M.A. / Because of the high incidence of hypertension amongst South African blacks, many hypothesis have been forwarded to account for the relative higher index of hypertension amongst South African blacks when compared to whites. Because of the virtue lack of endemic proportions of hypertension in South African blacks at the beginning of this century, the often - quoted genetic hypothesis that hypertension is genetically determined would seem not to hold for South African situation. However, this was not yet tested as one of the risk factors or precursors to hypertension, namely the higher indices of cardiovascular reactivity had not been compared in the South African group between white and black subjects. This study investigated the hypothesis that the offspring of black hypertensive parents would show greater cardiovascular reactivity than those of black non-hypertensive parents, and also show greater cardiovascular reactivity than the children of white hypertensive parents as well as the children of white non-hypertensive parents. These hypotheses were partially supported. As expected the children of black hypertensives did show greater indices of cardiovascular reactivity when compared to both children of white hypertensives and the children of black non-hypertensives. An interesting finding however, was that the children of white hypertensives had shown greater indices of the psychological construct of state anxiety than the children of black hypertensive and black non-hypertensive subjects. Whereas this study supported the hypothesis that an inherited cardiovascular reactivity would and could account for the greater index of hypertension amongst South African blacks, it is also possible that the non-psychological expression of tension or cardiovascular reactivity in the form of state anxiety could partially account for the results herein obtained.

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 (Migration and Displacement Studies), March 2017 / Background: Policy responses to communicable diseases and other noncommunicable ones in South (ern) Africa have not adequately engaged with mobility. While Southern African Development Community member states have all adopted clear policies and programmes to deal with communicable diseases for their population in South Africa and elsewhere, deliberately, these do not extend to non nationals. In South Africa, there is a perception that many health care workers are not aware of national health policies and legislation that affect their practice, which leads to poor outcomes. But, in reality, a number of polices and guidelines are incomplete or inapplicable to non nationals, making frontline discretion unavoidable. Objectives: This study mainly sought to understand the practices that frontline health care workers adopt to navigate a space of blurred policy and the “grey areas inbetween” (McConnel, 2010), in relation to migration and antiretroviral treatment, using bottom-up policy analysis, namely “street-level bureaucracy” (Lipsky, 2010) as an analytical tool. Methods: Qualitative methods were used including policy review, literature review, in-depth interviews with frontline health care workers and participant observation. Findings: Empirical research in Vhembe district and Johannesburg found that in spite of several institutional challenges, health care workers were providing health care services and antiretroviral treatment to various categories of non-nationals reliant on public health care, albeit sometimes with some difficulties. But, the difficulties they faced in providing antiretroviral treatment were policy and systems related, in that, those that had a hard time accessing treatment did so because they were not in possession of identity documents, required referral letters or spoke non-native languages in the absence of translation services. This thesis illustrates the various innovations frontline health care workers employed to address these challenges. It demonstrates that health care workers discretion plays a crucial role in health care delivery, and there is need to recognise the importance of informal elements such as human relationships, communication networks, leadership and motivation towards the policy function of the country’s health system. It concludes that the informal practices of frontline health care workers ought not only to be recognised but also strengthened where possible. / XL2018

A Research Report submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements of the Degree of Master of Arts, Applied Ethics for Professionals. Johannesburg, 2017 / Many asylum seekers and refugees in South Africa reportedly find it difficult to access basic health care services. The issue about foreign nationals in relation to health care can be considered from different angles. The concept of access, though, points to gate-keeping. Gate-keeping is the practice that guides decision making about who has access to what and to what extent they might enjoy benefits. In this essay, the question of whether gate-keeping is a morally justifiable practice in South Africa in relation to asylum seekers and refugees’ right to basic health care services is explored. It is concluded that carefully considered and consistently implemented gate-keeping might be a morally justifiable practice that could contribute to ensuring that resources are distributed fairly. It is also argued that the kind of gate-keeping often observed is inconsistent with human rights and Ubuntu precepts. These moral frameworks seem to be the main ones shaping the view of most South Africans as well as our institutional arrangements. Considering the current South African context in which asylum seekers and refugees have difficulty in accessing basic health care services, patriotic bias claims are considered. However, it is concluded that partiality towards compatriots ought not to hold sway when any human being’s basic needs are at stake. / MT2018

The physical, psychological and social development of school children has been neglected - partly because they were seen as healthy "survivors" of the ravages of childhood illnesses, and partly because of the way in which health services are organized (such as the traditional under-five maternal and child health (MCH) services and the curative PHC clinic services). From the age of five years children undergo rapid and profound bio-psycho-social development, to emerge in adolescence as the next generation of leaders and workers. Securing their future growth and development is vital for any society to be economically and socially productive. A substantial body of national and intemational literature has recognised the detrimental impact of helminthic infections and micronutrient deficiencies on the physical and psychological health and development of school children; which requires appropriate nutritional interventions. Concern has been expressed that these adverse biological, physical and social deprivations have a cumulative impact on several dimensions of children's growth. Most important, apart from stunting physical growth, is the inhibition of educational development of school children. Recent evidence strongly suggests a powerful interaction between physical and psychosocial growth and development of children. Inhibition of either component of a child's well-being has adverse implications. Conversely, investments in the physical and psychological development of children are likely to generate substantial health and educational benefits and are a worthy investment to secure a healthy future generation. In summary, there are a number of reasons for, and benefits of, investing in school-based health and nutrition interventions. They are likely to improve learning at school and enhance educational outcomes; create new opportunities to meet unfulfilled needs; redress inequity; build on investments in early child development and promote and protect youth and adolescent development. Health and nutrition interventions such as school feeding programmes, micronutrient supplementation and deworming aim to improve primary outcomes of macro and micro-nutrient deficiencies, parasitic and cognitive status; as well as secondary outcomes of developing integrated comprehensive school health policies and programmes. This rationale served as the conceptual framework for this study. This theoretical framework views improvements of the health, nutritional, cognitive and scholastic development status of school children as the primary focus of policies, strategies and programmes in the health and education sector. This focus constitutes the central core of this thesis. Optimum social development requires investments in both the health and educational development of school children, so as to maximise the synergies inherent in each sector and to operationalise national and international strategies and programmes. As part of the larger RCT study a comprehensive nutritional, health and psychological profile of rural school children was established through a community-based cross-sectional study. Eleven schools were randomly selected from the Vulamehlo Magisterial District in southern KwaZulu-Natal (KZN). Within each school, all Standard 1 pupils, aged between 8 - 10 years, were selected giving a final study sample of 579 children. Some of the observed prevalence's were stunting (7.3%), wasting (0.7%), anaemia (16.5%) (as measured by haemoglobin below 12 g/dl), vitamin A deficiency (34.7%) (as measured by serum retinol below 20 ug/dl) and serum ferritin below 12ng/ml (28.1%). This study established that micronutrient deficiency, parasitic infestations and stunting remain significant public health problems among school-aged children in South Africa. Combining micronutrient supplementation and deworming are likely to produce significant health and educational gains. To determine the impact of single and combined interventions (anthelminthic treatment and micronutrient supplements) on nutritional status and scholastic and cognitive performance of school children, a double-blind randomised placebo controlled trial was undertaken among 579 children 8-10 years of age. There was a significant treatment effect of vitamin A on serum retinol (P<0.01), and the suggestion of an additive effect between vitamin A fortification and deworming. Vitamin A and iron fortification also produced a significant treatment effect on transferrin saturation (P<0.05). Among the dewormed group, anthelminthic treatment produced a significant decrease in the prevalence of helminthic infections (P<0.02), but with no significant between-group treatment effect (P>0.40). Scholastic and cognitive scores and anthropometric indicators were no different among the treated or the untreated children. Fortified biscuits improved micronutrient status among rural primary school children; vitamin A combined with deworming had a greater impact on micronutrient status than vitamin A fortification on its own; while anthelminthic treatment produced a significant reduction in the overall prevalence of parasite infection. The prevalence's of Ascaris lumbricoides, Trichuris trichiura and Schistosoma haematobium declined significantly sixteen weeks post-treatment. The levels of both prevalence and intensity in the untreated group remained constant. The cure rates over the first two weeks of the study were 94.4% for Ascaris lumbricoides, 40% for Trichuris trichiura, and 72.2% for Schistosoma haematobium. The benefits of targeted school-based treatment in reducing the prevalence and intensity of infection supports the South African government's focus of using school-based interventions as part of an integrated parasite control programme. These strategies and programmes were found to be consistent with the recommendations of WHO and UNICEF. The nutritional transition facing developing and middle-income countries also has important implications for preventive strategies to control chronic degenerative diseases (Popkin B, 1994; WHO 1998; Monyeki KO, 1999). This descriptive study, comparing BMI data of school children over three time periods, found a rising prevalence of overweight and obesity among South African school children. Obesity as a public health problem requires to be addressed from a population or community perspective for its prevention and management. Environmental risk factors such as exposure to atmospheric pollution remain significant hazards for children. Lead poisoning is a significant, preventable risk factor affecting cognitive and scholastic development among children. The prevalence of elevated blood lead (PbB) levels in rural and semi-urban areas of KwaZulu-Natal (KZN) as well as the risk factors for elevation of PbB among children in informal settlements were examined. This study investigated over 1200 rural and urban children in two age groups: 3-5 and 8-10 years old. Average PbB level in peri-urban Besters, an informal settlement in the Durban metropolitan region, was 10 ug/dl with 5% of the children showing PbB level of greater than 25 ug/dl. By comparison, average PbB value in Vulamehlo, a rural area located 90-120 km from Durban, was 3.8 ug/dl and 2% of the children's PbB levels were greater than 10 ug/dl. Since the cognitive and scholastic performance of school children was a primary outcome measure in this study, it was important to explore other factors that influenced this variable. The performance scores of all four tests in the battery, among the cohort of a thousand rural and urban children, were in the lower range. The educational deficit identified in this test battery clearly indicates the impact of the inferior "Bantu" educational system that African children have experienced in South Africa. Aspects of the School Health Services that were investigated in this descriptive study included the services provided and their distribution; assessment of health inspection; health education and referral processes undertaken by the School Health Teams; perceptions of managers, providers and recipients of the service; as well as the costs of the provision of the service in KwaZulu-Natal. In KwaZulu-Natal, there were School Health Teams In all the 8 health and education regions in the province. In total, there were 95 teams in the province, consisting of nearly 300 staff members. The School Health Teams were involved in a wide range of activities - 74% of all teams were involved in health inspection and 80% were involved in health education. The total annual cost of delivering School Health Services in the province in 1995 was estimated to be approximately R8 750 000. Given the rise of HIV and AIDS in the province, School Health Services need to play a central role not only in prevention, but also in assisting with the acceptance of HIV-positive children within schools. It is recommended that the current and future draft SHS policy guidelines be approved by the relevant authorities for immediate implementation. Districts should consider developing "Health Promoting Schools", with School Health Teams being a central resource. This thesis has explored several aspects of the epidemiological profile of school children in rural and urban settings in KwaZulu-Natal. It has established that school children are exposed to a range of risk factors ranging from nutritional deficits, parasitic infections, atmospheric lead poisoning and a rising prevalence of overweight. All of these risk factors may compromise their physical, psychological and social development. A number of health interventions have been identified, which have the potential to address these problems. Such investments are essential to secure the health of future generations. / Thesis (M.D.)-University of Natal, Durban, 2001.

Physical inactivity is recognised as a major risk factor for non-communicable diseases such as hypertension, cardiovascular disease, diabetes and cancer. Current recommendations for participation in physical activity are 30 minutes or more of moderate-intensity physical activity on most, but preferably all days of the week. The aim of the study was to determine the effect of a physical activity programme on weight, blood pressure, body mass index and body fat classification among high school learners through a short-term physical activity intervention programme.

<p>This study investigated the societal perception of refugee men as being a risk group, being polluted and the consequent risk of HIV infection they might face. It also determined the factors that could expose them to the risk of HIV infection while living in exile in South Africa.</p>

Thesis (MTech (Surface Design))--Cape Peninsula University of Technology, 2007 / This thesis focuses on an educational Surface Design Intervention (SDI) for inmates. It covers the present day situation, from 2006 to 2007, in a Western Cape correctional facility, regarding the needs of a selected group of inmates. This group of 20 inmates consists of 10 HIV/Aids positive and 10 HIV/Aids negative participants. The thesis argues that there is potential to plan, design and implement an educational SDI, in a group-work situation, with these participants in order to establish the SDI as a skills-development programme and a therapeutic-intervention and income-generating resource. In addition, this research study aims to understand and interpret how the various inmate participants, in a social setting, construct the world around them and what effect and impact the SDI has on them. This intervention is facilitated by two qualified art therapists and involves the use of different art materials through which the prison inmates express and explore their thoughts, feelings and concerns in a safe, contained and supportive space. The health and wellness literature provided the conceptual scaffolding against which to frame the SDI. The literature indicated that a holistic approach to rehabilitation and instruction is vital to help inmates function optimally in daily life. Ultimately, the SDI process indicates the value of identity formation, emotional expression and ethical development. The thesis concludes that oppositional discourses present in the lives of these prisoners can, and indeed should be reconciled in order for them to achieve a positive affirmation of their status. These polarities, once bridged, offer a moderating influence on these prisoners' lives, which contribute to their wellbeing and success both inside and potentially outside of prison.

Thesis (MTech (Biomedical Technology))--Peninsula Technikon, 2004. / The prevalence of obesity amongst both the adult and paediatric population has assumed almost epidemic proportions in many developed and developing countries. A recent study by the Medical Research Council found that a disturbing 20% of all South African children could be categorized as being obese. Limited data is currently available on the prevalence of obesity in South African children, particularly from the previously disadvantaged population. Given the global epidemic of paediatric obesity, hypertension and type-2-diabetes and the limited available data relating to obese South African children, further studies to enhance the understanding of the risk factors associated with the epidemic are imperative.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Physical inactivity is recognised as a major risk factor for non-communicable diseases such as hypertension, cardiovascular disease, diabetes and cancer. Current recommendations for participation in physical activity are 30 minutes or more of moderate-intensity physical activity on most, but preferably all days of the week. The aim of the study was to determine the effect of a physical activity programme on weight, blood pressure, body mass index and body fat classification among high school learners through a short-term physical activity intervention programme. / South Africa

South African hospitals, as a result of numerous factors, have the problem of an increasing workload for nursing staff, which in turn may affect patient treatment quality. This project aimed at addressing patient treatment quality specifically from the perspective of worker capabilities by investigating the strain level and predicted human error probability associated with specific patient-centered tasks in the South African health care sector. This was achieved through two independent yet interlinked studies which focused on seven patient-centred tasks. The tasks analysed were the tasks of setting up and changing intravenous medication, administering injection and pill medication, measuring blood glucose, temperature and heart rate and blood pressure. In the first study, work environment and task characteristics, task structure and execution were analysed. In addition to the task execution, the resulting strain levels, in the form of heart rate measures and subjective ratings of workload, were studied. The second study determined the error protocols and predictive error probability within the healthcare environment for the seven pre-defined tasks. The results for the first study established that different organizational and environment factors could affect task complexity and workload. The individual task components and information processing requirements for each task was also established. For the strain analysis, significant results for the tasks were determined for heart rate frequency and the heart rate variability measures, but some of these were contradictory. For the second study, specific error protocols and error reporting data were determined for the hospital where this research was conducted. Additionally the predictive error probability for the pre-defined tasks was determined. This combined approach and collective results indicate that strain and predictive error probability as a result of task workload can be determined in the field as well as being able to identify which factors have an effect on task strain and error probability. The value of this research lies in the foundation that the gathered information provides and the numerous potential applications of this data. These applications include providing recommendations aimed at improving nursing work environment with regards to workload, improving patient treatment as a result of a reduction in errors and the potential foundation these results provide for future research