Magister Scientiae Dentium - MSc(Dent) / The Gauteng province is divided into 5 districts each of which have a public based oral health programme. Each district provides oral health treatments such as dental extractions with treatment of pain and sepsis, preventive dentistry, simple restorations, removable prosthodontics (complete and partial dentures) and minor oral surgery in selected facilities. The main treatment modality in most government based dental clinics is dental extractions (Department of Health, 2003). This indicates the poor status of the population’s teeth. Dental caries is a condition that can be prevented if adequate efforts are made to practice preventive dentistry. Preventive dentistry has been a treatment modality that has been practiced poorly or almost completely ignored in several oral health facilities for many years. This neglect could be due to several factors such as in adequate knowledge regarding preventive dentistry procedures, poor attitude towards preventive dentistry, lack of motivation, or lack of resources (Clark, 2011). The purpose of this study is to determine why preventive dentistry has been neglected for so many years.

Magister Public Health - MPH / Evaluation of health programmes is essential to assist programme managers in decision-making and accountability to the population they serve. Additionally, regular monitoring and evaluation of TB/HIV collaborative activities are used as a means to assess quality, effectiveness and coverage of services; yet little attention has been given to this in most developing countries. In the southern region of Ethiopia, since the inception of the TB/HIV collaborative activities in 2005, there has not been any formal evaluation pertaining to the implementation status of integrated TB/HIV services at routine program level. However, a series of TB/HIV reviews underlined many challenges that have adversely affected the implementation nationally. However, studies conducted on the quality of TB and HIV/AIDS services tend to be broad and not targeted to the integrated TB/HIV program and therefore, it was necessary to assess the implementation status in a more focused way with a vision to determine its adequacy or otherwise and make appropriate recommendations to improve integrated TB/HIV services in the town. Aim: To assess the implementation of integrated TB/HIV activities in the health facilities of Hawassa town administration Study design: Cross sectional study Study population: All health facilities, health managers, and records of TB and HIV patients in Hawassa town administration Sample population: The study population encompassed TB and HIV clinics, managers of each health facility, and sampled records of individual clients/patients enrolled in the HIV/AIDS/TB treatment and care program, from each health facility in the year 2009/10. Data collection: Face-to-face interviews with facility managers, observation of the rooms in which TB/HIV services are rendered and a review of patient records, were undertaken. Analysis: Descriptive statistics with frequencies and percentages were used for analysis of facility based resource inputs, TB case finding and management, and HIV case finding and management practices. Indicator variables extracted from the record review were transformed into scales (0 or 1) and weighted to reflect the levels of TB/HIV service quality, integration and resources input. After weighting, experts' opinion was used to set a cut off level (75%) to categorize the relative service quality received by individuals and the level of integrated care provided by facilities into "adequate" or "inadequate". Bivariate analysis was done to assess the effect of independent predictor variables on outcome variables. We used a– P value of 0.1 on bivariate analysis as the cut off point for inclusion of variables into the multivariate analysis. Prevalence ratios, adjusted prevalence odds ratios, and 95% confidence intervals were used to present outcomes. Results: Availability of resource inputs for HIV/AIDS care was inadequate in half of the facilities in Hawassa town whereas, laboratory infrastructure for TB/HIV care was adequate in all facilities. Most (91%) HIV/AIDS patients had their CD4 count and weight (96%) measured at baseline. However, the trend declined over time and the practice was better in hospitals than in health centres. HAART status was a strong predictor of CD4 count improvement and improvement in CD4 count was found to be a strong predictor of body weight gain. TB case finding and management practices in HIV/AIDS clinics were found to be adequate in the health facilities in Hawassa town. Ninety five percent and 86% of HIV positive patients were screened for TB at baseline and at the last clinical visit respectively, of which 98%, 93% and 81% of patients co infected with TB and HIV were provided with DOTS, CPT and ART respectively. However, only 11% of HIV positive patients without active TB were provided with IPT. Only HAART status was found to be a strong predictor of TB case finding. Quality of HIV/AIDS care in health facilities in Hawassa town was adequate. Availability of at least a minimum number of staff and being on HAART were found to be strong negative and positive predictors of quality respectively. Overall, 91% of patients on HAART were retained in care at the end of the year (alive and on treatment), 6% were retained and 3% died. Resources for the TB program were deficient in our study area. Three out of four facilities had inadequate overall input resources required for good quality TB care and the fourth barely managed to achieve adequate status. However, laboratory infrastructure and availability of forms and registers were adequate in all the facilities. There was a high degree of HIV case finding and a high prevalence (17%) of HIV among TB patients. Despite this, the overall HIV care provided was inadequate, with only 64% and 73% of TB/HIV co-infected patients being provided with HAART and co-trimoxazole respectively and 22% of TB/HIV co-infected patients not enrolled in HIV care. Among sputum positive TB patients good quality TB care was found to be a strong predictor of successful treatment outcome Our study also showed consistently very high quality TB service provision in the town despite the lack of required resources. Conclusion and Recommendations: The study showed that there was relatively good quality provision of TB and HIV services despite inadequate input resources and that quality of care was positively associated with good outcomes. The study also indicated that HAART benefited patients substantially and hence earlier initiation could be the way forward. We recommend that to further improve quality of care one stop shopping services (availing both anti-TB and HIV care at the same service point within a clinic) be established. In addition, we recommend improved patient monitoring, especially for Pre-ART patients, be established.

Trata-se da meta-avaliação de um processo avaliativo desenvolvido por secretários e assessores técnicos municipais de uma região de saúde do estado de São Paulo, com foco nos critérios de utilidade e participação. É uma pesquisa qualitativa, cuja base empírica foi 1) o material produzido em sete oficinas realizadas com os representantes municipais, com vistas à avaliação de um aspecto da linha de cuidados em saúde sob a ótica da integralidade; e 2) as entrevistas semiestruturadas realizadas com os mesmos atores após a finalização do processo avaliativo. Para a avaliação do critério de utilidade, utilizou-se principalmente o referencial de KIRKHART (2000), com o objetivo de ampliar a análise para além do uso instrumental dos achados avaliativos e focá-la na identificação de influências múltiplas exercidas por um fenômeno complexo como um processo avaliativo. A análise do critério participação se deu com base no referencial de COUSINS e WHITMORE (1998), buscando a identificação no material empírico de decisões ou aspectos contextuais que fizeram com que a opção participativa fosse aprofundada ou limitada no processo em foco. O trabalho destaca a importância de explicitar pressupostos que baseiam a metodologia da avaliação/ meta-avaliação escolhida, e a necessidade de se buscar referenciais teóricos de análise compatíveis com a opção realizada, frisando a inexistência de posturas neutras ou estudos totalmente objetivos; e a importância de capacitar avaliadores a acompanharem a demanda dos participantes de um processo participativo com a flexibilidade necessária para conferir-lhe o maior aproveitamento possível. Conclui-se pela viabilidade, com vantagens, da realização de processos participativos locais com gestores na Saúde Pública, destacando a possibilidade de ganhos em formação e o enriquecimento dos processos de negociação em nível do território, de forma coerente à política de construção das regiões de saúde no SUS. / This study aims to meta-evaluate an evaluation process developed by policymakers and technical advisors of a Health Region of Sao Paulo, centering on criteria of utility and participation. It analyzes the feasibility and possible benefits of using a participatory methodology in Public Health evaluations, highlighting aspects that facilitate and hinder this undertaking. It is a qualitative research, which empirical basis was 1) the material produced in seven workshops with municipal representatives, aiming the evaluation of an aspect of health care from the perspective of integrity; and 2) semi-structured interviews with the same actors after completion of the evaluation process. KIRKHART´s theoretical framework (2000) was used to evaluate the utility criterion, in order to expand the analysis beyond the instrumental use of the evaluation findings, and focus it in identifying multiple influences exerted by a complex phenomenon as an evaluation process. The evaluation criterion of participation was based on references of COUSINS e WHITMORE (1998), aiming to identify decisions or contextual aspects in the empirical material that made participatory option limited or depth in the focused process. The work highlights the need to seek theoretical frameworks of analysis consistent with the methodological choice carried out in order to enhance the identification of evaluation gains and limitations, and enable evaluators to monitor the demand of participants in the evaluation process with flexibility to reach its best use, even in those cases where there are limitations on the possibilities of participation. The results confirmed the viability, with advantages, of holding local participatory processes with policymakers and managers in Public Health, highlighting the possibility of gains in education and the enrichment of the negotiation process in the territory level, consistent with the policy of building health regions in SUS.

Trata-se da meta-avaliação de um processo avaliativo desenvolvido por secretários e assessores técnicos municipais de uma região de saúde do estado de São Paulo, com foco nos critérios de utilidade e participação. É uma pesquisa qualitativa, cuja base empírica foi 1) o material produzido em sete oficinas realizadas com os representantes municipais, com vistas à avaliação de um aspecto da linha de cuidados em saúde sob a ótica da integralidade; e 2) as entrevistas semiestruturadas realizadas com os mesmos atores após a finalização do processo avaliativo. Para a avaliação do critério de utilidade, utilizou-se principalmente o referencial de KIRKHART (2000), com o objetivo de ampliar a análise para além do uso instrumental dos achados avaliativos e focá-la na identificação de influências múltiplas exercidas por um fenômeno complexo como um processo avaliativo. A análise do critério participação se deu com base no referencial de COUSINS e WHITMORE (1998), buscando a identificação no material empírico de decisões ou aspectos contextuais que fizeram com que a opção participativa fosse aprofundada ou limitada no processo em foco. O trabalho destaca a importância de explicitar pressupostos que baseiam a metodologia da avaliação/ meta-avaliação escolhida, e a necessidade de se buscar referenciais teóricos de análise compatíveis com a opção realizada, frisando a inexistência de posturas neutras ou estudos totalmente objetivos; e a importância de capacitar avaliadores a acompanharem a demanda dos participantes de um processo participativo com a flexibilidade necessária para conferir-lhe o maior aproveitamento possível. Conclui-se pela viabilidade, com vantagens, da realização de processos participativos locais com gestores na Saúde Pública, destacando a possibilidade de ganhos em formação e o enriquecimento dos processos de negociação em nível do território, de forma coerente à política de construção das regiões de saúde no SUS. / This study aims to meta-evaluate an evaluation process developed by policymakers and technical advisors of a Health Region of Sao Paulo, centering on criteria of utility and participation. It analyzes the feasibility and possible benefits of using a participatory methodology in Public Health evaluations, highlighting aspects that facilitate and hinder this undertaking. It is a qualitative research, which empirical basis was 1) the material produced in seven workshops with municipal representatives, aiming the evaluation of an aspect of health care from the perspective of integrity; and 2) semi-structured interviews with the same actors after completion of the evaluation process. KIRKHART´s theoretical framework (2000) was used to evaluate the utility criterion, in order to expand the analysis beyond the instrumental use of the evaluation findings, and focus it in identifying multiple influences exerted by a complex phenomenon as an evaluation process. The evaluation criterion of participation was based on references of COUSINS e WHITMORE (1998), aiming to identify decisions or contextual aspects in the empirical material that made participatory option limited or depth in the focused process. The work highlights the need to seek theoretical frameworks of analysis consistent with the methodological choice carried out in order to enhance the identification of evaluation gains and limitations, and enable evaluators to monitor the demand of participants in the evaluation process with flexibility to reach its best use, even in those cases where there are limitations on the possibilities of participation. The results confirmed the viability, with advantages, of holding local participatory processes with policymakers and managers in Public Health, highlighting the possibility of gains in education and the enrichment of the negotiation process in the territory level, consistent with the policy of building health regions in SUS.

PhD (Health Sciences) / Department of Advanced Nursing Science

Magister Public Health - MPH / Summary:The aim of this study was to produce a preliminary assessment of the DRAF by determining its face validity, testing reliability and usability of its diagnostic classification tool, and to produce a set of preliminary recommendations on the viability of the DRAF before it is released for use within the Family Health Programme.

Magister Public Health - MPH (Public Health) / The oral health programme in Lesotho aims to offer curative, preventive, promotive and rehabilitative oral health services. However, observations as well as annual reports suggest that oral health service utilization is poor, as most patients only attend dental clinics with advanced stages of decayed teeth which can only be extracted. The reasons for this very undesirable late utilization of oral health services have not been systematically explored and understood in Lesotho. This makes it difficult for health planners to find solutions for improving access, utilizations and responsiveness of oral health services.

South Africa’s freshwater quality and quantity is declining and consequently impacting on the ecological health of these ecosystems, due to increased agricultural, urban and industrial developments. The River Health Programme (RHP) was designed for monitoring and assessing the ecological health of freshwater ecosystems in South Africa, in order to effectively manage these aquatic resources. The RHP utilises biological indicators such as in-stream biota as a structured and sensitive tool for assessing ecosystem health. Although the RHP has been widely implemented across South Africa, no attempts have been made to explore microbial ecology as a tool that could be included as one of the RHP indices. This study used selected microbial responses and water physico-chemical parameters to assess the current water quality status of the Buffalo River. This study showed that water quality impairments compounded in the urban regions of King William’s Town and Zwelitsha and also downstream of the Bridle Drift Dam. The results also showed that the lower and the upper catchments of the Buffalo River were not significantly different in terms of water physico-chemistry and microbiology, as indicated by low stress levels of an NMDS plot. Though similarities were recorded between impacted and reference sites, the results strongly showed that known impacted sites recorded the poorest water physico-chemistry, including the Yellowwoods River. However, the Laing Dam provided a buffer effect on contributions of the Yellowwoods River into the Buffalo River. Multivariate analysis showed that microbial cell counts were not influenced by water physico-chemical changes, whilst microbial activity from the water and biofilm habitats showed significant correlation levels to water physico-chemical changes. This study demonstrated that further investigations towards exploitation of microbial activity responses to water physico-chemical quality changes should be channelled towards the development of microbiological assessment index for inclusion in the RHP.

Submitted by Yasmin Oliveira (yasmincunha@gmail.com) on 2016-04-20T18:34:35Z No. of bitstreams: 1 Dissertação_Yasmin Oliveira.pdf: 661470 bytes, checksum: 8894d5151a23c715752274b1ca2cf3c9 (MD5) / Approved for entry into archive by Maria Auxiliadora da Silva Lopes (silopes@ufba.br) on 2016-04-25T13:29:05Z (GMT) No. of bitstreams: 1 Dissertação_Yasmin Oliveira.pdf: 661470 bytes, checksum: 8894d5151a23c715752274b1ca2cf3c9 (MD5) / Made available in DSpace on 2016-04-25T13:29:05Z (GMT). No. of bitstreams: 1 Dissertação_Yasmin Oliveira.pdf: 661470 bytes, checksum: 8894d5151a23c715752274b1ca2cf3c9 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A presente pesquisa investiga o Programa Saúde na Escola (PSE), particularmente os significados que os professores e a equipe de Saúde da Família (eSF) — médico, enfermeiro, agente comunitário e odontólogo — atribuem às práticas de educação em saúde. Implementado nacionalmente em 2007, o PSE nasceu de uma política intersetorial, entre a saúde e a educação. Partindo de uma abordagem qualitativa, este estudo valeu-se de observação participante e entrevistas semiestruturadas para a coleta dos dados, feita em uma escola do ensino fundamental I do município de Sapeaçu, na Bahia, que aderiu ao PSE. Tendo como base teórica algumas das ideias centrais de autores como Vigotski, Bruner e Valsiner, na análise, parte-se do pressuposto de que a experiência humana é uma realidade subjetiva culturalmente organizada e constantemente recriada. Nesse sentido, estudaram-se as ações do PSE em Sapeaçu explorando as práticas de educação em saúde e seus significados para profissionais envolvidos no programa. A análise dos dados pautou-se no discurso dos sujeitos sobre o PSE e nas observações em campo e revelou que, embora a implantação do PSE tenha trazido dificuldades e desafios, também foram identificadas ações que contribuíram para a formação dos estudantes, considerando a atenção e promoção da saúde e a prevenção de doenças. Os significados de educação em saúde oscilam de acordo com o estilo de pensamento adotado por cada sujeito, mas as atividades desenvolvidas no PSE são verticalmente decididas pelos ministérios da Saúde e da Educação, ou pela Coordenação Municipal do Programa. Avanços foram identificados principalmente na atenção à temática da saúde nas escolas após a implantação do programa no município, mas a falta de interação entre as equipes escolares e de saúde é um empecilho à boa condução e continuidade do programa. / ABSTRACT This research aims to investigate the School Health Programme (Programa Saúde na Escola: PSE) by examining the meanings that teachers and the Family Health team – a doctor, a nurse, a community health agent and a dentist – attribute to health education practices. Established nationally in 2007, the PSE grew out of an intersectoral policy between health and education. Based on a qualitative approach, data was collected through participant observation and semi-structured interviews and the study was conducted in a Level I Primary School in the municipality of Sapeaçu, Bahia, which implements the School Health Programme. Based on certain theoretical ideas central to authors such as Vygotsky, Bruner and Valsiner, the analysis sets out from an assumption that the human experience is a culturally organized and constantly recreated subjective reality. In this sense, it seeks to study PSE activities, within a municipality in Bahia, by exploring health education practices and their meanings for the professionals involved in the programme. Data analysis was based on subjects’ discourse about the School Health Programme and field observations. The data analysis revealed that the implementation of the PSE creates a number of difficulties and challenges for both Family Health professionals and teachers. However, it is worth noting that certain activities were identified that contributed to students’ education in relation to health care, promotion and prevention. The meanings of health education are related to each subject’s life history, experience, knowledge and beliefs. The activities implemented by the PSE are, in general, decided vertically, through the Ministries of Health and Education and the Programme’s Municipal Coordination Department. Important progress was identified in the areas of health and education, principally in the attention paid to the theme of health in schools, following the establishment of the PSE within the municipality. The study identified a lack of interaction between the school and health teams, which was the principal

This study identifies the Integrated School Health Programme’s implementation constraints in (Ekurhuleni Metropolitan Municipality, Southern Region), and describes how these constraints have affected the implementation of school health services. This predominantly qualitative study employed the structured interview-based research design and focus group discussion approaches, with the target population consisting of school health nurses and educators working with them in Ekurhuleni Metropolitan Municipality, Southern Region. The criterion-referenced sampling strategy was opted for, because of the researcher’s knowledge of the research environment. The focus group discussions, structured interviews and participant observations complement the study’s data collection methods. The principal findings depicted the Integrated School Health Programme was not as effective as expected in its implementation. The main constraints were identified as lack of resources and knowledge; and poor teamwork of the Department of Health, the Department of Basic Education, and parents. Emanating from these findings, the study recommends innovative collaboration mechanisms between the two government departments, and that relevant and sufficient resources should be allocated for effectively implementing the Integrated School Health Programme. / Health Studies / M. P. H.