Published Article / The abattoir Hygiene Management System (HMS) was regulated in South Africa under the Meat Safety Act 40 of 2000. Presently, there is no national regulated microbiological standard to compare against meat tested at abattoirs as an indicator of good hygiene practices. The aim of the study was to establish a provincial guideline for a microbiological baseline. This may be used to verify the performance of the implemented HMS. Thirty red meat and twenty-two poultry abattoirs were sampled to determine baseline Total Bacterial Counts (TBCs). The results of this study were compared to standards presently used in the United Kingdom (UK). The results compared favourably.

Cervical cancer is the primary cause of cancer deaths among Haitian women; however, the social context of cervical cancer among Haitian immigrant women has not been systematically examined. The ways in which women assign meaning to this disease, understand its causality and situate it within the broader context of gynecological health are poorly understood. Further, Haitian immigrant women's perceptions of disease risk, including knowledge and understanding about Human Papillomavirus (HPV), the primary etiologic factor in cervical cancer, have not been explored. Few studies have assessed health behaviors, including culturally mediated feminine hygiene practices, among Haitian immigrant women, which may negatively impact gynecological health. This exploratory study examines these dimensions of gynecological health using ethnographic methods including participant observation, observation, informal and semistructured interviewing and surveys. Ethnographic data contextualize this disease in larger cultural and historical contexts. In addition, these data informed the construction of a 92-item survey, ensuring content validity of the personal questions women were asked about feminine hygiene practices and the agents they use. This survey, administered to 246 women in Little Haiti, Miami, represents an application of medical anthropology to epidemiologic research. Each survey respondent also was evaluated for cytology and sexually transmitted infections (STIs), including HPV, using a self-sampling medical device. Quantitative analysis of survey data indicates that prevalent STIs (Chlamydia) are significantly associated with feminine hygiene practices; however, HPV infection and cervical cancer are not associated with the practices. The practices are likely underreported in the survey sample. Qualitative analysis reveals that women's constructions of gynecological health are inseparable from cultural beliefs that emphasize feminine hygiene. Beliefs guide behaviors, which include vaginal douching and intravaginal washing, using plant-based therapies, imported commercial products and chemical compounds. These practices serve the purpose of not only cleaning, but also drying and tightening the vaginal environment for increased sexual pleasure of male partners. Attempts to preserve relationships, and reduce the chance that partners will take mistresses, occur through maintaining intimate hygiene and, in some cases, by other ethnomedical means.

Magister Public Health - MPH / Background: Millennium Development Goal 7 was to ensure environmental sustainability by aiming to halve the proportion of people without sustainable access to basic sanitation and safe drinking water by the year 2015. The 2015-MDG Report estimated that the use of improved sanitation rose from 54% to 68% globally, but the target of 77% was not met, and that implies slowing the progress in the health and education sectors. Although Malawi has made significant progress in increasing access to safe water and improved sanitation in comparison to other Sub-Saharan African countries, disparities in improved water supply and sanitation within Malawi remains a challenge. In Malawi, only about a quarter of all schools have improved latrines with a ratio of one latrine for every sixty learners. While the water and sanitation situation in primary schools of Malawi is reported to be making progress, such progress remains unreported in secondary schools. Aim: The purpose of this qualitative study was to provide insight on the water and sanitation situation in secondary schools by understanding factors that influence learners' use of the water and sanitation facilities and personal hygiene practices in a girls' boarding secondary school in Zomba District, Malawi. Methodology: This study employed a descriptive qualitative study design using individual interviews, focus group discussions (FGDs) and observations. A purposive sample consisting of 12 learners participated in two FGDs, while individual interviews were conducted with 6 prefects, 2 teachers responsible for sanitation at the school and 1 matron. The FGDs and individual interviews were targeted at exploring these participants' perceptions, experiences, challenges faced in the use of water and santation facilities and perceptions of appropriate interventions to improve hygiene practices and utilization of sanitation services. Thematic analysis was used to analyze the data. Findings: The findings indicate that there were several factors that influenced learners' use of water and sanitation and their hygiene practices at the school. One of the main challenges was the irregular supply of safe water by the Southern Region Water Board which meant that alternate sources of water, which was not always potable, had to be used instead. Poor water and sanitation infrastructure and facilities including lack of privacy in shower cubicles and the poor condition of the incinerator that is meant for disposal of sanitary pads were other challenges facing the learners. There were also insufficient toilets and shower cubicles for the number of learners at the school. A good number of learners knew the importance of hand washing for their personal health at school, but limited accessibility to running water compromised their hand washing practices and personal hygiene including menstrual hygiene. Conclusion: It can be concluded that the challenging factors occur at the macro, meso and micro levels but more importantly that these levels are interrelated and impact on one another, emphasising the complexity of the water and sanitation situation in the study school, but could most likely also be the situation at other schools in Malawi. Therefore multi-level interventions will have to be put in place to address these challenges. Recommendations: The present study recommends that at macro level the Department of Education should provide an enabling environment and political will to facilitate development of a multi-sectoral approach that would complement the school operation rules to improve the adequacy of the water and sanitation facilities and hygiene practices. In addition, the Southern Region Water Board should ensure a reliable supply of safe water to the school and provide better infrastructure of piped water. At meso level (school organisational level), the school management should take more responsibility for maintaining the infratstructure. In addition, the school-board, the school management and parents'-teachers' association and learners should form a committee to discuss and implement strategies that would enhance the learner's use of water and sanitation facilities at the school and ensure their privacy and dignity. At micro level, the school, the communities including families and religious leaders should encourage personal hygiene practices repeatedly amongst everybody.

Before the availability of antibiotics minor infections could become life threatening. Nurses working in voluntary and public hospitals in Britain were exposed to such risks. This thesis uses both oral testimonies and published sources in order to examine their practices concerning the management of infection risks. The detail of nursing work in this period has been generally hidden in nursing histories of the 1930s and 1940s which have addressed mainly political, recruitment, educational, registration and status issues. Whilst these histories may comment about menial duties, and the culture and discipline in clinical areas, they lack detailed exploration of the day-to-day work of the nurse. This novel study contributes to redressing the balance by examining nursing practice between the discovery of penicillin in 1929 and its widespread availability in Britain in 1948. Data analysis, including the oral testimonies of nineteen former nurses who worked between 1929 and 1948, suggests that nursing practice during this period placed enormous emphasis on cleanliness and hygiene. It is argued that this was linked to sanitarianism which influenced nursing practice before its replacement by germ theory. Probationer nurses learnt their skills in managing infection risks to themselves and their patients in a disciplined and safe way. This was achieved through the exercise of strict routines and a hierarchy of tasks that provided a graduated exposure to the patient and infection risks. This thesis draws on debates in the literature about purity, vocation and status to explore, and add weight to this argument. The analysis also identifies that the introduction of sulphonamide drugs and antibiotics altered nursing practices in the management of both infection risks and patients with infection. Whilst the full effects of these changes are not examined in this thesis, it is argued that the significant impact of these drugs was such that the emphasis on cleaning and hygiene became diminished in importance and nursing had to redefine its role. It suggests that more prominence needs to be given to changes in clinical practice in the history of nursing. This study breaks new ground by suggesting the rigorous training of nurses in cleaning and hygiene tasks was needed in order to manage the infection risks faced by nurses before the availability of antibiotics.

Methicillinresistent Staphylococcus aureus (MRSA) är en multiresistent bakterie som är ett hälsoproblem över hela världen. Genom mutationer i bakterien skapas en resistens mot antibiotika. Faktorer som bidrar till den ökade spridningen och resistens av MRSA är bland annat dålig handhygien/hygien bland vårdpersonal på sjukhus, samt överanvändning av antibiotika. Personer som är bärare av MRSA riskerar då att inte kunna behandlas med antibiotika vid bakteriella infektioner, vilket kan medföra längre vårdtider eller i värsta fall hot mot hälsan och riskerar då att inte överleva dessa infektioner. Syfte: Att beskriva vårdprogram för MRSA i Sverige, Tyskland och Spanien. Metod: Metoden som använts är litteraturöversikt. Resultat: Vårdprogrammen för att minska spridningen av MRSA består samma riktlinjer i de olika länderna i Europa. Varför spridningen ser olika ut beror i stor utsträckning på vilka förutsättningar som finns i de olika länderna samt hur antibiotikakonsumtionen ser ut. Vissa länder har hög exponering av antibiotika inom djurhållningen, vilket ökar spridningen av MRSA. Konklusion: Trots stora skillnader i spridningen av MRSA ligger inte problemet i vårdprogrammen och dess riktlinjer för MRSA för länder i Europa. Vid jämförelse av länder med hög spridningen av MRSA respektive låg blev slutsatsen att det största problemet ligger i vilka förutsättningar vårdpersonalen har för att genomföra goda hygienrutiner samt brist eller bättre tillgång på kunskap och mer frekventa utbildningar kring MRSA och spridningen av resistenta bakterier.

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京都大学 / 新制・課程博士 / 博士(地球環境学) / 甲第24986号 / 地環博第247号 / 新制||地環||49(附属図書館) / 京都大学大学院地球環境学舎環境マネジメント専攻 / (主査)教授 越後 信哉, 准教授 田中 周平, 教授 藤原 拓, 准教授 原田 英典 / 学位規則第4条第1項該当 / Doctor of Global Environmental Studies / Kyoto University / DFAM

Philosophiae Doctor - PhD (School of Public Health) / Poor water, sanitation and hygiene (WASH) services and practices in communities are known to be responsible for most of the infections occurring among infants and young children in developing countries. A combined effect of disease, poor diet, care practices and other factors among infants/children are known to lead to undernutrition reported in most developing countries. Apart from the reduced growth and productivity potential that malnutrition exhibits on the affected population, it is also an underlying cause to 50% of child mortality in poor communities. In light of this, the primary objective of the study was to evaluate the effect of poor WASH practices on growth and infectious disease incidence in infants and young children aged 6-23 months in the rural district of Monze in Zambia.

Food-borne illnesses are responsible for disease globally. One of the most important strategies for combating food-borne diseases is the training of food handlers. Using social cognition theory as a framework, the purpose of this study was to assess the effectiveness of the mandatory training program for food handlers in a rural parish in Jamaica. A cross-sectional survey, using self-administered questionnaires, was used to assess and compare food safety knowledge and self-reported practices of food handlers trained in 2 government training programs, while using untrained food handlers as controls. Descriptive and inferential statistics such as t test, chi-square test, and ANOVA were used to explore relationships between training and knowledge and practice. According to study results, trained food handlers had a statistically significant higher mean knowledge score (65.61% vs. 59.0%, p < 0.05) and mean practice score (67.40% vs. 60.35%, p < 0.05) than untrained food handlers, although these scores were significantly lower than the minimum acceptable standards of 70%. Results of this study may assist policy makers in designing effective training programs for food handlers, which should ultimately lead to a safer food supply for the consuming public and a reduction in food-borne disease outbreaks in Jamaica.

The aim of this study was to assess the environmental sanitation conditions with regard to water, sanitation, waste management and personal hygiene of households of Dukem town in Ethiopia. A cross-sectional study design was used to conduct the research. A total of 391 households had participated in the study. Majority of households had access to improved source of drinking water. The mean per capita per day water consumption of the households was low. Two-thirds of households had improved toilet facilities. Availability of improved waste management was grossly inadequate. Two-thirds of households had washed hands after visiting toilet. Generally households had good domestic environmental sanitation conditions but it also emerged that the households were deprived from full range of access to the most essential environmental sanitation services. Therefore, the inadequate level of service to the study area could be seen as opportunity for further focused improvements towards universal access to improved environmental sanitation. / Health Studies / M.A. (Public Health)