>Magister Scientiae - MSc / The identification of the association between socio-demographic characteristics and HIV was found to be a useful tool in determining the important risk factors in Sudan. In this study, the relationship(s) between HIV test results and the demographic characteristics such as gender, age, residence area, employment, education, marital status and religion in Omdurman, Sudan were investigated. The data were collected from patients visiting Omdurman National Voluntary Counseling and Testing (VCT) Centre from April 2005 to April 2006. The study sample was represented by 320 patients. Tables were used in the data analysis to present the distribution of the participants by the result of HIV test and demographic factors; odds ratios were also obtained from these tables. The Chi-square test was used to test the association between each socio-demographic factor and the result of HIV test; the Pvalue obtained from this test was measured at a significance level of 0.05. Finally, the joint effect of all demographic factors on HIV test results was tested using logistic regression. A significant association between socio-demographic characteristics and HIV test results was observed. It showed a higher incidence rate in females, middle-aged, married, employed and Christian individuals. HIV was also found to be higher in urban areas than in rural areas. The lower incident rate was observed among educated individuals.

Magister Scientiae (Physiotherapy) - MSc(Physio) / In addition to football and basketball, volleyball has become a very popular sport globally over the last 30 years. The International Federation of Volleyball represents about 150 million players in approximately 170 countries. While a large body of research has been conducted regarding the nature and prevalence of volleyball injuries internationally, very little has been done locally or on the African continent to assess the status of injuries incurred at professional or amateur levels. The aim of this study is to determine the prevalence of injuries sustained by professional volleyball players of a club in the WPVU in one season. An exploratory, descriptive, nonexperimental approach was used for this study on 42 volleyball players at the University of the Western Cape Volleyball Club. A self–administered questionnaire that was based on a questionnaire used in a Dutch national volleyball study was used in the present study. A response rate of 89.4% was obtained. The collected data were captured and analysed by means of the Statistical Package for Social Science version 14.0 (SPSS). The associations between variables were evaluated by means of the chi-square test and a 5% level of significance was used. The results were displayed using tables, bar chart, and pie chart. Most of the volleyball players sustained one or more injuries in the season, giving a prevalence rate of 88.1%. The incidence rate was 1.2 injuries per player. Injuries prevalence was higher among male players 54.1% than female players 45.9%. Among the injured players, ankle and knee injuries showed the highest injury prevalence with 25.5% for each followed by 19.6% for shoulder injuries. The study revealed 69.2% injury prevalence with a higher significance (p=0.04) that players who are injured in the ankle were in contact. Half of the injuries (50%), which occurred gradually, were prevalent in the shoulder, followed by the knee (28.6%), then the ankle and fingers (14.3%). Players in the left and right front row were significantly (p=0.008) more prone to be injured during spiking. Awareness programmes highlighting prevention strategies and physiotherapy intervention are required for coaches and players at the University of the Western Cape Volleyball Club to assist in the prevention of volleyball injuries

Magister Scientiae (Physiotherapy) - MSc(Physio) / Chronic non-communicable diseases, including cardio-vascular diseases and stroke, cancer, type 2 diabetes and chronic pulmonary disorders, are rapidly emerging as leading causes of morbidity and premature mortalities globally. The majority of the populations worldwide have experienced major transformations in disease profiles and health status characterized by a shift from infectious diseases and nutritional deficiencies to a predominance of chronic diseases of lifestyle. This epidemiological transition is regarded as an outcome of the environmental and socioeconomic changes following urbanization.Common behavioral health risk factors, such as smoking, risky alcohol consumption,sedentarism, overweigh/obesity and hypertension, have consistently been attributed to the development of chronic non-communicable diseases among populations.This thesis seeks to describe the epidemiology of the major common risk factors for noncommunicable diseases among people living in Mombasa, Kenya. The study responds to the WHO’S recommendations on comprehensive and continuous risk factor surveillance as an essential component of the public health information system and a vital health promoting strategy in the control and prevention of non-communicable diseases.A cross-sectional study design using the WHO STEPwise protocol was employed.Convenient stratification of the Mombasa population was done according to gender, age and setting categories. Using the Yamane formula n = N/1+ N(e²), a sample of 500 participants aged 15 to 70 years was arrived at. The researcher then conveniently selected public high schools, tertiary institutions, workplaces and a marketplace as the study settings.The WHO STEPS instrument (Core and Expanded Version 1.4) was used for data collection. Step 1 involved gathering information on socio-demographic characteristics and health-related behaviors of the participants using close-ended structured questions. Step involved the taking of simple anthropometrical measurements pertaining to height, weight, waist circumference, blood pressure and pulse rate.Data were captured, cleaned and analyzed using the Statistical Analysis System (SAS) and SPSS version 16.0. Chi-square and Spearman correlation tests were used to determine associations between socio-demographic variables and behavioral health risk factors.The results indicated that 61% of the study participants possessed at least one of the investigated risk factors. 17% of the participants had a multiple risk factor profile, with 54% more females having a higher mean risk factor score compared to 46% of their male counterparts.Physical inactivity, hypertension and overweight/obesity were the most common registered risk factors, accounting respectively for 42%, 24% and 11%. Physical inactivity and hypertension formed the commonest cluster of multiple risk factor patterns; they co-occurred in 68% of the participants with a multiple risk factor profile.Increasing age, female gender and a low level of educational attainment were factors seen to be significantly associated with the development of risk factors for non-communicable diseases among the participants. It was observed that the burden of risk factors was unequally distributed among Mombasa residents; intervention programs based on our findings should therefore be used to ensure effectiveness. Future studies using nationally representative samples are further suggested to provide a more comprehensive analysis of a national risk factor profile.

Magister Public Health - MPH / Background: STIs are of major public health concern in developing countries, not least because they facilitate transmission of HIV, but also because they are important causes of mortality and morbidity among African populations, resulting in, among other things, adverse birth outcomes, neonatal and infant infections, ectopic pregnancy, anogenital cancer,infertility, pelvic inflammatory disease, and death. Thus, effective treatment needs to be prompt and accurate to control the spread, and morbidity and mortality of STIs. Even though syndromic approach to the management of STIs is effective, most evaluations have focused on syndromic STI management within STI clinics as opposed to research studies. Partner notification is an integral component of the syndromic approach and is aimed at preventing onward transmission of infection as well as re-infection. It includes informing sexual partners of infected people of their exposure, administering presumptive treatment, and providing advice about the prevention of future infection.Methods: This is a cross sectional descriptive study based on a retrospective review of STI data of study participants in KICoS aged 18 to 34 years. A non probability convenience sampling method was used to recruit study participants. A total of 1,277 participants were prescreened into KICoS of whom 847 were enrolled into this study. Data was collected using CAPI and ACASI questionnaires as well as Teleforms which was analysed in SAS for windows 9.1. Results: Syndromic prevalence of STIs was 5.7% while the aetiological prevalence was 32.8%.Risk factors to STI acquisition included, being female, having multiple sexual partners,having lower than tertiary education, using recreational drugs and being HIV. Agreement between the interviewing methods as well between the syndromic and laboratory diagnosis ranged from fair to substantial. This was also true for the agreement between laboratory and CAPI as well as between the laboratory and ACASI. Sensitivity was generally low while specificity was high. Uptake of contact tracing cards was high though with very low uptake of contact treatment with only 2.1% and 0.4% partners of the syndromically and aetiologically diagnosed participants coming for treatment.Conclusions: STI is a problem in this community and thus there should be more emphasis on risk reduction messages in patient education to mitigate the spread of STIs. The performance of syndromic management was very poor against the aetiological diagnosis thus there needs to further review the use of syndromic diagnosis of STIs in research settings. Partner tracing needs to be intensified since there was very poor partner treatment even with high uptake of contact cards.Acknowledgements: This study would have not been what it was without the immense support I received from many individuals all of whom cannot be mentioned here. I would however want to thank the Dr Wairimu Chege (Principal Investigator, KICoS) for her inspiration and encouragement. I would also like to thank my supervisor, Ernie Kunneke for going through this study with me repeated times including on a ride to the airport. On the same note I would also like to thank my lecturers and student administrators at the SOPH. My gratitude also goes to my colleagues Richard Ndivo, Sherri Pals and Eleanor McLellan-Lemal for all the support they accorded me throughout this research.I would also want to give my heartfelt gratitude to my family. My daughter Akinyi who used to type with me at night, her mother Auma for understanding my late nights up and finally to my Parents Mr and Mrs Gideon and Monica Otieno for understanding the importance of education and taking me to school through all the difficulties. Last but not least I would like to express my gratitude to the almighty God for having seen me through this process.

Magister Scientiae - MSc / The aim of the study was to determine the prevalence of and risk factors contributing to work-related musculoskeletal injuries amongst underground mine workers in Kitwe, Zambia.

Magister Public Health - MPH

Chagas disease is caused by the parasite Trypanosoma cruzi and transmitted by multiple triatomine vectors across the Americas. In Central America, the predominant vector is Triatoma dimidiata, a highly adaptable and genetically diverse Hemiptera. In this research, we used a novel reduced-representation DNA sequencing approach to discover community dynamics among multiple biotic factors associated with Chagas disease in Central America, and assess the infestation patterns of T. dimidiata after seasonal and chemical disturbances in Jutiapa, Guatemala. For our first study, we used a hierarchical sampling design to obtain multi-species DNA data found in the abdomens of 32 T. dimidiata specimens from Central America. We aimed to understand (1) the prevalence of T. cruzi infection, (2) the population genetics of the vector and parasite, (3) the blood meal history of the vector, and (4) gut microbial diversity. Our results indicated the presence of nine infected vectors harboring two distinct DTUs: TcI and possibly TcIV. We found significant clusters among T. dimidiata populations in countrywide and within-country levels associated with sylvatic ecotopes and diverse domestic genotypes. There was significantly higher bacteria species richness in infected T. dimidiata abdomens than those that were not infected, with further analysis suggesting that gut bacteria diversity relates to both T. cruzi infection and the local environment. We identified vertebrate blood meals from five T. dimidiata abdomens including chicken, dog, duck and human; however, additional detection methods are necessary to confidently identify blood meal sources. In our second study, we analyzed the GBS genotypes of 440 T. dimidiata specimens collected in two towns of Jutiapa, Guatemala. Our aim was to assess (1) the domestic population patterns that aid the recovery of T. dimidiata after an insecticide treatment in El Carrizal and (2) the seasonal changes that regulate the dispersal of the vector in the untreated communities of El Chaperno. Results showed that the insecticide application was effective at reducing the population abundance immediately after the application in El Carrizal; nevertheless, 18-month post-treatment the town-wide infestation and genetic diversity were recovering. Within-house relatedness among specimens recovered 18 months post-treatment, suggesting that the insecticide treatment failed to fully eliminate domiciliated colonies. In contrast, lack of change in abundance or genetic diversity in El Chaperno implied absence of dispersers from sources beyond the town periphery, while evidence of a decrease of relatedness among individuals implied dispersal among houses. After the insecticide treatment in El Carrizal, population reduction led to lack of genetic spatial autocorrelation; nevertheless, rapid dispersal into neighboring houses lead to autocorrelation 18 months after the insecticide treatment. This pattern was also observed in El Chaperno, where an increase in spatial autocorrelation during seasonal dispersal suggests spillover to close-by households. The creation of a novel genomics pipeline allowed us to understand community and dispersal patterns of T. dimidiata and other biotic factors important for the prevalence and transmission of Chagas disease at local and regional levels. Future studies should include complementary approaches for taxa verification (e.g. bacteria 16S barcoding, PCR-base detection), as well as expand the scope of local population analyses to peridomestic and sylvatic genotypes that could suggest a broader range of vector sources and region-wide patterns of temporal and spatial dispersion.

Asthma has been reported in children as a leading chronic illness in the US and around the world. It is also the third leading cause of hospitalization among children under the age of 15, and is also one of the most common causes of school absenteeism. Children are at higher risk of asthma attacks and they pose a higher burden on health care system. Nearly 20.6% of middle and high school children in Florida have been told they have asthma, this prevalence has grown over 3% from 2006 to 2012. Changes in air pollutant levels are often related to health outcomes, e.g. prevalence of chronic asthma. Exposure to ambient air pollutants have been reported to exacerbate asthma attacks especially in children. Often agencies and governing bodies utilize national level health impact assessments (HIAs) to estimate local levels of health impacts. The US EPA (Environmental Protection Agency) developed the Benefit Mapping and Analysis Program (BenMAP) to estimate impacts on health due to changes in air pollution. Recent studies have shown that assessment of regional exposure is important to understand health impacts of pollutants at the local level. To use BenMAP effectively for HIA in Florida, one may have to update the prevalence rates and concentration response (CR) functions in BenMAP with Florida data. The main purpose of the research was to develop a method which can estimate impact of change in criteria pollutants on childhood asthma outcomes in Florida. The rates present in BenMAP are based on national estimates, which are higher than the rates for Florida. If these rates are used for the HIA method then the change in asthma emergency department visits estimated by BenMAP may be an overestimate with higher uncertainties. There are no baseline rates for asthma exacerbation ED visits in BenMAP, an asthma exacerbation is a more severe and poorly managed case of asthma. Asthma ED visit prevalence rates will tend to overestimate the asthma exacerbation rates by 64%, if used. Detailed review of US-EPA’s BenMAP software and peer reviewed literature was performed to identify the gaps in BenMAP for asthma assessments. The CR functions were developed using local pollutant and outcomes data. CR functions were added to BenMAP to bridge the gaps. The baseline prevalence and exacerbation rates at county level by age group, gender and race ethnicity were developed. This study highlights that an increase of 10 µg/m3 of PM2.5 contributes about 2% to asthma ED visit rate, in children 5-12 and is lower, for 13-18 olds (0.6%). The baseline prevalence and exacerbation rates at county level for asthma in children differed by race/ethnicity. This study publishes the ED rates by county and by gender, race and ethnicity from 2010 to 2014, which are recent rates and have not been published to such granularity by the State or by any other researcher. Current pollutant data in BenMAP is only available through 2008, and EPA has recommended it should be updated for analysis purposes. This study has updated the monitor data in BenMAP for Florida counties for 2010-2014. There are three major contributions of this study. Firstly, the study contributes to publishing childhood emergency department prevalence rates for asthma and exacerbation in the State of Florida by age group, race/ethnicity and gender. Secondly, development of concentration response functions specific to Florida using the time series analysis to show the impact of PM2.5 on asthma exacerbation emergency department visits, incorporating both temporal and spatial variability of PM2.5 during the study period. Finally, the study demonstrates the utility of using local (county-level) baseline asthma prevalence rates and local pollutant data for State HIA in Florida. The local PM2.5 data in BenMAP can be used for other health outcome assessments, researchers will only have to update the prevalence rates for the health outcome used in their study. Estimation using local data will be less prone to uncertainties using National level data, the use of local data has been emphasized by several researchers. The study recommends future work in refining spatial grid resolution in BenMAP to zip code level to facilitate studies at neighborhood level. Another recommendation is to further design research to study SES in context to dietary changes and better understand social injustices in areas with diverse population. A population-based study in conjunction with Florida Asthma Coalition (FAC) asthma cases from doctors’ offices is recommended which will be able to control for misclassifications, and include weather and allergens in analysis while studying individual pattern of exposure and diet.

Human beings are social creatures. Accordingly, fear of social situations can be severely disabling. Social anxiety disorder (SAD) is characterized by excessive fear of negative evaluation in social or performance situations. SAD has an early onset and often goes undetected an untreated. Descriptive studies on non‐clinical samples are required in order to find ways to prevent SAD and associated consequences. This thesis aimed at examining epidemiological variables of SAD in adolescence which is the critical period for onset of SAD. More exactly, issues of detection and prevalence, victimization and developmental course were addressed. Data was collected in four different community samples, using cross‐sectional and longitudinal designs. In the first study (n=169), psychometric evaluation of a screening questionnaire for use with adolescents was conducted. The second study (n=2128) investigated prevalence of SAD in students in grade 6‐8 (age 12‐14 years). In the third study (n=3211), the association between SAD and victimization in high‐school students (aged 17) was investigated. Finally, in the fourth study (n=350), longitudinal associations between social anxiety and depressive symptoms were investigated, with 4 waves of data from grade 7 to grade 11. Self‐reported SAD was found among 4.4% of students in grade 6‐8 and among 10.6% of high‐school students. Females reported SAD to a significantly higher degree than males in all age groups. Experiences of peer victimization, maltreatment and sexual victimization were significantly more common in those reporting SAD than in non‐cases. Social anxiety was stable over adolescence. Further, peer victimization in grade 7 predicted social anxiety that mediated subsequent depressive symptoms. In conclusion, self‐reported SAD is common in Swedish adolescents and especially in girls and older adolescents. Social anxiety is stable over adolescence and correlated with depressive symptoms over course. The high prevalence rates, stable course and mediation of depressive symptoms call for early detection and prevention of social anxiety. The relationship between victimization and SAD needs to be investigated further in controlled prospective studies on children and adolescents.

There has been significant debate, specifically within the African context, regarding the validity of using HCT data as part of routine surveillance data for the HIV epidemic. The use of HCT data in tracking the prevalence of HIV, as well as in estimating incidence rates for HIV, has been applied in some African countries, and may offer opportunities to strengthen surveillance in the Gauteng Province, South Africa. Literature suggests HCT data are biased as a result of the high proportion of repeat testers, where repeat testing may be related to high risk sexual behaviour. (1–8) It has been suggested that HCT data be separated into first-time- and repeat tester data in prevalence or incidence estimations. (9) The aim of this research was to determine if there are demographic and HIV prevalence differences between first-time- and repeat testers, as suggested in the literature. (9) Existing mobile HCT unit data was used from the Foundation for Professional Development (FPD). The data was collected in the Tshwane Metropolitan Municipality, Gauteng Province, South Africa. An observational, cross-sectional study design was applied. A systematic random sample of 400 first-time testers and 400 repeat-testers was drawn and analyzed. The findings of this study indicated an overall 10.0% (n=80) HIV prevalence rate. When compared to the Gauteng adult prevalence (15+) of 14.4%, the study prevalence is lower. (10) When looking at the characteristics of the first-time tester and repeat tester groups, there was an HIV prevalence rate of 12.5% (n=51/407, p=0.0152) in the first-time tester group, and 7.4% (n=29/393, p=0.0152) HIV prevalence rate in the repeat tester group. Although literature suggests that repeat testers are the more at risk population, the finding in this study clearly demonstrates that there is a difference in HIV prevalence between first-time- and repeat testers. When first-time/repeat tester was used as the dependent variable, it was found that females are 0.6 less times likely to be a first-time tester compared to males (OR=0.6, p=0.001). The finding of a difference in HIV prevalence between first-time- and repeat tester groups was consistent with three other studies in Ethiopia, Uganda and Kenya. In these studies, HIV prevalence in first-time testers was slightly higher than in that of repeat-testers. (3,11,12) It was found that there is a difference in the HIV and demographic profile between those who test for HIV for the first time and those who are repeat testers. The perceived risk and vulnerability to HIV plays a heavy role in motivating individuals to test once, or repeatedly. In regards to disease surveillance, this study did not prove that the population that utilises mobile HCT are representative of the Tshwane population. This study highlighted the need to better understand the sub-groups and characteristics of those who test for the first-time and those who test repeatedly for HIV. In conclusion, this study has provided evidence that there is a difference between the HIV prevalence of first-time- and repeat testers. However, there is good reason to doubt that the prevalence rate of first-time testers is genuine. Copyright / Dissertation (MSc)--University of Pretoria, 2013. / School of Health Systems and Public Health (SHSPH) / Unrestricted