Thesis (M.P.H.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 61-68).

Thesis (Ph. D.)--University of Hong Kong, 1994. / Includes bibliographical references (leaves 249-266).

published_or_final_version / Community Medicine / Master / Master of Public Health

Thesis (Licenciado en Nutriciʹon y Dietʹtica)--Universidad Tʹecnica del Norte. Facultad Ciencias de la Salud Escuela de Nutriciʹon y Dietʹeica. / Abstract in Spanish and English.

Thesis (PhD) - Faculty of Life and Social Sciences, Swinburne University of Technology, 2007. / Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Faculty of Life and Social Sciences, Swinburne University of Technology - 2007. Typescript. "September 2007". Includes bibliographical references (p. 173-204).

Thesis (Licenciado en Nutriciʹon y Dietʹtica)--Universidad Tʹecnica del Norte. Facultad Ciencias de la Salud Escuela de Nutriciʹon y Dietʹeica. / Abstract in Spanish and English.

Diarrhea diseases remain one of the greatest health problems in many parts of the world. In some cases, the disease is mild and self-limiting; however, the symptoms may be very severe in the elderly and young children (Smith and Cheasty, 1998), as well as in immune compromised patients such as HIV/AIDS patients. The disease is one of the hallmarks of HIV/AIDS in developing countries and is also a cardinal clinical manifestation of water borne infections (Obi et al., 2007). According to a World Health Organization report (WHO, 2004), diarrhea was rated second, after respiratory infections out of the eight deadliest diseases worldwide and was responsible for 1.8 million deaths per year. This infectious disease which can cause dehydration is primarily a symptom of gastrointestinal infection, but chemical irritation of the gut or non-infectious bowel disease can also result in diarrhoe. Studies have shown that the predominant causative agents of acute and persistent diarrhoe are Gram-negative rods such as Escherichia coli, Vibrio cholerae, Aeromonas, Campylobacter, Salmonella species, Shigella species, Plesiomonas shigelloides and Yersinia enterocolitica (Obi et al., 1995, 1998, 2003; Lainson and Silva, 1999; Coker et al., 2002; Oyofo et al., 2002). Aside from bacterial agents of diarrhoea, other causative pathogens include protozoa such as Giardia lamblia and Cryptosporidium parvum; viruses such as norwalk virus and rota virus. Although fungal agents such as Candida have been shown to be prevalent in children with diarrhoe (Enweani et al. 1994), a more recent study (Forbes et al., 2001), associated higher Candida counts with recent antibiotic use. Faecal concentrations of Candida were higher in patients with diarrhoe, but the study confirmed no association between faecal candida or other yeasts and diarrhoe. Norwalk viruses, calci-like viruses and rota viruses are the major viral agents of diarrhoe. According to Parashar et al., (2006), rota virus is the leading cause of diarrhoe hospitalisation among children worldwide, causing 440,000 annual deaths in children under 5 years of age.

The purpose of this study was to explore the knowledge and practices of caregivers/mothers of under-five children with diarrhoea-related illnesses admitted at the referral hospital. The setting for this qualitative study was the referral hospital located in the Sol Plaatje Municipality, Northern Cape Province. Unstructured interviews were conducted with caregivers/mothers of under-five children with diarrhoea admitted to the referral hospital. Colliazzi’s seven steps of data analysis (1998) as cited in Bazeley (2013:65) were used to analyse data. The study population was the caregivers/mothers of children with diarrhoea admitted to the referral hospital. The findings assisted us in understanding the knowledge the caregivers/mothers had with regard to the management of diarrhoea and in improving the health education guide used to teach caregivers/mothers. / Health Studies / M.A (Public Health)

Diarrhea is the second leading cause of death in children under-5; it kills more children than HIV/AIDS, measles, and malaria combined. Despite this significant health burden, our ability to anticipate and prepare for diarrhea outbreaks remains limited. Precipitation and temperature variability have been shown to affect diarrhea dynamics and therefore contribute to outbreak predictions, but the observed environment-diarrhea relationships are complex and context-specific, depending on local pathogen distribution, host population behavior, and physical environments. To date, studies in sub-Saharan Africa, where the burden of under-5 diarrhea is particularly high, are limited due to sparse diarrheal disease surveillance data. In this dissertation, we leverage unique under-5 diarrhea incidence data to explore the effects of meteorological variability on childhood diarrhea incidence and develop a real-time forecasting system for diarrheal disease in Botswana, where diarrhea remains an important cause of childhood morbidity and mortality. The study focuses in Chobe District, which has an annual dry (April – September) and wet (October – March) season, during which the Chobe River, the primary source of drinking water in the region, floods. Weekly cases of under-5 diarrhea in Chobe District exhibit strong seasonal dynamics with biannual outbreaks occurring during the wet and the dry season. In Chapter 1, we show that wet season diarrhea incidence is strongly associated with increased rainfall and Escherichia coli concentrations in the Chobe River, while dry season incidence is associated with declines in Chobe River flood height and increased total suspended solids in the river. In Chapter 2, we confirm the existence of an El Niño-Southern Oscillation teleconnection with southern Africa by demonstrating that La Niña conditions are associated with cooler temperatures, increased rainfall, and higher flooding in Chobe District during the wet season. In turn, we show that La Niña conditions lagged 0-5 months are associated with higher than average incidence of under-5 diarrhea in the early wet season (December – February). In Chapter 4, we develop and test an epidemiological forecast model for childhood diarrheal disease in Chobe District. The prediction system uses a compartmental susceptible-infected-recovered-susceptible (SIRS) model coupled with Bayesian data assimilation to infer relevant epidemiological parameter values and generate retrospective forecasts. The model system accurately forecasts diarrhea outbreaks up to six weeks before the predicted peak of the outbreak, and prediction accuracy increases over the progression of the outbreak. Many forecasts generated by the model system are more accurate than predictions made using only historical data trends. This dissertation work is an important step forward in our understanding of the links between proximal and distal climatic variability and childhood diarrhea in arid regions of sub-Saharan Africa. Furthermore, it advances methods for generating accurate long-term and short-term forecasts of under-5 diarrhea. We demonstrates the potential use of ENSO data, which are publicly available, to prepare for and mitigate diarrheal disease outbreaks in a low-resource setting up to 5 months in advance, and develop a model-inference system that can generate accurate predictions during an outbreak. Deaths caused by diarrhea are preventable using low-cost treatments. Hence, accurate predictions of diarrhea outbreak magnitudes could help healthcare providers and public health officials prepare for and mitigate the significant morbidity and mortality resulting from diarrhea outbreaks.

Thesis (D.P.H.)--University of Hawaii at Manoa, 1994. / Includes bibliographical references (leaves 161-170). / Microfiche. / xiv, 170 leaves, bound ill., col. map 29 cm