O propósito desta pesquisa foi o de contribuir para a discussão de questões que dizem respeito às peculiaridades do ensino em saúde pública do Programa de Pós-Graduação Stricto Sensu da Faculdade de Saúde Pública da Universidade de São Paulo (FSP). Trata-se de um estudo de caso, cujo caminho metodológico buscou compreender o processo de formação mediante as representações daqueles que nele atuam. Foram colhidos depoimentos de dez alunos e oito professores e analisados documentos referentes ao desenvolvimento dos cursos de mestrado e doutorado na FSP entre 1990 e 1997. A partir do estudo foi possível constatar que a pós-graduação da FSP não vem respondendo às mudanças ocorridas no quadro social sanitário do país, e às recentes transformações no ensino superior, ressentindo-se de um projeto próprio que responda às novas necessidade de formação de profissionais nesse campo. / The purpose of this research was to contribute to the discussion of subjects regarding to the peculiarities of the teaching in the public health of the Post Graduation Stricto Sensu Program of the Faculdade de Saúde Pública of the Universidade de São Paulo (FSP). It is a case study whose methodology is an attempt to understand the educacional process according to the representation by those who are directly involved in this program. Statements from ten students and eight teachers have been gathered and documents related to the development of the master’s degree courses have been analysed, so as to the doctor’s degree courses, in the FSP, between 1990 and 1997. In carrying out this study it was possible to identify the Post Graduation Program of the FSP has not been providing any guidance that should corresponding the recent changes occured in the social and sanitary sector as well as in the university teaching in the country, revealing a lack of a personal educational development that provides the real requiriments in preparing professionals in this area.

O propósito desta pesquisa foi o de contribuir para a discussão de questões que dizem respeito às peculiaridades do ensino em saúde pública do Programa de Pós-Graduação Stricto Sensu da Faculdade de Saúde Pública da Universidade de São Paulo (FSP). Trata-se de um estudo de caso, cujo caminho metodológico buscou compreender o processo de formação mediante as representações daqueles que nele atuam. Foram colhidos depoimentos de dez alunos e oito professores e analisados documentos referentes ao desenvolvimento dos cursos de mestrado e doutorado na FSP entre 1990 e 1997. A partir do estudo foi possível constatar que a pós-graduação da FSP não vem respondendo às mudanças ocorridas no quadro social sanitário do país, e às recentes transformações no ensino superior, ressentindo-se de um projeto próprio que responda às novas necessidade de formação de profissionais nesse campo. / The purpose of this research was to contribute to the discussion of subjects regarding to the peculiarities of the teaching in the public health of the Post Graduation Stricto Sensu Program of the Faculdade de Saúde Pública of the Universidade de São Paulo (FSP). It is a case study whose methodology is an attempt to understand the educacional process according to the representation by those who are directly involved in this program. Statements from ten students and eight teachers have been gathered and documents related to the development of the master’s degree courses have been analysed, so as to the doctor’s degree courses, in the FSP, between 1990 and 1997. In carrying out this study it was possible to identify the Post Graduation Program of the FSP has not been providing any guidance that should corresponding the recent changes occured in the social and sanitary sector as well as in the university teaching in the country, revealing a lack of a personal educational development that provides the real requiriments in preparing professionals in this area.

Philosophiae Doctor - PhD / The prevention of abortion related complications and mortality is dependent on the availability, accessibility and usability of emergency post-abortion care (PAC) throughout the health care system. Unfortunately, abortion is not legal in Nigeria and Nigerian women, especially adolescents, are often unable to obtain adequate post-abortion care services due to a variety of reasons. A review of literature shows that adolescent PAC patients receive worse care than older women seeking PAC services. There is widespread recognition of the need to overcome these barriers and make it easier for women to obtain the PAC services they need. Therefore, overall aim of this research study was to provide empirical information on the barriers and challenges to adolescents' PAC and develop a policy document to inform reproductive health services for Nigerian hospitals. To develop this policy document, the study specifically sought to assess knowledge of reproductive-health and related post-abortion care services among health care providers; describe the adolescents' perception of post-abortion care received; determine the service providers' perspectives on adolescents' post-abortion care challenges and barriers; analyze the challenges and barriers faced by adolescents in obtaining post-abortion care services; explore ways in which the knowledge about challenges and barriers to adolescents' post-abortion care can be used to inform policy; develop policy document and make recommendations in key areas to improved PAC services in Nigeria as part of working towards improving reproductive health services.

<p>This study investigated the challenges facing a category of community health workers (Health Surveillance Assistants) in rural Malawi district of Nkhatabay following the expansion of their programme funding from the Global Funding to fight AIDS, Tuberculosis and Malaria (GFATM). The study has noted that HSAs are facing serious accommodation problems due to the lack of involvement of communities in their selection and that many HSAs are recruited from outside their catchment areas. The study has put forward some recommendations to the Ministry of Health and other stakeholders like United Nations Children&rsquo / s Fund (UNICEF) and the World Health Organization (WHO) to consider in making the HSAs programme in Nkhatabay district effective. Some of the recommendations made are that supervision of the HSAs by the EHOs and the ECHNs should be intensified and that infrastructure support should be provided to the HSAs for them to be able to deliver the EHP. Infrastructure like buildings and equipment like refrigerators and bicycles should be provided to HSAs and ensure that there is a plan for their maintenance.</p>

<p>This study investigated the challenges facing a category of community health workers (Health Surveillance Assistants) in rural Malawi district of Nkhatabay following the expansion of their programme funding from the Global Funding to fight AIDS, Tuberculosis and Malaria (GFATM). The study has noted that HSAs are facing serious accommodation problems due to the lack of involvement of communities in their selection and that many HSAs are recruited from outside their catchment areas. The study has put forward some recommendations to the Ministry of Health and other stakeholders like United Nations Children&rsquo / s Fund (UNICEF) and the World Health Organization (WHO) to consider in making the HSAs programme in Nkhatabay district effective. Some of the recommendations made are that supervision of the HSAs by the EHOs and the ECHNs should be intensified and that infrastructure support should be provided to the HSAs for them to be able to deliver the EHP. Infrastructure like buildings and equipment like refrigerators and bicycles should be provided to HSAs and ensure that there is a plan for their maintenance.</p>

Magister Public Health - MPH / This study investigated the challenges facing a category of community health workers (Health Surveillance Assistants) in rural Malawi district of Nkhatabay following the expansion of their programme funding from the Global Funding to fight AIDS, Tuberculosis and Malaria (GFATM). The study has noted that HSAs are facing serious accommodation problems due to the lack of involvement of communities in their selection and that many HSAs are recruited from outside their catchment areas. The study has put forward some recommendations to the Ministry of Health and other stakeholders like United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) to consider in making the HSAs programme in Nkhatabay district effective. Some of the recommendations made are that supervision of the HSAs by the EHOs and the ECHNs should be intensified and that infrastructure support should be provided to the HSAs for them to be able to deliver the EHP. Infrastructure like buildings and equipment like refrigerators and bicycles should be provided to HSAs and ensure that there is a plan for their maintenance. / South Africa

Magister Public Health - MPH / The Health Extension Program (HEP) was initiated under the Health Sector Development Program (HSDP II) in 2002/03. The central philosophy of these initiatives was based on the belief that if the right knowledge and skill is transferred, each household can take responsibility for producing and maintaining its own health. The HEP is delivered through Health Extension Workers (HEWs), who are local women and have completed grade 10. Recruitment of these workers is conducted by kebele (village) and woreda (district) councils. Following this they are provided with a one year training prior to being employed by the district health office. The HEP guideline states that all HEWs should be assigned to a health post within their own community.The rationale for this requirement is that health policy makers and mangers believe that the deployment of non-local HEWs results in poor performance and turnover. However, there is no evidence to support this assumption. This study was conducted to better understand the effect of place of selection on the performance of health posts and turnover of Health Extension Workers in Jimma Zone, Ethiopia.A cross sectional analytical study design was utilized to assess the effect of place of selection on the performance of health posts and turnover of HEWs in a randomly selected sample of six districts of Jimma Zone. A systematic record review on the activity reports for the Ethiopian Fiscal Year (EFY) 2003 was conducted on all selected health posts in Jimma Zone(239 randomly selected health posts from all functional rural and urban health posts in Jimma Zone) obtained from the district health office. Descriptive statistics was computed to describe the socio demographic characteristics and the level of performance. Chi-square test was performed to test the relationship amongst the variables.The finding from this study showed that HEWs who are assigned outside of their communities performed as well or even better than those recruited from the same communities.The differences between the relationship of staff turnover and retention couldn‟t be estimated due to limited availability of information related to this factor. Overall, despite the widely held opinion among policy makers that recruiting HEWs from the same community enhances their performance; there is little empirical evidence to support this argument based on the findings from this study. Thus, it is essential to explore additional factors and criteria in the selection and recruitment process beyond residence-based measures in the expectation to enhance the performance of the HEWs.

Introduction: Physical inactivity is thought to contribute to the emergence of non-communicable diseases in post-conflict settings of low-income countries. Sport-for-development (SfD) organisations in these regions claim to improve the health of programme participants. However, there is a paucity of supporting evidence. I assessed the impact of a voluntary community-based SfD intervention on the physical activity (PA), physical fitness (PF) and mental health (MH) of adolescents in Gulu, Uganda. Methods: The Acholi Psychosocial Assessment Instrument (APAI), standing broad jump (SBJ), multi-stage fitness test (MSFT) and BMI-for-age (BFA) were adapted to the local context. I tested their feasibility and reliability with a repeat-measures design (n=70). A cross-sectional analysis of a random sample was used to assess the local needs and establish the PF and MH of the adolescents reached by the intervention (n=1464). This was also the baseline assessment for the impact evaluation. It comprised a randomised control trial (n=144) nested within a cohort study (n=1400) and triangulated by cross-sectional assessment of PA using accelerometry (n=54). Results: The adapted PF and MH measures demonstrated good intra-tester reliability (ICC>0.75). Adolescents in Gulu predominantly had “healthy” BFA (>90%). They performed better than global norms for the SBJ (p<0.001), but worse for the MSFT (p<0.05). The girls who registered for the intervention had higher PF at baseline (p<0.05) and experienced no significant benefits when compared to the community. The aerobic capacity of the boys intervention group increased relative to the community (p<0.01), but was not significantly different to the trial control group whose PF also improved. The PA results concurred with this finding. Boys in the intervention group experienced a deterioration in MH relative to their peers (p<0.05). Implications: It is feasible to apply rigorous evaluation methods to SfD interventions. Although adolescents in Gulu have poor aerobic capacity, a voluntary programme may not reach those at risk. Interpreting the impact evaluation was limited by a lack of programme development theory, but suggested that opportunities for non-competitive play may confer PF benefit without harming MH. Further investigation is warranted.

Objective: As long-term results of conservative treatment for obesity are discouraging, bariatric surgery is becoming a treatment option for extremely obese adolescents. However, mental and behavioral problems need to be respected when treating this vulnerable target group. Methods: A detailed systematic literature review on pre- and post-operative depressive, anxiety and eating disorder symptoms of adolescent patients was performed in PsychINFO, PubMed and Medline electronic databases. Results: Twelve studies met the inclusion criteria. Although strength of evidence was limited, results suggested that pre-operatively a third of adolescents suffered from moderate to severe depressive disorder symptoms and a quarter from anxiety disorder symptoms, while a substantial number showed eating disorder symptoms. Post-operatively, levels of depressive disorder symptoms significantly improved. Original articles on outcomes of eating and anxiety disorder symptoms after weight loss surgery were not found. Conclusions: Further attention is needed on consistent clinical assessment of mental health disturbances and their consecutive treatment in adolescents. Future research should also focus on psychological and psychosocial predictors of weight loss after bariatric surgery.

The study was an assessment to determine the health rehabilitation interventions employed by Zimbabwe health actors between 2009 and 2011. It also was to ascertain the extent to which the interventions met criteria for effective rehabilitation, and that includes, health rehabilitation should ease the transition between health humanitarian and health development. Data was collected through interviewing health actors and review of policy documents while a vulnerability analysis approach was applied. The study revealed that, while the implemented health recovery interventions resulted in halting the health crisis, their role in facilitating progress towards health development was marginal. There were clear humanitarian residual issues and evidence of weak areas of the health system. A clear pathway needed to be mapped by actors, particularly policy makers to ensure effective rehabilitation. However, this seemed to lack in some areas. There were numerous overlapping and repetitive policies with little detailed guidelines. / Development Studies / M.A. (Development Studies)