As at 2014, 19 million children aged < 16 years were visually impaired, 1.4 million of these children were blind and needed visual rehabilitation interventions. Surveys, mostly utilizing key informants (KI), have suggested that the prevalence of blindness in children in Sub Saharan Africa ranges between 2 -8 per 10,000 children. Childhood eye disease is rare and conditions are difficult to detect; thus, surveys to estimate the prevalence of blindness requires rigorous, costly and difficult methods to obtain reasonable estimates among children. Key informant programs, which engage the community in case finding, have been shown to be a reasonable alternative to large scale surveys and were used in Madagascar in 2014 by four regional eye care programmes. I propose to analyse the data generated from the programmes to quantify the prevalence of eye conditions among children and how the KIs performed. Method: The analysis will use data collected in a cross sectional approach. Statistical analysis will be conducted using Stata (15.0) statistical software. Data from all of the KI registers will be pooled and overall magnitude estimates calculated. KI productivity and sub-group analyses will include assessment of demographic characteristics of the children and the KI by age and sex. Ethical approval will be provided by the UCT Health Research and Ethics Committee and the Madagascar Ministry of Health. Discussion: The results from this study will help child eye health programmes to determine how best to use KI to better serve children with vision loss, and guide in the provision of eye services for children care.

Masters of Science / Substance abuse among the youth is one of the main social challenges in South Africa and around the world. The purpose of this study was to explore the reasons of substance abuse among the youth in Grabouw, Western Cape Province of South Africa. The reason why this research was conducted was because the Interdisciplinary Teaching and Learning Unit (ITLU) of the University of the Western Cape approached the Department of Social Work with research topics that emerged from the Faculty of Community and Health sciences involvement in the Theewaterkloof communities. One of the concerns expressed by the community of Grabouw is the high prevalence of substance abuse in this community. This study therefore explored the reasons for substance abuse amongst the youth of Grabouw. The research was conducted using the ecological approach as a theoretical framework. A qualitative research methodology was used to explore the phenomenon under study. The research project followed an explorative, descriptive and contextual research design and with this the researcher sought to understand the reasons for substance abuse. The data was gathered through semi-structured one-on-one interviews and focus group discussions and was later analyzed using qualitative thematic analysis. The findings showed that the reasons for substance abuse among the youth in the rural area of Grabouw are contextual reasons in which the family plays a major role in influencing substance use and also peer pressure, lack of recreational facilities, low religious involvement, experimenting and negative role models within the family and community, the ‘dop’ system, unemployment, availability and affordability were identified as the major reasons for substance abuse. The second major theme that emerged from the study was the psychological reasons for substance abuse. This includes low self-esteem, relieving stress, sexual stimulation, motivation to do unlawful things and boosting performances in sporting activities. The researcher has put forward various recommendations that will contribute towards solving substance abuse.

Substance Use Disorder (SUD) is associated with high mortality rates and remains a public health concern in the United States. Although, numerous interventions are offered for adolescents struggling with substance misuse, minimal research is available on the effectiveness of treatments to reduce recidivism. Researching the most effective treatment offered to adolescents is crucial to treatment adherence and recovery. The purpose of this study is to determine the most effective SUD treatment for adolescent patients by exploring the perceptions and experiences of treatment therapists providing treatment. The trans-theoretical model was used with elements of the social cognitive theory as a guide to, adolescent placement in treatment programs and behavior changes. Twenty-three treatment therapists at Community Mental Health Centers from 23 counties in the State of Indiana were interviewed using the Colaizzi phenomenological methodological approach to obtain verification, validation, and validity for this study. Results suggested that assertive post-discharge plans after SUD treatment, motivational interviewing, cognitive-behavioral therapy, higher power faith for strength, and family involvement was evidence of effectiveness. Seven themes emerged from 225 significant statements. Among the dominant themes were understanding of SUD as a disease and the importance of family involvement in the treatment process. The study findings have the potential for positive social change to address the stigma of stereotyping of SUD through educational campaigns.

Magister Public Health - MPH / Antiretroviral therapy (ART) improves the quality of lives of people living with HIV/AIDS by suppressing HIV replication and improving the patient’s immunity. An improved immunity will help prevent patients from contracting opportunistic infections. Adherence to ART is vital to obtain good clinical outcome for patients. Defaulting ART leads to increase in viral load, decreased host immunity, development of HIV drug resistant strains, exposure to opportunistic infections and ultimately death. HIV positive patients who are on ART face many challenges in adhering to their medications, these challenges act as barriers to their adherence to treatment. This study explores the barriers that adult patients in a hospital in Eastern Cape of South Africa face while on treatment. These barriers include individual factors, socio-economic factors, health service factors, medical regimen factors.

Au Québec, il est connu que l’insécurité alimentaire (IA) touche davantage les immigrants récents que la population québécoise en général, mais il n’existe pas de données spécifiques pour les réfugiés. Les réfugiés, contrairement aux autres immigrants, ont fui leur pays par crainte d’être persécutés et n’ont pas nécessairement choisi d’immigrer au Québec ni même au Canada. Nous savons que la situation vécue par les réfugiés est particulièrement difficile étant donné la nature permanente et forcée de leur migration, mais les facteurs affectant leur sécurité alimentaire, surtout pour ce qui est des aspects culturels, sont peu étudiés. Depuis 2015, plus de 60 000 réfugiés syriens ayant fui la guerre ont été réinstallés au Canada, dont près de 14 000 au Québec, faisant de cette vague le plus important accueil de réfugiés au Canada considérant le nombre d’individus et le court délai. Le but de cette étude est de comprendre comment les facteurs socio-économiques, géographiques et culturels affectent l’insécurité alimentaire des ménages de réfugiés syriens au Québec. Plus spécifiquement, les objectifs sont d’étudier les impacts du lieu de réinstallation, de la catégorie d’immigration et du statut social, entre autres, sur la sécurité alimentaire des réfugiés au Québec, en plus d’explorer les perceptions des informateurs clés et des réfugiés quant aux barrières et aux facteurs contribuant à leur sécurité alimentaire. Pour ce faire, des entrevues semi-dirigées ont été conduites auprès d’informateurs clés (n=9) et une enquête transversale comprenant des questionnaires sociodémographiques et de sécurité alimentaire (Module d’enquête de sécurité alimentaire des ménages, MESAM) a été effectuée auprès de réfugiés syriens réinstallés au Québec (n=49), en plus d’entrevues semi-dirigées chez certains participants (n=34). Les participants ont été recrutés par la méthode boule de neige. Au niveau de la partie qualitative, des analyses de contenu inductives ont été effectuées de façon distincte chez les deux populations à l’étude. Les résultats de l’enquête transversale montrent que 52% des réfugiés syriens de notre échantillon vivent en situation d’IA, ce qui est comparable aux taux obtenus chez d’autres populations de réfugiés au Canada ainsi qu’aux États-Unis et en Australie. À travers les 2 entrevues semi-dirigées, on constate qu’il est important de s’intéresser aux périodes prémigratoire et migratoire en plus de la période postmigratoire puisque ces expériences sont relayées de manière soutenue par les participants. Une fois au Canada, bien que la précarité financière soit l’élément le plus étudié de la vulnérabilité des ménages à l’IA, la qualité des aliments, ce qui inclut le goût de ceux-ci, ainsi que l’accès géographique à des aliments du Moyen-Orient sont des éléments qui ressortent fréquemment des entrevues et apparaissent comme étant des déterminants importants. En conclusion, plusieurs pistes ont été abordées pour expliquer la vulnérabilité à l’IA des réfugiés syriens réinstallés au Québec et cela montre l’importance, pour la prévention de l’insécurité alimentaire chez cette population, de se préoccuper non seulement de l’aspect financier, mais aussi de plusieurs autres aspects, dont ceux culturels. / Food insecurity (FI) is known to affect recent immigrants more than the general population of Quebec, but there are no specific data for refugees. Refugees, unlike other immigrants, fled their country for fear of persecution and did not necessarily choose to immigrate to Quebec or even to Canada. We know that the situation experienced by refugees is particularly difficult given the permanent and forced nature of their migration, but the factors affecting their food security, especially regarding cultural aspects, are little known. Since 2015, more than 60,000 Syrian refugees who fled the war have been resettled in Canada, including almost 14,000 in Quebec, making this wave the most important influx of refugees to Canada, given the number of individuals and the short delay. The purpose of this study is to understand how socio-economic, geographic and cultural factors affect the food security status of Syrian refugee households in Quebec. More specifically, the objectives are to study the impacts of the place of resettlement, the immigration category and social status, among others, on the food security of refugees resettled in Quebec, in addition to exploring the perceptions of key informants and refugees as to the barriers and factors contributing to their food security. To achieve this, semi-structured interviews were conducted with key informants (n = 9) and a cross-sectional survey including socio-demographic and food security questionnaires (Household Food Security Survey Module, HFSSM) was conducted with Syrian refugees resettled in Quebec (n = 49), in addition to semi-structured interviews with some participants (n = 34). Participants were recruited by the snowball method. At the qualitative level, inductive content analyses were carried out separately for the two study populations. Results from the cross-sectional survey show that 52% of the Syrian refugees in our sample are food insecure, which is comparable to the numbers obtained in other refugee populations in Canada as well as in the United States and Australia. In the semi-structured interviews, we note that the pre migratory and migratory periods need to be considered in addition to the post migratory period, which is usually more studied. Once in Canada, although financial insecurity is the most studied element of household vulnerability to food 4 insecurity, the quality of food, which includes its taste, as well as geographic access to Middle-Eastern foods are items that frequently emerge from interviews and seem to be therefore appear to be important determinants. In conclusion, several ways have been explored to explain the vulnerability to food insecurity of Syrian refugees resettled in Quebec, and this shows the importance, for the food insecurity prevention in this population, of being concerned not only with the financial aspect, but also with several other aspects, including the cultural ones.

本研究以城鄉差異觀點，評估台灣鄉村型社區心理衛生中心之服務需求，具體目的有(1)分析台灣縣市及雲林縣鄉鎮與心理衛生有關之各項社會指標，以驗證社區心理衛生相關問題的城鄉差異性；(2)瞭解雲林縣及其鄉鎮關鍵訊息提供者對高度農業地區各項社區心理衛生問題嚴重程度、問題型式、地理分佈與相關在地服務資源之看法；(3)瞭解雲林縣高度農業人口鄉鎮社區居民對其村落各項相關心理衛生問題嚴重程度、問題型式、社區壓力源、因應方式與求助情形之看法；(4)由社區居民調查結果，抽取鄉村心理衛生相關問題之共同因素，並歸納諸項調查研究與指標分析結果，初步擬定出一「台灣鄉村心理衛生指標系統目錄」。 研究方法採用多方法評估策略。社會指標分析方面，共計分析台灣地區23個縣市24項及雲林縣20個鄉鎮市16項心理衛生相關問題，以比較不同農業人口分群其發生率或盛行率之差異。關鍵訊息提供者調查方面，使用自編問卷分別調查雲林縣30位與二崙與水林兩鄉69位政府單位、民間機構或專業個人等。社區居民調查方面，二崙與水林兩鄉共發出2049份問卷，回收1074份(52.4%)，有效問卷為967份(41村、97.6%)。統計方法有描述統計、集群分析、t考驗、單因子變異數分析、皮爾森積差相關分析、因素分析等。 研究主要發現如下：(1)高度農業人口地區之老年、低教育程度、喪偶、外籍配偶、身心障礙、意外事故死亡、醫事人員平均服務人口數等比例明顯較高，離婚、全般刑案、竊盜、強盜搶奪、暴力犯罪、強制性交等比例則較低。(2)台灣縣市心理衛生相關嚴重問題社會指標之地理分佈概況不明顯，但雲林縣心理衛生相關嚴重問題比例則以高度農業人口的二崙與麥寮兩鄉明顯較高。(3)雲林縣與二崙、水林兩鄉關鍵訊息提供者皆認為人口外移與老化、老人問題(獨居、貧窮、安養等)、電話詐騙等問題比例較高。雲林縣關鍵訊息提供者主觀覺得口湖、台西與四湖為最亟需心理衛生服務的農業鄉鎮。二崙鄉關鍵訊息提供者主觀覺得大庄、楊賢與港後為該鄉最亟需心理衛生服務的村落。水林鄉關鍵訊息提供者主觀覺得水北、塭底與大山為該鄉最亟需心理衛生服務的村落。(4)二崙與水林兩鄉社區居民認為電話詐騙、人口外移、農產經營影響、人口老化、家庭經濟壓力等問題比例較高，青少女母親(含未婚懷孕)、家庭人數眾多、親友與鄰居死亡頻傳、自殺、性侵害、精神疾病、家庭暴力、家庭虐待等比例較低。(5)二崙與水林兩鄉居民認為「社區孤立與無望感」來自人口老化、多孤獨貧窮老人、人口外流嚴重、生活無聊、缺乏休閒娛樂等因素較多，「犯罪被害擔憂與恐懼」來自竊盜、詐騙、嗑藥吸毒等問題較多，「社區憂鬱現象」來自個人與家庭經濟壓力、失業、農業損害或收益等因素較多。(6)二崙與水林兩鄉居民認為其感受社會壓力源以治安惡化為主，農業壓力源以農產收益與自然災害為主，社區壓力源以治安不佳、衛生環境不良、缺乏休閒娛樂等較多，學校壓力源以城鄉差距大、教育與學習資源不足、課業或升學壓力、教育政策多變等較多，家庭壓力源以經濟收入與子女教養為主，個人壓力源以經濟收入、身體健康、工作壓力等較多。(7)二崙與水林兩鄉居民指出習慣(或主要)抒解或因應壓力方法，以「找人聊天」居首，只有6.5%曾求助於親友之外的專業人員。(8)雲林縣現有7個單位或機構(衛生局─社區心理衛生中心與長期照護管理示範中心、社會局─各課、家庭教育中心、台大醫院雲林分院精神科、雲林區心理衛生諮詢服務中心與生命線協會)共提供37個鄉村心理衛生相關服務項目。 本研究由社區居民調查結果，共抽取出七個因素構面並分別命名為「一般社區心理衛生問題」、「農業社區心理衛生問題」、「環境污染」、「經濟壓力」、「居住生活風險」、「犯罪」與「家庭婚姻特性」，並歸納諸項調查研究與指標分析結果，初步擬定出一「台灣鄉村心理衛生指標系統目錄」(5大指標向度，14個指標項目)。 文末，研究者並根據研究結果與國內外相關文獻，分別提出鄉村居民心理健康政策、鄉村心理衛生指標系統、農業危機服務、老人心理衛生、社區孤立與無望感、犯罪被害恐懼、環境污染心理影響、鄉村性別與族群心理議題、鄉村學校之預防功能、鄉村心理衛生服務模式等10項建議。 / The purposes of this thesis were: (1) to analyze the differences of some social indicators related to mental health of Taiwan (23 cities/counties) and Yunlin county (20 townships). (2) to understand the opinions of the key informants about community mental health problems. (3) to survey community residents of agricultural areas about the subjective perceptions of their mental health. (4) to set up a summative index of Taiwan Rural Mental Health indicators System. This research used a multi-method strategy. Data collected in the spring of 2005 included 24 social indicators of 23 cities/counties in Taiwan, and 16 social indicators of 20 cities/township in Yunlin, and questionnaires of 99 key informants and 967 community members of Erh-lun and Shui-lin Township of Yunlin County. Major findings of this study were as follows: (1)Significant differences were found in the social indicators about the numbers of older population, the lower educational status, the widowed, the foreign spouse, and the disabled, the accidental injury-related deaths in agricultural counties. In contrast, urbanized areas had higher rates of the divorced, all criminal case, larceny, robbery and forceful taking, violent crime, rape, and the average number of people serviced by per medical personnel . (2)The geographic analysis in terms of the mental health status and service needs of residents revealed no significant differences among 23 cities/counties, but significant differences among 20 cities/township (Yunlin County), Erh-lun and Mailiao had much more problems. (3)Yunlin County’s key informants indicated that the areas of Kou-hu, Tai-si and Sih-hu have high needs for mental health services. Erh-lun’s key informants indicated that 3 villages have high needs for mental health services. Shui-lin’s key informants indicated that 3 villages have high needs for mental health services. (4)Most respondents of resident sample ranked the following mental health problems as serious: fraudulent telephone calls, out-migrant, farm crisis, being elderly, and family economic hardship. (5)Most respondents of resident sample employed “chatting with others” as stress-relieving or coping method. Besides “family and friends”, only about 6.5% of respondents reported that they sought help from mental health professionals or specialists. (6)To set up the initial rural mental health indicator systems of Taiwan: a summative index consists of 14 items and is divided into five dimensions The recommendations for rural mental health policies, indicator systems, program strategies and rural mental health service delivery issues were also suggested.