To address the current leadership challenges within the South African health system, it is important to understand what influences the nature and practice of leadership within healthcare organisations. This thesis presents research about the interlinkages between context, leadership practices and staff satisfaction and morale – as indicators of leadership effectiveness - in district hospitals. The study represents one of the few detailed empirical inquiries into these issues in South Africa and adds to the still limited body of relevant empirical evidence in low- and middle-income countries. The research specifically drew on organisational and leadership theory to shape its strategies of data collection and analysis. It was conducted in two case study, district-level, hospitals. Multiple sources of data were collected, including document reviews, non-participant observations, and in-depth qualitative interviews. Data from staff satisfaction surveys carried out separately from this study were also considered. The in-depth interviews involved the three broad cadres of clinical, nursing, and administrative staff working within the hospitals, including those with and without formal managerial roles. Thematic analysis was applied in analysing experience in each case study hospital and also in cross-case analysis. This analysis involved iterative inductive, deductive, and abductive processes. The thesis generates insights about the leadership practices experienced in the case study hospitals that may both engender (positive practices) or undermine (negative practices) staff satisfaction and morale. Positive leadership practices also nurtured the collective leadership that itself enhanced teamworking and influenced the hospital context to spread collective leadership more widely. These leadership practices were, in turn, influenced by contextual elements internal and external to the hospital, some of which themselves had possible consequences for staff satisfaction and morale. Critical features of hospital external context included hospitals' histories and backgrounds, as well as the wider bureaucratic context of rigidity in which they are situated. Key features of hospital internal context influencing collective leadership were, meanwhile, internal power structures and processes, professional identity, and cross-professional relationships. This analysis of the interactions between hospital context, collective leadership and staff satisfaction and morale illuminates the complex dynamics of hospitals. This Leadership Trinity offers insights of relevance to health system reform in South Africa, and more specifically, to implementation of current National Health Insurance proposals.

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The growing burden of HIV and non- communicable disease (NCD) syndemic in Sub Saharan Africa, has necessitated introduction of integrated models of care in order to leverage existing HIV care infrastructure for NCDs. However, there is paucity of literature on long term treatment outcomes for multimorbid patients attending integrated care. We describe long term treatment outcomes among multimorbid patients who attended integrated ART and NCD clubs (IC), a novel model of care piloted in 2014 by the Western Cape Government in South Africa. We followed up multimorbid patients for 12 months, who enrolled for IC at Matthew Goniwe and Town II clinics before September 2016. Median adherence proportions, HIV viral suppression and retention rates were calculated at 12 months before and after IC enrolment. Rates for achieving targets for blood pressure and glycosylated haemoglobin were determined at 12 months prior, at IC enrolment and at 12 months post IC enrolment. We describe demographic and clinical variables among all patients at IC enrolment and used multivariable logistic regression to evaluate for predictors of NCD control 12 months post IC enrolment. As of 31 August 2017, 247 patients in total had been enrolled into IC for at least 12 months. Of these, 221 (89.5%) had hypertension, 4 (1.6%) had diabetes mellitus and 22 (8.9%) had both in addition to HIV. Adherence was maintained before and after IC enrolment with median adherence proportions of 1 (IQR 1-1) and 1 (IQR 1-1) respectively. HIV viral suppression rates were 98.6%, 99.5% and 99.4% at the three time points respectively. Retention in care was high with 6.9% lost to follow up at 12 months post IC enrolment. Optimal blood pressure control was achieved in 43.1%, 58.9% and 49.4% of participants whereas optimal glycaemic control was achieved in 47.4%, 87.5% and 53.3% of diabetic participants at the three time points respectively. Multivariable logistic analyses showed no independent variables significantly associated with NCD control. Multi-morbid people living with HIV achieved high levels of HIV control in integrated HIV and NCD clubs. However, intensified interventions are needed to maintain NCD control in the long term.

Includes bibliographical references. / The purpose of this study was to review past SL projects that have been implemented by GEMP 1 and 2 students, in order to inform the future planning and conduct of the SL programme in the faculty. A document review of all available Power Point presentations for projects implemented from 2006 - 2011 was undertaken employing content analysis. Of approximately 286 projects completed, 183 documents were available for review.

Includes bibliographical references. / [Background] Tuberculosis is a major public health concern for South Africa which has one of the highest recorded incidence rates in the world. Previous research [1998 South African Demographic and Health Survey (SADHS)] reported a crude association between alcohol use and tuberculosis. This study aimed to examine evidence for a relationship, and the size thereof, between alcohol consumption and previous tuberculosis in the 2003 SADHS as a means of informing tuberculosis prevention. [ Methods ] This study was a secondary analysis of cross sectional data collected as part of the 2003 SADHS. Tuberculosis lifetime risk was derived from respondent reports of past tuberculosis episodes based on being informed by a healthcare worker. Alcohol consumption, problem drinking as well as selected explanatory variables were generated from similar questions from the adult questionnaire of the SADHS. The CAGE questionnaire was used to measure symptoms of alcohol problems. Logistic regression was used to model the relationship between past tuberculosis and both alcohol consumption and CAGE. [ Results ] Current and previous alcohol consumption were found to be associated with an increase in odds of tuberculosis in both men and women, with odds ratios ranging iii from 1.1 (95% CI 0.9 - 2.5) to 2.8 (95% CI 1.4 - 5.7) after adjusting for potential confounding effects of socioeconomic factors, smoking, nutritional status and age. Having a CAGE score of either 1 to 2 or 3 to 4 was associated with a doubling [OR 2.2 (95% CI 1.0 - 4.8) and quadrupling [OR 4.4 (95% CI 1.4 - 13.4)] in the odds of tuberculosis respectively. [ Discussion ] and conclusion Behavioural and biological mechanisms of effect of alcohol on tuberculosis may explain the findings. Impairment of the immune system, both acute and long term, has been suggested as the mechanism of increased susceptibility to tuberculosis. On the other hand, high risk living conditions and behaviour associated with problem drinking provide potential for increased exposure and susceptibility to tuberculosis infection. The study was able to control for several potentially confounding socioeconomic predictor variables although not HIV infection. The results complement a body of research that has documented the adverse effects of alcohol consumption on health in general and tuberculosis specifically. The findings thus provide more evidence for public health practitioners to tackle the problem of tuberculosis via specific efforts to control alcohol use and abuse, in addition to other methods of tuberculosis control.

Over time, the majority of patients with Crohn's disease (CD) will develop irreversible gastrointestinal (GIT) damage, notably strictures or fistulas, impacting negatively on quality of life and resulting in hospitilisation and surgery. Early and aggressive drug therapy with immunomodulators (IMMs) and biologics may alter the likelihood of these complications and improve long-term outcomes. However, this approach is extremely expensive and carries its own battery of side-effects such as infections and malignancy. In addition there are a sizable number of patients with CD who will have a benign disease course and never require potent medical therapies or surgical intervention. As a result, there has recently been a surge of interest in early identification of those people who are at risk of developing complicated disease. The aim of our study was thus to indentify predictive factors for poor outcome CD in a South African setting, in order to select those who would most benefit from early and aggressive medical therapies.

Includes bibliographical references. / This study was conducted in Gaborone city, Botswana. Botswana is a small country in south central part of Africa with a population of 1.7 million (Botswana population census, 2001) The overall aim of the study was to examine barriers and facilitating factors influencing the readiness for and acceptability of voluntary HIV testing among the youth aged 18-24 years in Gaborone, Botswana. A quantitative methodology was used in this study. A multistage sampling strategy was also used to recruit one hundred and forty four (144) participants. Information on socio-demographic characteristic, knowledge and utilization of VCT sexual behaviour and perception of risk was gathered by use of a self administered structured questionnaire. STATA version 8 was used to analyse the results of this study. Summary statistics, chi-square test and logistic regression were employed in the analysis. Participants comprised of students from senior secondary schools and tertiary education institutions from the sampled schools of Gaborone. The modal level of education was secondary and the more than half of participants (56%) were females. Their age ranged from 18-24 years. The majority of participants (75%) were sexually active and just over a third 36% of all participants considered themselves not at risk of HIV. VCT knowledge was reported by a significant proportion (59%) who also reported knowledge of VCT sites. HIV testing was reported by a minority of participants 42% and the most commonly reported reason for testing was media campaigns encouraging HIV testing whilst the most commonly reported reason for not testing was never been sexually active. Findings from this study revealed that, HIV test acceptance among the youth is still an area that needs greater attention. The facilitation of HIV testing amongst the young people and removal of barriers to testing can be achieved through a focus on use of strategies that seem vii to work such as the media. Also, there is need to ensure utilization of VCT services by youth through making them understand of the role that VCT plays in preventing HIV and AIDS.

Includes bibliographical references. / While the Copper T intrauterine device (IUD) is one of the most used methods of contraception around the world, only 1% of women in sub-Saharan Africa use this method. The IUD is a safe and highly effective form of long-acting contraception that provides protection for up to 10 years and has a lowrisk of pregnancy (less than 1% during the first year of use). The IUD is highly beneficial in that it can provide protection for women who want to delay or space childbearing and unlike methods such as the injectable or oral contraceptive, does not require users to make numerous visits to their health care facility or obtain a further supply. The IUD is free in the public sector in South Africa, but remains an unpopular choice among women. The purpose of this study was to test the effectiveness of a brief counselling intervention on the uptake of the IUD among women in Cape Town, South Africa. Part A of this dissertation (Protocol) is comprised of a proposal that was accepted by the University of Cape Town (UCT) Human Research Ethics Committee (HREC) and the Provincial Government of the Western Cape (PGWC). It describes the study background and methods. Part B (Literature Review) presents the current state of IUD use in sub-Saharan Africa as well as the level ofunmet need for contraception in the region. It illustrates the effectiveness of the IUD and gives a summary of interventions related to IUD uptake. It also discusses the need for increased use of the long acting and permanent methods in sub-Saharan Africa. Part C (Article) presents the results as a journal article. The incidence of the primary outcome was lower than expected. Five percent of women assigned to the control group went to family planning to make an appointment for IUD insertion, while 4% of those in the intervention group made an IUD insertion appointment. Knowledge of the IUD was not high with only 46% of women having heard of the method. After being given a description of the IUD, 36% of women said they would consider using the IUD. Twenty-seven percent of women stated that they would be interested in receiving an IUD that day. The method was not often mentioned to clients as only 16% reported having discussed the IUD with a health provider. Chi-squared analysis identified characteristics which were related to a participant being aware of the IUD. In this regard, being older and having higher gravidity were both significantly associated factors. The results suggest that IUD is a method that women are interested in learning more about and potentially using. It is clear that a more intensive and comprehensive campaign is needed in order to increase demand for the IUD in South Africa.