<p>The current study aimed to describe the extent and reasons for substituting and switching HAART at the Katutura Intermediate Hospital in Windhoek, Namibia</p>

<p>Background: Malaria is the leading cause of death of Uganda&rsquo / s children under 5 years of age and the number-one cause of illness in adults in Uganda. The success of malaria treatment strategies is closely linked to the behavior of patients and caretakers of young children. In the case of malaria this includes accessing appropriate treatment for&nbsp / suspected malaria in time. In Bungokho Sub County, in spite of the efforts by district health workers and the Ministry of Health to implement the malaria control, prevention and treatment strategies, pregnant women and caretakers of children under 5 years of age continue to present late for treatment in the health units resulting in possible avoidable&nbsp / death or disability. Aim and objectives: The aim of this study was to explore the factors that lead to late presentation of children and pregnant women with malaria for treatment at health units. This was done by exploring the perceptions of caregivers of children under five years and pregnant women on the community&rsquo / s knowledge and understanding of the&nbsp / symptoms and treatment of malaria / and describing perceptions of caregivers and pregnant women on health care provision at the health units and alternative treatment for malaria. Methods :The study was conducted in Bungokho Health sub-district, in Mbale district, Eastern Uganda over a two month period in 2009. It was a descriptive exploratory study using qualitative research methods. Four focus groups were carried out, two with caregivers of children under 5 years and two with pregnant women, with each focus group consisting of eight participants. Two caregivers and two pregnant women were identified from the focus groups for further indepth interviews. Four in-depth interviews were conducted with health unit staff from Bungokho HCVI. Notes were taken and observations made during the focus groups and interviews. The proceedings were audio-taped and recordings used to expand and clarify notes. Thematic content analysis was used to analyze the data and identify recurrent themes from the focus group discussions and&nbsp / interviews of the reasons for late presentation for malaria treatment. Results: All caregivers were women, a significant majority of whom were peasants who had not gone beyond the primary education. Caregivers were aware of the general symptoms of malaria but associated more serious or dangerous symptoms with other causes including&nbsp / witchcraft. Pregnant women, on the other hand, seemed to have sound knowledge of both the general and dangerous symptoms of malaria and were likely to attend the health&nbsp / units timeously for reatment. Religious beliefs and practices, particularly belief in the healing ability of prayers prevented early reporting of malaria cases to health units leading&nbsp / to late presentation. Alternative treatment of malaria from traditional herbalists was also sought by the communities particularly when the intensity of malaria was at its peak during the rainy season. Poverty in the community seemed to play a big role in shaping community preference for treatment sources, as well as early presentation to the health&nbsp / units. It was found that the anticipated cost of laboratory tests and sundries at the health units deterred caregivers from taking children under five to health units. There was therefore a strong reliance (and preference for) community medicine distributor&rsquo / s (CMDs) because of free services and easy access. Lack of support from spouses (in particular husbands) coupled with the rude behavior of health workers towards caregivers and pregnant women discouraged visits to health units. The long waiting time and intermittent drug stock-outs also created a negative perception of service at the health units. Conclusions and recommendations: There is need for further sensitization of communities on the need to seek prompt treatment for children under five years of age at the health units (that is, within 24 hours of the onset of fever). Training and supervision of CMDs should be strengthened to ensure consistent supply of drugs, correct dosage of anti-malarial medication and improvements in the referrals to the health units. In order to improve&nbsp / service delivery at the health units, there is need to review and strengthen human resource management of the health units, including staffing requirements and management&nbsp / practices, such as support and supervision, patient care standards and client feedback mechanisms. It is also important that there are adequate stocks of anti-malarial drugs&nbsp / and laboratory supplies at health units.</p>

Sibling caretaking, although common across time and cultures, has not been well researched from the carer’s point of view. In Nicaragua, ranked as one of the poorest countries in the Americas, sibling caretaking is common. The country’s historical background and its state of chronic poverty, widespread unemployment, loose family structures, and migration and mobility makes of the old practise of shared management child care a necessity. Households headed by sing¬le mothers constitute a particular Nica¬raguan charact¬eristic. Many children are expected to help in their own families and care for their siblings and other children living in their households. In its broadest sense sibling caretaking is a public health concern, and we conducted this study to widen the understanding of the phenomenon as it is represented in a setting undergoing a rapid social transition. The main objectives were to identify, describe and analyse the life situation of sibling caretakers in poor areas in León, Nicaragua, with focus on how they perceived it themselves. A combined qualitative and quantitative methodological design was used, mainly applying an ethnographic approach. A further ambition was to explore involvement of children in a participatory research process in accordance with the ‘Convention on the Rights of the Child’. The overall emotion expressed among the caretakers was pride, even if their situation often was characterized by stress and coping problems. They perceived their work as important for their families and they appreciated to fend for their siblings. Household work and nurturing of siblings were shaping the future lives of the caretakers and constituted part of their socialization. Even if many of these children achieve essential life skills as caretakers, they are at risk of falling behind as they grow older. Their long-term personal development is likely to be hampered by the obligations they have as caretakers. The carers' awareness of missing out on education was the most problematic issue for them. From a societal point of view, caretaking has negative consequences. The individual child is marginalised with limited access to basic education, contributing to overall low educational levels in Nicaragua. While the structuring conditions leading to sibling caretaking may be difficult to change, awareness of how these can affect children might make way for improvements in terms of access to school education and support from the society. The knowledge gained from this study should be further utilised to plan for interventions that take children’s perspectives into consideration.

This article considers the evolution of international business cycle interdependencies among 27 developed and developing countries since the beginning of 1870s, utilising the generalized vector autoregressive (VAR)-based spillover index of Diebold and Yilmaz (2012), which allows the construction of a time-varying measure of business cycle spillovers. We find that, on average, 65% of the forecast error variance of the 27 countries' business cycle shocks is due to international spillovers. However, the magnitude of international business cycle spillovers varies considerably over time. There is a clear increasing trend since the end of World War II and until the middle 1980s. After that, international business cycle interdependencies declined during the period that was dubbed the Great Moderation, and stabilized around the beginning of the twenty-first century. During the Great Recession of 2008-2009, international business cycle spillovers increased to unprecedented levels. Finally, developed countries are consistently ranked as net transmitters of cyclical shocks to developing counties throughout the sample. (authors' abstract)

During the past decade, entrepreneurship and its implications in a developing country context has gained increased attention in research. In Uganda, women in businesss are leading the way in the entrepreneurial development. In addition, the internationalization of small entrepreneurial firms has lately been given more attention within international business research. The purpose of this thesis is to combine these two emerging phenomena within international business in order to investigate how the female entrepreneur's means at hand influence the internationalization initiation of her small and medium-sized enterprise in Uganda. By investigating the subjects in the matter, important components of the entrepreneur's means has been examined. To ensure a deeper understanding, a qualitative research has been followed. This thesis derives from an abductive approach. Due to the lack of previous research on the subject, it benefitted from a combination of inductive empirical research combined with theoretical insights. The literature review takes off from the concept of entrepreneurship and thereafter explores the concept of opportunity, means and internationalization. A conceptual framework concludes the literature review by illustrating the relations between the concepts. The conceptual framwork provided themes for collecting and was used to analyze the empirical data gathered in Uganda by adopting a multi-case approach. The analysis discusses theoretical concepts and empirical findings in contrast and relation to each other, structured by the conceptual framework. This is followed by a concluding chapter stating implications, limitations and suggestions for further research. The outcome of this study has provided a deeper understanding of who the entrepreneur is, what she knows and how she uses her networks and personal ties to go abroad. The findings have resulted in the main theoretical implication of filling the research gap of female entrepreneurship in developing countries as well as providing an example of how the effectual approach can be used when studying entrepreneurship witin international business. We suggest that entrepreneurs and their SMEs benefit from engaging in business networks at an early stage of the internationalization process. Within networks, effectual means are working together to develop market knowledge and find opportunity for international activities.

Magister Public Health - MPH / Background: Namibia is one of the Southern African countries hardest hit by the HIV epidemic, with an estimated one out of every five people infected (MoHSS, 2004). Approximately 80,000 of the infected population currently require antiretroviral treatment (ART). In order to prevent the progression of the HIV infection to AIDS, patients are required to take antiretroviral medicines lifelong. This lifelong use exposes patients to toxicities of these medicines and the only available options of managing the toxicities of ARVs are to treat the toxicity or substitute or switch the offending medicines. Aim: The current study aimed to describe the extent and reasons for substituting and switching HAART at the Katutura Intermediate Hospital in Windhoek, Namibia. Methodology: A descriptive retrospective case series study, in which medical records were reviewed to determine the extent and reasons for substituting and switching HAART was conducted. Random sampling was used to draw a sample of 500 from 3477 adult HAART patients who commenced treatment between 1 January 2002 and 31 December 2006. A prepiloted data collection tool was used to collect the data. The following information was collected: baseline CD4 count, weight, initial ARVs, first and second ARV substitutions, ART switch and the reasons for substituting ARVs or switching ART during the indicated period. Epi Info version 6 was used to analyse frequencies, means and medians of all important variables in the data set. Results: The sample was made up of 500 HAART patients; 60% were females. The median age of the sample was 34 years (Inter-quartile range (IQR) 30 – 40) and the median CD4 cell count was 153 cells/mm3 (IQR 96 – 212) at initiation of therapy. The median time on treatment before first substitution was 28 months (IQR 24 – 34), whereas the median time before second substitution was 10 months (IQR 6 – 15) from the time of the first substitution. The median time before switching was 31 months (IQR 24 - 39). A total of 31% of the study subjects underwent a substitution once, whereas 1.8% underwent a second substitution. Only six (1.2%) patients switched to a second line treatment after the modification of the treatment. The most commonly recorded reason for the first substitution was toxicity (19%). As in other studies, stavudine (D4T), nevirapine (NVP) and efavirenz (EFV) were the ARVs associated with most of the recorded toxicities. High viral load (50%) was the most reported reason for switching. In almost half of the substitution cases the reasons for substitution were not stated, and in a third of the switch cases the reasons for switching were not stated. Conclusion: The rate of substitution at 31% was similar to that found in other resource poor settings, however, the rate of switching (1.2%) was much lower than was found in similar settings. The main reason stated for substituting antiretrovirals was “toxicity”. / South Africa

Masters of Public Health - see Magister Public Health / Background: Malaria is the leading cause of death of Uganda's children under 5 years of age and the number-one cause of illness in adults in Uganda. The success of malaria treatment strategies is closely linked to the behavior of patients and caretakers of young children. In the case of malaria this includes accessing appropriate treatment for suspected malaria in time. In Bungokho Sub County, in spite of the efforts by district health workers and the Ministry of Health to implement the malaria control, prevention and treatment strategies, pregnant women and caretakers of children under 5 years of age continue to present late for treatment in the health units resulting in possible avoidable death or disability. Aim and objectives: The aim of this study was to explore the factors that lead to late presentation of children and pregnant women with malaria for treatment at health units. This was done by exploring the perceptions of caregivers of children under five years and pregnant women on the community knowledge and understanding of the symptoms and treatment of malaria; and describing perceptions of caregivers and pregnant women on health care provision at the health units and alternative treatment for malaria. Methods :The study was conducted in Bungokho Health sub-district, in Mbale district, Eastern Uganda over a two month period in 2009. It was a descriptive exploratory study using qualitative research methods. Four focus groups were carried out, two with caregivers of children under 5 years and two with pregnant women, with each focus group consisting of eight participants. Two caregivers and two pregnant women were identified from the focus groups for further indepth interviews. Four in-depth interviews were conducted with health unit staff from Bungokho HCVI. Notes were taken and observations made during the focus groups and interviews. The proceedings were audio-taped and recordings used to expand and clarify notes. Thematic content analysis was used to analyze the data and identify recurrent themes from the focus group discussions and&nbsp; interviews of the reasons for late presentation for malaria treatment. Results: All caregivers were women, a significant majority of whom were peasants who had not gone beyond the primary education. Caregivers were aware of the general symptoms of malaria but associated more serious or dangerous symptoms with other causes including witchcraft. Pregnant women, on the other hand, seemed to have sound knowledge of both the general and dangerous symptoms of malaria and were likely to attend the health units timeously for reatment. Religious beliefs and practices, particularly belief in the healing ability of prayers prevented early reporting of malaria cases to health units leading to late presentation. Alternative treatment of malaria from traditional herbalists was also sought by the communities particularly when the intensity of malaria was at its peak during the rainy season. Poverty in the community seemed to play a big role in shaping community preference for treatment sources, as well as early presentation to the health units. It was found that the anticipated cost of laboratory tests and sundries at the health units deterred caregivers from taking children under five to health units. There was therefore a strong reliance (and preference for) community medicine distributor's (CMDs) because of free services and easy access. Lack of support from spouses (in particular husbands) coupled with the rude behavior of health workers towards caregivers and pregnant women discouraged visits to health units. The long waiting time and intermittent drug stock-outs also created a negative perception of service at the health units. Conclusions and recommendations: There is need for further sensitization of communities on the need to seek prompt treatment for children under five years of age at the health units (that is, within 24 hours of the onset of fever). Training and supervision of CMDs should be strengthened to ensure consistent supply of drugs, correct dosage of anti-malarial medication and improvements in the referrals to the health units. In order to improve service delivery at the health units, there is need to review and strengthen human resource management of the health units, including staffing requirements and management practices, such as support and supervision, patient care standards and client feedback mechanisms. It is also important that there are adequate stocks of anti-malarial drugs&nbsp; and laboratory supplies at health units. / South Africa

Magister Curationis - MCur / This study explored the lived experience of spouses living with depressed partners. A qualitative phenomenological, exploratory study design was used to explore the lived experience of the spouses, identifying the coping strategies and challenges that they face as they live with the depressed partners. A purposive sample of seven spouses living with their depressed partners who were being treated in outpatient department were recruited to participate in the study. In-depth, face-to-face interviews were conducted, audiotaped with the participants’ permission and transcribed verbatim. The data from the transcripts, field notes, and demographic questionnaires was organized ready for analysis. Thematic data analysis was used to code the data, and group the codes to form categories. The categories were further regrouped to form themes. The themes were conceptualized and contextualized to uncover the meaning that the spouse carers attached to the lived experience. It emerged that most of the spouses described their partners and the relationship negatively due to the burden of care. The male carers as compared to the female carers expressed the negativity more and it impacted on the quality of care they were providing to the depressed partners. It was revealed that inadequate professional support was linked with the ineffective coping strategies employed by the spouse carers. Hence, most of the spouse carers presented with symptoms of depression and were at the stage of impoverishment according to the adaptive potential assessment model. A recommendation to involve spouse carers in the treatment plan and improve the support system to the spouse carers was made to the stakeholders of health service providers at the primary health level.

Magister Curationis - MCur / The study explores the experiences of nurses who care for severe/profound intellectual disabled patients at Level 3 Psychiatric Hospital in Cape Town. People with severe intellectual disabilities require constant care and supervision which can only be provided in specialised units. In the Western Cape, one such facility is a special section for the intellectually disabled at a level three hospital. Intellectual disability is a serious lifelong disability that places a heavy burden on affected individuals. Caring for these patients may affect the individuals who work within the intellectual disability services. This study explores the experiences of nurses who care for these patients. A Phenomenological research design was chosen as the researcher identified it as the most appropriate method to describe the lived experiences of the nurses. Purposive sampling was used to select 10 participants. However, data saturation was reached after interviewing eight participants. Data was collected through in-depth unstructured interviews. The audio-taped responses were transcribed verbatim and phenomenological data analysis done. Ethical clearance was obtained from the Higher Degrees Committee of the University of the Western Cape. Permission to do the research at the level three hospitals was sought from the Associated Psychiatric Hospital Committee. Consent to participate in the study was obtained from the participants, and ethical principles were adhered to. Participants were informed of the right to withdraw at any stage of the study and intervention offered when required. Trustworthiness of the research process was ensured. Findings: from this study the nurses who care for severe/profound intellectual disabled patients reported that they were not adequately prepared to care for these patients. It has also been reported that caring for the severely/profound disabled comes with some consequences, where emotional (negative and positive), physical and professional consequences were mentioned. The shortage of resources was found to be one of the challenges the nurses experienced. The nurses felt unappreciated for the work they did and less supported by their employer.

This inquiry focussed on a single unit of analysis: TeleTuks Schools, a community outreach initiative of the University of Pretoria, South Africa and is classified as a case study. It sought to explain why despite technology that permits bi-directional oral communication during televised instruction, learner participation was poor. The exploration of literature related to instructional television (ITV) and social communication, ensured a richer understanding of ITV as delivery mode as well as potential reasons for low responsivity during telelessons. It also raised awareness of the particular challenges of utilising ITV in a developing country context. This inquiry was informed by an interpretivist paradigm and the theoretical stance related to a synthesis of several communication models designed for mass media while the concept interaction as a key element of instructional communication was also dissected. Initially, a small-scale quantitative approach, established how prevalent poor participation was while rich experiential interview and video data identified why learners refrained from participating overtly. The use of Atlas.tiTM to systematically analyse the volume of unstructured data as a single unit, not only facilitated analysis but also enhanced the validity of the inquiry. An inductive analysis of the research data generated three significant and interrelated themes: Paradoxical perceptions, Presenter nescience, and Problematic practicalities and partnerships. These accounted for why learners did not respond as expected during televised instructional episodes. Key findings suggested that the rate of learner participation during telelessons was not influenced by an isolated factor as initially anticipated, but by a combination of variables. Technical and methodological design limitations were complicated by ineffective communication skills on the part of both presenters and viewers. Incongruence between the findings and initial suppositions added to an overarching sense of mismatch and led to the proposal of a theory linked to instructional dissonance i.e. the ignorance or denial of distortions that negatively affect communication between the instructor and student. Instructional communication is successful but not meaningful as a mismatch of sense or utility occurs. Recommendations for theory and practice are deemed applicable to mediated instructional contexts. Research avenues for further exploration relating to interaction in blended learning environments have been suggested. / Thesis (PhD (Curriculum Studies))--University of Pretoria, 2005. / Curriculum Studies / unrestricted