Background: The study examined the effects of the determinants of under-five mortality in Malawi. It therefore aimed to estimate the rate or prevalence of under-five mortality in Malawi and to examine differentials in infant and child mortality by socio-economic, demographic, environmental, health-seeking behaviour and nutritional value. Methods: This study involved a secondary data analysis of the 2010 Malawi Demographic and Health Survey (MDHS) data set of children under five years old and women who had given birth in the five years preceding the survey. The Kaplan-Meier survival analysis and multivariate hazard analysis were used to examine the relationship between under-five mortality and socio-economic. demographic, environmental, health-seeking behaviour and nutritional factors. Results: The results show that birth order, mother's education, place of residence. region and exclusive breastfeeding were significantly associated with under-five mortality. The results also show that there was no significant association between under-five mortality and other indicators of socio-economic. demographic. environmental, health-seeking behaviour. The results also show that more deaths of under-fives occurred during infancy than during childhood. Conclusion: The results show that more deaths occurred during the first months after birth than after 12 months of age. This showed that mother's education, birth order, place of residence, region and breastfeeding had a greater influence on the survival of the child. / Thesis (M.Soc.Sc. Population Studies) North-West University, Mafikeng Campus, 2014

Southeast Asia carries a large burden of endemic zoonotic diseases, in livestock and humans, especially in countries where livestock production is increasing among rural households for income generation and poverty reduction. This thesis explores the risk factors for transmission of pig-associated zoonoses – particularly Q fever, brucellosis, hepatitis E, and Japanese encephalitis – in northern Lao PDR, with a view to development of recommendations for “catch-all” control measures to impact on multiple diseases, improving biosecurity and preventing disease transmission to the human population. Research included (i) a qualitative assessment of the knowledge, attitudes, and practices of villagers related to pig-associated zoonoses and their risk factors using focus group methodology; (ii) an assessment of health seeking behaviour at hospital/health centre and village level to examine factors that influence choice of health care provider and determine the impact of health seeking behaviour on illness and treatment costs, and an examination of non-conventional health care sources to understand the complexity of health seeking behaviour and influences on choice of health care provider and, lastly, (iii) health care provider and service delivery assessments to determine healthcare facility routine service delivery procedures and assess capability in diagnosing and treating illness. In terms of disease, the most common illnesses reportedly seen by all those interviewed were respiratory illness, acute febrile illness and diarrhoea, confirming them as the leading causes of morbidity. Knowledge and awareness of the etiological agent of pig-associated zoonoses among villagers, patients, and health care providers was very poor for brucellosis and Q fever, with limited awareness of hepatitis E. Most were aware of Japanese encephalitis. Clinical diagnosis and symptomatic treatment of illness is the normal practice and identification of causative agents in human illness does not often occur. All three empirical assessments identified poor diagnostic capability as a major concern. Focus group discussions revealed that knowledge and awareness of disease risk factors, and of zoonoses in general, was low among villagers. Practices related to food consumption, latrine usage, hand hygiene and sanitation, which are known disease risk factors, were found to be a concern in study villages. Attitudes and practices adopted by villagers in relation to human and animal health and health seeking behaviours were strongly influenced by financial circumstances, access to appropriate healthcare facilities, spiritual beliefs, and a lack of knowledge and resources to maintain the health of both animals and humans. The first point of care when experiencing illness was often the health centre or a local traditional healer or spiritual healer or pharmacist/drug seller, depending on location. This was followed by the district hospital, if nearby. Many villagers described going back and forth between traditional medicine and modern medicine service providers, with 76% (19/25) of participants reportedly seeing more than one type of healthcare provider for a given episode of illness. Self-medication was the most common practice (84% of all participants) irrespective of the care provider consulted. Attendance at a healthcare facility was dependent on available funds and the perceived severity of illness. Overall household costs ranged between no cost, because of the “poor patient” policy that exempts vulnerable groups from paying for care, and $2500 USD for medical treatment, hospital stay, transportation and sometimes food. Healthcare workers at all facility levels (from health centre to provincial hospital) expressed a lack of confidence in making an accurate diagnosis for these pig associated zoonoses due to poor diagnostic capability in their respective facilities. A One Health approach to zoonotic disease surveillance that incorporates transdisciplinary methods and partnerships will lead to improved understanding of the underlining social determinants of health and their impact on health-seeking behaviours, disease transmission and ultimately disease reporting.

There is ample academic evidence indicating high levels of HIV stigma among BSSA communities. The research suggests that disadvantaged and marginalised social groups like the BSSA communities experience high levels of HIV and sexually transmitted infections. There is a significant amount of quantitative research in the public domain on HIV and stigma. Quantitative research has shown that BSSA communities present late with HIV and sexually transmitted infections often owing to HIV stigma. Currently there is limited published qualitative information on the factors influencing HIV stigma and sexual health seeking behaviour among BSSA communities, particularly from the perspective of the communities themselves. This research study explored beliefs and perceptions in the construction of HIV stigma and sexual health seeking behaviour among Black sub-Sahara African (BSSA) communities in one city in the UK. The Silences Framework, which sits within aspects of feminism, criticalist and ethnicity-based approaches, provided the theoretical underpinning for this study. An exploratory qualitative study methodology was used to identify and explore the key factors influencing the construction of HIV stigma and sexual health seeking behaviour among BSSA communities. Five focus groups and fifteen one-to-one semi-structured follow-up interviews were conducted to collect the data. The institution of Marriage, Religion, Reported HIV statistics, Politics and Immigration, HIV as a Sensitive subject, sexual health professionals Cultural competence, gender stereotyping, Sexual Orientation and Social Media emerged as key pillars underpinning the social scripts associated with the construction of HIV stigma and sexual health seeking behaviour. The experiences emanating from the pillars of HIV stigma, identified in this study, showed the impact of social, political and personal contexts associated with specific sexual scripts among the participants impacting on the construction of HIV stigma and sexual health seeking behaviour. The 'silences' contained in the socially determined scripts were important in understanding the phenomenon under investigation. The findings from this study were reviewed in light of current sexual health policies and strategies to consider how sexual health professionals and services can best meet the health care needs of BSSA communities. This thesis contributes to current knowledge of HIV stigma and ethnicity, by concluding that the construction of HIV stigma and sexual health seeking behaviour among BSSA communities takes place during different contexts of socialization, in a bid to conform to the perceived expectations of society which may be real or imagined. Furthermore, conformity is also influenced by commonly shared and personal appraisal of socially determined relevant issues. These contexts form the bases on which sexual scripts are given meaning and HIV stigma is constructed alongside a socially sanctioned pattern of sexual health seeking behaviour. This study makes an additional contribution in that it is the first time that The Silences Framework has been used to research HIV and stigma among BSSA communities. This research study compliments the currently available pool of quantitative data linking issues of HIV stigma and ethnicity in the United Kingdom. The findings from this exploratory qualitative research study reveal a wide range of critical issues to encourage further qualitative research in the area, while indicating new issues to consider in developing UK based interventions to address HIV stigma and sexual health seeking behaviour among BSSA communities.

Magister Curationis - Mcur / According to Brown (2010), influenza kills and hospitalises thousands of people every year, about thirty-five thousand and two hundred thousand respectively. Some studies have shown that one of the major reasons that people do not take part in preventative behaviour concerning influenza would be some misconceptions and lack of knowledge. The purpose of this study was to investigate perceptions and attitudes of nursing students at a University in the Western Cape about influenza and their prevention and health seeking behaviour against influenza infection. This topic is important as nursing students are a part of the population group that is frequently exposed to influenza, either at their institutions of learning or in the hospitals and clinics, where they come into contact with patients in their roles as health care workers. A comprehensive review of the literature around perceptions and attitudes and health seeking behaviours regarding influenza was undertaken and considered by the researcher. Most of the literature reviewed came from Western countries as not much research has been done in Africa on the topic. From the literature reviewed, the researcher decided to use the Health Belief Model as a conceptual framework for this study as it has proven to be relatively effective in previous studies of this nature as well as in predicting people's health seeking behaviours.

Master of Public Health - MPH / Background: The Western Cape's Comprehensive Service Plan (CSP) is committed to "treating the right patient at the right level right, with the right skills and at the right cost" (Page 1, Tygerberg Hospital Annual Report, 2007). Occupational therapy (OT) Managers in the Metro District, Western Cape Province are in the process of aligning the OT services to the new CSP document. A major problem is the high default rate (non attendance) and irregular attendance (patient attends but skips sessions) amongst paediatric out-patients. In order to properly improve the OT paediatric services, it is vital for the OT managers to know the reasons for the poor utilisation of the OT services at the paediatric out-patient units. Purpose of study: The irregular attendance and high default rates (where patients stop attending the OT sessions completely) among children are a major problem at three OT out-patient units in Cape Town, Western Cape Province. The occupational therapists who work at these units are adamant that this impacts negatively on the child's progress. This study sought to explore the factors influencing the utilisation of the OT service in these three OT paediatric out-patient units in the hope of providing relevant information to the OT managers of these units in order to rethink the current service and make appropriate changes to improve adherence and treatment progress. Study design: This was an exploratory study using qualitative research methods. In-depth interviews were conducted with ten parents of children who have to attend the OT out-patient services. One group discussion was conducted with the occupational therapists that provide the services at the out-patient units. Sampling: Purposive sampling methods were employed to select four occupational therapists (at least one from each unit) and ten parents (at least three from each unit, with at least two who attended poorly and one that attended regularly). Analysis: Thematic analysis was used to interpret the data. The data was coded and categorised according to themes that emerged during data analysis. Results: The results of this study revealed that the factors that impact the utilisation of the OT service at the three OT units is complex. Factors that influenced the utilisation of the OT services in this study were related to the OT service such as staff attitude, relationship between the occupational therapist and the mothers as well as their child, communication between the mother and the occupational therapist, treatment progress, parent involvement in the OT programme and access to the OT service. Other factors such as the mothers' perception of the severity of the child's health condition, family support, work factors and family support were important factors related to the mother. The findings also revealed that environmental factors namely stigma, discrimination and travelling to the OT units impacted utilisation of the OT service. The participants made recommendations on how to improve the service. Conclusion: This study describes the complexity of what impacted the utilisation of the OT services and how closely interlinked these different factors are. It is evident from the findings of this study that a comprehensive, client centred approach is required to properly deal with the factors that negatively impact the utilisation of this service. Recommendations: A multi-faceted approach is required. Important issues to address are the shortage of occupational therapists across the levels of health care in the Western Cape Province; improving on the client centred approach in OT intervention programmes; advancing advocacy against stigma and discrimination against children with disabilities; and making public transport more accessible to children and their mothers.

This study focuses on African male refugees and asylum seekers in Pretoria/Tshwane, the capital city of South Africa. Beyond the motives for their displacements, refugees, carrying different kinds of disturbances into their ‘new home’, seek health and therapy, because the very condition of being refugees can be understood as a health-seeking condition. An ethnographic study was conducted to investigate the different means, therapies and cures used by refugees from other African countries in order to correct the fractions of their lives that have been disrupted on their journey to becoming refugees. The study found that these male refugees associated health with self-fulfilment or well-being and this couldn’t be achieved without removing the stumbling blocks that were in their ways. Being in a foreign country and having been through humiliation and other disturbances, the need to consult certain institutions became a necessity, thus challenging the ‘classic’ constructions of masculinity. Being far from home increased the level of vulnerability and the need thereof to seek help. Belief in a magico-religious system being part of African healing systems and part of the corollaries of globalisation, modernity and urbanism; explanations for various causes of misfortune and cures were found in consulting pastors, healers, diviners, astrologists. Some of those healers and religious leaders from other African countries, being refugees were also in search of well-being, thus triggering the creation of their new professions in the land of refuge. Copyright / Dissertation (Master of Arts)--University of Pretoria, 2012. / Anthropology and Archaeology / unrestricted

Female genital schistosomiasis (FGS) is a chronic manifestation of schistosomiasis, a waterborne parasitic infection, and is estimated to impact 56 million women predominantly in Sub-Saharan Africa. Currently, there is scarce literature on FGS and related health-seeking behaviour (HSB) among at-risk women. The objective of this mixed-method study is to understand the socio-cultural determinants of HSB and the health information trust networks for women at-risk of FGS in Ghana. A cross-sectional survey and twelve focus group discussions (FGDs) were conducted in the North Tongu and Weija Districts of Ghana. A total of 863 cross-sectional surveys and 12 FGDs were administered in both districts. There was an overall lack of awareness of FGS among adult women (38.9%). Only 48.8% of women reported HSB from the 86 women who choose to talk about their FGS-related symptoms. HSB was significantly associated with monthly steady income (p-value: 0.036) and level of education (p-value: 0.15,0.27), when controlling for age group and source of trusted health information. Some of the determining themes for HSB included: environmental and systemic context, shared norms, and apprehensions. Active and passive health information-seeking behaviour also emerged through the FGDs. Taking a mixed-method approach allowed for the appraisal of both methodologies and provided validity to the results. The lack of awareness of FGS indicates the need for tailored health information campaigns in endemic communities. More research is required on the FGS diagnostic and treatment capabilities of health facilities to understand their impact on HSB of women. This investigation finds that social, environmental, and cultural determinants are involved in the HSB of women at-risk for FGS, in North Tongu and Weija.

Magister Public Health - MPH / Globally, 1600 women and over 5000 newborn babies die daily of preventable causes and over 90% of these deaths occur in developing world. An estimated 358000 maternal deaths occurred worldwide in 2008 with developing countries accounting for 99%. In Zambia, maternal mortality ratio has been estimated to be 591 deaths per I 00,000 live births underscoring the great challenge posed by maternal and child health problems. At the same time, utilization of antenatal care services by pregnant women, supervision of deliveries by skilled person and postnatal care services is low in most regions of Zambia. Since professional attendance at delivery is assumed to reduce maternal and infant mortality, poor antenatal care (ANC) utilization may lead to increased infant and matern.al mortality and morbidity.This study sought to assess the barriers to utilization of antenatal care services in Kazungula district, Zambia. A qualitative exploratory study was used to uncover participants' experiences and perceptions on barriers to use of ANC.Focus group discussions were used to gather information from primegravidae and multigravidae not attending or irregularly attending ANC services and from traditional birth attendants. In-depth interviews were conducted with key informants namely the health centre in-charge and leader of safe motherhood support group.Data was analyzed through thematic content analysis. From the transcripts, patterns of experiences coming from direct quotes or through paraphrasing common ideas forming part of the themes were listed. Data from all the transcripts relating to the classified patterns were identified and placed under the relevant theme. Thereafter related patterns were combined and listed into sub-themes. The analysis involved drawing together and comparing discussions of similar themes and examining how these relate to the variations between individuals and groups that assisted in understanding the phenomenon of interests. The study revealed that utilization of ANC was impeded by multiple interrelated factors such as low socio economic and educational status of women, influence of the older generation, traditional and cultural practices. Previous negative experiences with health workers such as bad attitude of health workers and perceived poor quality of care were mentioned as factors that negatively affect utilization of ANC services. Other notable barriers were built in confidence resulting from previous safe deliveries, family size and competing priorities, fear of being tested for HJY and physical the accessibility.The study recommends that the district and its partners address the barriers if efforts in safe motherhood will yield meaningful impact. DHMT in the long term plan needs to train and deploy skilled personnel to rural health centres. They should have a deliberate policy on rural incentives to motivate trained staff to remote areas. More health posts need to be built as a way of taking health care services as close to the family as possible. In addition, for the short term plan there is need to provide inservice training for staff on safe motherhood and circulate guidelines. Orient staff on focused antenatal care (FANC).DHMT should ensure continuum of, care by supporting adequate supplies, equipment, drugs and transport to the health facilities.

Pulmonary Tuberculosis (TB) is a significant cause of morbidity in Uganda. TB control in the Ugandan district of Butaleja remains poor, characterised by TB case detection and cure rates below national targets. A qualitative exploratory and descriptive study was conducted to identify factors associated with health-seeking behaviour of TB patients in Butaleja district; with an aim to present recommendations for promoting positive health-seeking behaviour amongst the patients. Data was collected through individual in-depth interviews with seven diagnosed TB patients and analysed using Creswell’s (2009:186) analytic spiral steps. The findings revealed three major themes, namely; the nature of health-seeking behaviour, factors associated with the health-seeking behaviour and advice to others experiencing similar symptoms. The health-seeking behaviour of participants was generally poor, characterised by delay in seeking proper medical treatment for TB. Health system, individual and social factors contributed to poor health-seeking behaviour among the participants. The study recommends health system and community interventions targeted at individuals to improve health-seeking behaviour for Pulmonary TB / Health Studies / M.A. (Public Health)

Background: Antenatal care (ANC), facility delivery and postnatal care (PNC), are proven to reduce maternal and child mortality and morbidity in high burden settings. However, few rural pregnant women use these services sufficiently and it is essential to identify the barriers. Aim: The aim of this study was to examine barriers, with a focus on water, sanitation and hygiene (WASH), affecting women’s decision to seek care during pregnancy, childbirth and postnatal period in rural Kenya, and to examine if the Afya intervention helped overcome barriers. Methods: A qualitative study was conducted in the Siaya County, Kenya. 25 mothers were selected by using purposive sampling for in-depth interviews and focus group discussions. Assessment of WASH facilities was conducted at 5 healthcare facilities. Data were analysed by content analysis method. The “three delay model” informed the analytic process and discussion. Results: Women delayed seeking or did not attend ANC and PNC or gave birth at home, due to lack of knowledge of benefits of maternal health services and on complications; traditional and religious beliefs; embarrassed over pregnancy; busy with other life activities or of fear of HIV status and hospitals. Gender norms, distance and transport costs were the contributing factor for delaying in reaching the hospital. Unprofessional and inadequate number of staff, lack of equipment and supplies, and the water, sanitation and hygiene quality were factors delaying receiving quality care. The assessment showed on inadequate WASH facilities. Conclusion: Use of antenatal care, delivery and postnatal care in rural western Kenya is influenced by several barriers. The findings suggest a need to increase the knowledge about ANC and PNC, and to lower barriers preventing women from reaching the healthcare facility. There is also a need to improve the WASH facilities and the healthcare personnel’s treatment.