MPH / Department of Public Health / Prostate cancer (PC) screening is a strategy to identify cancer before it causes symptoms. However, men’s participation in prostate cancer screening seems inadequate and remains a public health concern worldwide. This leads most men to be diagnosed with an advanced prostate cancer where cancer cells spread to other parts of the body. The aim of this study was to assess the knowledge and attitudes of males towards prostate cancer screening at a selected village in Thulamela Municipality, Limpopo province. The study adopted a quantitative approach using a descriptive cross-sectional survey. A well-structured questionnaire was used to collect data from 245 men who are 40 years and above. The sample was selected using the simple random sampling technique. The Statistical Package for Social Scientists (SPSS) version 25.0 was used to analyse the collected data; and the results were presented in percentages, frequencies and tables. Cross tabulation, Chi square and Phi and Cramer’s V test were also utilised to test for association and effects size respectively at .05 level of significance. Respondent’s knowledge as an explanatory variable, screening practices as response variable was assessed. The findings of this study showed that 64.1% of respondents had inadequate knowledge about prostate cancer. About 62.4% respondents had no prior knowledge regarding prostate cancer and 69% of respondents didn’t know the age at risk for the development of PC, while 81.9% of respondents had never heard about PC, and 35.9% didn’t know that PC can be treated. 84.9% of respondents had positive attitudes towards PC screening, however, 96.7% had never undergone screening for prostate cancer and 46.9% indicated that they will never undergo PSA test. Furthermore, the study found a significant association between men’s knowledge of PC and their willingness to undergo PC screening, X2 (3, N=245) = 48.44, p = .001; men’s knowledge of PC was significantly related to their attitudes towards PC, X2 (1, N = 245) = 17.63, p = .001. The effect size was moderate, ɸ = .27. Knowledge was significantly associated with all the demographic variables. Therefore, this study recommends widespread public health campaigns focusing on educating men about prostate cancer risk factors, symptoms, treatment and ways to prevent and manage it through healthy lifestyles. / NRF

Magister Public Health - MPH / Background: Optimal management of Type 2 diabetes requires that patients have a convenient method of collecting chronic medication. In the Western Cape Province, Type 2 diabetes patients can collect chronic medication from primary health care facilities including community health centres. The Chronic Dispensing Unit (CDU) was established to facilitate the dispensing of chronic medication by making medication collection more convenient for patients and was expected to improve medication collection. However, it has been observed that some Type 2 diabetes patients fail to collect pre-packed CDU parcels on the prescribed date and time which could result in poor treatment outcomes and secondary complications. This study therefore aims to explore the factors that influence collection of CDU chronic medication parcels by Type 2 diabetes patients from the Elsies River Community Health Centre (CHC), a primary health care facility in the Western Cape Province. Methodology: An exploratory qualitative research design was used to explore the personal-, social-, health system-related factors that affect collection of pre-packed CDU parcels. Semistructured interviews were conducted in English or Afrikaans with 18 purposefully selected Type 2 diabetes patients who are registered to collect pre-packed CDU parcels from the Elsies River CHC, and three key-informants from the Elsies River CHC. Data was recorded using a digital recorder. Interviews were transcribed and analysed using inductive content analysis. Results: The main factors that facilitate collection of pre-packed CDU parcels were support from family and social support. On the other hand, social factors that were reported as barriers to collection were the safety of the patients and collectors failing to collect on behalf of the patient. Patients' recognition of the value of their treatment and value of the service were the main personal factors which facilitated collection. Personal factors that were reported as a barrier to collection included forgetfulness, laziness and tiredness. Other personal factors that were reported by participants as barriers to collection were illness, transport problems, financial constraints and anticipating non-collection. Health service related factors reported as facilitating factors were reduced waiting time and mistrust of the off-site collection system. In addition, participation in the diabetes chronic club and pharmacy support were also reported as facilitating factors. Negative staff attitude and a limited collection time for pre-packed CDU parcels were reported as barriers to collection by Conclusion: Various personal-, social and health service related factors affect the collection of pre-packed CDU parcels by Type 2 diabetes patients from the Elsies River CHC. To improve collection among patients who fail to collect on their appointment date, the factors that have been found to facilitate collection should be extended to more patients. Recommendations: It is recommended that patients surround themselves with support structures including family, friends and community organisations to assist and motivate them in displaying adherent behaviour. Patients who make use of independent collectors should ensure that these individuals are reliable to avoid an undersupply of medication. Counselling and health promotion should be provided to patients by health service staff as a means of encouragement and empowerment. The diabetes club which serves as a source of information and support should be accessed by more patients. Open communications channels between health service staff and patients should be constructed to ensure that staff are aware of the barriers patients face.

Thesis (M.A. (Clinical Psychology)) -- University of Limpopo, 2020 / The integration of mental health care (MHC) into primary health care (PHC) has been identified as a practical intervention to: increase accessibility to mental health care; reduce stigma and discrimination against people living with mental illnesses; improve the management of chronic mental illness; and, to reduce the burden of comorbidity of mental illnesses with other chronic illnesses. In the South African context, integrating MHC into PHC also seeks to respond to numerous legislative reforms, with the aim of providing comprehensive health care, particularly to previously disadvantaged populations. The aim of the present study was to explore the perceptions of facility managers in the Tshwane District (Gauteng Province) towards the integration of mental health into PHC. Fifteen participants from the Tshwane district facilities participated in the study. The participants were selected through a non-probability purposive sampling method. Data was collected through in-depth interviews using a semi-structured questionnaire, and analysed using the thematic coding approach. Significant findings suggested that the major hindrances to the realisation of the policy objectives may be due to: the lack of rehabilitation and psychotherapeutic services; insufficient skill and knowledge of mental health on the part of staff; insufficient or unsuitable practice space in the facilities; and, poor cooperation between South African Police Services, Emergency Medical Services and Primary Health Care. Inter-facility communication, district implementation support and policy knowledge has notably increased over the years and were deemed to be amongst the biggest enablers.

Magister Public Health - MPH / Background: Tuberculosis (TB) poses a major public health challenge in South Africa and in the Northern Cape Province. The province has the third highest in TB incidence rate in the country. Poor adherence to TB treatment impacts negatively on treatment outcomes. Siyanda district in the Northern Cape Province has the second highest number of TB defaulters in the province despite the fact that 79.9% of these patients are on Community Based Direct Observation of Treatment (CBDOT). Aim: To explore the reasons for defaulting of TB patients from TB treatment in the CBDOT Programme in the Siyanda district, Northern Cape Province Study design: This was a qualitative exploratory study. Study population and sampling: Two TB nurses with varying years of experience in the TB Control Programme serving as key informants were selected from the participating facilities in the study area. Ten TB defaulters who were on the CBDOT programme were selected from the Electronic TB Register. Two focus group discussions (FGDs) comprising of purposively selected DOT Supporters (five in one group and six in the other) from different NGOs in the community were selected for maximum variation. Data collection: Key informant interviews were conducted with the TB nurses. Records of all defaulters in the study population were reviewed including clinic progress notes and patient TB treatment cards. In-depth interviews were conducted with the TB patients. FGDs were conducted with DOT supporters. Analysis: Analysis commenced simultaneously with collection of data. This enabled the researcher to continuously review and reflect on the data collected. Thematic content analysis was done.Categories emerged through the inductive process of the data analysis. Notes that were kept during data collection, reflections, audiotapes and transcripts were used to support the thick description of the findings. Results: The participants generally appreciated the programme and mostly had a good relationship with the DOT supporters. However, the quality of care exacerbated by inadequate health services such as lack of adherence counselling training of health professionals, low levels of education amongst TB defaulters, were found to be major contributory factors to TB defaulting. The patients interrupted treatment several times before defaulting, were not counselled during the interruption phase and understood TB messages differently. TB defaulters in the Siyanda District face socio economic challenges which include alcohol abuse, a major historic ill in the district and the grape farming community in the region. The impact of the disability grant on TB treatment adherence remains anecdotal and requires further research as TB defaulters did not admit to defaulting so that they could continue benefiting from the disability grant although these statements were refuted by the DOT supporters and key informants. The attitude of employers and fear of losing employment were also contributing factors. Conclusion and recommendations: It has become evident that TB in the Siyanda District is a public health issue. The predominantly rural, impoverished and transient community that moves to the farms to seek employment requires a CBDOT programme that will address pertinent challenges in the district to achieve a positive reduction in the TB defaulter rate. It will require collaboration with stakeholders including farmers, to address the challenges posed by the disease. Improved staff allocation, staff capacity development and community education are also recommended to improve quality of care.

The background and problem statement focuses on antiretroviral therapy (ART) and the use of mobile technology to improve compliance within a primary health care (PHC) context in South Africa. South Africa is one of the countries, globally, with the highest HIV incidence and prevalence and ART enrolled patients visiting PHC facilities. Compliance to ART plays an integral part in effective HIV/AIDS management. HIV/AIDS management entails a complex process of patient education and pharmacological control to improve ART compliance in South Africa. Studies were done in South Africa on reminder messages as most studies focused on chronic conditions in general. A literature review explored what is known about ART and mobile technology to improve compliance. Literature confirmed that compliance through reminder messages were done worldwide and in Sub-Saharan countries. Previous research indicated that the compliance rate of the patients increased through reminder messages. Yet there is a gap in the literature regarding reminder messages combined with health education on ART compliance. The aim of the study was to determine the impact of reminder messages combined with health education on ART compliance among patients receiving ART at a PHC facility Methodology: The study followed a quantitative, experimental, intervention, randomised multi-group, pre- and post measurement design (Creswell, 2012:1, Welman et al., 2012:80). The research design is experimental because the researcher applied an intervention (reminder messages) to two experimental groups. Random sampling was applied and participants were grouped into three groups: Group A, (control group), Group B, (reminder messages only) and Group C (reminder messages combined with health education). A preand post-measurement design is followed as each participant’s pill count and return date were measured before and after the reminder messages with/without health education were given. The sample size was 202 eligible patients receiving Regime 1 and 2 ART’s (Lamuvidine, Tenofovir, Efavirenz, Nevirapine, Alluvia® and Zidovudine) at a PHC facility in the North West, South Africa (N=202). The sample size was determined with guidance of statistical services to ensure that results obtained from the study would be reliable and significant. Data collection was done in three phases. Phase one (1) consisted of collecting the biographical data and a pre-measurement of pill count and return dates for participants in Groups A, B and C. Phase two (2) consisted of sending bi-weekly messages (Group B) via WinSMS and with health education (Group C) for three (3) months. Phase three (3) consisted of post-measurement of participants’ pill count and return date for Groups A,B and C. Data collection stretched over six months (October 2013-March 2014), namely three months pre-measurement, then activation of intervention combined with another three months post-measurement. Descriptive and inferential statistical analysis was conducted through SPSS (SPSS Inc., 2013). Descriptive statistics indicated that more female patients visited the PHC facility for ART on a more regular basis. It was concluded that the experimental group proved a slight increase in compliance with regards to return date after the SMS intervention. No difference was noted in compliance to pill counts. It can also be concluded that pill counts is a complex monitoring procedure with room for error from the patients’ aspect. / MCur, North-West University, Potchefstroom Campus, 2015

The background and problem statement focuses on antiretroviral therapy (ART) and the use of mobile technology to improve compliance within a primary health care (PHC) context in South Africa. South Africa is one of the countries, globally, with the highest HIV incidence and prevalence and ART enrolled patients visiting PHC facilities. Compliance to ART plays an integral part in effective HIV/AIDS management. HIV/AIDS management entails a complex process of patient education and pharmacological control to improve ART compliance in South Africa. Studies were done in South Africa on reminder messages as most studies focused on chronic conditions in general. A literature review explored what is known about ART and mobile technology to improve compliance. Literature confirmed that compliance through reminder messages were done worldwide and in Sub-Saharan countries. Previous research indicated that the compliance rate of the patients increased through reminder messages. Yet there is a gap in the literature regarding reminder messages combined with health education on ART compliance. The aim of the study was to determine the impact of reminder messages combined with health education on ART compliance among patients receiving ART at a PHC facility Methodology: The study followed a quantitative, experimental, intervention, randomised multi-group, pre- and post measurement design (Creswell, 2012:1, Welman et al., 2012:80). The research design is experimental because the researcher applied an intervention (reminder messages) to two experimental groups. Random sampling was applied and participants were grouped into three groups: Group A, (control group), Group B, (reminder messages only) and Group C (reminder messages combined with health education). A preand post-measurement design is followed as each participant’s pill count and return date were measured before and after the reminder messages with/without health education were given. The sample size was 202 eligible patients receiving Regime 1 and 2 ART’s (Lamuvidine, Tenofovir, Efavirenz, Nevirapine, Alluvia® and Zidovudine) at a PHC facility in the North West, South Africa (N=202). The sample size was determined with guidance of statistical services to ensure that results obtained from the study would be reliable and significant. Data collection was done in three phases. Phase one (1) consisted of collecting the biographical data and a pre-measurement of pill count and return dates for participants in Groups A, B and C. Phase two (2) consisted of sending bi-weekly messages (Group B) via WinSMS and with health education (Group C) for three (3) months. Phase three (3) consisted of post-measurement of participants’ pill count and return date for Groups A,B and C. Data collection stretched over six months (October 2013-March 2014), namely three months pre-measurement, then activation of intervention combined with another three months post-measurement. Descriptive and inferential statistical analysis was conducted through SPSS (SPSS Inc., 2013). Descriptive statistics indicated that more female patients visited the PHC facility for ART on a more regular basis. It was concluded that the experimental group proved a slight increase in compliance with regards to return date after the SMS intervention. No difference was noted in compliance to pill counts. It can also be concluded that pill counts is a complex monitoring procedure with room for error from the patients’ aspect. / MCur, North-West University, Potchefstroom Campus, 2015

Waste resulting from healthcare activities is hazardous due to its potential risk of infection to healthcare workers, waste workers and the public. Many tools and approaches have been applied in waste management in developed countries, but are not suitable for application in developing countries due to their complexity and extensive data and resource requirements. WasteOpt was therefore developed and applied as an appropriate decision-making tool in the developing country context. WasteOpt comprises of the Analytical Hierarchy Process (AHP), costing and Life cycle management (LCM). The purpose of this study was to identify environmentally sound technologies (ESTs) that minimise the risk of infection by healthcare waste (HCW) in rural clinics. Rural clinics were selected because apart from financial constraints, they are challenged by the lack of procedure, infrastructure and technologies to develop reasonable waste management plans that can be implemented within a practicable time frame. WasteOpt was applied to aid in identifying ESTs in relation to the infection risks and costs of the technologies. Experts in waste management in Lesotho were involved in a workshop for the ranking of technologies. The overall weighting values of the rankings were converted to risk factors for individual options and for alternatives (combination of options). Risk factors were classified as low, medium and high risk. The technologies within a single class were differentiated by analysing the cost of acquiring and running the technology to qualify as ESTs. The ESTs identified for Lesotho are Engineered containers, Refrigerated engineered facility, engineered wheeled transport, detailed procedures, multi chamber incinerator, engineered pit and landfill. Ten (10) clinics in Lesotho were also assessed as case studies using the WHO RAT. The RAT was first modified to include questions on financial management at the clinics. The calculated risk factors were applied to the case studies to assess the risk under which healthcare workers operate in those clinics. The additive minimum risk for the overall life cycle of waste was 4.0 (excluding central treatment and disposal). The clinic workers were found to be at a risk of between 1.1 x 10-4 and 7.8 x 10-5, which proves that rural clinics in Lesotho are still using inappropriate technologies. In terms of financing for waste management, public clinics were found to have little decision-making powers over funds and had less accountability measures. CHAL clinics which are managed by churches in Lesotho had more control of funds and exhibit more accountability. All clinics had no targets for saving funds from waste management activities. WasteOpt can be applied as a decision-making tool for HCW in Lesotho since it overcomes the barriers that inhibit environmentally sound management of HCW in developing countries. In conclusion: WasteOpt can be applied as a decision-making tool for different types of waste by replacing HCW options with respective ones and designing a relevant questionnaire for qualitative data capture. WasteOpt can then be applied in a developing country to aid sustainable waste management decision-making. Informed decision-making helps resource poor managers to select cost-effective but low-risk options, which will be sustainable in the future. / Dissertation (MSc (Environmental Technology))--University of Pretoria, 2007. / Chemical Engineering / unrestricted