In contemporary multicultural societies, health is emerging as a fundamental right alongside education and welfare: a frame of reference endorsed by the Government of National Unity in South Africa. Health workers are confronting issues far beyond the more traditional modes of health education. The initial thrust of this research was to investigate the most relevant social, health and education knowledge bases and issues relative to health education in cross cultural encounters in order to formulate universal guidelines applicable to the national situation. Differences inherent in allopathic and traditional health systems are explored in historical time, in conjunction with concepts of social change, communality in diversity and the co-existence of multiple realities. An understanding of common denominators across all human and group experience emerges and, with it, insight into problems that occur when universalistic conceptions of human behaviour are linked to communicocentric hegemony. The parameters within which cross cultural health education are viewed are extended through an analytical, empirical evaluation of the andragogic consequences of a broader conceptualisation of culture and the patterned relationships existing between elements within society. The ontic fact that similar variables may have widely different meanings and be differently construed by people whose life experiences differ is affirmed. Culture shock becomes a potential personal reality for all engaged in cross cultural encounters. Radical reflection on human nature and the eidos of man constitutes the foundation upon which the aims and various theories of health education are systematically and progressively evaluated. Evidence surfaces that the original intent of the research was rooted in the Western medical tendency towards standardisation, specialisation and the creation of scientifically validated routines for professional practice and that gaps exist between the theory and practice of health education and the everyday experiences of people. On the basis of scientifically based insights, guidelines have been formulated to narrow the divide between the factual, linearly based procedural aspects of health education and the human experience of learning. The guidelines embody the notion that the health educator's role in cross cultural encounters is one of facilitating meaningful, appropriate and informed choices on the part of adult learners. / Educational Studies / D.Ed. (Philosophy of Education)

Text in Afrikaans / Summaries in Afrikaans and English / Die doel van die sensus was om 'n perspektief te verkry oar die bestuur van plaaslike owerhede in die Vrystaat se primere gesondheidsafdelings deur verpleegkundiges. Faktore rakende die omvang van die verpleegkundige in beheer se bestuursfunksies, die werksverhoudinge tussen hulle en hul hoofde, hul optimale benutting ten opsigte van bestuur en sekere aspekte van hul bestuursopleiding is ge"ldentifiseer as belangrike komponente. Ontleding van data het getoon dat verpleegkundiges en hoofde van mekaar verskil ten opsigte van hul sienings rakende die bestuursfunksies van die verpleegkundige in beheer. Werksverhoudinge tussen die verpleegkundiges en hul direkte toesighouer is nie altyd bevredigend nie. Die swak benutting van hul bestuursvaardighede blyk vir die verpleegkundiges in beheer onaanvaarbaar te wees. Sekere aspekte van die bestuursopleiding van verpleegkundiges behoort aandag te geniet. Plaaslike owerhede behoort aan verpleegkundiges geleenthede vir voortgesette bestuursopleiding te bied. Aanbevelings om die optimale benutting van verpleegkundiges in beheer van primere gesondheidsafdelings van plaaslike owerhede te bevorder, is geformuleer. / The purpose of this census was to obtain a perspective on the management of primary health services of local authorities by nurses in the Free State. Factors regarding the extent of management in primary health care services by nurses, working relationships between them and their superiors, their optimal utilisation with regard to management and certain aspects of their managerial training, were identified as important components. Analysis of data indicated that nurses and their superiors differ from one another regarding their views on managerial functions of the nurses in charge. Working relationships between nurses in charge and their superiors were not always satisfactory. Nurses found the poor utilization of their management skills unacceptable. Certain aspects of the managerial training of nurses should receive attention. Local authorities should provide opportunities for ongoing managerial training for nurses. Recommendations to utilise nurses in charge of primary health care services optimally, were formulated. / Health Studies / M.A.

Decentralisation of the multidrug resistant tuberculosis (MDR TB) programme to primary health care (PHC) facilities in the Nelson Mandela Metropolitan was implemented in order to improve the effectiveness of MDR TB services. This study explored the knowledge gaps of nurses at PHC facilities as regards MDR TB. A quantitative, cross-sectional descriptive study was conducted; data was collected using a structured questionnaire. Non-probability sampling was applied in this study. A convenient sampling technique was used and 25 of the 42 facilities were selected. Thirty-two respondents completed the questionnaire with a response rate of 64%. Descriptive statistics were used to describe the data. Only 38% of the nurses had been trained on MDR TB. Overall scores were high with a mean knowledge score of 61%. However there were knowledge gaps regarding side effects of MDR TB medication. This study revealed gaps in knowledge of certain areas of MDR TB management / Health Studies / M.A. (Public Health)

Text in English / Cervical cancer remains the leading cause of cancer mortality among women worldwide, a burden in the developing countries and commonly detected through symptoms at later invasive stages. The study aimed at establishing knowledge and awareness of the importance of cervical cancer screening in the Makhuduthamaga Sub-district by exploring the perceptions of women and professional nurses and through the review of the National Cervical Cancer Screening Policy (2013). Recommendations to address the gap in knowledge and to inform the National Cervical Cancer Screening Policy were developed based on the study findings. A mixed-method approach was used in this study through a sequential explanatory design, which is quantitatively driven was used. Quantitative data were obtained by using a researcher developed checklist. The checklist was developed from variables stated in the National Cervical Cancer Screening Policy and was used to review its implementation. Qualitative data was obtained through in-depth interviews with individual women and focus group discussions with professional nurses. The study was conducted in ten randomly selected clinics of Makhuduthamaga Sub-district. Purposive sampling was done to obtain qualitative data. An average score of 9.7 was obtained for all ten clinics that participated in the study with regard to the evaluation of the implementation of the National Cervical Cancer Screening Policy. Only 6 (60%) clinics implemented the policy whereas 4 (40%) clinics did not implement the policy. Women and professional nurses perceived cervical cancer screening as important. Lack of knowledge among women regarding cervical cancer screening contributed to the majority of women not screening for cervical cancer. Lack of resources, the 10 year interval of normal cervical cancer screening, the use of disposable vaginal speculums and brushes, lack of standardized cervical cancer screening training, centralization of cytology laboratories came out as factors that negatively influence the uptake of cervical cancer screening. Cervical cancer screening awareness campaigns, availability of resources and standardized in-service trainings on cervical cancer screening were recommended to enhance the cervical cancer screening uptake. Key concepts: / Health Studies / D. Litt. et Phil. (Health Studies)

An increase in diarrhoea and upper respiratory tract infection has been noted for the past five years and this is associated with the prevalence of Human Immune-deficiency Virus and Acquired Immune Deficiency Syndrome. HIV infection is an increasingly common cause of childhood morbidity and mortality in South Africa. In some areas of the country, like the Eastern Cape, more than 30 percent of the women attending antenatal clinics are HIV infected. Without intervention, approximately one third of the babies born to these HIV infected mothers will get infection from their mothers (WHO, 2003). Aim and Objectives of the study: The study was meant to assess the specific knowledge and skills of professional nurses at the primary health facilities regarding management and integration of childhood illnesses, evaluate the quality of training of professional nurses on aspects of IMCI including integration of HIV within IMCI programme for children under five years in Primary Health Care facilities in Mdantsane Township. Methods: A quantitative descriptive method was used for this study. The questionnaire developed by the researcher was used for data collection. The items on the questionnaire were divided into four (4) subsections. The questionnaire was administered to all professional nurses on duty and those available at the time of data collection. A checklist for IMCI was used to collect data from Road to Health files of children who were HIV positive admitted in the pediatric ward at Cecilia Makhiwane Hospital. Results: The results of this study for all the variables examined showed that the highest score was 56 percent and the lowest was18 percent.These results indicated that the knowledge and skills of professional nurses were inadequate.

Basic Antenatal Care (BANC) is a way of training or upgrading the knowledge and skills of all nurses, midwives and doctors involved in antenatal care at the primary health care level so that the minimum care can be provided effectively. This study was conducted to investigate the implementation of the BANC program by midwives in the Mdantsane clinics during February 2009. Methods: A descriptive study design was undertaken targeting midwives providing antenatal care to pregnant women, in 14 clinics of Mdantsane. Data was collected from 25 midwives in the clinics, and from 140 ANC cards of women attending ANC on the day of their visit to the clinic. Results: The majority of midwives providing BANC in Mdantsane clinics were not trained in BANC. There were 10 trained midwives and 15 not yet trained. A total of twenty five midwives were involved in the study. The number of visits according to the BANC schedule was well known by the midwives in the study. The content of the visits was well known for the first visit, but for subsequent visits, the participating midwives could not state exactly what they do on these visits. They perceived BANC as something beneficial for both midwives and pregnant women with 24 of the participating midwives rating BANC as advantageous. In completing an ANC card, the midwives scored between 48 percent and 100 percent. Under examination, they scored between 52 percent and 100 percent. Lastly on interpretation and decision making, they scored between 0 percent and 92 percent. This could have troubling consequences for the health status of the mother and baby. Weaknesses in providing antenatal care identified in the study included participating midwives failing to fill in the last normal menstrual period (LNMP) and the estimated date of delivery (EDD), which was a worrying observation. Plotting of the gestational age at first visit was also not carried out well as only 47 percent of the midwives in the study did this, meaning that there would be a miscalculation of the gestational age thereafter throughout the pregnancies. The body mass index (BMI) was not calculated as the maternal height and weight were not written on the ANC card. This should be completed in order to check the nutritional status of the pregnant woman to help supplement, if malnourished, and educate on diet, if overweight. Only 17 percent of the midwives in the study plotted the foetal presentation. Failure to plot foetal presentation could lead to complications during delivery because women with abnormal presentations could end up delivering in a clinic instead of the hospital.Conclusion: This study showed that even though midwives are implementing BANC among pregnant women, it is not being carried out correctly. Therefore the programme will not be as beneficial as it would be if put into practice correctly. This is highlighted by the lack of knowledge from the untrained midwives regarding the content of care on subsequent visits. Thus there is an urgent need for BANC training to be conducted and monitored at various sites.

PhD (Health) / Department of Public Health / The Government of South Africa in response to a prevalent human immunodeficiency virus (HIV) has adopted an approach of integrating HIV/AIDS service into primary health care, as a key to achieving universal access to antiretroviral treatment (ART). Despite the government’s efforts of integrating HIV service into Primary Health Care (PHC), insufficient numbers of PHC staff and inadequate infrastructure is challenging when integrating HIV/AIDS service into PHC. This study explored the extent of HIV service integration into PHC and whether the clinic/health centre’s environment is enabling to integrate HIV service into PHC. Barriers to HIV/AIDS services integration as well as attitudes of PHC nurses were assessed. The overall purpose of this study was to develop guidelines to facilitate the integration of HIV/AIDS services into PHC in Vhembe district of Limpopo province, South Africa. An exploratory sequential mixed methods design was used. The qualitative data was collected and analysed before and results for qualitative approach used to build a subsequent quantitative phase. The current study revealed that HIV/AIDS services are integrated into every existing programme at the PHC clinic and health centres; these include: Immunisation programme, Family planning, PMTCT and ANC programmes, STIs, minor ailments and chronic illness and TB. The study further revealed that the environments at PHC clinics and health centres are not enabling the integration of HIV/AIDS services into PHC due to insufficient staff and inadequate infrastructure. Guidelines to facilitate the integration of HIV/AIDS services based on the findings was developed. The study recommendations comprise; increasing knowledge of HIV serostatus, accelerating HIV prevention, accelerating the scale-up of HIV treatment and care, creating of enabling environment for the integration of HIV/AIDS services into PHC, nursing education and training and nursing education and training.

Medicinal plants of Thulamela municipality are experiencing challenges due to human activities, resulting in some of the medicinal plants becoming difficult to find, declining, endangered or even extinct. Unsustainable harvesting is threatening the survival of certain medicinal plant species used as a source of primary healthcare in the area. This study investigates aspects related to traditional healers' perceptions with regard to collection, ethnobotanical importance and conservation status of indigenous medicinal plants used by traditional healers around Thulamela municipality. Information on medicinal plants was gathered by means of semi-structured interviews, field walks, personal observation and a literature review. A total of 90 medicinal plant species, which belong to 47 families, from a total of 82 genera commonly used by traditional healers to treat different ailments, were recorded. About 87% of traditional healers indicated that some medicinal plants are difficult to find; only 13% of healers did not experience difficulties in finding some medicinal plants. / Environmental Sciences / M. Sc. (Ornamental Horticulture)

Public demands have forced countries to explore new ways of rendering primary health care to reach the poor who are not within reach of the modern health care systems. New categories of health care personnel, like lay health workers emerged. There are vast differences in the roles of these lay health workers as was revealed with an extensive literature search. The phenomenology qualitative research method was used to investigate perceptions of farm lay health workers regarding their roles in rural areas. A convenience, non-random sample (N=5) was used for focus group discussions and in-depth interviews to collect data. The latter revealed five main themes associated with the role of farm lay health workers: (1) community link; (2) carer; (3) community developer; (4) counsellor and (5) role model. Guidelines were formulated to enhance the role of lay health workers in the rural Western Cape Province and to improve the quality of care to rural communities / Health Studies / M.A. (Health Studies)

The purpose of the study was to describe and explore the provision of quality care in the primary health care clinics of Limpopo within the framework of the Batho Pele principles' service standards by determining the level of implementation of these principles. The aim was to improve compliance with the Batho Pele principles. The researcher conducted a quantitative, exploratory and descriptive study in four selected primary health care clinics. Data collection was done using structured questionnaires for interviews and observation. Two groups of respondents participated in the study, namely patients (n=185) and nurses (n=21). The study highlighted the level of implementation of the Batho Pele principles in four primary health care clinics in the Capricorn District, Limpopo. The findings revealed that the Batho Pele principles were regarded as important criteria to assess quality care. Recommendations were made to improve the level of implementation of some of the principles. / Health Studies / M. A. (Health Studies)