<p>Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens &amp / Zupan, 2005). Early&nbsp / detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing&nbsp / countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking&nbsp / behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home&nbsp / visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit,&nbsp / community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing&nbsp / community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured&nbsp / questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers&rsquo / home or at the study&nbsp / offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis.&nbsp / Descriptive analysis was&nbsp / conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant&nbsp / associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were&nbsp / enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the&nbsp / highest number of which occurred within&nbsp / the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking&nbsp / their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW.&nbsp / Conclusion: This study found&nbsp / high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South&nbsp / African National Department of Health (SANDOH) which will involve the establishment of family health worker teams&nbsp / including community health workers. A key function of these workers will&nbsp / be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with&nbsp / non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by&nbsp / community health workers. Most of the referrals in this study were&nbsp / neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal&nbsp / and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater&nbsp / realization of a team approach to PHC.</p>

Innovative ways to conduct disease surveillance are required to address the complexity of Ciguatera Fish Poisoning (CFP). Mixed methods were employed to explore CFP epidemiology and interdisciplinary approaches to its surveillance in the Turks and Caicos Islands (TCI). Quantitative analyses of cross-sectional data collected by the TCI’s National Epidemiology and Research Unit in 2010 demonstrated that a low percentage of residents reported lifetime histories of illness following fish consumption (3.9%). Furthermore, gender, age, island, and home remedy use were significantly associated with reported clinic visitation by ill individuals. Next, a multisectoral CFP surveillance model was conceptualized. A qualitative exploration of the model’s hypothetical integration into TCI’s health system revealed that several systemic and contextual factors could influence the future uptake of interdisciplinary CFP surveillance. Targeted interventions are recommended to improve national CFP surveillance and to facilitate the growth of interdisciplinary networks between stakeholders from TCI’s health, fisheries and environment sectors. / Canadian Institutes of Health Research, Ontario Veterinary College, University of Guelph, Ministry of Health and Human Resources of the Turks and Caicos

<p>Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens &amp / Zupan, 2005). Early&nbsp / detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing&nbsp / countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking&nbsp / behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home&nbsp / visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit,&nbsp / community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing&nbsp / community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured&nbsp / questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers&rsquo / home or at the study&nbsp / offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis.&nbsp / Descriptive analysis was&nbsp / conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant&nbsp / associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were&nbsp / enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the&nbsp / highest number of which occurred within&nbsp / the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking&nbsp / their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW.&nbsp / Conclusion: This study found&nbsp / high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South&nbsp / African National Department of Health (SANDOH) which will involve the establishment of family health worker teams&nbsp / including community health workers. A key function of these workers will&nbsp / be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with&nbsp / non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by&nbsp / community health workers. Most of the referrals in this study were&nbsp / neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal&nbsp / and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater&nbsp / realization of a team approach to PHC.</p>

Pulmonary Tuberculosis (TB) is a significant cause of morbidity in Uganda. TB control in the Ugandan district of Butaleja remains poor, characterised by TB case detection and cure rates below national targets. A qualitative exploratory and descriptive study was conducted to identify factors associated with health-seeking behaviour of TB patients in Butaleja district; with an aim to present recommendations for promoting positive health-seeking behaviour amongst the patients. Data was collected through individual in-depth interviews with seven diagnosed TB patients and analysed using Creswell’s (2009:186) analytic spiral steps. The findings revealed three major themes, namely; the nature of health-seeking behaviour, factors associated with the health-seeking behaviour and advice to others experiencing similar symptoms. The health-seeking behaviour of participants was generally poor, characterised by delay in seeking proper medical treatment for TB. Health system, individual and social factors contributed to poor health-seeking behaviour among the participants. The study recommends health system and community interventions targeted at individuals to improve health-seeking behaviour for Pulmonary TB / Health Studies / M.A. (Public Health)

Magister Public Health - MPH / Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens Zupan, 2005). Early detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit, community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers home or at the study offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis. Descriptive analysis was conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the highest number of which occurred within the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW. Conclusion: This study found high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South African National Department of Health (SANDOH) which will involve the establishment of family health worker teams including community health workers. A key function of these workers will be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by community health workers. Most of the referrals in this study were neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater realization of a team approach to PHC. / South Africa

PhD / Department of Public Health / See the attached abstract

The purpose of the study is to investigate lived experiences of refugees when accessing healthcare services in Pretoria, South Africa. A qualitative phenomenological research approach was followed which assisted in exploring and describing the day-to-day lives of refugees living in Pretoria regarding their health outcomes. Face-to-face interviews were conducted on purposively selected participants, representing refugees from different African countries ranging from age 27 to 58 years. Collected data were transcribed, coded, and relevant themes were extracted and analysed by employing Colaizzi's seven-step analysis framework. Main findings demonstrated that the public healthcare services accessed by refugees, compared to private healthcare services, can be described as mostly dysfunctional. Also, healthcare providers from public healthcare services are often hostile towards refugees of African descent. Failure to speak a local language, unofficial documentation as viewed by a healthcare provider on duty, being a foreigner, and failure to pay undue consultation fees led to refugees being denied access to healthcare or receiving negative treatment in the public healthcare sector. Recommendations for programmes to promote human rights and refugee awareness in healthcare facilities could subsequently contribute to alleviating complications around access to healthcare services, which would denote improved health outcomes for the refugees. / Health Studies / M. P. H. (Health Studies)

This research was stimulated by an indication that members of the Africa Gospel Church do not utilise professional health care services optimally, probably due to religious reasons. This may also be the result of registered nurses&#8217; inability to render culture congruent care. To render culture congruent care, nurses require knowledge of the belief system and the health seeking behaviours of the church members. The qualitative research investigated the religious beliefs and health seeking behaviours of members of the Africa Gospel Church in Francistown, Botswana. An exploratory ethnonursing research method was applied. Semi-structured interviews were held with two purposively selected samples. Qualitative data analysis was done using computer software to reduce data and interpret the research results. The study indicated that members utilise the Church structure for health care purposes and seek health care mainly from priests and prophets. / Advanced Nursing Sciences / M.A. (Nursing Science)

This study investigated the social factors influencing the poor uptake of HIV Testing and Counselling (HCT) services by middle-aged black men in Pimville, Soweto. A qualitative research approach was used for this study in which ten men and two key informants were interviewed. Themes explored were the participants’ biographical characteristics, knowledge of HIV and AIDS, health-seeking behaviours, understanding of multiple sexual partnerships, male circumcision, and challenges in using HCT services. Various social behaviour change theories formed the theoretical framework guiding this study. It was found that fear, stigma and cultural factors are major reasons for the poor HCT uptake. Despite the men’s high HIV risk perceptions, behaviour change lags behind. Greater efforts to establish a men’s forum to discuss sexual health matters in Pimville are recommended. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

This study investigated caregivers' perceptions with regard to vaccine-preventable diseases in terms of six constructs of the Health Belief Model. A qualitative research design that is explorative, descriptive and contextual in nature was employed in order to understand and describe the perceptions influencing access and utilisation of services that lead to missed immunisation opportunities and consequently outbreaks of vaccine-preventable diseases. The data-collection techniques were individual unstructured in-depth interviews, field notes and clinical records. The sample consisted of twenty two (N=22) caregivers who volunteered to be interviewed. The study has highlighted that caregivers' perceptions or cognitive factors play an important role for having children in completing immunisation schedule to protect the public from vaccine-preventable diseases. It is recommended that mass media programmes are needed to address the role of vaccines in reducing high morbidity and mortality rates caused by vaccine preventable diseases and improvement in access to immunisation services. / Health Studies / MPH (Health Studies)