PhD (Mathematics) / Department of Mathematics and Applied Mathematics / In this study, we developed multiscale models of vector-borne diseases. In general, the transmission of vector-borne diseases can be considered as falling into two categories, i.e. direct transmission and environmental transmission. Two representative vector-borne diseases, namely; malaria which represents all directly transmitted vector-borne diseases and schistosomiasis which represents all environmentally transmitted vector-borne diseases were studied. Based on existing mathematical modelling science base, we established a new multiscale modelling framework that can be used to evaluate the effectiveness of vector-borne diseases treatment and preventive interventions. The multiscale models consisted of systems of nonlinear ordinary differential equations which were studied for the provision of solutions to the underlying problem of the disease transmission dynamics. Relying on the fact that there is still serious lack of knowledge pertaining to mathematical techniques for the representation and construction of multiscale models of vector-bone diseases, we have developed some grand ideas to placate this gap. The central idea in multiscale modelling is to divide a modelling problem such as a vector-bone disease system into a family of sub-models that exist at different scales and then attempt to study the problem at these scales while simultaneously linking the sub-models across these scales. For malaria, we formulated the multiscale models by integrating four submodels which are: (i) a sub-model for the mosquito-to-human transmission of malaria parasite, (ii) a sub-model for the human-to-mosquito transmission of malaria parasite, (iii) a within-mosquito malaria parasite population dynamics sub-model and (iv) a within-human malaria parasite population dynamics sub-model. For schistosomiasis, we integrated the two subsystems (within-host and between-host sub-models) by identifying the within-host and between-host variables and parameters associated with the environmental dynamics of the pathogen and then designed a feedback of the variables and parameters across the within-host and between-host sub-models. Using a combination of analytical and computational tools we adequately accounted for the influence of the sub-models in the different multiscale models. The multiscale models were then used to evaluate the effectiveness of the control and prevention interventions that operate at different scales of a vector-bone disease system. Although the results obtained in this study are specific to malaria and schistosomiasis, the multiscale modelling frameworks developed are robust enough to be applicable to other vector-borne diseases. / NRF

MPH / Department of Public Health / Background: Malaria is a public health issue killing more than 435 000 people in Sub Saharan Africa. In South Africa, malaria is endemic in 3 provinces namely: Limpopo, Mpumalanga and Kwazulu Natal. Limpopo Province contributes more cases than the other provinces in the country. Purpose: The purpose of the study was to assess community knowledge and prevention practices of malaria at Masisi village, in Mutale Municipality, Vhembe District. The study was conducted at Mutale municipality, Vhembe District. Methodology: A quantitative cross-sectional descriptive approach was used. Data was collected using a questionnaire with open and close ended questions. The targeted population was made up of males and females between the ages of 18 to 75. Validity and reliability have been ensured in the study and the results for reliability were 0.85. Pretesting was done in 5 household at Sanari village which is near Masisi village as they share the same characteristics. A sample of 152 participants was selected from the target population by means of systematic sampling and then select them randomly. Questionnaires were used to collect data. There after Data were analyzed using SPSS version 24.0. The analyzed data were presented in tables, graphs, and in percentages. Results: The findings revealed that majority of the participants 103(67.8%) have secondary education, and most of them, 103(67.8%) are unemployed. The study revealed that about 77% have knowledge regarding malaria transmission. About 130(85.5%) indicated that malaria is caused by a mosquito bite. About 57(38.51%) indicated that they use mosquito coils and nets in their household. Conclusion: Malaria still poses a threat to the lives of people living in malaria endemic areas. Community members at Masisi village have better insight regarding malaria transmission, causes and signs and symptoms. Although the community shows a better understanding of the prevention method they still has to put this into practice in order to eliminate malaria in the area. Health workers are doing a great job in educating the community regarding malaria related issues. / NRF

This study investigated caregivers' perceptions with regard to vaccine-preventable diseases in terms of six constructs of the Health Belief Model. A qualitative research design that is explorative, descriptive and contextual in nature was employed in order to understand and describe the perceptions influencing access and utilisation of services that lead to missed immunisation opportunities and consequently outbreaks of vaccine-preventable diseases. The data-collection techniques were individual unstructured in-depth interviews, field notes and clinical records. The sample consisted of twenty two (N=22) caregivers who volunteered to be interviewed. The study has highlighted that caregivers' perceptions or cognitive factors play an important role for having children in completing immunisation schedule to protect the public from vaccine-preventable diseases. It is recommended that mass media programmes are needed to address the role of vaccines in reducing high morbidity and mortality rates caused by vaccine preventable diseases and improvement in access to immunisation services. / Health Studies / MPH (Health Studies)

This study investigated caregivers' perceptions with regard to vaccine-preventable diseases in terms of six constructs of the Health Belief Model. A qualitative research design that is explorative, descriptive and contextual in nature was employed in order to understand and describe the perceptions influencing access and utilisation of services that lead to missed immunisation opportunities and consequently outbreaks of vaccine-preventable diseases. The data-collection techniques were individual unstructured in-depth interviews, field notes and clinical records. The sample consisted of twenty two (N=22) caregivers who volunteered to be interviewed. The study has highlighted that caregivers' perceptions or cognitive factors play an important role for having children in completing immunisation schedule to protect the public from vaccine-preventable diseases. It is recommended that mass media programmes are needed to address the role of vaccines in reducing high morbidity and mortality rates caused by vaccine preventable diseases and improvement in access to immunisation services. / Health Studies / MPH (Health Studies)

PhD (Geography) / Department of Geography and Geo-Information Sciences / Malaria is a climate-change concatenated biological hazard that may, like any other natural hazard, can lead to a disaster if there is a failure in handling emergencies or risks. A holistic solution for malaria mitigation can be provided when indigenous knowledge is complemented with scientific knowledge. Malaria remains a challenge in South Africa and Limpopo province is the highest burdened malaria-endemic region. Specifically, Vhembe District is the highest burdened followed by Mopani District (Raman et al., 2016). This research sought to mitigate malaria transmissions in Mopani District through the integration of indigenous and scientific knowledge. The study was carried out in Mopani District of South Africa and 4 municipalities were involved. These are Ba-Phalaborwa, Greater Tzaneen, Greater Letaba, and Maruleng. A pragmatism philosophy was adopted hence the study took a mixed approach (sequential multiphase design). Data was collected from 381 selected participants through in-depth interviews, a survey and a focus group discussion. Participants for the in-depth interviews were obtained through snowballing and selected randomly for the survey, while for the focus group discussion purposive sampling was used. The study applied constructivist grounded theory to analyze qualitative data and to generate theory. Statistical Package for Social Sciences version 23.0 was used for quantitative data. Based on empirical findings, it was concluded that temperature and rainfall among other various factors exacerbate malaria transmission in the study area. Results of the study also show that people in Mopani District predict the malaria season onset by forecasting rainfall using various indigenous knowledge based indicators. The rainfall indicators mentioned by participants in the study were used in the developed early warning system. An Early warning system is an essential tool that builds the capacities of communities so that they can reduce their vulnerability to hazards or disasters. In the design of the system, Apache Cordova, JDK 1.8, Node JS, and XAMPP software were used. The study recommends malaria management and control key stakeholders to adopt the developed early warning system as a further mitigation strategy to the problem of malaria transmission in Mopani District. / NRF

CONCLUSION: A multi-faceted hand hygiene intervention with pocket-sized containers of alcohol-based hand rub was effective in increasing hand rubbing compliance and reducing incidence of total infections requiring hospitalization in elderly LTCFs. Its effect on outbreaks still needs further investigations. The questionnaire developed in this study may be a simple and effective method to assess the attitude and compliance change of the HCWs after implementing a hand hygiene programme. / DESIGN: Clustered randomized controlled trial / INTERVENTIONS: After a 3-month run-in period, we randomized three LTCFs to the treatment and three to the control group. The treatment group received pocket-sized containers of alcohol-based hand rub, education and reminding materials. The control group received basic life support education and workshops. They were followed up for another seven months. We measured the hand hygiene compliance of the HCWs by direct observation and recorded the incidence of infections of the residents from their hospital discharge summaries. / OBJECTIVE: To investigate the effectiveness of a multi-faceted hand hygiene programme with pocket-sized containers of alcohol-based hand rub for infection control in elderly long-term care facilities (LTCFs) / OUTCOMES & DATA ANALYSIS: Primary outcomes were direct observed compliances of hand washing and antiseptic hand rubbing of the HCWs, incidence of infections requiring hospitalization and death rate due to infection of the residents, and outbreaks of the LTCFs. Secondary outcomes were change in hand hygiene attitude and self-reported compliance. / PARTICIPANTS: All health care workers (HCWs) of the LTCFs recruited by snowball sampling. Their job categories were nurses, nursing assistants and physiotherapists. / RESULTS: In the treatment group, the compliance of alcohol-based hand rubbing increased significantly from 1.5% (5/333) to 15.9% (233/1465) (p=0.001) and total compliance increased from 25.8% (86/333) to 33.3% (488/1465) (p=0.01) after intervention. Total incidence of infections decreased from 31 cases in 21,862 resident days (1.42 per 1,000 resident-day (rd)) to 33 cases in 50,441 resident days (0.65 per 1,000 resident-day) (p=0.002) and death rate due to infection decreased from 8 cases in 21,862 resident days (0.37 per 1,000 rd) to 5 cases in 50,441 resident days (0.1 per 1,000 rd) in the treatment group (p=0.01). Pneumonia significantly decreased by 0.63 per 1000 rd (p=0.001). In the control group, there were no changes in both antiseptic hand rubbing and hand washing. The total incidence of infections increased from 0.49 to 1.04 per 1000 rd (p=0.004) and no change in death rate due to infection (p=0.45). No outbreaks of influenza and norovirus occurred during the whole study in both groups. / SETTING: Six LTCFs for the elderly / The attitude of antiseptic hand rubbing on infection control increased significantly in the treatment group but there was no change under different situations in the control group. The self-reported compliance of antiseptic hand rubbing increased significantly in the treatment group. There were no changes on the self-reported compliances in the control group. The agreement of the direct observed results and the self-reported compliances was 75% (kappa coefficient = 0.5). / Yeung, Wing Kin. / Adviser: Tze Wai Wong. / Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 100-106). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Indiana University-Purdue University Indianapolis (IUPUI) / Vaccinations are an important step in preventing childhood illnesses and disease outbreaks in the community. Complete immunizations before school assure eligibility for enrollment and protect children against severe illness. The fact that foreign-born children of Latino immigrants face health disparities in receiving vaccinations is well documented. However, there is little information in the literature about the actual experience of immigrants facing the complexities of the health system, and through their eyes, which factors ultimately affect vaccination rates of immigrant Latino children. The purpose of this study is to give voice to Latino immigrant families who have recently immigrated to the United States, in terms of the issues they encountered when engaging the health care system for vaccinations.