The main aim of this thesis is to investigate whether residence near hazardous waste landfill sites is associated with an increased risk of congenital anomaly. The thesis reports results of a multi-centre case-control study carried out in 10 regions in 6 European countries. Cases were live births, stillbirths, and induced abortions with major congenital anomalies resident at birth within a 7 km area around hazardous waste landfill sites. Controls, two per case, were non-malformed births resident in the same area. A total of 1089 cases of non-chromosomal anomaly, 270 cases of chromosomal anomaly, and 2508 controls were selected around 26 landfill sites. A 3 km zone around sites was defined as the zone of most likely exposure. An expert panel of four landfill specialists scored each landfill site according to their potential to cause exposure of nearby residents. A statistically significant 33% excess in risk of non-chromosomal anomalies was found for living within 3 km of a hazardous waste landfill site. The risk of non-chromosomal anomaly declined steadily with increasing distance from a site. Confounding factors or biases do not readily explain these findings. Risk of chromosomal anomalies was raised near sites but did not reach statistical significance. There was little evidence for relative risk of congenital anomaly (non-chromosomal or chromosomal) close to landfill sites to be associated with hazard potential of landfill sites, adding little support to a possible causal relationship. However, in the absence of a 'gold-standard' for the classification of hazard potential, misclassification of sites may have occurred. Lack of information on exposure of residents near the study sites or near landfill sites in general, limits interpretation of the results. Socio-economic status is a potential confounding factor in the current study but little is known in the literature about socio-economic status as a risk factor for congenital anomaly. This study finds a higher risk of non-chromosomal congenital anomaly and certain specific malformation groups in more deprived populations. These findings require follow-up in studies with larger geographical coverage.

The core theme of this thesis is the potential contradiction between the objective of economic growth in terms of the sustenance of the natural environment and human health. The basic research theme is the identification of the underlying political and economic processes that relate to rising air pollution and corresponding ill-health in cities. It explores the relationship between air pollution and child ill-health in Houston, a highly developed US city. The analysis points out that since the early 1900s, there has been rampant unregulated economic growth in Houston and that weak environmental protection has contributed to both past and current concentrations of industrial pollution, the net result of which is that the environment is severely damaged and human health is deleteriously affected. The thesis indicates theoretical and epistemological limitations in emerging interpretations and highlights that air pollution and ill-health are not simply physical or social problems but they reflect the integration of biological mechanisms and political and economic priorities. This thesis reconceptualizes the connection between the economy and the environment, integrates abstract and empirical investigation, defines the structural character of spatial relations, combines global economic processes with local patterns of environmental degradation, and links historical growth to ecological and health changes. The field-work consisted of a large comparative household survey to examine local air pollution and child ill-health. It was informed by investigations of institutions and documents and complemented by semi-structured interviews. Clusters of child ill-health were found in low-and high-income households in areas near petrochemicals. While it is clear that the socio-economic circumstances of each household influenced the state of child health, this study demonstrates that spatial relations also played a significant role in the relationship. The procedures and analyses are conceptualized through a critical realist methodology, contextualized in a political-economy approach and framed within a theoretical perspective of historical social relations.

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Eight selective surveillance methods were assessed for their effectiveness in detecting hospital infection and the time required for data collection. The methods were compared with a reference method which was designed to identify all patients and infections in the study population (patients occupying 122 beds of a district general hospital). The selective methods were: - laboratory based ward surveillance - laboratory based telephone surveillance - ward liaison surveillance - laboratory based ward liaison surveillance - risk factor surveillance - temperature chart surveillance - treatment chart surveillance - temperature and treatment chart surveillance. The proportions of community acquired infection (CAI) and hospital acquired infection (HAI) detected by the selective surveillance methods varied; the highest proportion of CAI (70%) was identified by treatment chart surveillance, and temperature and treatment chart surveillance, and of HAI (71%), detected by laboratory based ward liaison surveillance. The time for data collection ranged from 1.5 hours/122 beds/week for laboratory based telephone surveillance to almost 8 hours for temperature and treatment chart surveillance. The time for the reference method was 22.1 hours/122 beds/week. Using the proportion of patients with HAI detected and time required for data collection to assess the methods, laboratory based ward liaison surveillance was the most effective and an efficient method. This method was revised minimally and introduced into six district general hospitals by infection control nurses. The time for data collection ranged from 4 to almost 8 hours/120 beds/week. The revision did not affect the proportion of HAI detected, however, the proportion of CAI identified was significantly reduced. The reproducibility of laboratory based ward liaison surveillance was good. The results will enable infection control teams to make an objective and rational choice of methods for the surveillance of hospital infection.

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Magister Legum - LLM / African states are interested in the development of nuclear power (also referred to as atomic power) for the generation of electricity and desalination. These include Algeria, Egypt, Ghana, Kenya, Morocco, Namibia, Niger, Nigeria, Tunisia, South Africa, and Uganda. The nuclear governance in South Africa has adopted principles into its legal system which require it to comply with the objectives of numerous resolutions, conventions, treaties, bilateral and multilateral agreements. Therefore, there is an obligation upon the government through ‘reasonable legislative and other measures’ to manage nuclear matters, such as nuclear accidents, in a manner that protects the general public, atomic industry workers as well as prevents the pollution of the surrounding environment. It has been seven years since the Fukushima Daiichi Nuclear Power Plant Accident that occurred in Japan on 11 March 2011, when considerable amounts of radioactive material from the damaged plant released into the environment. Health hazards, associated with exposure to low levels of ionising radiation, are a significant concern following such an accident. A nuclear disaster can potentially violate not only the right to health of workers, but that of residents and evacuees alike, particularly pregnant women, older persons, and children. Regional and international human rights conventions impose obligations on state parties to “take whatever steps necessary to ensure that the right to the highest attainable standard of health is enjoyed by all as soon as possible”. In most cases, when a nuclear accident occurs, workers within the nuclear plant are expected to mitigate emergencies. The danger of this expectation is that it could violate their fundamental human rights.