A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Science in Medicine (Pharmaceutical Affairs) Johannesburg, 29 August 2014 / In South Africa’s current healthcare structure, about 8.3% of GDP is spent on healthcare. This is well above the WHO recommended 5% of GDP spend. Despite the heavy spending, health outcomes remain poor when compared to similar middle-income countries. Solutions need to be found to cut back on healthcare costs. Approximately half (4.1%) of the healthcare spend is consumed by the private sector which benefits a very small segment (16%) of the population. This segment is largely on medical schemes. Using generic medicines can aid in cutting back on drug costs but are generics being adequately assimilated by the consumers of healthcare in the private sector? The objective of the study was to evaluate the perceptions attitudes and knowledge of the consumers of healthcare in the Northern suburbs of Johannesburg towards generic medicines. A survey was conducted on a sample of 402 respondents across 9 randomly selected pharmacies in the Johannesburg north region between November 2012 and February 2013. A researcher administered questionnaire was the sole data collection tool. Questions asked covered the research objectives and also included demographic data and other explanatory variables. Data analysis was carried out in SAS. The 5% significance level was used throughout, unless specified otherwise. The chi-squared (Χ2 ) test was used to assess the relationships between categorical variables. Fisher’s exact test was used for 2 x 2 tables or where the requirements for the Χ2 test could not be met. The strength of the associations was measured by Cramer’s V and the phi coefficient respectively. Key results on respondent demographics included high representation of the higher income earning groups (78% >R10 000); furthermore 44% had completed tertiary education, 60% were comprehensively insured, 61% regularly visited a pharmacy, 38% were on prescription medication and 24% on chronic medicine. On knowledge, 5% of respondents were able to most accurately define generic medicines. On attitudes, 78% had used generics however the level of agreement was lower for the highest education category (p<0.0001; Cramer’s V=0.18). Trends favoured brands over generics with increasing severity of illness as generics were chosen by 10% in major illness and 5% in chronic illness. 80% perceived generics as safe while 95% perceived brands as safe. 75% of respondents felt that generic medicines were as effective as branded medicines. 15% indicated that branded medicines have fewer side effects. 64% showed positive perceptions of quality of generics compared to 93% for brands. Bowker’s test of symmetry was significant (p<0.0001) showing a shift towards slightly more negative perceptions towards generic medicines amongst those who thought highly of brand quality. Knowledge of generics was overall low. Perceptions regarding safety, quality, efficacy, and side effects of generic medicines were generally positive but responses proved more positive for brands. Attitudes towards generic medicines were mostly positive however willingness to use generics lessened with increasing severity of illness. Household income, health insurance (medical aid) status, level of education, experience with medicines and racial demographics played a key role in explaining consumer beliefs and behaviours. Pharmacists and Doctors had a positive influence on generic use patterns amongst other factors.

A thesis submitted in fulfilment of the requirements for the degree of Master of Public Health in the department of school of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg, 2003 / Smoking is a preventable cause of death. Young people start smoking at an early age due to certain external influences such as peer pressure, advertising etc. Once they start smoking, they often remain smokers forever because of the addictive effects of nicotine. The international studies show that the high morbidity and mortality rates caused by cigarette smoking can be reduced if health promotion strategies target school going children. The aim of the study was to investigate knowledge, attitudes and practices of students in matric as regards smoking in the Greater Tshwane Metropolitan area (Pretoria). This will inform the health promotion programmes, in particular health education, dealing with tobacco smoking prevention and control in schools / IT2018

Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (leaves 165-178).

Thesis (Ph. D.)--University of Missouri-Columbia, 2006. / "December 2006" The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. Includes bibliographical references.

A Research report submitted to the Faculty of Health Sciences at the University of the Witwatersrand in partial fulfillment of Master of Medicine in Emergency Medicine Johannesburg, 2016 / Objective Intimate partner violence (IPV) is a significant social and health concern in South Africa, with far reaching consequences. One in three South African women will experience IPV, and many of the survivors of IPV will have contact with Emergency Care Practitioners (ECPs), either for treatment related to the direct sequelae of the abuse or for other health issues. ECPs already play a role in identifying and managing IPV but current knowledge, attitudes and practices were not known. The aim of the study therefore was to describe current levels of knowledge, attitudes and practices regarding IPV amongst ECPs, including doctors, nurses and paramedics in South Africa and to describe differences according to the respondent's reported prior training and profession. Methods A prospective, cross sectional study was performed using an online survey administered anonymously to ECPs in South Africa. Information regarding demographic data, qualification, prior IPV training, knowledge, attitudes and practices towards IPV were obtained. Results One hundred and fifty three respondents completed the survey. Of those 56% were doctors, 33% paramedics and 9.8% nurses. In total 65% reporting having received no training on IPV. There was a significant association between respondents reporting having received any IPV training and improved self-reported knowledge (p=0.0001), and actual knowledge (p=0.011). Of the respondents in clinical practice 75% had diagnosed IPV in the last six months, although the frequency of diagnoses being made is lower than would be suggested by the South African prevalence rates. Those respondents who reported any prior training on IPV were more likely to have diagnosed IPV in the last 6 months (p= 0.0076) Most of the ECPs who diagnosed IPV counselled the patients on options and/or referred to police and/or social workers. Conclusion Although ECPs are diagnosing and managing IPV, training in this important health concern is inadequate. Any reported training on IPV for ECPs improves self-reported knowledge, actual knowledge and practices regarding IPV. / MT2017

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Objetivou-se avaliar o conhecimento, a atitude e a prÃtica dos enfermeiros atuantes na EstratÃgia SaÃde da FamÃlia (ESF) acerca do controle da sÃfilis na gestaÃÃo; associar as variÃveis explanatÃrias com o conhecimento, a atitude e a prÃtica dos enfermeiros acerca do controle da sÃfilis na gestaÃÃo e comparar o conhecimento e a atitude com a prÃtica em relaÃÃo à sÃfilis na gestaÃÃo. Trata-se de um estudo avaliativo do tipo Conhecimento, Atitude e PrÃtica (CAP) e abordagem quantitativa, realizado no perÃodo de junho a agosto de 2012, com 171 enfermeiros da ESF, utilizando-se como instrumento um questionÃrio inquÃrito CAP em relaÃÃo à sÃfilis na gestaÃÃo. Os dados foram organizados em tabelas e grÃficos, segundo a estatÃstica descritiva e inferencial utilizando-se os testes Mann-Whitney, Kruskal-Wallis, Qui-quadrado e Fisher. O estudo foi aprovado pelo COMEPE/UFC com o protocolo de n 81/12. Quanto ao perfil dos enfermeiros, verificou-se uma idade mÃdia de 37,5 anos, com 90,1% do sexo feminino, 64,3% com ensino superior em instituiÃÃes pÃblicas e 77,8% sÃo especialistas, formados hà cerca de 12 anos, atuando na ESF hà uma mÃdia de 9 anos e 53,8% tinha alguma capacitaÃÃo sobre a temÃtica. Em relaÃÃo ao conhecimento dos enfermeiros, a maioria (67,3%) foi classificada como adequado, mas ainda 32,7% de enfermeiros teve conhecimento inadequado e regular. Quanto à atitude e prÃtica, observou-se 97,1% dos participantes tinham crenÃas e opiniÃes adequadas e 94,2% as colocavam em prÃtica adequadamente. Houve uma associaÃÃo estatisticamente significativa entre a instituiÃÃo de graduaÃÃo e a atitude dos enfermeiros; a autoclassificaÃÃo positiva em relaÃÃo ao conhecimento acerca da sÃfilis na gestaÃÃo com a prÃtica adequada; o conhecimento e a prÃtica, bem como entre a atitude e a prÃtica. As principais dificuldades percebidas pelos enfermeiros no controle da sÃfilis congÃnita foram: a demora dos resultados dos exames de VDRL (45,6%); a dificuldade de convocar o(s) parceiro(s) e a sua adesÃo ao tratamento (28,1%), assim como o inÃcio tardio do prÃ-natal (19,9%). Frente ao exposto, destaca-se a importÃncia do reconhecimento da sÃfilis congÃnita como um importante problema de saÃde pÃblica pelo enfermeiro, visto que a partir de suas aÃÃes adequadas e baseadas no conhecimento tÃcnico-cientÃfico podem interferir diretamente no controle da sÃfilis congÃnita, ofertando-se uma assistÃncia prÃ-natal de qualidade, integral e humanizada.

Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 144-158).

No Brasil, o exame citolÃgico de Papanicolaou à a principal estratÃgia recomendada para a prevenÃÃo do cÃncer de colo do Ãtero (CCU), orientado para as mulheres de 25 a 64 anos, realizado a cada trÃs anos, apÃs dois exames normais consecutivos realizados com um intervalo de um ano. Esta pesquisa objetivou identificar os fatores relacionados com a prÃtica inadequada do exame Papanicolaou pelas mulheres em um municÃpio do interior do CearÃ. Para tanto, foi realizado um estudo transversal com abordagem quantitativa. A coleta foi no perÃodo de junho à outubro de 2013 no distrito sanitÃrio V do municÃpio de Juazeiro do Norte-CE. A amostra foi calculada atravÃs da fÃrmula para populaÃÃes finitas, perfazendo um valor de 240 mulheres, as quais foram inclusas a partir dos seguintes critÃrios: ter idade compreendida entre 20 e 59 anos; ter iniciado vida sexual e aceitar participar da pesquisa. Eram excluÃdas aquelas que nÃo estavam em plena condiÃÃo fÃsica ou mental e nÃo estavam na unidade de saÃde no momento da coleta de dados. Utilizou-se como instrumento de coleta de dados, o inquÃrito domiciliar do tipo Conhecimento, Atitude e PrÃtica, aplicado e posteriormente classificado pela pesquisadora segundo critÃrios de adequaÃÃo. Os dados obtidos foram armazenados e analisados pelo software STATA, versÃo 12.0. Os dados evidenciaram que todas as entrevistadas informaram ter ouvido falar do exame Papanicolaou, mas em 72,9% destas o conhecimento foi avaliado como inadequado. A atitude inadequada tambÃm apresentou percentuais elevados (73,3%). A prÃtica foi classificada como inadequada em 39,2% da amostra, na qual 13,3% afirmaram nunca ter se submetido ao exame, e 23,6% o realizaram hà mais de trÃs anos. ApÃs o teste de Odds Ratio ajustado, as seguintes variÃveis revelaram relevÃncia estatÃstica para a prÃtica inadequada: idade entre 20 e 29 anos (OR(IC)=2.25), estado civil solteira (OR(IC)=3.18) e conhecimento inadequado (OR(IC)=2.90). As dificuldades encontradas para a realizaÃÃo do exame Papanicolaou na unidade de saÃde, as variÃveis de maiores percentuais para a prÃtica inadequada foram: falta de material (68,1%), vergonha do profissional (27,6%) e nÃo gostar do profissional que realiza o exame (20,8%). Percebeu-se a partir desta pesquisa, a importÃncia do esclarecimento à populaÃÃo e a comunicaÃÃo efetiva por parte dos profissionais das equipes da EstratÃgia SaÃde da FamÃlia acerca da problemÃtica relacionada ao CCU e sua prevenÃÃo, assim como a garantia e apoio à continuidade do cuidado por parte dos gestores. / In Brazil, the Pap test is the primary recommended strategy for the prevention of cervical cancer (CCU) cancer, targeted at women 25-64 years old, held every three years after two consecutive normal tests performed a interval of one year. This research aimed to identify the factors related to inadequate practice of Pap smear for women examination on a city in the interior of CearÃ. Thus, a cross-sectional study was conducted using a quantitative approach. The collection was from June to October 2013 in the health district V of Juazeiro do Norte-CE. The sample was calculated using the formula for finite populations, totaling a value of 240 women who were included based on the following criteria: age between 20 and 59 years; have initiated sexual life and accepting participate. Excluded were those who were not in full physical or mental condition and were not at the clinic at the time of data collection. Was used as an instrument of data collection, the household survey-type Knowledge, Attitude, Practice, and subsequently applied by the researcher classified according to criteria of adequacy. Data were stored and analyzed using STATA software, version 12.0. The data showed that all respondents reported having heard of the Pap smear, but in 72.9% of the knowledge was assessed as inappropriate. Improper attitude also showed high percentage (73.3%). The practice was classified as inadequate in 39.2% of the sample, in which 13.3% reported never having undergone the examination, and 23.6% have done it for over three years. After the adjusted Odds Ratio test, the following variables showed statistical significance for appropriate practice: age between 20 and 29 years (OR (CI) = 2.25), single marital status (OR (CI) = 3.18) and inadequate knowledge (OR (CI) = 2.90). The difficulties encountered in the realization of the Pap smear in the health unit, the variables of higher percentages for inadequate practice were lack of material (68.1%), shame the professional (27.6%) and not like the professional who performs the examination (20.8%). It was realized from this research, the importance of clarifying the population and effective communication among professionals of the teams of the Family Health Strategy about the issues related to cervical cancer and its prevention, as well as warranty and support continuity of care by managers.

A Research Report submitted to the Faculty of Health Science, University of Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Community Dentistry Johannesburg, 2016 / Oral care for patients with HIV/AIDS plays a vital role in improving their nutritional intake, medication tolerance and effectiveness, treatment success rate, as well as quality of life. As the number of people living with HIV/AIDS increases, the possibility of oral healthcare professionals treating more patients with HIV/AIDS will increase and this will result in an increased risk of cross contamination in the dental setting. Aim was to determine the knowledge, attitude and infection control practices of undergraduate dental and oral hygiene students when managing patients with HIV/AIDS. This KAP survey was of a cross-sectional design with an analytical component conducted among 108 dental and oral hygiene students. A validated questionnaire was utilized as a study instrument of choice. A convenience sampling technique was utilized and all students in the target population formed the study sample. Results: The study sample had a mean age of 21 (20 - 23) years, with the majority being females 82 (75.93%) as opposed to 26 (24.07%) males. The average knowledge level of students regarding HIV/AIDS was approximately 55% with a standard deviation of 0.15; the median was 0.55 with a min-max value of (0.2-1.0). [Table2]. Twenty nine per cent of the students (31) had a moderate knowledge level regarding the management of HIV/AIDS patients. Just over half of the cohort, 60(55.56%) of the students had a positive attitude, 44(40.74%) had a passive attitude and 4(3.70%) students had a negative attitude. The infection control practices were of a good quality among the clinical students, with an average of 78.87% (std: 15.61%). Three quarters 53 (76%) of these students had good infection control practice and 17(24%) students had excellent infection control practices. Conclusion: The dental curriculum needs to be appropriately modified, existing learning activities and practical skills should be adapted to ensure future dental practitioners have the clinical competence, in combination with relevant knowledge to provide excellent and appropriate care to patients with HIV/AIDS or any other common transmissible diseases. / MT2017

Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 69-75).