Obesity and obesity-related diseases – such as type 2 diabetes – have become the most crucial indicators of population health in the 21st century. Formerly understood as ‘diseases of affluence’, obesity is now prevalent in the Global South posing serious risk to socioeconomic development. This is particularly true for rapidly developing countries where nutrition transitions are most apparent. There are many factors which impact on risk of obesity (e.g. gender, culture, environment, socioeconomic status, biological determinants). The problem is further aggravated within small island developing states where food security is exacerbated by factors associated with globalization and development. The thesis examines the surge of obesity and type 2 diabetes within Caribbean populations, using Barbados as a case study. A holistic approach was applied using an ecological health model. Moving away from the lifestyle model, the theoretical framework underpinning included sub-theories (e.g. social constructivism, feminism, post-colonial theory, concepts of memory and trauma).

This study investigated caregivers' perceptions with regard to vaccine-preventable diseases in terms of six constructs of the Health Belief Model. A qualitative research design that is explorative, descriptive and contextual in nature was employed in order to understand and describe the perceptions influencing access and utilisation of services that lead to missed immunisation opportunities and consequently outbreaks of vaccine-preventable diseases. The data-collection techniques were individual unstructured in-depth interviews, field notes and clinical records. The sample consisted of twenty two (N=22) caregivers who volunteered to be interviewed. The study has highlighted that caregivers' perceptions or cognitive factors play an important role for having children in completing immunisation schedule to protect the public from vaccine-preventable diseases. It is recommended that mass media programmes are needed to address the role of vaccines in reducing high morbidity and mortality rates caused by vaccine preventable diseases and improvement in access to immunisation services. / Health Studies / MPH (Health Studies)

Obesity and obesity-related diseases – such as type 2 diabetes – have become the most crucial indicators of population health in the 21st century. Formerly understood as ‘diseases of affluence’, obesity is now prevalent in the Global South posing serious risk to socioeconomic development. This is particularly true for rapidly developing countries where nutrition transitions are most apparent. There are many factors which impact on risk of obesity (e.g. gender, culture, environment, socioeconomic status, biological determinants). The problem is further aggravated within small island developing states where food security is exacerbated by factors associated with globalization and development. The thesis examines the surge of obesity and type 2 diabetes within Caribbean populations, using Barbados as a case study. A holistic approach was applied using an ecological health model. Moving away from the lifestyle model, the theoretical framework underpinning included sub-theories (e.g. social constructivism, feminism, post-colonial theory, concepts of memory and trauma).

Since the earliest reported cases of HIV/AIDS probably in 1959 in Africa, there has been a consistent progression in the new HIV/AIDS infection cases. In South Africa, Gauteng, records one of the highest HIV/AIDS prevalence rates in the country. The Department of Health (DOH) South Africa conducts ongoing studies on HIV/AIDS at provincial levels; these studies monitor the prevalence of HIV/AIDS amongst pregnant women attending antenatal clinics, as a tool for determining and monitoring the prevalence, trends, patterns and spread of the disease in the general population. This study analyses sentinel and spatial data collected from the (DOH) and Statistics South Africa (StatsSA) respectively, and depicts them in the form of spatial maps, and then critically analyses the spatial patterns that occur. The research findings would hopefully contribute to the overall knowledge of HIV/AIDS and provide framework and relevant literature for further investigation. / Geography / M.Sc. (Geography)

Since the earliest reported cases of HIV/AIDS probably in 1959 in Africa, there has been a consistent progression in the new HIV/AIDS infection cases. In South Africa, Gauteng, records one of the highest HIV/AIDS prevalence rates in the country. The Department of Health (DOH) South Africa conducts ongoing studies on HIV/AIDS at provincial levels; these studies monitor the prevalence of HIV/AIDS amongst pregnant women attending antenatal clinics, as a tool for determining and monitoring the prevalence, trends, patterns and spread of the disease in the general population. This study analyses sentinel and spatial data collected from the (DOH) and Statistics South Africa (StatsSA) respectively, and depicts them in the form of spatial maps, and then critically analyses the spatial patterns that occur. The research findings would hopefully contribute to the overall knowledge of HIV/AIDS and provide framework and relevant literature for further investigation. / Geography / M.Sc. (Geography)

A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M.A. (Health Studies)

Thesis (PhD)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: The emergence and re-emergence of viral human pathogens from wildlife sources in the recent past has led to increased studies and surveillance of wildlife for potentially zoonotic agents in order to gain a better understanding of the pathogens, their sources as well as events that may lead to viral emergence. Of the >1407 known human pathogens, 13% are classified as emerging or re-emerging, and 58% as zoonotic; 37% of the (re-)emerging and 19% of the zoonotic pathogens are RNA viruses, accounting for the majority of recently emerged infectious diseases with a zoonotic origin, such as HIV, Ebola, Hendra, Nipah, Influenza and SARS. This study focusses on potentially zoonotic viruses hosted by rodents (Muridae family), shrews (order previously known as Insectivora/Soricomorpha, now reclassified as Eulipotyphla) and bats (order Chiroptera). Rodents and bats represent the largest (~40%) and second largest (~25%) mammalian orders and both occur on every continent except Antarctica. Together, the three mammalian orders investigated represent the most relevant potential sources of new zoonoses. In this study I investigated the occurrence of astroviruses, arenaviruses, coronaviruses and hantaviruses in South African small mammal species belonging to the orders mentioned above. These viruses have either been implicated in recent emerging zoonotic events or are considered to have the potential to cause cross-species transmissions resulting in a zoonotic event. In the first part of the study specimens collected from various bat, rodent and shrew species were screened for viral sequences by broadly reactive PCRs; positive samples were characterised by sequencing and sequence analysis. A separate part of the study focussed on hantavirus disease in humans: a seroprevalance survey was conducted to determine the presence of hantavirus antibodies in the local population. Additionally, acutely ill patients with potential hantavirus disease were tested in an attempt to identify possible acute infections and define clinical hantavirus disease in South Africa. Screening of rodent and shrew specimens resulted in the identification of eight novel arenavirus sequences. Seven of the sequences are related to Merino Walk virus, a recently identified South African arenavirus, and the eighth sequence represents a novel lineage of Old World arenaviruses. Screening of bat specimens resulted in the identification of highly diverse novel astrovirus and coronavirus sequences in various South African bat species, including the identification of a viral sequence closely related to the recently emerged Middle East Respiratory Syndrome coronavirus. While the study did not identify hantavirus infections in any of the acutely ill patients, it found seroprevalences similar to those observed in Europe and West Africa. The results obtained highlight the importance of small mammals in the emergence of potential zoonoses and further reinforce the importance of viral surveillance of relevant wildlife species. Further in-depth studies of naturally infected reservoir host populations are required in order to gain a better understanding of virus-host dynamics and the events that lead to virus emergence. / German Research Foundation (DFG) (project number: KR1293/9-1/13-1) / The Polio Research Foundation and the NHLS Research / Harry Crossley Foundation, the Polio Research Foundation and Stellenbosch University for granting scholarships and bursaries for PhD.

A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M. A. (Health Studies)

INTRODUÇÃO: No Brasil, os doadores de sangue são submetidos à triagem clinica antes da doação através de um questionário padronizado que segue recomendações do Ministério da Saúde. Apesar de não ser obrigatório, os serviços de hemoterapia brasileiros costumam perguntar aos candidatos sobre o número de parceiros sexuais nos doze meses que precederam aquela doação de sangue. Os candidatos que referem um número de parceiros acima do limite permitido em cada hemocentro são recusados na triagem clínica pré-doação. Este estudo analisa as características demográficas, o número de parceiros heterossexuais e marcadores sorológicos em 689.868 doações de três hemocentros brasileiros, participantes do REDS-II, entre 1 de julho de 2007 a 31 de dezembro de 2009. MÉTODOS: Os doadores foram classificados de acordo com o número máximo declarado de parceiros sexuais nos últimos doze meses permitidos em cada hemocentro. Os valores de corte para Belo Horizonte, Recife e São Paulo são dois, três e seis parceiros, respectivamente. Foram realizados os testes de qui-quadrado e regressão logística a fim de examinar associações entre características demográficas, número de parceiros sexuais em doze meses e taxas de marcadores sorológicos individuais e globais positivas para o vírus da imunodeficiência adquirida (HIV), vírus linfotrópico humano (HTLV) tipo 1 e 2, hepatite B, hepatite C e sífilis. RESULTADOS: Doadores de primeira vez, jovens e com maior nível educacional foram associados a maior número de parceiros sexuais recentes, assim como o gênero em São Paulo e Recife (p < 0, 001). Marcadores sorológicos globais, para HIV e sífilis foram associados com maior número de parceiros em São Paulo e Recife (p < 0, 001), mas não em Belo Horizonte. Na análise de regressão logística, o número de parceiros sexuais foi associado com marcadores sorológicos positivos [razão de chance ajustada (AOR) 1,2-1,5], especialmente no HIV (AOR 1,9-4,4). Em conclusão, o número de parceiros sexuais nos doze meses antes da doação de sangue, foi associado com positividade para HIV e taxas globais de marcadores sorológicos para doenças transmissíveis por transfusão. A associação não foi consistente entre os centros, tornando difícil definir um valor de corte uniforme para todos os hemocentros brasileiros. Estes achados corroboram que o uso da informação dos contatos heterossexuais recentes é um importante critério de inaptidão e de melhora na segurança transfusional no Brasil / INTRODUCTION: In Brazil, blood donors undergo medical screening before donation through a standardized questionnaire that follows recommendations from the Ministry of Health. Although not required, most of the Brazilian blood centers routinely ask candidates about the number of sexual partners in the twelve months preceding that blood donation. Candidates who refer a number of partners over the limit allowed in each blood center are refused at the predonation clinic screening. This study analyzes the demographic characteristics, the number of heterosexual partners and serological markers in 689,868 donations from three Brazilian blood center, participants in the REDS-II, from 1 July 2007 to December 31, 2009. METHODS: Donors were classified according to the stated maximum of the number of sexual partners in the last twelve months, allowed at each blood center. The cutoff values for Belo Horizonte, Recife and Sao Paulo are two, three and six partners, respectively. We conducted the chi-square and logistic regression to examine associations between demographic characteristics, number of sexual partners in twelve months and rates of individual and global serological markers positive for human immunodeficiency virus (HIV), human lymphotropic virus (HTLV) type 1 and 2, hepatitis B, hepatitis C and syphilis. RESULTS: First time donors, young and better educated were associated with increased number of recent sexual partners, as well as gender in São Paulo and Recife (p < 0.001). Global serological markers for HIV and syphilis were associated with greater number of partners in Sao Paulo and Recife (p < 0.001), but not in Belo Horizonte. In logistic regression analysis, the number of sexual partners was associated with positive serological markers [adjusted odds ratio (AOR) 1.2 to 1.5], especially HIV (AOR 1.9 to 4.4). In conclusion, the number of sexual partners in the twelve months before blood donation was associated with HIV positivity and overall rates of serologic markers for transfusion-transmissible diseases. The association was not consistent among the Brazilian blood centers, making it difficult to set a uniform cut off value for all blood banks in Brazil. These findings confirm that, the use of information from recent heterosexual contacts is an important criterion of disability and improvement in transfusion safety in Brazil

São sistematizados e discutidos aspectos conceituais e operacionais da vigilãncia epidemiológica e do controle de eventos adversos à saúde, da monitorização em saúde pública, da pesquisa em saúde pública, do controle sanitário de produtos de consumo humano, riscos ambientais e do exercício profissional na área biomédica e, por fim, do apoio laboratorial aos serviços de saúde, vigilância epidemiológica e à pesquisa. Com fundamento nessa sistematização e discussão, é proposto um modelo de vigilância epidemiológica compatível com as diretrizes constitucionais vigentes e, portanto, aplicável, com as adaptações necessárias, ao processo de reorganização do Sistema Nacional de Saúde. Nesse modelo, os sistemas de vigilância epidemiológica para específicos eventos adversos à saúde seriam compostos por três sub-sistemas: a) Sub-sistema de informação para ações de controle: com a atribuição de coletar e analisar sistematicamente dados de específicos eventos adversos à saúde e/ou dos respectivos programas de controle, como também da coleta esporádica de informações por meio de inqüéritos e investigações epidemiológicas de campo. Neste sub-sistema as informações obtidas seriam rapidamente analisadas, para, com base nas recomendações técnicas disponíveis ou em normas já existentes, indicar as medidas imediatas de controle; b) Sub-sistema de inteligência epidemiológica: com a atribuição da análise sistemática dos dados recebidos do correspondente sub-sistema de informação para ações de controle para, incorporando os conhecimentos científicos e tecnológicos disponíveis, elaborar recomendações com as bases técnicas para as ações de controle de agravos específicos à saúde, divulgando-as regularmente a todos que delas necessitam. Este sub-sistema deverá identificar lacunas no conhecimento científico e tecnológico, referentes à especificos eventos adversos à saúde, induzindo pesquisas com vistas a superá-las. Deverá ainda constituir o primeiro nivel de incorporação, pelo Sistema Nacional de Saúde, do conhecimento produzido no campo da investigação cientifica e tecnológica; c) Sub-sistema de pesquisa: com a atribuição de desenvolver investigações cientificas e tecnológicas, induzidas pelo sub-sistema de inteligência epidemiológica e voltadas à solução de problemas emergentes e/ou prioritários em saúde pública. Nesse modelo os sistemas de vigilância para especificos agravos à saúde têm, obrigatoriamente, três componentes: a) coleta da informação; b) análise; c) ampla disseminação das informações analisadas acrescidas de recomendações com as bases técnicas para as ações de controle. Por sua vez, constituem a inteligência do Sistema Nacional de Saúde para específicos agravos à saúde, oferecendo condições técnicas para maior eficiência e eficácia e ainda, contínuo aprimoramento e atualização dos programas de saúde. / Conceptual and operational aspects of epidemiologic surveillance of adverse health events, public health monitoring, research in public health, sanitary control of human consuming products, risk from environment and from medical technologies, and laboratory support for health services, epidemiological surveillance and research are systematized and discussed. Based on this systematization and discussion it is proposed a concept of epidemiologic surveillance which is compatible with the established constitutional guiding, and thence applicable for reorganization process of National Health System, after requisitive adjusting. In this approach the Epidemiological Surveillance System for specific adverse health events would be consisted of three subsystems: a) Information for control actions subsystem: which assures the systematic collection and analysis of data on specific adverse health events and/or of the respective control programs, and of the sporadic collection of data by means of field epidemiological inquiring and investigation. In this subsystem the obtained data will be promptly analysed in order to identify the immediate measures, based on available technical recommendations or established guides or rules; b) Epidemiological intelligence subsystem: which conducts the systematic analysis of data received from the respective information subsystem control actions in order to elaborate recommendations with a technical basis of specific adverse health events related to a control intervention, and publishing them regularly and widely to all concerned, after being incorporated into available scientific and technologic knowledge. This subsystem should identify the gaps in the scientific and technologic knowledge related to the specific adverse health events, and induce researches with the purpose of overcoming these areas of weakness. It should also constitute the first level of incorporation of the knowledge in the scientific and technologic investigation are a by National Health System; c) Research subsystem: which is responsible for scientific and technologic investigation development by epidemiological intelligence subsystem and aimed at solving the emerging and/or priority problems in public health. In this approach the surveillance systems for specific adverse health events require three components: a) the information data collection; b) the data analysis; c) the wide diffusion of the analysed information data including the recommendation with technical support for control proceedings. In its turn, these components constitute the National Health System inteliggence for specific adverse health events to offer technical conditions for high efficiency and efficacy, and also a continuos improvement and modernization of health programs.