Breast cancer poses a serious public health concern. This case-control study describes the relationship of night-shift working on the development of breast cancer in 57 women diagnosed with breast cancer compared to 49 women with other types of cancer in the Vaal Triangle area (selected through non-probability purposive sampling from CANSA). The study revealed that women who work night-shift developed breast cancer 1.24 times more often than women who do not work nightshift (OR=1.24 [95% CI 0.52 to 2.89]). The odds ratio was further increased in women who worked rotating-shift (OR=1.44 [95% CI 0.58 to 3.59]). Night-shift work exposure was not statistically related to the development of breast cancer. It is recommended that the relationship between night-shift exposure and breast cancer risk be further explored through cross-sectional and cohort studies, and other breast cancer pathways. / Health Studies / M. A. (Public Health)

The practise of male traditional circumcision is severely challenged with enormous problems ranging from hospitalisation of the initiates as well as deaths of the initiates. The background of the problem is focused in the Eastern Cape Province where the researcher has noted several initiates being treated in hospitals for physical and as well for psychological problems. The objective of this study was to explore and describe newly initiated Xhosa men's experiences of traditional circumcision rites at East London in the Eastern Cape Province and to describe the guidelines for support of these newly initiated Xhosa men by public health professionals. A qualitative explorative, descriptive contextual and phenomenological design was followed. Purposive sampling technique was used to select the participants. Fourteen participants volunteered to participate in the study after they met the eligible criteria. Focused group interviews were used as a method for data collection. Data analysis of the study showed that there are several factors affecting newly initiated men whilst undergoing circumcision rites. These factors can present at any of the three circumcision stages i.e. pre-circumcision, peri-circumcision and post-circumcision. The recommendations of the study strongly suggest a cultural competence in rendering effective health care services to culturally and ethnically diverse clients. All the five constructs of cultural competence are entailed in the support guidelines that have been developed by the researcher. They are cultural awareness, cultural knowledge, cultural skill, cultural encounter and cultural desire. Finally limitation of the study and the need for a further research has been clearly stated. / Health Studies / M.A.

With the advent of the new National Health Act, health care in South Africa is at a critical point as this will be the first time in history that a National Health Insurance is being implemented in this country. Globally National Health Insurance has been around for more than a hundred years, however some countries with long established national health schemes are currently grappling with funding issues surrounding their health systems. South Africa should take note of these issues as it embarks on this journey. The objective of this study was to perform a literature review on how South Africa’s National Health Insurance can be funded taking cognisance of the history of the country and experiences of other countries. It is imperative for each country to achieve optimal health care funding to ensure the success and long-term sustainability of National Health Insurance. The analysis of the problems experienced by other countries revealed that balancing the three main funding options namely, allocated from the national revenue fund, user charges and or donations or grants from international organisations, is critical as the funds needed in a system to achieve coverage at an affordable cost is dependent on the current state of health care in a country. Considering South Africa’s history and current inequality in society and health care it is clear that the majority of funding for the National Health Insurance should be supplied by the national revenue fund. The required funds can either be raised by increasing existing taxes or introducing a new tax specifically aimed at financing the National Health Insurance. The use of user charges is important however, although not purely for a revenue collection point, but from a cost control point of view as well. Some studies have revealed that the lack of user charges results in a misuse of the system. / Financial Accounting / M. Phil. (Accounting Science)

The commercial mining of asbestos occurred in four Provinces of South Africa (Northern Cape, North West, Limpopo and Mpumalanga). It was initiated in the late 1800's and lasted for over a hundred years into the beginning of this century. As a producer of amphibole asbestos, South Africa far outpaced every other country being responsible for 97% of global production. The last crocidolite mine closed in 1996 and chrysotile in 2002. Anecdotal information concerning environmental contamination as a result of the former mining activities and the improper disposal of mine waste tailings has been reported by a variety of authors. Few comprehensive or systematic surveys have been conducted to date to document this issue and very little quantifiable research has been completed on the communities located in close proximity to the former mine sites to determine the extent of contamination. In 2004-2006 communities were surveyed within the Northern Cape and North West Provinces to determine the extent and severity of environmental contamination. This research developed and applied a methodology to select those communities suspected of environmental contamination, a targeted survey methodology, and a protocol for rapid sample laboratory analysis. A total of 41 communities were initially predicted by the model to be suspected for environmental asbestos contamination. Based on the inclusion of local knowledge, a final 36 communities were selected for a screening-level field assessment, 34 of which were found to contain environmental asbestos contamination at rates ranging from 20 to 100% of the surveyed locations. A total of 1 843 samples of soil and building material were collected in the screening level assessment. One community (Ga-Mopedi) was selected as being representative of the total cohort and a more detailed house to house survey was completed. A total of 1 486 samples were collected during the detailed survey. Results of the detailed survey revealed 26.2% of the homes were contaminated with asbestos containing soil and/or building material. A theoretical quantitative cumulative exposure assessment was developed to estimate the disease burden within the study area population of 126,130 individuals within the surveyed communities resulting in a predicted range of 25-52.4 excess deaths per year from lung cancer and mesothelioma due solely to environmental exposures to asbestos pollution.

Food is one of the main routes by which xenobiotic (synthetic) chemicals enter the body of man and wildlife. The routes could be from wrappers in which the foods are presented with possible transfer of the compounds to consumers, hence need for regular screening. The research work is aimed at investigating possible prevalence of phthalate esters in selected foods (cheese, polony and vienna) and their plastic wrappers from commercial stores in Tshwane metropolis. Food samples were purchased from selected stores, taken to the laboratory and stored at 4oC until analysed. Analysis was done by soxhlet extraction while determination and quantification of phthalates was carried out using Gas Chromatography-Flame Ionization Detection (GC-FID). Quality assurance of the process was by standard addition of the phthalate ester standards. Results obtained revealed good chromatographic separation of the analysed esters which ranged from 5.55 min for Dimethyl phthalate (DMP) to 8.96 min for Benzylbutyl phthalate (BBP). Instrumental detection limit of the esters varied from 0.03 - 0.05 μg/kg. The percentage recovery of the phthalate esters ranged from 75 – 90% from spiked cheese samples; 33 – 66% from spiked polony samples and 69 – 99% from spiked vienna samples. These recoveries are quite acceptable and applicable to the analysis and quantification of the compounds in the samples with the exception of Dibutyl phthalate (DBP) (33%); DMP (34%) and BBP (46 %) in polony samples. Results from chromatographic quantification revealed the absence of or non-detection of most of the analysed phthalate esters in the selected food samples. However, level of 0.031 μg/kg of BBP - 0.816 μg/kg of DMP were obtained in some of the analysed samples. / Environmental Sciences / M. Sc. (Environmental Science)

Submitted in fulfillment of the requirements for the degree of Doctor of Technology in Business Administration, Entrepreneurial Studies & Management Department, Durban University of Technology, Durban, South Africa, 2015.

Thesis (PhD)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: The Plankenbrug River runs past the dense settlement of Kayamandi, on the outskirts of Stellenbosch. This site was chosen to study the impact of water pollution from formal and informal urban developments on water quality and associated health factors. Aims of the study: (1) To determine some basic epidemiological characteristics of the exposed population of Kayamandi, their sanitation problems and reasons for poor hygiene; (2) To determine the microbiological and chemical pollution load patterns in the Plankenbrug River over time; (3) To investigate the spectrum of organisms present in the river (other than the indicator E. coli) and their epidemiological implications for health; (4) To establish the possible presence of organisms resistant to chlorine or to antibiotics in the river below Kayamandi as indicators of environmental hazard. Methods: During the period 5 May 1998 to 10 February 2003 microbiological and chemical analyses have been carried out every 6 weeks on water samples obtained at various points along the Plankenbrug River. Two large surveys (n=2196 persons and n=3568 persons) of the community of Kayamandi have been undertaken and door-to-door education campaigns were carried out with the aid of trained community health workers. Results: Below Kayamandi the river contains dangerously high levels of faecal contamination and it constitutes a health hazard to all persons coming into contact with the water. Up to 13 million Escherichia coli per 100 ml water was recorded (cut-off level as indicator of human safety is 1000 organisms per 100 ml water). Not all the faecal contamination originated from Kayamandi. Substantial amounts of faecal contamination sporadically entered the river at different points below Kayamandi. The pollution load resulting from these intrusions were sometimes larger than that contributed by the whole of Kayamandi. Water samples below Kayamandi were screened to ascertain what other pathogens were present. Amongst the organisms were 0 haemolytic Streptococcus Group A and B, Mycobacterium intracellulare, Staphylococcus spp, Klebsiella spp., Pseudomonas spp. and many others. The list of pathogens found had such serious implications that a confidential health warning was sent out to health care centres and other affected organisations in the area. |3 haemolytic Streptococcus Group A has never before been reported as isolated in viable form from free-flowing natural waters. Signs of increased resistance to chorine were found in organisms isolated from the river water. There were also organisms showing signs of resistance to commonly used antibiotics. The E. coli organisms that survived various levels of chlorine treatment also showed increased resistance to amoxycillin when compared to untreated E. coli organisms sampled from the Plankenbrug River. During the community phase of the project in Kayamandi a reduction in the pollution levels occurred over the summers of 2000 and 2001 (note that "improved" does not yet mean "safe" by any means). This can be ascribed to the multi-pronged approach of the project. Attention was given to service and repair of sanitation facilities, a strong accent on door-todoor community education about better sanitation behaviour, creation of a central reporting point for blockages and breakages, and training of artisans (plumbers, bricklayers, etc) from the community to help with upkeep. The community showed encouraging signs of wanting better sanitation education. The improvement in pollution levels is however in danger of reverting back to the previous dangerous situation if better support and co-operation cannot be obtained from the relevant authorities. There were 16.9% of households who reported one or more cases of diarrhoea during the survey period (5 weeks) - a very high prevalence seeing that the survey was carried out during a wet and cold winter period. Conclusions: Active planning and other steps to cope with the sewage intrusions into the river should be instituted without delay. The water quality of the Plankenbrug River downstream from Kayamandi is extremely poor. The water constitutes a serious health hazard and a threat to downstream economic activities. The settlement of Kayamandi demonstrated that education, when coupled with maintenance and repairs of existing toilet facilities, can bring about a reduction in pollution loads, but that this should be an ongoing process and not be reduced to sporadic attempts. / AFRIKAANSE OPSOMMING: Die Plankenbrug Rivier vloei verby die digbewoonde nedersetting van Kayamandi aan die buitewyke van Stellenbosch. Hierdie plek is gekies as studie-area om die impak te bestudeer van waterbesoedeling wat van formele en informele dorpsontwikkeling afkomstig is, asook die geassosieerde gesondheidsfaktore. Doel van die studie: (1) Om sommige basiese epidemiologiese eienskappe van die blootgestelde populasie, hulle sanitasieprobleme en redes vir die swak higiene te bepaal; (2) Om die mikrobiologiese en chemiese besoedelingspatrone in die Plankenbrug Rivier oor tyd te bepaal; (3) Om die spektrum van organismes teenwoordig in die rivier (anders as E. coli) te bepaal asook hulle epidemiologiese implikasies op gesondheid; (4) Om vas te stel, as indikatore van omgewingsgevaar, of daar moontlik organismes teenwoordig is wat weerstandig is teen chloriene en antibiotika in die rivier onder Kayamandi. Metodes: Gedurende die afgelope vier jaar is mikrobiologiese en chemiese ontledings elke 6 weke uitgevoer van watermonsters wat van verskeie punte op die Palnkenbrug Rivier verkry is. Twee groot opnames is in die gemeenskap van Kayamandi ondemeem (n=2196 persone en n=3568 persone) en deur-tot-deur opvoedingsveldtogte is uitgevoer met die hulp van plaaslik opgeleide gemeenskapsgesondheidswerkers. Resultate: Onder Kayamandi bevat die rivier gevaarlike vlakke van fekale besoedeling en dit hou gesondheidsgevare in vir alle persone war daarmee in aanraking kom. Op tot 13 miljoen Escherichia coli per 100 ml water is genoteer (boonste grens van veiligheid vir die mens is 1000 organismes per 100 ml water). Nie al die fekale kontaminasie is afkomstig van Kayamandi nie. Substansiele hoeveelhede kontaminasie dring die rivier binne op verskillende punte ver onder Kayamandi. Hierdie besoedelingslading is soms groter as wat van die hele Kayamandi afkomstig is. Watermonsters geneem onder Kayamandi is ondersoek om vas te stel watter ander siekteveroorsakende organismes ook teenwoordig was. Onder die organismes gevind was (3 hemolitiese Streptococcus Groep A en B, Mycobacterium intracellulare, Staphylococcus spp., Klebsiella spp., Pseudomonas spp. en baie ander. Die lys van patogene wat gevind is, het sulke emstige implikasies dat 'n vertroulike gesondheidswaarskuwing uitgestuur is na gesondheidsdienspunte en ander geaffekteerde organisasies in die gebied. (3 hemolitiese Streptococcus Groep B is nog nie vantevore aangemeld as lewensvatbaar geisoleer uit vryvloeiende natuurlike waters nie. Tekens is gevind dat daar organismes in die rivier voorkom wat weerstandig is teen chloorbehandeling en ook teen algemeen gebruikte antibiotika. Die E. coli organisme wat verskillende konsentrasies van chloorbehandeling oorleeef het, het ook verhoogde weerstand teen amoksisilien getoon wanneer hulle vergelyk was met onbehandelde E. coli organisme wat van die Plankenbrug Rivier gemonster was. Gedurende die gemeenskapsfase van die projek is daar 'n verlaging van besoedelingsvlakke in die rivier gevind gedurende die somers van 2000 en 2001 (let op dat "verbetering" hier nog glad nie "veilig" beteken nie). Dit kan toegeskryf word aan die veelvlakkige benadering wat die projek gevolg het. Aandag is geskenk aan diens en herstel van sanitasiegeriewe met 'n sterk klem op deur-tot-deur opvoedingsveldtogte met die oog op beter sanitasiegedrag, skepping van 'n sentrale aanmeldpunt vir blokkasies en brekasies, en opleiding van ambagslui (loodgieters, messelaars, ens) uit die gemeenskap om te help met onderhoud. Die gemeenskap het bemoedigende tekens getoon dat hulle beter sanitasie opvoeding verlang. Die verbetering in die besoedelingsvlakke in die rivier loop egter gevaar om terug te val na die vorige gevaarlike vlakke as daar nie beter ondersteuning en samewerking van die onderhawige owerhede verkry kan word nie. Daar was 16.9% van huishoudings wat een of meer gevalle van diarree aangemeld het gedurende die 5 weke van die opnameperiode - 'n baie hoe prevalensie siende dat die opname uitgevoer was gedurende 'n nat en koue winterperiode. Gevolgtrekkings: Aktiewe beplanning en ander stappe om die riool-indringing in die rivier die hoof te bied is gebiedend noodsaaklik en behoort sonder versuim ingestel te word. Die waterkwaliteit van die Plankenbrug Rivier stroomaf van Kayamandi is baie swak. Die water hou emstige gesondheidsgevare in en is ook 'n bedreiging vir die ekonomiese aktiwiteite stroomaf. Die nedersetting van Kayamandi demonstreer ook dat opvoeding, wanneer gekoppel aan onderhoud en herstel van bestaande toiletgeriewe in verlaging teweeg kan bring van besoedelingsvlakke, maar dat dit 'n voortgesette program moet wees en nie net sporadiese pogings nie.

For many decades, the World Health Organisation had highlighted the growing importance of chronic non-communicable diseases in developed and developing countries, with an increase in lifestyle-related diseases. Physical inactivity has been identified as one of the risk factors, in addition to other leading risk factors like diet, and the use of tobacco and alcohol, contributing to the occurrence of non-communicable diseases like cardiovascular diseases, cancers, obesity and type 2 diabetes mellitus. Based on the researcher's observations while living in Belhar community for more then ten years, it was hypothesized that the level of physical inactivity among adolescents could become a public health problem in the future if not addressed immediately.

Thesis (M Sport Sc (Sport Science))--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Adolescence is the period between childhood and adulthood. This phase starts between the ages of 11 and 13 years and ends between 17 and 21 years. Adolescence was seen as a phase of development, growth and excellent health in the past, but that is not the case in the 21st century. The health of adolescent are being influenced by technology such as computers and televisions, crime, poor eating habits, the absence of Physical Education at schools, urbanization, overpopulation and less available space for children to play. These aspects lead to a sedentary lifestyle which may impact their health in the form of hypokinetic diseases. The primary aim of this study was to determine the lifestyle patterns of adolescents in selected Western Cape high schools. The secondary aims of this study were to determine the lifestyle patterns of different ethnic groups; those of boys and girls; and to compare these lifestyle patterns with those of adolescents 10 years ago. In this study, two questionnaires were used for data collection: a questionnaire for the adolescents; and one for the Life Orientation teachers. The high schools (N=30) were randomly selected to partake in the study. Out of each school learners (N=60) were also randomly selected to partake in the study. The 60 learners consisted of [n=15] boys and [n=15] girls in Grade 9 and [n=15] boys and [n=15] girls in Grade 11 between the ages of 15 and 17 years. One Life Orientation teacher was also randomly selected from each school. Data from the two questionnaires were coded in computer format and statistically analysed with the computer program Stasoft Statistica Version 10. From the results of the study it can be concluded that neither White nor Coloured adolescents found school sport important nor they did not partake in sporting activities on a regular basis. Adolescent boys, on the other hand, were found to be much more active than adolescent girls. Adolescent girls preferred sedentary activities like listening to music and reading books. Both White and Coloured adolescents, and boys and girls, found their health to be excellent despite the fact that research showed the opposite to be true. White adolescents also found socialising more important than Coloured adolescents. Coloured adolescent on the other hand found household chores more important. Boys and Coloured adolescents attended self defence classes on a regular basis. This study is a follow-up study on one conducted by Van Deventer in 1999. It serves as a basis for further research and it is recommended that a new study should be conducted every 10 years to determine changes in the lifestyle patterns of adolescents so that it can be addressed. Further research is recommended because of the low feedback of Life Orientation teachers to determine and address the status of Life Orientation presently in schools, the attitudes of teachers and learners toward Life Orientation, Education and training of Life Orientation teachers, apparatus and facilities needs and time allocation towards the movement component in Life Orientation. Further research is also recommended because of the insufficient feedback received from Black learners. It is also important to determine their lifestyle patterns so that recommendations in this regard can be made. / AFRIKAANSE OPSOMMING: Adolessensie is die periode tussen die kinderjare en volwassenheid. Die fase begin tussen die ouderdomme van 11 en 13 jaar en eindig tussen 17 en 21 jaar. Adolessensie is vroeër as 'n fase van groei, ontwikkeling en goeie gesondheid beskou maar dit is nie meer die geval nie. Adolessente se gesondheid word huidig deur beskikbare tegnologie soos televisie en rekenaars, vervoer, misdaad, verstedeliking, minder sportgronde as gevolg van oorbevolking, gebrekkige Liggaamlike Opvoeding by skole en ongesonde eetgewoontes belemmer. Dit kan tot sedentêre leefstylpatrone aanleiding gee wat hipokinetiese siektes kan meebring. Die hoofdoel van die studie was om die leefstylpatrone van adolessente in geselekteerde hoërskole van die Wes-Kaapse Onderwysdepartement te bepaal. Daar was ook op die volgende subprobleme gefokus: die vergelyking van die leefstylpatrone van verskillende etniese groepe, die vergelyking van die leefstylpatrone van seuns en meisies en die vergelyking van die leefstylpatrone van huidige adolessente met dié van 10 jaar gelede. Twee vraelyste was vir die insameling van die data gebruik. Een wat leerders en die ander die Lewensoriëntering-onderwyser voltooi het. Die hoërskole (N=30) was ewekansig geselekteer. Uit elke hoërskool was leerders (N=60) ewekansig: uit Graad 9 [n=15] seuns en [n=15] meisies en uit Graad 11 [n=15] seuns en [n=15] meisies tussen die ouderdomme van 15 en 17 geselekteer. Een Lewensoriëntering-onderwyser per skool was ook ewekansig geselekteer. Die data wat vanaf die vraelyste verkry was, is in rekenaarformaat gekodeer en statisties verwerk. Stasoft Statistica Weergawe 10 is vir verdere dataverwerking gebruik. Daar is tot die gevolgtrekking gekom dat beide Wit en Bruin adolessente sport as onbelangrik geag het en ongereeld daaraan deelneem het. Adolessente seuns het sport belangriker geag en ook meer gereeld as adolessente meisies daaraan deelgeneem. Adolessente meisies het sedentêre aktiwiteite, soos om te lees en na musiek te luister, belangriker as adolessente seuns geag. Wit en Bruin adolessente, en die seuns en meisies, het hul gesondheid goed geag al bewys navorsing die teendeel. Wit adolessente het meer as Bruin adolessente gesosialiseer, terwyl Bruin adolessente huishoudelike take belangriker as Wit adolessente geag het. Adolessente seuns en Bruin adolessente het gereeld selfverdedigingsklasse bygewoon. Die onderhawige studie is 'n opvolgstudie wat deur Van Deventer in 1999 uitgevoer is en dien as rigtingwyser vir verdere navorsing. 'n Opvolgstudie elke 10 jaar is ideaal sodat die veranderinge in leefstylpatrone onder adolessente gemonitor en aangespreek kan word. Verdere navorsing word as gevolg van die lae terugvoersyfer van Lewensoriënteringonderwysers aanbeveel sodat die volgende aangespreek kan word: die status wat Lewensoriëntering huidig geniet; die gesindheid van onderwysers en leerders teenoor Lewensoriëntering; onderwyseropleiding; apparaat en fasiliteit behoeftes; en die tydstoekenning vir die bewegingskomponent van Lewensoriëntering. Verdere navorsing word as gevolg van die lae terugvoersyfer van Swart adolessente aanbeveel sodat hul leefstylpatrone ook bepaal en aanbevelings daarvolgens gemaak kan word.

Thesis (MTech (Environmental Health))--Cape Peninsula University of Technology, 2019. / Background: A recent review on the effects of ambient air pollution on human health in sub-Saharan Africa, specifically calls for an urgent need for more epidemiological studies in developing countries due to a lack of data in these countries. Air pollution information on exposure is important for understanding and addressing its public health impact in developing countries. In many African countries, the spatial distribution of air pollutants has not been quantified even though air pollution is a global public health risk. The main goal of the study was to quantify and compare the seasonal spatial variation of household air pollution in the 4 Western Cape neighbourhoods. Methods: Weekly indoor and outdoor measurements of Particulate Matter (PM2.5), Sulphur dioxide (SO2), Ozone (O3), Carbon monoxide (CO) and Nitrogen dioxide (NO2) were conducted at 127 households in four informal settlement areas (Khayelitsha, Marconi-Beam, Masiphumulele and Oudtshoorn) during one month each in summer and winter. PM2.5 measurements were conducted using Mesa Labs GK2.05 (KTL) cyclone with the GilAir Plus Air Sampling Pump, Gases were measured using Passam passive samplers. Statistical analyses were performed using Stata V12. Simple linear regression was used to evaluate the relationship between continuous exposure levels and the respective predictor variables. These include distance to major roads, bus routes, open grills and waste burning sites. Results: The highest average weekly outdoor PM2.5 and NO2 concentrations for summer were recorded in Milnerton (8.76 µg/m3 and 16.32 µg/m3 respectively). However, the highest average concentrations during winter for PM2.5 were recorded in Oudtshoorn (PM2.5: 16.07 µg/m3), whilst the highest NO2, was recorded in Khayelitsha (NO2: 35.69 µg/m3). SO2 levels were consistently low during both seasons. Noordhoek generally recorded the lowest average levels for all pollutants. Winter average weekly concentrations were generally higher than the levels recorded in summer for all pollutants. In a sub-sample of indoor and outdoor measurements, the results were comparable for PM2.5, NO2 and CO. However, the results of Ozone (O3) showed relatively higher (~10 times) outdoor compared to indoor levels. Linear regression modelling results revealed that significant predictors of elevated exposure to PM2.5 were proximity to construction activities and open grills. Analysis demonstrated a clear dose-response relationship with distance, with open grills within 1000m associated with a 0.33 µg/m3 increase in PM2.5 to 6.77 µg/m3 at a distance of 25 meters. Results from the linear regression modelling revealed that significant predictors of exposure to NO2 were proximity to rapid transport bus stops, bus routes, taxi routes and major routes. Distance to rapid transport bus stops demonstrated an increase in NO2 between 0.09 µg/m3 (at 1km) to 2.16 µg/m3 (at 50m) during summer. A similar pattern was observed for taxi routes and bus routes displaying an increase of 6.26 μg/m3and 6.82 μg/m3 respectively within the proximity of 1000 meters. / MAUERBERGER Foundation Scholarship