Magister Curationis - MCur / Psychiatric nurses are known for their person-centred care approach that offers help through a therapeutic communication approach. In South African nursing, a Professional Nurse is a nurse whose role include but not limited to conducting a comprehensive and holistic health assessment on clients of all age groups, with complex health problems, determines the health needs of the community, early detection, diagnosis, treatment and appropriate referral to higher levels of care.

Magister Psychologiae - MPsych / An epidemiological study was conducted with the main goal of describing the occurrences of the various STTs in the Eastern Cape province as well as biographical factors such as age, gender, and geographical location influencing them. Ten primary health care (PHC) centres located throughout the province served as sentinel sites for surveillance data collection for a period of 3 months using Daily and Monthly Report Forms. The surveillance data was analysed using relative frequencies to determine STis prevalence. The main findings from the present study suggest that the most frequently encountered female syndromes were vaginal discharge and lower abdominal pains and most frequent male syndrome was Urethral discharge. Other syndromes accounted for less than 10% of the ST! cases observed at the PHC centres during the study. The study also indicate that more STI patients were seen at urban PHC centres compared to rural ones and that most of the STI patients seen at PHC centres were women. These findings are helpfol for the Health Department in the Eastern Cape Province to effectively plan for the control and prevention of all ST!s including HIV I AIDS

Magister Public Health - MPH / Background: With the improvements in the effectiveness and availability of antiretroviral therapy (ART), perinatally infected children are surviving to adolescence and emerging as a significant sub-population living with HIV/AIDS in Zimbabwe. Adolescents, aged 10-19 years, face unique challenges related to adherence to chronic medication due to this period of vulnerability that is characterised by decreased parental support and supervision, decreased inhibition, increased risk-taking, and immature judgement. It is widely reported that poor adherence to ART leads to viral rebound, disease progression and drug resistance, in addition to increasing the risk of transmitting resistant strains of HIV to others. It is imperative to determine the factors that influence ART adherence among HIV positive adolescents so that effective interventions can be put in place. The current study described the factors that are associated with adherence to ART among HIV positive adolescents in Zimbabwe. Methodology: A cross-sectional survey of 136 randomly selected adolescents (10-19 years) who were receiving ART at two referral hospitals in Masvingo District in 2019 was undertaken. A questionnaire was administered to collect data on socio-demographic characteristics, adherence and factors related to adherence such as person/patient, health system, medication, disease characteristics and social factors. Clinical data were extracted from the Electronic Monitoring Patient System. SPSS v24 was used for descriptive and inferential analysis. Results: More than half of the participants (61%) had combined optimal adherence (dose adherence, schedule adherence and adhered to dietary instructions) in the previous three days. The most frequent reasons reported for missing HIV medications in the previous month was being away from home (50%); forgetfulness (25%); and having too many pills to take (25%). In bivariate analysis, only duration of time since HIV diagnosis was significantly associated with combined adherence to ART in the previous three days. Conclusion: Tailored interventions are recommended to address low adherence amongst adolescents. These interventions should include convenient clinic appointment schedules for adolescents to pick up medication, reminders to take medication, regimen change to a single dose, and peer education and adherence clubs to improve knowledge about HIV and treatment, and curb treatment fatigue.

Background: Malnutrition in the elderly is a serious problem that leads to complications as well physically as mentally for the individual and increased costs in society. There are guidelines and nutritionsscreening should be done when 65 > year. It is nurse’s responsibility to identify patients at risk. Research shows that not enough is being in done. Aim: The purpose of this literature study was to elucidate the nurse's experiences regarding prerequisites for identifying malnutrition in the elderly in primary care settings and elderly health care. Method: A general literature study was conducted with fifteen articles of which thirteen with qualitative method and two of mixed method. The articles were reviewed and analyzed using qualitative content analysis. Results: The results showed that nurses viewed education as an important measure. They felt knowledge would increase security and facilitate them to perform screening and identify malnutrition. The high workload, lack of resources and lack of guidelines and support from management was felt by nurses in many of the studies to be a major problem, which contributed to the difficulties with nutritional screening. Furthermore, the result appears that nutrition was not seen as important as other nursing measures. Nutrition was simply a low priority. Conclusion: Nurses perceived knowledge, guidelines and support from management were important and would facilitate nutritional screening. Keywords: Malnutrition, primary health care, elderly, nutritional assessment, barriers / Bakgrund: Malnutrition hos äldre är ett uttalat problem som leder till komplikationer såväl fysiskt som psykiskt för individen och ökade kostnader för samhället. Riktlinjer finns och nutritionsscreening bör göras på alla> 65 år. Det är sjuksköterskans ansvar att identifiera patienter i riskzonen. Forskning visar att detta ändå inte görs i tillräcklig utsträckning. Syfte: Syftet med denna litteraturstudie var att belysa sjuksköterskans upplevelser gällande förutsättningar att identifiera malnutrition hos äldre inom öppen hälso- och sjukvård samt äldrevård. Metod: En allmän litteraturstudie genomfördes med femton artiklar, varav tretton med kvalitativ metod och två av mixad metod. Artiklarna granskades och analyserades med innehållsanalys. Resultat: Resultatet visade att sjuksköterskor såg utbildning inom nutrition och nutritionsscreening som en viktig åtgärd. De menade att kunskap skulle ge ökad trygghet och underlätta för dem att utföra screening och därmed identifiera malnutrition. Den höga arbetsbelastningen, bristande resurser samt att riktlinjer och stöd från ledningen saknades upplevdes av sjuksköterskor i många av studierna vara ett stort problem som bidrog till svårigheterna att få nutritionsscreening att fungera både i primärvården och hemsjukvården. Vidare framkommer i resultatet att nutrition inte sågs som lika viktigt som andra omvårdnadsåtgärder. Nutrition prioriterades helt enkelt lågt. Slutsats: Sjuksköterskor upplevde att kunskap, tydliga riktlinjer och stöd från ledningen var betydelsefullt och skulle underlätta identifieringen av malnutrition. Nyckelord: Malnutrition, primärvård, äldre, nutritionsbedömning, hinder

There is an increasing interest in ethnomedical and ethnoveterinary practices, especially as it relates to the use of medicinal plants for treating various ailments. As a result, the current trend in government health authorities is to integrate herbal medicine with primary healthcare. This arises because nearly 80% of people in the developing world, particularly those from rural communities where modern drugs are unaffordable, inaccessible or, unavailable, depend on phytomedicine for primary healthcare. Despite this, however, most medical and veterinary professionals distrust herbal medicines due to concerns of scientific evidence of efficacy and safety. Hence, there is need for their validation, before herbal medicines gain wider acceptance and use. Traditional healers and rural farmers use extracts of Peltophorum africanum (a medicinal plant wide-spread in southern Africa and other tropical regions), to treat diarrhoea, helminths and abdominal parasites, dysentery, HIV-AIDS, acute and chronic pain, anxiety and depression, infertility, and to promote well-being and resistance to diseases. To evaluate these ethnobotanical leads, dried leaves, bark and root from mature P. africanum (Fabaceae) trees were extracted with acetone, ethanol, dichloromethane and hexane. Chromatograms were made on silica gel plates. Thin layer chromatograms (TLC) were sprayed with 0.2% 2, 2-diphenyl-1-picryl hydrazyl (DPPH) for qualitative screening for antioxidants. Quantification of antioxidant activity was done in comparison with L-ascorbic acid and Trolox (6-hydroxy-2, 5, 7, 8-tetranethylchromane-2-carboxylic acid). With regard to the extracts, minimum inhibitory concentrations (MIC) were determined for Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Enterococcus faecalis. The total antibacterial activity (TAA), signifying the volume to which active compounds present in 1 g of plant material can be diluted and still inhibit bacterial growth, was also determined. In vitro anthelmintic activity was evaluated by effects of acetone extracts on the egg hatching and larval development of parasitic nematodes Haemonchus contortus and Trichostrongylus colubriformis. The eggs and larvae of the two parasites were incubated in various concentrations of the leaf, bark and root extracts for two and five days respectively. Furthermore the efficacies of the acetone extracts were tested on lambs artificially induced with H. contortus and T. colubriformis infections. Toxicity was performed in brine shrimp and MTT assay on Vero monkey kidney cells. The extracts had substantial activity against both Gram-positive and Gram-negative bacteria, with MIC values of 0.08 mg ml-1 for Staphylococcus aureus and 0.16 mg ml-1 for Pseudomonas aeruginosa ; the corresponding TAA values were 1263 and 631 ml g-1. The acetone extracts the bark, and root of P. africanum had higher antioxidant activity than L-ascorbic acid (Vitamin-C) and Trolox (6-hydroxy-2, 5, 7, 8-tetramethylchromane-2-carboxylic acid), a synthetic vitamin-E analogue, and much higher than Ginkgo biloba extract (EGb 761). The standardized extract of Ginkgo biloba (EGb 761) is widely employed for its significant benefit in neurological disorders. The respective EC50 for the P. africanum root , bark and leaf extracts, L-ascorbic acid, and EGb761 were 3.82 µg ml-1, 4.37 µg ml-1, 6.54 µg ml-1, 5.04 µg ml-1, and 40.72 µg ml-1. The extracts inhibited egg hatchability and larval development (from L1 to infective stage L3) of both H. contortus and T. colubriformis (both parasitic nematodes of ruminants) at concentrations of 0.2-1.0 mg ml-1. The plant extracts, at concentrations of 5-25 mg ml-1 completely lysed larval forms (L1) and eggs of the nematodes. In all assays, the root extracts had higher antibacterial, antioxidant and anthelmintic activity than the bark and leaf. Although the extracts were safe and non-toxic, the reduction in faecal egg and adult worm counts in lambs infected with H. contortus and T. colubriformis was not statistically significant (P=0.073). From the acetone extracts of the root, a brownish crystalline compound, bergenin was isolated. Bergenin was also assayed for toxicity with brine shrimp and Vero monkey kidney cells like the extracts, where the compound was found to be not toxic. In a disc diffusion test, the inhibitory activition of bergenin was determined for the bacteria E. coli, P. aeruginosa, Mycobacterium vaccae, and the fungi Sporobolomyces salmonicolor and Penicillium notatum. Bergenin had reasonable antimicrobial activity against S. salmonicolor, moderate activity against M. vaccae, E. coli and P. aeruginosa, but non inhibitory against P. notatum. P. africanum extracts have therefore, potential for treatment of infection-related diseases by either directly inhibiting bacterial growth or by stimulating the immune system of the host. The traditional use of P. africanum concoctions against diarrhoea, dysentery and unthriftness, may be also due to anthelmintic activity as these signs are consistent with parasitic astroenteritis. Antioxidants are also important in boosting the immunity, critical in the management of helminthosis. There is ample scientific and empirical evidence supporting the use of plantderived antioxidants in the control of human immunodeficiency virus (HIV) and neurological diseases. Synergistic activity of plant antioxidants has been proposed as a mechanism by which viral replication and immune cell killing in HIV infection can be inhibited. Antioxidants may have neuro-protective (preventing apoptosis), as well as neuro-regenerative roles. Due to the high antioxidant activity of its extracts, P. africanum has prospects in the chemotherapy of HIV and management or control of neurodegenerative diseases. Thus there is great potential of P. africanum extracts in medicine. Further isolation and bioassay characterization of bioactive compounds from P. africanum is recommended as well as refinement of in vivo tests in target livestock, or clinical trials. Better methods of plant extraction easily adaptable to rural communities for sustainable exploitation of the tree, may have to be devised especially those using the leaves instead of bark or root. / Thesis (PhD(Paraclinical Sciences))--University of Pretoria, 2007. / Paraclinical Sciences / unrestricted

Bakgrund: Psykisk ohälsa ökar i hela samhället och klassas enligt WHO som en av vår tids största folkhälsoproblem. Psykisk ohälsa innefattar allt från lättare psykiska besvär till avancerade psykiatriska diagnoser. WHO har konstaterat att primärvården utgör en optimal plattform att ta hand om personer med psykisk ohälsa vilket innebär en ny roll för sjuksköterskor verksamma inom primärvården. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter och attityder av att möta patienter med psykisk ohälsa inom primärvården. Metod: En litteraturöversikt genomfördes där 17 vetenskapliga artiklar söktes fram i databaserna CINAHL, PubMed och PsycINFO. Artiklarna, vilka utgjorde grunden för litteraturöversiktens resultat, kvalitetsgranskades innan resultaten slutligen analyserades genom en integrerad dataanalys. Resultat: De huvudkategorier som framkom vid sammanställningen av resultatet var förhållningssätt, kunskap och kompetens samt utmaningar. Resultatet kunde påvisa en kunskapslucka hos sjuksköterskor inom primärvården gällande psykisk ohälsa. Det framkom vidare att sjuksköterskor inte var befriade från negativa attityder och stigmatiserande förhållningssätt. Resultatet visade även på utmaningar som tidsbrist och hög arbetsbelastning vilka utgjorde hinder i att ta sig an den berörda patientgruppen på ett tillfredsställande sätt. Slutsats: För att sjuksköterskor i deras nya roll inom primärvården ska kunna hantera patientgruppen med psykisk ohälsa på ett begripligt och meningsfullt sätt behövs både utbildning samt möjligheten att ge patientgruppen den tid som behövs. Enligt sjuksköterskorna behövs fortbildning inom psykisk ohälsa samt ytterligare teoretisk kunskap och praktisk erfarenhet inom området. Vidare har utbildning genom erfarenhetsexperter visat sig ha god inverkan på såväl kunskap som attityder. / Background: Mental illness is increasing throughout society and is classified according to the WHO as one of the biggest public health problems of our time. Mental illness includes everything from mild mental disorders to advanced psychiatric diagnoses. WHO has established that primary care is an optimal platform for caring for people with mental illness, which means a new role for nurses active in primary health care. Aim: The aim was to describe nurses' experiences and attitudes of encountering patients with mental illness in primary health care settings. Method: A literature review was conducted where 17 scientific articles were searched in the databases CINAHL, PubMed and PsycINFO. The articles, which formed the basis for the results of the literature review, were quality checked before the results were finally analyzed through an integrated data analysis. Results: The main categories that emerged during the compilation of the results were attitudes, knowledge and competence and finally challenges. The result was able to demonstrate a knowledge gap among nurses in primary health care regarding mental illness. It further emerged that nurses were not free from negative and stigmatizing attitudes. The results also showed that challenges, such as lack of time and high workload, constituted obstacles in addressing the affected patient group in a satisfactory manner. Conclusions: In order for nurses in their new role in primary care to be able to handle the patient group with mental illness in an understandable and meaningful way, both training and the opportunity to give the patient group the time needed are crucial. According to the nurses, further training in mental illness as well as more theoretical knowledge and practical experience is needed. Furthermore, education through experts by experience has been shown to have a good impact on knowledge as well as attitudes.

Philosophiae Doctor - PhD / Oral diseases are a major public health problem in the Seychelles, amidst a contracting budget coupled by a lack of national oral health policy and strategic plan to promote oral health. The oral disease burden is attributed to numerous determinants operating at different levels –macro, population and community, and at the person level. The study set out to examine the determinants that contribute to poor oral health in the Seychelles through an exploration of the social, cultural, economic and environmental factors influencing the oral health of adults. The purpose of the study was to develop an evidence-based theoretical framework that would inform future policy and practice for oral health. Set in the mixed research paradigm, a qualitative and quantitative research approach was used to obtain a deeper understanding of the pathways and mechanisms operationalizing determinants. Using a purposive sampling approach, individual and group interviews were conducted with patients, dental staff and a representative of the upper management.

Magister Artium (Development Studies) - MA(DVS) / South African health professionals’ competencies, especially those of managers have been placed under the spotlight. In the community health centres (CHCs) situated in low socio-economic status areas in Cape Town, a shortage of human resources has been an area of importance, as it exacerbates the impact of competence and service delivery by the healthcare managers.

Magister Legum - LLM / In South Africa, there are two health systems through which health services are delivered,1 namely private and public. These two systems were inherited from the apartheid regime.2 With South Africa’s political change from a system of parliamentary sovereignty to a constitutionally supreme system in 1996, huge changes were bound to come including changes to the health sector.3 This meant the overhauling of health legislation, as the right of access to health care services became guaranteed in the Constitution of the Republic of South Africa, 1996.4 In 1997, the White Paper on the Transformation of the Health System (White Paper on Health)5 was introduced with the aim of developing a national health system.6 There has been a lot of progress made in reforming the health sector, however there are still many cracks that the national government aims to remedy through the realisation of universal health coverage (UHC).

Objectives. To describe the qualitative aspects of the notifiable diseases surveillance system of the Gauteng Province, South Africa; to conduct a cross-sectional survey on knowledge and practices pertaining to disease notification among private sector primary health care providers in Gauteng Province; to measure the degree of underreporting of notifiable diseases versus positive laboratory diagnoses using malaria as a cases study; and to identify the correctible short-comings in the Gauteng Health Department’s diseases surveillance system and to recommend ways of addressing these to improve the system and its performance. Design. This is an evaluation study consisting of both the qualitative aspects and quantitative descriptive components of the notifiable disease system in Gauteng Province. The study designs used for the qualitative description were literature and policy review and a semi-structured interview with communicable disease coordinators. The quantitative research comprised of a telephonic questionnaire administered to a random sample of private general practioners and secondary data analysis comparing malaria cases notified to the Gauteng Provincial Department of Health with public and private sector laboratory data and clinical surveillance data. Setting. The study setting was the Gauteng Provincial Health Department and public and private health care service providers in Gauteng Province. The study period extended from 1 January to 30 June 2006. Subjects. The subjects of the study were the Gauteng Health Department’s disease surveillance system, public and private sector health care providers including private primary health care practitioners. Outcome measures. Outcome measures for the qualitative system description were the status of selected system attributes namely usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, positive predictive value, representativeness and stability. Outcome measures for the knowledge and practice survey of private general practitioners were reporting compliance and knowledge of notifiable conditions. The primary outcome measure for the secondary data analysis was the proportion of laboratory diagnosed cases of malaria notified to the provincial health department. Results. The notifiable disease surveillance system in Gauteng is deemed useful by the public sector communicable disease coordinators but less so by the private sector general practitioners. Data quality as indicated by completeness of residential detail reporting on meningococcal notifications varied between 29% and 57% by district. Thirty seven percent of general practitioners report compliance with notifications and the mean score for knowledge on notification status of medical conditions was 56%. The sensitivity of notifications of malaria compared with laboratory notifications was 26% with relatively higher notification rates where cases occurred in children under 15 years of age. Conclusions. The notifiable disease surveillance system in Gauteng Province is relatively flexible and reasonably structured however this research suggests that there is suboptimal use of the information for local action in certain areas. Private General Practitioners self-report a low level of compliance citing time constraints and lack of motivation; knowledge of the notification status of selected medical conditions is lower than expected. The completeness and accuracy of notification data, as demonstrated in malaria notifications, is insufficient to gauge a true picture of burden of disease in the province. / Dissertation (MMed)--University of Pretoria, 2007. / School of Health Systems and Public Health (SHSPH) / Unrestricted