Thesis (Ph. D.)--University of Iowa, 1998. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.A.(Biokinetics, Sport and Leisure Sciences))--University of Pretoria, 2008. / Includes bibliographical references.

This research project examined the changing expectations and knowledge of Managers in the Department of Health who attended the Sexual Health Counselling Project offered by Rhodes University, East London, South Africa. These managers came from contexts in which the hierarchical medical model is firmly entrenched. The Sexual Health Counselling Project, drawing on theoretical principles from Narrative and other theories,presented a challenge to the standard management practices used by the managers. It also challenged how they dealt with clients. This research explored changes in expectations and knowledge prior to and during a two- week training course that the managers attended. A personal awareness and shift in knowledge occurred for many managers who examined their current practices. Some managers, who were firmly entrenched in the hierarchical model,found it difficult to change their ways of working.

Magister Public Health - MPH / The aim of this study was to assess the factors associated with HIV risk behaviours in women in Livingstone, Zambia. A cross-sectional analytical survey using a structured questionnaire was carried out in two sites in Livingstone, which were selected on the basis of differences in socio-economic status. Married women and women in the urban community are at high risk of contracting HIV and every effort should be made to ensure that HIV/AIDS programmes help to reduce their vulnerability to HIV infection. / South Africa

A crisis is unfolding because of the deaths among people in the labour force. It is expected that business, government and labour address the problem of HIV and AIDS. An intervention such as, introduction of policies and strategies would help in the awareness of the epidemic to the society as a whole. This study looks at the effect of HIV on gender inequality and its implications in the labour sector. There are large social and economic gaps between women and men in Malawi, and these inequalities have played a central role in the spread of HIV; hence it is imperative to consider women when developing HIV workplace policies, because they seem to be hit harder with the epidemic than men. Empowering women to refrain from risky relationships and protecting themselves and asserting their rights would decrease the high HIV prevalence percentage for women. The study use annual Labour participation rate, female (% of female population ages 15+) and annual labour participation rate, male (% of male population ages 15+) data obtained from (www.tradingeconomics.com) and annual Prevalence of HIV, total (% of population ages 15-49) obtained from World Bank over the period of 1980 to 2009. Prior to doing the regression analysis, the time series data is tested for stationarity using correlograms and the Augmented Dickey Fuller (ADF) test on each data set. The results suggest that there is a negative relationship between HIV/AIDS and labour on both genders for this period and that there is a gap on the effect of AIDS on women and men in the labour sector. The time series data is found to be 1(2), intergrated of order 2. The HIV data is regressed onto the labour data, using Ordinary Least Squares (OLS). Following the regression line is the Engel-Granger method which is used to test for cointegration. Other tests include diagnostic tests and stability tests / Thesis (M.Sc.(Computer Science) North-West University, Mafikeng Campus, 2011

published_or_final_version / abstract / Surgery / Doctoral / Doctor of Philosophy

A Research Report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfilment of the degree of Master of Medicine in the branch of Internal Medicine. / Background. Primary immune thrombocytopenia (ITP) is a rare disease causing significant morbidity. South Africa has a high prevalence of HIV infection which may be associated with immune thrombocytopenia. There is a paucity of clinical, management and outcome data on immune thrombocytopenia in the local South African setting. Objectives. To compare the demographics, clinical presentation, management and treatment outcomes of immune thrombocytopenia in HIV positive and HIV negative patients and to compare the treatment outcomes with established international guidelines. Methods. This was a retrospective comparative study conducted at Charlotte Maxeke Academic Hospital, Johannesburg, from January 2003 to December 2014. Adults (≥ 18 years) with confirmed diagnosis of ITP were included. Hospital charts of eligible patients were reviewed to extract data on their clinical presentation, diagnosis, HIV status, treatment and outcomes. A comparison was made between HIV positive and negative patients. Descriptive analysis was performed on the data and results were presented graphically. The P-value of <0.05 was regarded as significant. Results. A total of 250 patients were screened, of which 154 patients met eligibility criteria for the study. 91% of the patients were female, 58% were HIV negative and 42% were HIV positive. The 25-35 year age-group comprised the highest percentage of HIV positive patients (42%). There was no difference in the presentation of symptoms between HIV positive and HIV negative patients. Response to first line therapy was not significantly different between the HIV positive and HIV negative patients (p=0.1370). The patients who went on second line therapy, showed excellent response with approximately 80% reaching complete response. There was no difference in HIV positive and HIV negative groups. Conclusion. In a large central hospital in a high HIV prevalence setting, there is no significant difference between HIV positive and HIV negative patients in terms of clinical presentation, treatment and outcomes in confirmed patients with immune thrombocytopenia. The management of ITP at the CMJAH is comparable to that of published guidelines. / MT2017

Thesis (M.Sc. Med.) (Epidemiology and Biostatistics))--University of the Witwatersrand, Faculty of Health Sciences, 2014. / Introduction Ano-genital warts affect at least 30 million people worldwide. Ano-genital warts are caused by low risk Human Papilloma virus infections in 90% of cases. In African populations the ano-genital warts have not been adequately investigated thus our main goal was to highlight the factors associated with the occurrence of ano-genital warts among HIV infected individuals. Studies in both men and women have shown that the likelihood of getting anogenital warts is significantly increased when one is infected with HIV hence the need to investigate in this population. More over data suggests that HPV infection occur more frequently among HIV infected individuals because of the HIV associated CD4+ T-cell immune-suppression. Methods We conducted an analytical cross sectional study of routinely collected secondary medical data from Ward 21 ART clinic at the Hillbrow community centre in Hillbrow Johannesburg central. Our study participants were all HIV infected patients 16 years and older who attended the ART clinic between 01 January 2009 and 31 December 2011 and were recorded in the therapy edge database. Our outcome was clinically diagnosed ano-genital warts. We analysed data using the Chi squared test or Fischers exact test to make comparisons in bivariate analysis. Logistic regression was used to assess factors associated with ano-genital warts. Factors assessed were other STIs namely syphilis, herpes simplex virus type 2 and scabies as well as age, gender, first CD4 and employment status and ART status of a patient. The Models were assessed using the linktest and the Hosmer Lemeshow goodness of fit test. Results Ano-genital warts (AGWs) prevalence was 4% (251 out of 6634) among females and 3% (118 out 4116) among males. Prevalence of AGWs in both females and males decreased with increasing age. In females the prevalence was between 1% and 8% and in males it was between 1% and 4%. The odds of having ano-genital warts among females if one was above 25 years ranged from 1.6 to 18.3, showing an upward trend. Among females a CD4 count of less than 200 cells/ml3 was also associated with ano-genital warts occurrence, OR 1.32(1.02 - 1.72). Among males the odds of having ano-genital warts if one was not on ART were 1.53 (1.01 – 2.31) times when compared to those who were on ART. Discussion and Conclusion Prevalence of genital warts was highest among the younger age groups in both males and females and it decreased with increasing age consistent with literature. Age was strongly associated with ano-genital warts and the association became stronger with increasing age among females while no association was found among males. In line with findings from other studies we found low CD4 count of ≤ 200 cells/m3 to be associated with ano-genital warts in HIV positive females; however it was a weak association. Among males a weak association between ART status and ano-genital warts was established and none in females. This is consistent with the fact that in the post ART era there has been no substantial decline in HPV infections.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment for the degree Masters of Medicine in Paediatrics (MMed) Johannesburg 2014 / Introduction Mycobacterium tuberculosis meningitis (TBM) is a severe manifestation of extra-pulmonary tuberculosis (EPTB) in children, particularly under 5 years of age. Children are vulnerable to EPTB as they are immunologically immature and unable to contain Mycobacterium tuberculosis (MTB) infection in the lung. Common neurological sequelae of TBM include focal motor deficits, vision loss and hydrocephalus. Early stage diagnosis and timeous anti-tuberculosis treatment decreases the case fatality rate of TBM. Objective To characterise the burden, clinical presentation, laboratory markers and short-term outcome of TBM in HIV-infected and HIV-uninfected children. Methods The electronic databases of admission of children at Chris Hani Baragwanath Academic Hospital (CHBAH), between January 2006 and December 2011 with a diagnosis of TBM were reviewed. Individual patient records were retrospectively reviewed for clinical and laboratory data. In addition, admissions from the neurosurgery wards were also reviewed. In patients whose medical records were unavailable, laboratory data was used. Results The overall incidence of TBM in 2006 was 6.96 per 100 000 (95% Confidence Interval [95%CI]: 4.46-10.36), peaked at 9.87 per 100 000 (95% CI: 6.91-13.67) in 2009 and subsequently declined to 3.18 per 100 000 by 2011 (95% CI: 1.64-5.56). There was a 38.6% (95% CI: 10.0-58.0; p=0.011) reduction in the overall incidence of TBM when comparing the period 2006-2009 with the period 2010-2011. This decline was particularly evident in HIV-infected children (49.6% reduction; 95%CI: 1.05-74.35; p=0.042). There were no differences in the clinical symptoms of TBM or tuberculosis between HIV-infected and -uninfected children. Previous history of TB was significantly higher in HIV-infected children compared to HIV-uninfected children (OR 4.63; 1.40-15.22; p=0.011). Tuberculin skin test positive-reactivity (OR 0.09; 0.02-0.43; p=0.002) and sputum culture positivity (OR 0.29; 0.10-0.86; p=0.025) were less common in HIV-infected compared to -uninfected children. Cerebrospinal fluid cytology and biochemistry results were similar between HIV-infected compared to -uninfected children. Morbidity (22.7% in HIV-infected vs. 33.0% in -uninfected) and mortality (6.4% in HIV-infected vs. 6.9% in -uninfected) were similar between HIV-infected and -uninfected children. Conclusion The incidence of TBM has decreased over the study period 2006 to 2011.This decrease was temporally associated with an increase in the uptake of antiretroviral treatment in HIV-infected individuals.