MPH / Department of Public Health

Department of Advanced Nursing Science / MCur

MSc (Microbiology) / Department of Microbiology

Thesis (LLM. (Development and Management Law)) -- University of Limpopo, 2019 / In South Africa, the concept of virginity testing has been under the spotlight because of the Children’s Act 38 of 2005 partially legalising it. Section 12 thereof, provides for the testing to be performed on both male and female children over the age of sixteen with their informed consent. It has also been revived as a Zulu custom which gained momentum in response to the HIV/AIDS pandemic. This custom is, however, in contrast to the approach highlighted in the Act, since it targets only the girl child and mostly without her informed consent. Although a girl’s virginity is said to bring honour to her family, it also comes with inherent risks, since, in African societies, the myth that sex with a virgin, or a girl-child can cure AIDS, is prevalent. This dissertation examines, from a human rights perspective, the concept of virginity testing and related procedures/ provisions, the role and function of the virginity testers, as well as expectations/experience of the participants (the girls tested). The study asserts that the practice of virginity testing is a violation of human rights, strips the girl of her dignity, represents an invasion of bodily privacy and leads to degradation and humiliation. Virginity testing, according to this study, leads to limitation of rights and unfairly discriminates against the girls tested and cannot be justified in terms of the limitation clause, as provided by section 36 of the Constitution of the Republic of South Africa, 1996. As part of the comparative study, the analysis of the position in Senegal, regarding the successful abolishment of a similar discriminatory cultural practice, provides lessons on how both the South African government and NGO’s can work towards law reform in order to address the problem of virginity testing.

Abstract in English / The overall aim of this study was to construct and describe a conceptual framework that can serve as a frame of reference for organisational stakeholders to sustain a community coalition to manage alcohol misuse as a risk factor of HIV infection in a specific community in the North West Province, South Africa. A Participatory Action Research (PAR) design that was qualitative and theory generative in nature was followed in this study. A phased approach with specific objectives aligned to the PAR cycle, namely observe (Phase One), reflect (Phase Two), plan (Phase Three) and act (Phase Four), was followed. These phases were actualised through an exploratory, descriptive and contextual research design, guided and theoretically influenced by critical theory. Data in Phase One were collected through 10 key informant interviews. Data were collected in Phases Two to Four through 10 dialogue meetings. Data collected in the four phases were used to construct and describe the conceptual framework that was evaluated by five experts in the field of mental health and substance misuse for refinement (Phase Five). Thematic data analyses was done to identify emerging themes. Key issues identified were that the community is characterised by fragile community coalitions that hamper the management of alcohol misuse as a risk factor of HIV infection. Factors to be considered to sustain the coalition were identified as sharing a common vision, promoting a trusting relationship, formalising the coalition, transformational leadership, strengthening organisational unity, and access to financial resources. This research adds knowledge in the field of mental health and substance misuse by providing a sustainable community coalition conceptual framework for organisational stakeholders to manage alcohol misuse as a risk factor of HIV infection. The conceptual framework could be used to inform policy, further research, education and improve practice in the field of mental health and substance misuse. Although the study was limited to a specific geographical area of a community in the North West Province, South Africa, the findings can be adapted to fit a specific setting. / Health Studies / D Litt et Phil. (Health Studies)

A research report submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Arts in Development Studies, 2017 / HIV/AIDS is a social epidemic that continues to impact the lives of countless young people in Southern Africa and possibly poses one of the biggest threats to adolescent health and sexuality; and is one of the main challenges faced by youth in their transition to adulthood. However, despite the fifteenth year running of the South African government’s HIV/AIDS programme, prevalence rates continue to increase annually pointing to disjuncture between government intervention and the causal mechanisms involved in the spread of HIV/AIDS. Furthermore, literature on men’s sexuality in Southern Africa remains embedded within a ‘predatory masculinity and female vulnerability’ paradigm which results in a gendered analysis of HIV/AIDS and a side-lining of the male perspective which then places young men at a high risk of HIV infection. Therefore, in an attempt to understand the disconnect between literature and high prevalence rates; and to contribute to a better understanding of men’s health and sexuality, a qualitative study using focus group discussions and in-depth interviews was conducted amongst young black heterosexual men (19- 25 years old) to discover the factors that determine condom use among young men living in an RDP housing settlement in Daveyton on the East Rand of Johannesburg. The research findings show that condom use in the sample is predicated upon the young black heterosexual men’s definition of masculinity, the nature of the sexual relationship and sexual partner, and – to a lesser extent - the social accessibility of the condom. As they move from adolescence to adulthood, there is a transition of their understanding of masculinity from one characterized by promiscuous sexual behavior where the use of condoms is seen to diminish the degree of one’s masculinity, to a masculinity fostered by responsible sexual behaviour and accompanied by condom use. The study also found that young men expressed a distance from the supposedly hegemonic view of violent masculinity and male dominance in sexual relationships and that the search for love and the ability to provide for one’s partner was what was most valued in young men’s self -conception of masculinity and sexuality. This then negatively impacted condom usage in romantic relationships as such relationships were perceived to contain less risk and it was assumed that they are predicated on trust; positing love as the biggest barrier to condom use. Furthermore, the study found that although condoms are physically and economically accessible, they are not socially accessible due to the stigma attached to sexual activity among adolescents – which results in a barrier to condom usage. Therefore, findings suggest that the government’s condom promotion programmes - based on the tenets of education (on the subject of pregnancy and sexually transmitted diseases) and physical accessibility of condoms - are largely inconsistent with the factors that determine condom use among young men. This implies that there is a need to develop tailored condom promotion programmes targeted at male sexuality / XL2018

Thesis (MPH.) -- University of Limpopo, 2022 / Background: Termination of pregnancy among young women is a public health issue, particularly in South Africa where high prevalence of pregnany terminations has lately been reported. It is estimated that 260000 terminations of pregnancy take place in South Africa every year. Studies in South Africa have reported that risk factors associated with termination of pregnancy such as financial problems, being poorly educated, being young, unemployed, dependent on parents, widowed or single and other relationship problems were most common. Approximately 1200 pregnancies were terminated in the District Hospital of Limpopo Province between 2017 and 2018. There is also an increased rate of unintended pregnancy among HIV positive women which suggest that women with HIV may be more likely to terminate pregnancy but chooses not to terminate due to fear of being judged. Therefore, the primary objective of this study was to investigate the risk factors associated with termination of pregnancy at a District Hospital in Limpopo Province. Methodology: A cross-sectional descriptive retrospective review study in which convenience sampling of the records of women who terminated pregnancies was used in this study. A self-constructed data extraction tool was used to extract the data from patients records. The tool covered variables such as the age of the women, educational status, marital status, year and month of termination of pregnancy, gestational age, parity, and gravidity, HIV status and circumstances leading to termination of pregnancy. Data analysis was done using the STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). The independent t-test was used for variables having two categories as it assesses whether the difference between means of two groups are statistically significant. This test was performed at the 95% confidence level. The p-value of less than 0.05 in the study results was used for statistical significant difference in means between the categories which were investigated. vi Results: The mean age was 27.9 years (standard error [Std. Err.] =0.37) and majority of women who terminated pregnancies were in the age group 20 – 24 years, single and had a secondary educational level. There was a statistical significance difference between age groups and the gestational age, parity and gravidity at p=0.004 and p<0.001 respectively. The proportion of women who were at gestational age of 1 to 8 weeks decreased with increasing maternal age from 22.4% in age ≤20 years to 13% in age group 30 – 34 years. There was again a statistical significance difference (p<0.001) in relation to number of pregnancies that have each resulted in the birth of an infant capable of survival (parity) and similarly to gravida. The prevalence of HIV amongst women who terminated pregnancy in the current study was found to be 21.3% and the risk of women who terminated pregnancies being HIV positive increased significantly with age as older women (age 20 years and above) were 6.5 times more likely to be HIV positive as compared to younger ones (p<001). Low educational level, gestational age of more than 13 weeks and parity of 1 – 2 were significantly associated with termination of pregnancy. The association of gravida of women who terminated pregnancies and HIV revealed that women who were in their second or third pregnancies (gravida) while HIV positive were 3.9 times more likely to terminate pregnancies as compared to those who were first pregnancy (p<0.001). Marital status was not significantly associated with termination of pregnancy. Conclusion: Termination of pregnancies among adolescents and youth is a major public health issue and the findings of this study highlight the need to address the structural socio-economic drivers of family planning which results in high number of termination of pregnancy amongst the youth. Structural interventions, such as increasing contraceptive use which may be useful for reducing the burden of unplanned pregnancies. These findings suggest the need for targeted interventions for women of child-bearing age to access reproductive health interventions to prevent unintended pregnancies and the associated risk of termination.

Thesis (PhD)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The prevention of mother-to-child transmission (PMTCT) of HIV is a key maternal and child health intervention in the context of the HIV/AIDS pandemic in South Africa. Accordingly, the PMTCT programme has been incorporated in the District Health Management Information System (DHMIS) that collects monthly facility-based data to support the management of public health services. To date, there has not been a comprehensive evaluation of the PMTCT information system. By comparing the experiences in two health districts, using the Performance of Routine Information System Management (PRISM) framework and tools, this study seeks to evaluate the availability, quality and use of process and output indicators for monitoring PMTCT interventions. A comparative analytical and observational study was undertaken using a multi-method approach which included: a self-administered survey of health information personnel to assess confidence and competence levels for routine health information system (RHIS) tasks, an assessment of the routine PMTCT data for quality, completeness, accuracy, and data use; and a facility survey of RHIS processes and resources. In addition, in-depth interviews with 22 key informants and observations in health facilities were conducted. Data were collected from 57 health facilities in a convenience sample of two health districts, and also from 182 health information personnel in the 57 health facilities, three sub-districts, and two district offices. Descriptive statistics, χ2-test, correlation and multiple regression analyses were conducted using STATA® Version 13. A general inductive approach was also used to analyse the qualitative data, which was used for triangulation. The study revealed considerable data quality concerns for the PMTCT information with an average accuracy between the register and routine monthly report of 51% and between the routine monthly reports and DHMIS database of 84% suggesting that the primary point of departure for accurate transfer of data is during the collation process. The importance of human factors was emphasised by the observation that the average confidence level for performing RHIS-related tasks (69%) was not commensurate with the average competence levels (30%). Education was found to be associated with competence, implying that levels of education may be associated with the level at which RHIS competencies are acquired; and that three years or more of post-matriculation education is necessary. Motivation, on the other hand was not associated Stellenbosch University https://scholar.sun.ac.za iv with competence. The study observed the absence of processes such as data-quality checks and data-analysis in place in facilities. There was a general absence of a culture of information use, as a result of lack of trust in the data, and the inability of programme and facility managers to analyse, interpret and use information. We observed differences in the data accuracy by organisational authority, and multivariate analysis and qualitative information suggested that feedback may be an essential process to ensure quality. Although the PRISM framework has been developed from a multi-disciplinary evidence base, this study has been able to validate some of the internal assumptions but has also found some aspects that were not supported such as motivation and data display. Data collected from a larger number of facilities will be required to investigate this further. Institutional capacity to improve RHIS processes, ensure core competencies for RHIS-related tasks are needed, and in the longer term, measures to tackle problems associated with low pass rates in numeracy subjects among high school learners are needed. Further exploration of the possible factors that may influence data accuracy, such as supervision, training and leadership are needed as well as investigating the relationships between human and institutional agency-related aspects, in particular, how individual actions can bring about changes in institutional routines. Further study is needed to determine how decision for planning and evaluating key programmes such as PMTCT are made, and what informs such decisions if not routine data. / AFRIKAANSE OPSOMMING: In die lig van Suid Afrika se MIV/VIGS-pandemie kan ’n ingryping op gesondheidsvlak ’n belangrike rol speel om moeder-na-kind-oordrag (beter bekend as PMTCT) van MIV te voorkom. ’n Inligtingstelsel vir distriksgesondheidsbestuur – die DHMIS – was ontwerp vir die invordering van maandelikse fasiliteitsdata, wat gebruik kan word om die bestuur van openbare gesondheidsdienste en -programme te ondersteun. Die inligtingstelsel self was nog nie omvattend evalueer nie. Hierdie studie het die ervarings van twee gesondheidsdistrikte vergelyk met behulp van die PRISM- (Performance of Routine Information System) raamwerk en -instrumente. Derhalwe het hierdie studie die beskikbaarheid, gehalte en gebruik van proses- en uitsetaanwysers probeer bepaal om die PMTCT-ingrypings te monitor. ’n Vergelykende analitiese en waarnemingstudie is onderneem met behulp van ’n veelvuldige benadering. Die verskillende metodes het ’n selfopname onder gesondheidsinligtingspersoneel ingesluit om hul selfvertroue en bevoegdheid in roetinegesondheidsinligtingstelsel (RHIS)-take te evalueer. Daar was ook ’n assessering van die PMTCT-roetinedata om datagehalte, -volledigheid, -akkuraatheid en -gebruik te beoordeel.’n Fasiliteitsopname oor RHIS-prosesse en –hulpbronne was ook gedoen. Ander navorsingsmetodes het diepte-onderhoude met 22 sleutelpersone ingesluit, sowel as waarnemings in gesondheidsfasiliteite. Data is van 182 gesondheidsinligtingpersoneel van die 57 gesondheidsfasiliteite in ’n geriefsteekproef van twee gesondheidsdistrikte ingesamel. Deskriptiewe statistiek, χ2-toetsing, korrelasie en veelvoudige regressie is met behulp van STATA® weergawe 13 ontleed. ʼn Algemene induktiewe benadering is ook gevolg om die kwalitatiewe data te ontleed. Die studie toon dat menslike faktore ’n impak op datagehalte en -inligting kan hê, met ’n gemiddelde akkuraatheidsyfer van 51% van beide die register en roetine maandelikse verslae. Die akkuraatheid van die maandelikse verslae en RHIS databasis is 84%, wat aandui dat akkuraatheid slegs toegepas word indien inligting uit die staanspoor korrek aangeteken word. Die impak van menslike hulpbronafaktore was beklemtoon toe daar bevind was dat hoewel 69% van RHIS-dataverwerkers vertroue getoon het in die gebruik van RHIS-verwante take, slegs 30% wel bevoeg was om die werk te doen. Opvoeding was grootliks geassosieer met bevoegdheid, wat moontlik voorstel dat sekere vlakke van opvoeding benodig word vir spesifieke RHIS-bevoegdhede. Minsten drie jaar tersiêre opleiding word aanbebeel. Motivering was nie met Stellenbosch University https://scholar.sun.ac.za vi bevoegdheid geklassifeer nie. Die studie het bevind dat daar te min aandag aan datagehalte en –analise gegee word in fasiliteite. Oor die algemeen was daar nie ’n ordentlike kultuur van inligtinggebruik nie, a.g.v. die feit dat daar nie vertroue in die data was nie. Terselftertyd was program- en fasiliteitbestuurders nie bevoeg om inligting te analiseer en ontleed nie. Ons het verskille in die akkuraatheid van data opgetel wat deur organisasie-hoofde gedoen was. Meervoudige analise en kwalitatiewe informasie stel voor dat terugvoering ’n belangrike deel van die proses moet wees om kwaliteit te verseker. Hoewel die PRISM-raamwerk saamgestel was uit ’n multi-dissiplinêre bewyslewering, kon hierdie studie sommige van die interne voorneme valideer, maar daar was aspekte wat nie gestaaf kon word nie. Inligting van ’n groter aantal fasiliteite sal benodig word om verder hierna ondersoek in te stel. Institusionele kapasiteit word benodig om RHIS-prosesses te verbeter en basiese vaardighede vir RHIS-verwante take te verseker. Op langtermynvlak moet daar ook gekyk word na probleme wat lei tot laë slaagsyfers in syfervaardighede in hoërskoolleerders. Verdere ondersoek moet ingestel word om vas te stel watter faktore moontlik akkurate data teweeg kan bring. Dit sluit toesig, opleiding en leierskap, asook die verhoudings tussen menslike en agentskap-verwante aspekte in. Die feit dat optrede op individuele vlak veranderings in institusionele roetines kan aanbring, moet spesifiek na gekyk word. Verdere studies kan help om vas te stel hoe besluite vir beplanning en evaluaring vir hoofprogramme soos PMTCT gemaak word – asook hoe die besluite gemaak word indien hulle nie roetine voorafgaan nie.

Thesis (MPhil)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: Mineworkers in South Africa are in abundance as mining is the main occupation especially in the former black homeland. These mineworkers retrenched or retire, and returned to their homeland. Transkei is a former black homeland where abundant retired mineworkers reside to their destiny. Migrancy, which for century has been such a conspicuous feature of the South African labour system, and thought to be a significant contributor to the spread of HIV/AIDS (Lurie M, 2000). The migrant labour system in Transkei region was attributed very extensively to contagious disease especially related with sexually transmitted diseases (STI) like HIV/AIDS. It is estimated that 2 million of the 5 million black mineworkers in South Africa at the time were migrant labourers. Majority of them are from the Transkei region. The ex-mineworkers in this study group are between 41 and 78 years of age (mean 55 years). They have serviced in the mines from 5 to 48 years (mean 20 years). All are married, and having children between 1 and 10 ((mean 6). Fifty seven percent ex-mineworkers did not answer about their number of sexpartners. Only 43% mentioned that they have one partner. Only 31% mineworkers were consuming alcohol. Of them 9% were consuming everyday, and 18% twice in a week. In this study, HIV/AIDS related knowledge, attitudes and behaviour of exmineworkers, living in the remote rural areas of Transkei region of Eastern Cape, were elicited by sending questionnaires to them. Only 19.9% have replied back. There is absolute lack of knowledge in 13.6%, and negative attitude in 27% of the ex-mineworkers. Risks of unsafe sex have been observed among 69%. Of them, 48% have mentioned that they have trust in their wives. Urinary tract symptoms were indicated by 18%, and HIV positivity was reported by 4.5% of mineworkers. There is suicidal tendency (life is not worth living) was found in 22.7% of ex-mineworkers, and a majority (16%) mentioned that it is related with their sickness. Majority of ex-mineworkers have good knowledge about HIV/AIDS, and positive attitude for the survivals. They have also been practicing sex without condoms, but they have provided reasoning to be a faithful to their partners. There is a high level of awareness and a positive attitude towards HIV/AIDS individuals. It was observed that there is less risk taking sexual behaviour among exmineworkers. / AFRIKAANSE OPSOMMING: 'n Groot gedeelte van Suid-Afrikaanse mynwerkers is uit die Transkei gebied afkomstig. Daar word konserwatief beraam dat tussen twee en vyf miljoen mynwerkers jaarliks tussen hulle werkplek en die myne migreer en dat hierdie migrasie ingrypende inplikasies vir die verspreiding van die MI-virus het. Die doel van hierdie studie is om die kennis, houding en gedrag van mynwerkers ten opsigte van MIV/Vigs by 'n steekproef van 198 voormalige mynwerkers in die Transkei te toets. Die inligting is deur middel van 'n vraelys en onderhoude gedoen en daar word tot die gevolgtrekking gekom dat die kennis van Vigs en die voorkoming daarvan besonder goed is by hierdie steekproef. Die implikasies van die bevindinge van die studie word uitgespel en voorstelle vir verdere studies word aan die hand gedoen.

DCur / Departmet of Public Health / See the attached abstract below