The studies within this thesis have made a valuable contribution to our understanding of anthelmintic resistance in Scotland and in particular to the prevalence of benzimidazole (BZ) and ivermectin (IVM) resistance, the expression of multiple resistance and its management. Parasitic gastroenteritis (PGE) is a major welfare issue not only for Scottish, UK and European farmers but also for livestock producers throughout the world. Parasites such as Haemonchus, Trichostrongylus and Teladorsagia are estimated to cost the sheep industry hundreds of millions of dollars annually. To date control has largely been achieved using anthelmintics, but over reliance on anthelmintics has led to the development of multi class anthelmintic resistance (AR) and the realization that intensive chemoprophylaxis is not a sustainable approach for the control of nematodoses. The first two papers contributing to this thesis assessed the prevalence of benzimidazole (BZ) and ivermectin (IVM) resistance within ovine gastrointestinal nematode populations in Scotland. The prevalence of BZ resistance in selected Scottish lowland sheep farms was around 24% in 1991 but this had risen to over 80% by 2001. The first cases of ivermectin resistance in sheep were only detected in 2001 but a small scale survey in 2004 showed that 35% of the farms (6 from 17) surveyed had IVM resistance, with Teladorsagia and Trichostrongylus being identified as the resistant genera. The isolation of a triple class resistant T. circumcincta (MTci5) population has enabled research to focus on the important issue of the therapeutic and prophylactic management of this emerging problem. The third and fourth papers detail a series of controlled efficacy tests conducted on MTci5 that confirmed, in the short term at least, it should be possible to use a milbemycin (moxidectin; MOX) or combination treatments, with IVM and one other class of anthelmintic to control nematodoses (>90% efficacy) caused by adult and/or immature worms. However the study examining larval susceptibility highlighted the important role that immature stages can play in the selection and transmission of resistance. Currently there are no tests that can detect the presence of these resistant larval stages. The fifth paper outlines parasitological findings from the farm where MTci5 was isolated following the confirmation of multiple class resistance. Substantial efforts were made to find solutions to maintain sustainability and profitability of the enterprise though ultimately the use of MOX selected for a, predominately Teladorsagia, population against which the persistent activity of the compound was only negligible with the reappearance of eggs in faeces occurring between 21 and 28 days post treatment. Effective sustainable control of AR populations not only requires an understanding of the phenotypic and genotypic mechanisms that underpin resistance but also improved means of ensuring that our farmers are made aware of and utilize identified best practice approaches. The written and verbal responses of the farmers to questions relating to best practice advice (papers six and seven) would suggest that many of the recommendations for delaying the selection and transmission of AR (ACME, Moredun Foundation and sustainable control of parasites of sheep (SCOPS), DEFRA) are not being followed, recommendations such as the effective quarantine treatment of newly purchased animals and dosing animals at the manufacturers’ recommended dose rate were followed by only 20% and 56% of farmers respectively.

Doctor of Philosophy / Department of Diagnostic Medicine/Pathobiology / David G. Renter / Salmonella and Campylobacter are two leading causes of human foodborne disease. Cattle can asymptomatically shed these organisms in their feces. Fluoroquinolones are antimicrobials used to treat both humans and animals. With concerns over antimicrobial resistance, antimicrobial use in livestock has become scrutinized. Data on prevalence and susceptibility of Salmonella and Campylobacter in feedlot cattle, particularly those exposed to fluoroquinolones, are sparse. The purpose of the research described in this dissertation was to determine the prevalence and quinolone susceptibility of Salmonella and Campylobacter isolated from feedlot cattle and to determine whether these outcomes were associated with fluoroquinolone use. First, an observational study was performed at five commercial feedlots that used enrofloxacin (a fluoroquinolone) as first-line treatment for bovine respiratory disease (BRD). Fecal samples were collected from cattle pens with various levels of BRD and exposure to enrofloxacin. Salmonella and Campylobacter prevalence and susceptibility to quinolones, nalidixic acid and ciprofloxacin, were evaluated. Prevalence of Salmonella and Campylobacter was highly variable among and within feedlots. All but one Salmonella isolate was susceptible to nalidixic acid and ciprofloxacin, whereas 49% (126/256) of the Campylobacter isolates were resistant to both antimicrobials. However, the number of enrofloxacin treatments was not associated with the prevalence or susceptibilities of either organism. A second, experimental study assessed prevalence and quinolone susceptibilities of Salmonella and Campylobacter in feces of feedlot cattle administered enrofloxacin for the control of BRD (metaphylaxis). Cattle with no history of fluoroquinolone exposure were randomly assigned to either an enrofloxacin treated pen or a non-treated, control pen. Cattle feces were repeatedly collected and cultured for Salmonella and Campylobacter, with isolates tested for susceptibilities to nalidixic acid and ciprofloxacin. Overall, Salmonella and Campylobacter prevalence estimates were relatively low and decreased over time. Resistance prevalence was negligible for Salmonella, but was high for Campylobacter. However, there was no evidence that enrofloxacin metaphylaxis impacted the prevalence of Salmonella or Campylobacter, nor did it significantly affect their susceptibility to human quinolones. In conclusion, enrofloxacin use in feedlot cattle does not appear to have a significant impact on the prevalence or resistance of Salmonella and Campylobacter.

Introduction The purpose of this analysis was to identify social, behavioral and cultural factors associated with HIV infection among the Luo people residing on the southern part of Kenya and Somali in the Eastern part of Kenya. Previous studies have linked higher prevalence of HIV in the Luo community to cultural practice such as widow inheritance, and lack of circumcision among men. Analysis was conducted to determine the difference cultural and behavior practice between the Luo and Somali using Kenya demographic health survey (DHS) data, collected between 2008 and 2009, and used statistical computing Software program(SAS) for analysis. Results There were 6906 participants in this survey, 3023 were males and 3811 females. The minimum age was 15 and the maximum age was 54. About 73% of the Luo were Christian and 25% were Catholic, compared to the Somali who were 99% Muslim. 98% of Somali were circumcised and 99% of the Luo were not circumcised. About 60% of the Luo used condoms compared to the 25% of Somali. Multivariate analysis comparing Luo and Somali showed the Luo were at high risk of getting HIV infection compared to Somali adjusted odds ratio (OR= 13.34;95% Cl 2.19 – 81.11). Conclusion Different risk factors were contributing to higher prevalence of HIV among the Luo community. This study was an observation study, hence the cultural and behavior difference observed cannot be used to established causality due to study design limitation. This study finding can be used to develop future study examining the cultural and behavioral risk factors associated with HIV transmission in Africa.

Trichomonads are anaerobic flagellated protists that are either parasites or commensals. They frequently inhabit digestive, respiratory, and urogenital tracts of vertebrates, including domestic cats and dogs. In these hosts, four trichomonad species has been described: Tetratrichomonas canistomae and Tetratrichomonas felistomae that are commensals of the host oral cavity; Pentatrichomonas hominis, a commensal of intestinal tract that could be found in dogs and cats but also in other mammals including humans; and pathogenic Tritrichomonas foetus that causes, in addition to cattle infection, feline intestinal trichomonosis. Although, trichomonads in dogs and cats are probably of cosmopolitan distribution we have no information about their presence in Czech Republic. The first aim of this study was to distinguish types of trichomonads present in the oral cavity of dogs and cats and to get preliminary epidemiological data. The second aim was to demonstrate the presence of Tritrichomonas foetus in cats and dogs in the Czech Republic and to identify potential risk factors for the disease. Cultivation and nested PCR were used to determine the presence of trichomonads in dogs and cats. Sequencing and phylogenetic analysis based on ITS1-5.8rRNA-ITS2 gene sequence was used to identify species of isolated...

MSc (Med), Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand / Introduction: Tuberculosis (TB) persists as a serious global public heath problem of a magnitude requiring urgent attention. The increase in new cases of TB in African countries where the prevalence of HIV is relatively low has been associated with other host and environmental factors. There is little or no comparable data on the association between host and environmental related factors and TB incidence in low HIV prevalence regions of South Africa. Objectives: This study aims to investigate host and environmental factors associated with incident TB in one region of South Africa. Methods: 3493 TB-free participants were recruited, and baseline data collected at the beginning of 2003 in the Lung Health Study in Ravensmead and Uitsig, Cape Town, South Africa. The TB register was used to identify new cases among the 3493 participants between 2003 and 2007. Results: Of the 3493 study participants, 109 developed TB; i.e. 57 males and 52 females. The incidence of TB in the Ravensmead and Uitsig study population was 632 per 100 000. Cohabiting, OR= 2.09 (95% CI= 1.05 - 4.17), smoking, OR= 2.19 (95% CI= 1.48 - 4.14), and history of imprisonment OR= 1.88 (95% CI= 1.09 - 3.23) were all statistically associated with TB incidence in multiple logistic regression models. The summary population attributable fraction for these three factors was 53.2%. Conclusions: TB incidence was high in this community. Cigarette smoking was one of the most important predictors of TB incidence, and the proportion of smokers in this population was relatively high. TB control and prevention strategies need to focus on interventions which will reduce or limit the impact of TB risk factors.

MSc (Med) Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand / Research Project Title: HIV Prevalence and Factors Associated with HIV Infection in South Africa: Analysis of the Antenatal Clinic Survey Data. Background: In sub-Saharan Africa, the HIV epidemic is commonly monitored through the sentinel surveillance of pregnant women attending antenatal clinics (ANC), which provides important indications for planning and evaluating public-health interventions. Many of such surveillance systems in South Africa reported limited information on factors associated with HIV infection, even though the survey collected information related to a woman’s participation. This is likely to compromise the development of effective preventive programmes that are more focussed. To address this, the 2005 HIV (ANC) surveillance data was used with the objective of increasing the available information on the HIV epidemic in the country and identifying the socio-demographic factors associated with HIV infection in each province. Methodology: The data from the 2005 ANC survey was analysed in depth. The chi-square test was used to test bivariate associations for categorical associations of HIV infection and other associated factors. In addition a logistic regression model was used to explore the association of sociodemographic and other variables with HIV infection in each province. Results: The HIV prevalence reported in this study was similar to earlier reports released by the Department of Health in 2005. That is the overall HIV prevalence is 30.1% (29.5-30.8%) with KwaZulu Natal having the highest (39.1%, 37.5-40.1%) and Western Cape recorded the lowest HIV prevalence of 15.9% (14.1-17.4%).

O presente estudo teve como objetivo verificar a prevalência de anemia em crianças de 3 a 12 meses de idade, associada às variáveis maternas, neonatais e de aleitamento materno, atendidas num serviço de saúde de Ribeirão Preto, SP. Neste estudo, que foi um recorte de um projeto multicêntrico, utilizou-se parte dos dados coletados na UBDS Vila Virginia, em Ribeirão Preto-SP, a fim de se atingirem os objetivos propostos. Estudo transversal, observacional, descritivo e quantitativo, do qual participaram 121 mães e seus respectivos filhos, de 3 a 12 meses de idade, atendidos no serviço de puericultura da UBDS Vila Virgínia, turno da tarde, no período de 01 de setembro/2005 a 31 de julho/2006. No seu desenvolvimento, realizaram-se entrevistas com as mães, para preenchimento do formulário, e também colheu-se amostra de sangue da região do calcâneo da criança, para dosagem da hemoglobina (Hb). Adotaram-se três critérios internacionais, como parâmetros de anemia, usando-se para as crianças de 3 a 5 meses de idade completos dois critérios, de Hb < 10,0 g/dL segundo padrão Brault-Dubuc e Hb< 10,3 g/dL, padrão Saarinen; para as crianças e 6 a 12 meses de idade incompletos, critério de Hb < 11,0 g/dL, adotado pela OMS. Na análise dos dados, utilizaram-se distribuição de freqüências, médias, desvios padrões e medianas, teste de associação e regressão logística. Do total de 69 crianças de 3 a 5 meses de idade completos, a prevalência de anemia foi de 17,4 e 20,2%, segundo padrões Brault-Dubuc e Saarinen, respectivamente. Nas crianças de 6 a 12 meses de idade incompletos, a prevalência de anemia foi de 48,0%, segundo critério da OMS. No total de 121 crianças de 3 a 12 meses de idade, a prevalência de anemia foi de 30,6 e 32,2%, respectivamente, segundo combinação dos três critérios. Não encontrou-se associação entre anemia e variáveis maternas e formas de morar e viver das famílias; porém, com relação às variáveis infantis, encontrou-se forte associação entre anemia e idade da criança; não se identificou associação entre anemia e sexo, peso ao nascer, idade gestacional e consumo de ferro medicamentoso. Quanto à anemia e aleitamento não se encontrou associação estatisticamente significativa entre os diferentes tipos e duração do aleitamento materno. O consumo de água e chá aumentou 1,8 vez o risco de adquirir anemia mas, o resultado não foi estatisticamente significativo. O uso de leite de vaca fluido apresentou-se associado à anemia, aumentando em 1,7 vez o risco de adquiri-la. / This study aimed to verify the prevalence of anemia in children 3 to 12 months old associated to maternal, neonatal and breastfeed variables, assisted in a health service in Ribeirão Preto, SP. Part of the data collected for a multicenter project in the UBDS (Basic and District Health Unit) Vila Virginia was used. This is a cross-sectional, observational, descriptive and quantitative study. A total of 121 mothers and their respective children, 3 to 12 moths old, assisted in the child care service of the UBDS Vila Virginia in the afternoon shift in the period between September 1st, 2005 to July 31st, 2006 participated in the study. Mothers were interviewed in order to fill in the form and blood samples were collected from the children\'s calcaneus region to determine the hemoglobin (Hb) dosage. Three international criteria were adopted as parameters of anemia. For children 3 to 5 months old, two criteria were used, the standard Brault-Dubuc, Hb<10.0 g/dl and the standard Saarinen, Hb<10.3 g/dl and for children 6 to under 12 months old, the criterion adopted by WHO, Hb < 11,0 g/dl, was used. In the data analysis, frequency distribution, mean, standard deviation and median, association test and logistic regression were used. From the 69 children, 3 to 5 months old, the prevalence of anemia was 17.4 and 20.2%, according to Brault-Dubuc and Saarinen standards, respectively. For children 6 to under 12 months old, the prevalence of anemia was 48.0% according to the WHO criterion. In the total, for 121 children 3 to 12 months old, the prevalence of anemia was 30.6 and 32.2% respectively, according to the three combined standards. There was no association between anemia and maternal variables and families\' living conditions. However, there was strong association between anemia and children\'s age; no association between anemia and gender, weight at birth, gestational age and consumption of medicamentous iron were found. There was also no statistically significant association between anemia and breastfeeding in terms of types and duration of breastfeeding. The consumption of water and tea increased 1.8 times the risk of acquiring anemia though the results was not statistically significant. The consumption of liquid cow milk was associated to anemia and increased 1.7 times the risk of acquiring it.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Introduction: Cerebral palsy is one of the leading causes of disability globally. The number of new cases of children with cerebral palsy (CP) is on the increase. Rehabilitation is the most common intervention used to help children with CP in Kenya. Early initiation of the rehabilitation process, and involvement of the family are important for optimal functional outcomes for children with cerebral palsy. This study aimed to establish the incidence of children under six years old with CP at the physiotherapy and occupational therapy department at Kenyatta National Hospital, Kenya in 2015. This was done in order to establish the need for rehabilitation services. Furthermore, the study aimed to explore and describe the direct patient process of care as part of the current rehabilitation process followed for children with CP from the age of 0to 6 years in order to identify any room for improvement. Study population and Methodology: Data were collected in two phases. Phase A consisted of collecting information pertaining to the number of new cases (incidence) of children with CP under six years of age in 2015 treated at the therapy (occupational and physiotherapy) departments at KNH. For this purpose, all records of children with CP under the age of six years at the rehabilitation department in 2015 were included and reviewed. For Phase B, a mixed methods approach and a parallel convergent design were used to explore the direct patient process of care component of the rehabilitation process.

nÃo hà / A coinfecÃÃo entre o VÃrus da ImunodeficiÃncia Humana (HIV) e o VÃrus da Hepatite B (HBV) possui os mesmos fatores de transmissÃo e como consequÃncia os fatores de risco associados, explicam a alta prevalÃncia destes agentes infecciosos no nosso meio. O presente estudo estimou a prevalÃncia da coinfecÃÃo HIV e HBV e descreveu as caracterÃsticas individuais que agem como fatores de risco para aquisiÃÃo desta coinfecÃÃo, com o intuito de utilizar esta informaÃÃo para o aconselhamento. A amostra utilizada foi composta pelos 805 pacientes infectados com o HIV no estado do Piauà que buscaram o LACEN-PI para monitoramento da carga viral e dos linfÃcitos T CD4+. A prevalÃncia da hepatite B (HB), utilizando o marcador anti-HBc total, foi de 29,3% e, para o HBsAg este valor ficou em 2,5%. A prevalÃncia do Anti-HBc total foi 38,3% na faixa acima dos 40 anos, 38,6% para o sexo masculino, 31,9% entre os solteiros, 47,7% entre os aposentados, 50,7% entre os que relataram antecedente de icterÃcia, 54% entre os que tiveram hepatite com diagnÃstico mÃdico, 40,7% entre os com passagem por reformatÃrio ou prisÃo, 38,1% entre usuÃrios de droga nÃo endovenosa, 35,7% entre os com contato sexual com usuÃrio de droga ilÃcita, 48,8% entre os com preferÃncia homossexual/bissexual, 44,9% entre os que disseram ter contato sexual raro com prostituta, 37,1% entre os que tiveram DST e 31,4% para os com carga viral abaixo de 10.000 cÃpias/mL de sangue. Foram observadas significÃncias estatÃsticas entre as variÃveis e a frequÃncia de positividade do anti-HBc total. As informaÃÃes deste trabalho poderÃo ser utilizadas no combate, aconselhamento e prevenÃÃo do avanÃo, do nÃmero de casos HB em pacientes HIV positivos. / The coinfection between the Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) has the same transmission factors and consequently the associated risk factors explain the high prevalence of these infectious agents in our midst. This study estimated the prevalence of HIV and HBV coinfection and described the individual characteristics that act as risk factors for acquisition of coinfection, in order to use this information for advice. The sample was composed of 805 patients infected with HIV in the state of Piauà who sought the LACEN-PI for monitoring viral load and CD4 + T lymphocytes. The prevalence of Hepatitis B (HB), using the marker anti-HBc, and was 29.3% for HBsAg this value was 2.5%. The prevalence of Anti-HBc was 38.3% aged over 40 years, 38.6% for males, 31.9% among unmarried, 47.7% among retirees, 50.7% among who reported a history of jaundice, 54% among those who were diagnosed with hepatitis, 40.7% among those passing through reformatory or prison, 38.1% among non-intravenous drug users, 35.7% with sexual contact with illicit drug users, 48.8% with a preference among homosexual / bisexual, 44.9% among those who reported having sexual contact with a prostitute rare, 37.1% among those who had STD and 31.4% for those with viral load below 10,000 copies / mL of blood. We observed statistical significance between variables and the frequency of positive anti-HBc. The information in this work could be used in combat, counseling and prevention of advancement, the number of HB cases in HIV positive patients.

>Magister Scientiae - MSc / Background: Changing trends have been observed in the prevalence, etiology, imaging practice and pattern of presentation of mid facial fractures in different geographical regions. Conventional (plain) radiographs remain the most common initial investigative tool for general appraisal of suspected fractures, while advanced imaging is currently the most common final investigation. This study explored the clinico-radiologic patterns of mid facial fractures with main focus on demographic characteristics, etiology, fracture patterns and imaging practice. Aim: To determine the Prevalence, Clinical and Radiologic patterns of mid-facial fractures at Tygerberg Oral Health Centre, Faculty of Dentistry, University of the Western Cape Methodology: A retrospective cross sectional quantitative descriptive study of mid facial fractures was conducted at The University of the Western Cape’s Faculty of Dentistry based at the Tygerberg Oral Health Centre (TOHC). The study population comprised 239 patients who presented with mid facial fractures over 2 years, from January 2015 to December 2016. The data captured included demographic details, etiology, fracture site(s) and radiological investigations performed. Results: A vast male predominance was observed (M: F=5.3:1). The age range was 7-76 years (mean 31.94; SD 13.13). The most affected age category was 21 to 30 years (39.7%) while the least affected groups were children aged 0 to 10 years and patients above 70 years old. A total of 285 individual fractures were identified among the 239 patients (mean of 1.2 fractures per patient). The most common pattern of fracture was zygomatic complex (24.9%) while Le Fort fractures were the least common (5.3%). 20.1% of patients had concomitant fractures of other bones of the face and skull. There was no association between gender and site of fracture (p = 0.812). Panoramic radiography was the most common initial investigation. A panoramic radiograph in combination with various conventional extraoral views were sufficient for diagnosis in 18.8% of the patients. However, majority (53.6%) had all the three types of imaging performed (panoramic radiograph, conventional extra oral views and advanced imaging). The most common etiological factor was assault (73.6%). There was no association between gender and aetiology of fracture (p = 0.537)