structured questionnaires, self-response mailed questionnaires as well as follow-up telephone interviews. Three groups of respondents participated in the study. The respondent groups included 383 internally displaced persons (IDPs), 5 water, sanitation and hygiene (WASH) specialists and 5 specialists from 5 mobile phone providers in Mogadishu. The study showed that there is good potential for an effective, cost efficient and scalable short message service (SMS) based public health education platform in Somalia. The study has also come up with recommendations on key considerations to ensure viability of the Public health education platform. It is envisaged that the recommended platform shall increase speed, access, spontaneity, coverage and reduced cost per capita, a combination of which form the hallmark of a good emergency health response. Ultimately this effort shall contribute to improved health, reduced suffering and reduced deaths in fragile humanitarian contexts. / Health Studies / M.A. (Public Health)