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Thesis (D.P.H.)--University of Hawaii at Manoa, 1991. / Includes bibliographical references (leaves 168-178). / Microfiche. / xiv, 178 leaves, bound ill. 29 cm

The Comprehensive Health Investment Project is a community health project operating in Roanoke, Virginia that is designed to address the needs of families and their children who do not have access to continuous health services. This study examined parental characteristics of those parents participating in the Comprehensive Health Investment Project. Five surveys, which assess parental satisfaction, parental skills, parental comfort, sense of community, and safety practices were administered to parents and subsequently collected for analysis. It is the data from these surveys which provide invaluable descriptions of these parents and family dynamics. Results indicate that the participating parents have high levels of parenting satisfaction and a high level of involvement with their children. The parents had a low sense of community. Overall, parents followed good safety practices with their children. Some questions, when cross tabbed with demographic variables, demonstrated an interaction between the response and the selected variable. However, there was no apparent trend for the interaction to be true for all questions. A description of the method of data analysis and the parenting characteristics exhibited by these parents is included. Recommendations and suggestions are also provided to better assist the CHIP staff in service provision. This research will assist providers in measuring parental program effectiveness and will expand existing knowledge regarding parental practices and satisfaction. / Master of Science

The purpose of this dissertation was to identify the components of women's domestic health work in networks surrounding poor Mexican American and Anglo households and compare women's experiences as domestic health workers. Women representing 10 Mexican American households and 10 Anglo households and their surrounding domestic networks were recruited for this study. Criteria for participation included the presence of at least one child in the household $\le$5 years of age and household income at or below the federally-defined weighted poverty threshold. Sources included, first, 66 interviews with women (n = 26) residing in the study households. Second, women kept 3-week daily health diaries on behalf of all household members. And third, women participated in an inventory of household medications. The study employed several analytic methods, including descriptive statistical analyses, phenomenological insight, taxonomic analyses of women's knowledge structures, life history analysis, thematic analysis, and narrative analyses. The results of the study emphasized several points, including the: (a) gendered but hotly contested nature of domestic responsibility for health, with responsibility negotiated between men and women in households, and disputed between households and social service agencies; (b) significant role played by women's informal networks in defining and evaluating the enactment of maternal responsibility; (c) workings of women's coalitions and cooperatives that protect women's threatened interests and redistribute resources among women; (d) influences governing the transmission of child health and illness knowledge and skills across generations of women; (e) double-edged nature of self-medication that appears as both a source of female autonomy and expertise, yet paradoxically and simultaneously can act as an inappropriate, self-palliating balm for the hurt incurred from inadequate accessibility to quality professional health care for poor women and children; and (f) cross-cutting influences of ethnicity and historical situation in each of the above domains. Women pieced together resources from their cultural background, femaleness, and sometimes their poverty; all these factors also entailed contradictory disadvantages in the production of household health. The health and social policy implications of this study were described in detail in the dissertation, as were the women's own visions for an approximation of utopia.

This thesis examines the changing patterns of mortality in Scotland, with particular emphasis on whether there are widening mortality inequalities among small areas in Scotland. The annual number of deaths in Scotland has decreased steadily since the 1950s, yet mortality rates in Scotland are amongst the highest in Europe for many causes. Furthermore, mortality from some causes, such as suicide, has been increasing over time, particularly among young adults. Evidence suggests that inequalities in mortality have widened over time in Scotland, despite substantial investment in policies aimed at reducing inequalities. Therefore, it is important to seek geographical clues that might help explain what causes these high mortality rates. The changing patterns in Scottish mortality between 1980 and 2001 were examined for small areas, created by the author, known as Consistent Areas Through Time (CATTs). These areas have the same boundaries for each census, so that direct comparisons over time are possible. In this study, CATTs have been used to investigate three aspects of the mortality gap in Scotland. First, the widening mortality gaps between 1980-1982 and 1999-2001 are examined for the total population and for premature mortality (<65 years). Second, the influence that geographic scale and deprivation have on the relationship between population change and premature mortality are assessed. Third, suicide inequalities are examined for the younger (15-44 years), older (45+) and total population, using mortality ratios and statistical modelling. The research found that inequalities in premature mortality (< 65) have widened for all causes of death studied, particularly for suicide. The negative association between mortality and population change was affected by geographic scale, but this relationship could not be fully explained by deprivation. Small area analyses found that the Highlands and Islands had higher suicide rates than elsewhere in Scotland for males, but not females, when social variables were controlled for.

This study aims to characterize and understand the search for health in a rural Transkeian community. It begins with the observation that the people of Jotelo have to negotiate considerable hardships in their daily lives. These hardships include the impact of malnutrition, undernourishment and a wide range of diseases like tuberculosis, typhoid and gastro-enteritis. To survive ill-health, people develop numerous practical strategies. Most significantly, they attempt to maximise availalble resources, like cash, their relations with others and local medical facilities. Hence the study attempts to characterize how and why patients select various kinds of therapy in their search for health. By focusing on patients' recourses to treatment, the study reveals that the search for health is as much a personal experience as it is a social and economic one. This idea is developed in an analysis of the links betw'een work, illness and social reproduction. The point which emerges from this discussion captures the central theme of the study: the search for health is a profoundly personal, social and economic experience. This notion is strengthened by an examination of the historical and contemporary nature of local health and health care. It is observed that health and health care is intimately linked to the local and wider political economy. This not only serves to contextualise the discussion on patients' actual experiences, but points to the fact that these experiences are part of wider processes. By depicting the search for health in this way, the study hopes to have illustrated what people do in times of illness and why. Yet it also claims to have gone beyond such a depiction. By abstracting from its findings, it aims to conclude that the search for health is not merely caused by various local and wider processes, to which it has referred. In other words, it hopes to avoid a deterministic view of patients' experiences in times of distress. Instead, it is argued that the search for health is ultimately an integral part of the local and wider economic and political environment

Thesis (PhD)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: Good health is a major imperative for social, economic and personal development, thus an important dimension of quality of life. Quality of life, in turn, is significantly influenced by access to the goods and services provided by the State. Access to infrastructure and services such as water and sanitation, has direct effects on health. Thus, the delivery of health, water and sanitation services should ensure improved access to basic needs, enhance the health profile of poor communities and their access to employment opportunities. Safe clean water supplies and adequate sanitation services therefore are among the major determinants of health. Health-related services such as water and sanitation should ensure a certain average life expectancy and eliminate mass disease and ill health. Mindful of the fact that there are many factors that determine the quality of life, the aim of the study was to investigate the impact of health, water and sanitation services in improving the quality of life among poor communities. To do this, this study adopted a comparative qualitative analysis approach between poorly serviced and adequately serviced areas. Subsequent to the findings, this study espouses constructive suggestions and recommendations that could act as guidance to community development agencies' strategies in amelioration of the quality of life among poverty-stricken communities. The research was based on a narrow model of services (health, water and sanitation services) that have impact on improving the quality of life among poor communities. The empirical findings of this study indicate these services to be insufficient to draw conclusive findings in other aspects of the survey. The research was conducted in a sample of 573 households in 6 communities in the Eastern Cape and Western Cape Provinces in South Africa. The sample comprised 3 communities in the category classified as poorly serviced with health, water and sanitation services, and 3 communities that were regarded as adequately provided with these services. The data was gathered by means of structured questionnaires, administered by the researcher with the assistance of a trained field worker. Additional, the data was gathered by means of a semi-structured, open-ended interview with a Sister-in-Charge of a clinic in the rural villages. The interaction between variables on the improvement of the quality of life were explored by means of basic statistics, which made it possible to assess the effects of independent and dependent variables. The results of data analysis provided support for the proposition contained in the premise of the study that although the provision of health, safe clean water and adequate sanitation services lead to improvement in the standard of living, their impact alone does not incorporate all the attributes that enhance quality of life as suggested by mainstream schools of thought in the health sector. Poverty-related factors also have to be taken into account. As such, the findings of this study have shown that poverty, combined with poor public health conditions, inadequate nutrition, overcrowded poor quality housing, lack of accessible drinking water and sanitation, renders communities vulnerable to ill health. Given the poor socio-economic conditions prevalent in the communities under investigation, it was not surprising that tuberculosis was most prevalent in all areas. In line with the premise of this study, there were instances that povertyrelated factors such as income, housing and nutrition had significant influences with regard to improvement in the quality of life. It became evident therefore that in certain instances, health, water, and sanitation services alone are not sufficient to make conclusive findings. Thus, the impact of povertyrelated factors such as income, housing and nutrition necessitate expansion of factors that impact on the quality of life to include their influence. / AFRIKAANSE OPSOMMING: Goeie gesondheid is 'n belangrike vereiste vir sosiale, ekonomiese en persoonlike ontwikkeling, en dus ook 'n wesenlike aspek van 'n goeie lewensgehalte. Toegang tot goedere en dienste wat deur die staat voorsien word, het ook 'n beduidende invloed op lewensgehalte. Boonop het die toegang tot infrastruktuur en dienste soos water en sanitasie 'n direkte invloed op gesondheid. Die lewering van gesondheids, water- en sanitasiedienste verseker dus die bevrediging van basiese behoeftes, onderwyl arm gemeenskappe se gesondheidsprofiel en daarmee saam hul toegang tot werksgeleenthede verbeter word. Toegang tot veilige en skoon waterbronne en voldoende sanitasiedienste is gevolglik van die belangrikste gesondheidsbepalers. Gesondheidsverwante dienste soos water en sanitasie verseker 'n sekere gemiddelde lewensverwagting, en verminder die moontlikheid van wydverspreide siektetoestande. Met inagneming van die feit dat lewensgehalte deur talle faktore beïnvloed kan word, was die doel van hierdie studie om ondersoek in te stel na die invloed van gesondheids, water- en sanitasiedienste op die verbetering van lewensgehalte in arm gemeenskappe. Gevolglik is 'n vergelykende analise tussen areas met swak dienslewering en areas met bevredigende dienslewering uitgevoer. Op grond van die bevindinge word sekere voorstelle en aanbevelings gemaak wat kan dien as riglyne vir ontwikkelingsagentskappe ter bevordering van die lewensgehalte in arm gemeenskappe. Die navorsing was gegrond op 'n beperkte model van dienste (gesondheids, water- en sanitasiedienste) wat die verbetering van lewensgehalte in arm gemeenskappe beïnvloed. Die empiriese bevindinge van die studie toon aan dat hierdie dienste onvoldoende is om as basis te dien vir beslissende uitsprake oor ander aspekte van die opname. Die studie het 'n steekproef van 573 huishoudings in 6 gemeenskappe in die provinsies van die Oos-Kaap en Wes-Kaap in Suid-Afrika ingesluit. Die steekproef het bestaan uit 3 gemeenskappe met swak gesondheids, water en sanitasiedienste, en 3 gemeenskappe waar sulke dienste op 'n bevredigende vlak voorsien word. 'n Gestruktureerde vraelys is gebruik om die navorsingsinligting in te samel, wat deur die navorser en 'n opgeleide veldwerker toegedien is. Bykomende inligting is bekom deur 'n semigestruktureerde onderhoud met die verpleeghoof van 'n kliniek in 'n landelike gemeenskap. Die invloed van die verskillende veranderlikes op lewensgehalte is deur middel van basiese statistiese analise geëvalueer. Die resultate van die data-analise verleen 'n mate van steun vir die premis van die studie dat hoewel die voorsiening van gesondheid, veilige, skoon water en voldoende sanitasie tot 'n beter lewenstandaard kan lei, die uitwerking daarvan as sodanig nie alle vereistes insluit vir 'n beter lewenstaard nie, soos voorgestaan deur hoofstroom denkskole in die gesondheidsektor. Faktore wat met armoede verband hou moet ook in ag geneem word. Die studie se bevindinge dui dus daarop dat armoede, tesame met swak openbare gesondheidstoestande, onvoldoende voeding, gebrekkige behuising en swak water- en sanitasiegeriewe gemeenskappe meer kwesbaar maak. Weens die swak sosio-ekonomiese toestande in die gemeenskappe in die steekproef, is gevind dat tuberkulose wydverspreid voorkom. Alhoewel die studie se hipotese met betrekking tot verskeie aspekte bevestig is, was daar ook gevalle waar armoede-verwante faktore soos inkomste, behuising en voeding 'n beduidende rol gespeel het. Dit het dus geblyk dat gesondheids, water- en sanitasiedienste nie in alle gevalle voldoende is om swak lewensgehalte te verklaar nie. Dus sal die faktore wat op lewens kwaliteit 'n impak maak, uitgebrei moet word om vir die invloed van armoede-verwante faktore soos inkomste, behuising en voeding voorsiening te maak.

Thesis (MSc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: In developing countries the increasing number of the aged are often viewed as a problem. In particular, the indigent elderly residing in poor urban areas are at risk of becoming marginalised and underserved. The Western Cape has the third largest elderly population in proportion to the total population in the country. Social assistance in the form of a monthly pension is paid out to all elderly who pass a national means test carried out by South African Social Security Agency (SASSA). An assessment of the characteristics and health status of the elderly collecting old age pensions living in low-income urban poor communities in the City of Cape Town was carried out at pension pay points across four communities, i.e. Gugulethu, Khayelitsha, Mitchells Plain and Bonteheuwel. In community health surveys, choices regarding the methodology have to be made that can have profound effects on the study design and study outcomes. The milieu of the present study is one of urban poverty and specifically those urban elderly who qualify for non-contributory pensions (also called social cash transfers or government grants). The paucity of existing community-based studies on old-age pensioners in the City of Cape Town meant that a cross-sectional survey with wide-ranging coverage of demographic, social and health factors was the most logical design to employ in order to determine the extent of present needs and generate hypotheses for further controlled studies. A systematic random sample of 703 elderly was drawn at nine pension pay-out points in Cape Town Metropole. No pensioners refused to participate in the study. Structured interviews were carried out covering demographics, number of dependents, living conditions, socioeconomic circumstances, health status and needs and utilisation of health services. A reported 43% of participants lived in shacks and 88% reported regularly eating less than 3 meals a day. Eighty-seven percent of respondents reported waiting 3 hours or longer for medication at a clinic while 90% reported being dissatisfied with the service at their clinic. Fifty-eight percent of pensioners reported not being able to see well while 83% did not know where to get their eyes tested. Almost 70% of pensioners said that they have been ill-treated by a family member and 64% scored as severely depressed on the geriatric depression scale. In this study, 266 pensioners solely supported 471 children of which 65 (14%) were disabled children. In 95% of cases the pensioner does not receive any support from the child's parents. The study found that the elderly on a state grant had considerable unmet health needs and required assistance with activities of daily living. The indigent pensioners in this study bore a huge duty of care for minor children as custodial grandparents while not receiving a high level of health support themselves. / AFRIKAANSE OPSOMMING: Die toenemende aantal bejaardes word dikwels in ontwikkelende lande as 'n probleem gesien. In die besonder loop die bejaardes wat in lae-inkomste stedelike gebiede woon die risiko om gemarginaliseer te word en swak dienslewering te ondervind. Die Wes-Kaap het die derde grootste populasie van bejaardes in verhouding tot die totale bevolking in die provinsie. Sosiale bystand in die vorm van 'n maandelikse pensioen word betaal aan alle bejaardes wat die inkomstetoets slaag wat deur die Suid-Afrikaanse Agentskap vir Maatskaplike Sekerheid (SAAMS) uitgevoer word. 'n Ondersoek na die eienskappe en gesondheidstatus van bejaardes wat hulle ouderdomspensioene in lae-inkomste stedelike gemeenskappe in die Stad Kaapstad kom afhaal is uitgevoer. Die studie is gedoen by pensioen-uitbetaalpunte in vier gemeenskappe, naamlik Gugulethu, Khayelitsha, Mitchells Plein and Bonteheuwel. In gemeenskapsgesondheid-opnames moet keuses gemaak word ten opsigte van die metodologie wat diepgaande gevolge vir die studieontwerp en -uitkomste kan inhou. Die milieu van die huidige studie in dié van stedelike armoede en spesifiek die leefruimte van stedelike bejaardes wat kwalifiseer vir nie-bydraende pensioene (ook genoem sosiale kontantoordragte of staatstoelaes). Die gebrek aan bestaande studies van ouderdomspensioenarisse in Kaapstad het beteken dat 'n dwarsdeursnit-opname van die demografie, sosiale en gesondheidsfaktore die mees logiese ontwerp was om uit te voer. Dit is gedoen om die omvang van huidige behoeftes te bepaal en verdere hipoteses te genereer wat deur vergelykende studies ondersoek behoort te word. 'n Stelselmatige ewekansige steekproef van 703 bejaardes is getrek by nege betaalpunte in die Kaapse stadsgebied. Geen proefpersone het geweier om deel te neem nie. Gestruktureerde onderhoude is gevoer wat die volgende aspekte gedek het: demografiese eienskappe, aantal afhanklikes, gesondheidstatus en benutting van gesondheidsdienste. Van die deelnemers het 43% in informele behuising ("shacks") gewoon en 88% het gerapporteer dat hulle gereeld minder as 3 daaglikse maaltye eet. Daar het 87% gerapporteer dat hulle 3 uur of langer gewag het om medikasie by hulle plaaslike kliniek te ontvang terwyl 90% ontevrede was met die diens wat hulle by die kliniek ontvang het. Daar het 58% van die bejaardes gerapporteer dat hulle nie goed kan sien nie terwyl 83% van hulle nie geweet het waar hulle hulle oë kan laat toets nie. Omtrent 70% van bejaardes het gesê dat hulle deur 'n familielid mishandel word en 64% kon as ernstig depressief geklassifiseer word op die geriatriese depressieskaal. In hierdie studie was 266 pensioenarisse die enigste sorg en voog van 471 kinders van wie 65 (14%) gestremd was. In 95% van gevalle het die pensionaris geen geldelike of ander bydraes van die kind(ers) se ouers ontvang nie. Die studie het bevind dat bejaardes wat 'n staatstoelaag ontvang aansienlike onvervulde gesondheidsbehoeftes het en hulp benodig met aktiwiteite van daaglikse bestaan. Die behoeftige pensioenarisse in hierdie studie het 'n groot las gedra aan die versorging van minderjarige kinders as toesighoudende grootouers ("custodial grandparents") terwyl hulleself nie 'n hoë vlak van ondersteuning geniet nie.

MCur / Department of Advanced Nursing Science / Background: Perinatal and neonatal mortality rates remain high in South Africa especially in rural areas and townships where the majority of poor people live. With regard to perinatal and neonatal mortality, South Africa like many other developing countries has failed to achieve MDG 4 and 5 by 2015 regardless of many efforts by the governments. To achieve the SDG which replaced MDGs for child health, it is necessary for the South African public and private health care to reduce substantially perinatal and new born deaths, particularly in rural areas. There are many factors that contribute to a high perinatal mortality rate in public hospitals in rural areas. To understand these factors, a study was conducted with midwives from selected public hospitals in Limpopo, Vhembe district which experiences the highest perinatal mortality rates in South Africa. Purpose and methodology: The purpose of this research study was to assess factors contributing to high perinatal mortality rates in the selected public hospitals in Vhembe district. A quantitative, descriptive, exploratory and cross-sectional design was used to collect data from the sampled hospitals in the Vhembe district. Hospitals were purposively sampled based on the statistics of monthly deliveries. The target population consisted of all registered midwives who had been working in the maternity units for at least two years. Cochrane's formula was used to determine the sample from the target population for each hospital. A random sample of 110 respondents was selected upon which a questionnaire was administered to each by the researcher. Responses from the close-ended and open-ended questions was grouped and analysed quantitatively by means of Statistical Package for Social Sciences 23.0 (SPSS). Results and findings: Results were presented in frequency tables and graphs revealed that most of the midwives lacked knowledge and skills in a number of key areas needed for them to operate efficiently in the maternity wards. There was also high staff turnover which led to a few midwives being overworked. The utilisation of guidelines and protocols in maternity was left to individual midwives as the hospitals did not evaluate the use of it. Conclusions: Lack of key skills in assisting women in labour, and poor use of guidelines and understaffing were the main contributing factors to high perinatal mortality rates in the selected public hospitals of Vhembe district. Midwife attitudes were not a contributory factor. / NRF