The health sector has not yet begun to explore the full potential of geographical information system (GIS) technology for health research and planning. The goal of this thesis is to demonstrate this potential in Africa through the application of GIS to the most important health issues in the continent. In excess of 23,000 homesteads are mapped and interviewed throughout Hlabisa district, Kwa-Zulu Natal using differential global positioning systems (GPS). I use the GIS to analyse mode health care usage patterns. 87% of homesteads use the nearest clinic and travel an average distance of 4.72 km to do so. There is a significant logarithmic relationship between distance from clinic and usage by the homesteads (r2 = 0.774, p<0.0001). I propose the distance usage index (DUI) as a composite spatial measure of clinic usage. The index is the sum of the distances from clinic to all actual client homesteads divided by the sum of the distances from clinic to all homesteads within its distance-defined catchment. The index encompasses inclusion, exclusion and strength of patient attraction for each clinic. The DUI highlights significant disparities in clinic usage patterns across the district (mean = 110%, SD =43.7). The results of the study have important implications for health planning in Africa. I use GIS/GPS technology to quantify the spatial implications of a shift towards community-based treatment of tuberculosis using the DOTs strategy in Hlabisa. The mean distance from each homestead in the district to nearest supervision point is measured using a GIS. The shift in treatment strategy from hospital to community-based between 1991-1996 reduces the mean distance to treatment point from 29.6 km (94% of the population > 5km) to 1.5 km (entire population < 5km). GIS effectively documents and quantifies the impact of community-based tuberculosis treatment on access to treatment. I produce the first quantifiable evidence of a relationship between distance to roads and HIV prevalence using a GIS. HIV prevalence was measured through anonymous surveillance among pregnant women in Hlabisa and stratified by clinic attended. Assuming women attend the nearest clinic, the mean distance from homesteads to a primary or secondary road for each clinic catchment is strongly correlated with HIV prevalence (r = 0.66; p = 0.002). Further research is needed to better understand this relationship both at ecological and individual levels.I develop a methodology that has numerous applications to health systems provision in developing countries where limited physical access to primary health care is a major factor contributing to the poor health of populations. I use an accessibility model within a GIS to subdivide an area into units of equal workload using a range of physical and social variables. The methodology could be used to ergonomically design programmes for home-based care and tuberculosis directly observed treatment. It could also be used as a basis for more efficient distribution of community health workers. I use high-resolution long-term rainfall and temperature data to produce the first malaria seasonality (length, start and end of transmission season(s)) maps for Africa. I relate the model to population data and estimate the population exposure in a variety of transmission settings. I investigate the relationship between predicted length of transmission season and parasite ratio from 2335 geo-referenced studies of children <10 years across Africa. The research is the first to correlate actual malaria survey data with model predictions at a continental scale. The seasonality model corresponds well with historical expert opinion maps and case data. A significant logarithmic relationship is detected between predicted length of transmission season and parasite ratio (r2=0.712, p=0.001). I recompute the changes in the disease likely to occur as a result of global warming. The seasonality model constitutes an important first step towards an estimate of continental intensity of transmission. / Thesis (Ph.D.)-University of Natal, 2000.

Thesis (DTh)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: This thesis deals with the concept of Ũtugi in relation to the HIV and AIDS pandemic and its contribution to the ecclesial praxis of the Anglican Church of Kenya. The thesis scrutinizes the HIV and AIDS context in Kenya, examines the origins, the nature, the characteristics and the definition of Ũtugi and its role in socio-economic, political, cultural, moral and religious life of the Agĩkũyũ community in Central Kenya and assesses the ecclesial praxis of the Anglican Church of Kenya. This concern is prompted by the need for the Anglican Church of Kenya to marshal Ũtugi (traditional resources) to complement Christian hospitality (church resources), to enhance human dignity of PLWHA and to fight the HIV and AIDS pandemic. By employing a hermeneutical tool as a praxis approach to pastoral care and counselling to interpret theological and assess the Agĩkũyũ cultural concepts and using a non-empirical research method (a qualitative research) based on conceptual analysis, the study explores critically the role of Ũtugi within the context of HIV and AIDS and its appropriateness as a tool for pastoral care and counselling in the Anglican Church of Kenya. The study poses the following research questions: In which way can the Agĩkũyũ concept of Ũtugi be used to create a healing space? How can Ũtugi be used to reframe the prevailing ecclesiological paradigms applied by the Anglican Church of Kenya? How can Ũtugi as a cultural concept help the Anglican Church of Kenya to become relevant and contextual in her endeavour to respond to the challenges posed by the HIV and AIDS pandemic in the twenty-first century? The thesis unveils that the principles of Ũtugi can complement Christian hospitality to network and help the church to carry the burden of PLWHA, thus, enhancing their human dignity, sharing their joy and comfort, and journeying with them in their pain, sorrow and healing. It was also found that Ũtugi as a contextual model which is culturally rooted, is relevant to the Agĩkũyũ people and that it can help in transforming the existing ecclesial praxis of the Anglican Church of Kenya. Drawing from Daniël Louw's existential model for spiritual healing, the study assesses the appropriateness of Ũtugi as a model for pastoral care and counselling to PLWHA. It is revealed that Ũtugi is not only a paradigm that can augment their physical, social, psychological, economic, moral and spiritual aspects but that it has the capacity to deal with the existential threat of anxiety, guilt and shame, disillusionment and anger, despair and doubt, helplessness and vulnerability. Thus it can enable them to shift from their existential threats to a position of love, care, support, compassion, accommodativeness, liberation and hope. / AFRIKAANSE OPSOMMING: Hierdie navorsing gaan oor die kultuur-bepaalde konsep Ũtugi met betrekking tot die MIV en VIGS - pandemie en oor die bydrae van hierdie konsep tot die kerklike gebruike en ekklesiologiese-self-verstaan van die Anglikaanse Kerk in Kenia. In die navorsing word indringend gekyk na die MIV en VIGS konteks in Kenia, en die oorsprong, aard, eienskappe en definisie van Ũtugi en sy rol in die sosio-ekonomiese, politieke, kulturele, morele en godsdienstige lewe van die Agĩkũyũ-gemeenskap in Sentraal-Kenia gekyk. Die navorsing evalueer voorts die gemeentelike bediening van die Anglikaanse Kerk in Kenia. Hierdie ondersoek is noodsaaklik gemaak deur die behoefte van die Anglikaanse Kerk in Kenia om Ũtugi (tradisionele hulpbronne) te gebruik in aanvulling tot die Christelike verstaan van gasvryheid (kerklike hulpbronne) om die menswaardigheid van mense wat met MIV en VIGS saamleef, te verhoog en die MIV- en VIGS pandemie te beveg. Die navorsing sluit metodologies aan by die hermeneutiek. Die volg 'n praktykbenadering tot pastorale versorging en berading. Dit wil teologiese konsepte en die Agĩkũyũ se kulturele konsepte interpreteer, en deur middel van kwalitatiewe, kritiese analises vir die pastorale bediening aan mense wat positief met MIV getoets is, help sorg. In die lig van konseptuele analise, word daar in hierdie hierdie studie krities gekyk na die rol van Ũtugi binne die konteks van MIV en VIGS en na die gepastheid daarvan as instrument vir pastorale versorging en berading in die Anglikaanse Kerk van Kenia. In hierdie studie word die fundamentele vraag gestel: Hoe kan die Agĩkũyũ-konsep Ũtugi gebruik word om ruimte vir heling te skep en die heersende ekklesiologiese paradigmas in die Anglikaanse Kerk in Kenia omskep word sodat dit relevant en kontekstueel kan wees in die strewe om te reageer op die uitdagings van die MIV en VIGS pandemie in die 21ste eeu? Die navorsing toon aan dat die beginsels van Ũtugi Christelike gasvryheid kan aanvul om netwerke te vorm en die kerk te help om die las van mense wat met MIV en VIGS saamleef, te help dra. Só kan hulle menswaardigheid verhoog word, in hulle vreugde en gerief gedeel word, en saam met hulle deur hulle pyn, hartseer en soeke na heling pastoraal gereis word. Daar is ook bevind dat Ũtugi as 'n kontekstuele model wat kultureel gegrond is, relevant is vir die Agĩkũyũ-mense. Dit kan inderdaad bydra en kan help om die bestaande kerklike gebruike van die Anglikaanse Kerk in Kenia te verander. Deur gebruik te maak van Daniël Louw se eksistensiële model vir christelik-spirituele geestelike heling, word die gepastheid van Ũtugi as 'n model vir pastorale versorging en berading aan mense wat positief met MIV en VIGS saamleef, evalueer. Daar is bevind dat Ũtugi nie net 'n paradigma is wat hulle liggaamlike, sosiale, sielkundige, ekonomiese, morele en spirituele lewe kan versterk nie, maar dat dit ook die vermoë het om die eksistensiële bedreiging van angstigheid, skuld en skaamte, ontnugtering en woede, wanhoop en twyfel, hulpeloosheid en kwesbaarheid, pastoraal te hanteer. Dit kan 'n verskuiwing vanaf eksistensiële bedreigings na 'n posisie van liefde, sorg, medelye ondersteuning, tegemoetkomendheid, vryheid en hoop meebring.