Background: Health workers (HWs) are exposed to a wide range of chemicals used for cleaning and disinfection. This has been largely attributed to the ever-increasing demand for effective cleaning and disinfection in hospital settings in an effort to prevent healthcare associated infections. Over the last two decades, there has been increasing evidence linking cleaning agents to adverse work-related health effects such as rhinitis, asthma and contact dermatitis. There is however little information on the specific cleaning agents and tasks associated with various asthma-related outcomes. Furthermore, limited information exists regarding exposure-response relationships between the frequency of exposure to specific cleaning agents and asthma-related outcomes. This study investigated the prevalence and risk factors for work-related asthma (WRA) among HWs exposed to diverse cleaning agents in two academic tertiary public hospitals in southern Africa - South Africa and Tanzania. Methods: A cross-sectional study of 699 HWs was conducted. Exposure assessment included systematic workplace observations, environmental sampling for aldehydes (orthophthalaldehyde-OPA, glutaraldehyde and formaldehyde) and urine biomonitoring for chlorhexidine. Environmental sampling for aldehydes was conducted more extensively in the South African hospital (SAH). A pilot sampling in the Tanzanian hospital (TAH) revealed very low detectable levels of OPA and glutaraldehyde and as a result extensive measurements were not done. In the SAH, a total of 269 full-shift passive personal samples were collected from 164 HWs randomly selected from 17 different clinical departments. Passive sampling used TraceAir® AT580 monitors (Assay Technology, Livermore, CA). Biomonitoring for chlorhexidine was only conducted in the SAH since none of the HWs in the TAH used chlorhexidine. For the health outcome assessment, a total of 697 HWs completed interviews using the ECRHS questionnaire adapted for occupational contexts, which contained in-depth information on asthma, as well as detailed information on tasks and chemicals used during the course of their work. Sera was successfully collected from 682 HWs and analysed for specific immunoglobulin E (sIgE) antibody reactivity to common aero-allergens (Phadiatop) and specific occupational allergens (NRL - Hevea brasiliensis (Hev b5, Hev b6.02), chlorhexidine and OPA). Methacholine challenge tests (MCT) were performed on all South African HWs (n=318), based on standard inclusion criteria. Spirometry, accompanied by a post-bronchodilator (post-BD) test was conducted on all Tanzanian HWs (n=329) and a small proportion (n=25) of South African HWs where MCT was contraindicated. All HWs from both hospitals (n=654) underwent fractional exhaled nitric oxide (FeNO) testing during the working day prior to spirometry. Results: The prevalence of current asthma was 10% (atopic asthma 6%, non-atopic asthma 4%), while 2% had WRA. The prevalence of atopy was 43%, with 4% of workers being sensitised to OPA, 2% to NRL and only 1% to chlorhexidine. Environmental sampling demonstrated that OPA was detectable in 6 (2%) samples, all samples (Geometric mean (GM) = 0.010 ppm) being higher than the ACGIH exposure limit (0.0001 ppm). Workers with detectable OPA were found to have a longer duration of OPA use (OR = 1.28; 95% CI: 1.10 – 1.50). Formaldehyde was detectable in 103 (38%) samples (GM = 0.005 ppm), with 1% of samples having levels higher than the NIOSH TWA exposure limit (0.016 ppm). Asthmarelated outcomes (increasing asthma symptom score and FeNO) demonstrated consistent positive associations with certain medical instrument cleaning agents (OPA, QACs and enzymatic cleaners) and tasks (pre-cleaning of medical instruments, changing sterilisation solutions and manual disinfection of medical instruments) as well as certain patient care activities (disinfection prior to procedures, cleaning/disinfecting wounds, application of wound dressing, usage of adhesives and adhesive removing solvents). A particularly pronounced dose-response relationship was observed between work-related ocular-nasal symptoms and medical instrument cleaning agents (OPA, glutaraldehdye, QACs, enzymatic cleaners, alcohols and bleach; OR range: 2.50 – 12.08) and tasks (OR range: 2.58 – 3.97). Furthermore, a strong association was observed between higher asthma symptom scores and use of more sprays than wipes for fixed surface cleaning activities (mean ratio = 3.00; 95% CI: 1.50 – 5.98). Conclusion: This study has demonstrated that detectable exposures to OPA are higher and more isolated to certain departments than the more widespread low-level formaldehyde exposures present throughout the hospitals. Furthermore, cleaning agents have replaced NRL as important causes for WRA in health settings. Finally, specific cleaning agents such as OPA, quaternary ammonium compounds and enzymatic cleaners associated with medical instrument cleaning/disinfection as well as patient care activities and the use of sprays for fixed surface cleaning, are important environmental risk factors for various asthma-related outcomes among HWs in health care settings.

Includes bibliographical references. / The South African Triage Scale (SATS) was first implemented as an emergency centre triage scale in the Western Cape Province in 2006. This thesis describes the performance characteristics of the SATS when used by different levels of health care workers in Emergency Centres in the province. It explores the most appropriate methods for reliability and validity appraisal and demonstrates good performance characteristics, including reliability and validity. The results chapter of the thesis is presented in the form of published or submitted papers. The thesis concludes that the SATS has good performance characteristics, which supports the feasibility of further implementation in similar settings. It is suggested that this emergency centre triage scale be endorsed and adopted at National Health care level.

Non-communicable diseases (NCDs) have reached epidemic proportions globally and in South Africa. This thesis is situated within the health equity framework. The aim is to assess the extent of wealth related inequalities in NCDs and to assess the impact of the social determinants of health in mediating these inequalities. Data from the first South African National Health and Examination Survey (SANHANES-1) and wave 4 of the South African National Income Dynamics Study (NIDS) were used. The methods used include the concentration curve, concentration index and decomposition analysis to assess the drivers of socioeconomic inequality in NCDs and some causes of NCDs including smoking, obesity, high blood pressure; use of screening services and effective coverage for hypertension management. The prevalence of smokers is 18.7%, the population average BMI is 26.38 kg/m2, and the prevalence of hypertension is 29.7%. The distribution of these risk factors is pro-wealthy with concentration indices ranging from 0.048 for hypertension, 0.057 for smoking prevalence to 0.115 for obesity. While these risk factors are prevalent amongst the wealthy, the outcomes are worse amongst the poor. The concentration index for expenditure on cigarettes is strongly pro-poor, (-0.130) compared to the prowealthy smoking prevalence. The hypertensive poor suffer more severe hypertension with a concentration index of -0.054 for depth and -0.079 for severity, respectively. Obesity affects the wealthiest the most. However, the overweight adults who are poor tend to suffer more severe obesity as shown by a relatively smaller concentration index of depth (0.015) and severity (0.033) respectively. The overall utilisation of screening services is below 50% for eligible respondents. The two wealthiest quintiles benefit disproportionately more than they should, given their share of the population. This is particularly true for diabetes and cholesterol with a concentration index of 0.27 for cholesterol, 0.129 for diabetes and 0.052 for hypertension. Adults that do not take up screening services are predominantly the black race group, poor, rural, male, unemployed and uninsured. Only 23% of those with hypertension are diagnosed, on treatment and are controlled. Wealth-related variables such as education, wealth, health insurance coverage and province of residence drive most of the observed pro-wealthy inequalities in this thesis. Wealthier adults benefit to a larger extent from the care cascade, compared to the poor. Therefore, until there is a substantial increase in early diagnosis and effective treatment, high levels of mortality from NCDs will persist in South Africa. And until the poor are prioritised through radical policy change in all economic sectors, the observed inequalities will continue.

Includes bibliographical references (leaves 238-258). / This dissertation presents a framework for assessing equity and efficiency in health and health care for HIV-positive adults in South Africa, which is tested in the extensive analysis of empirical data on the costs and consequences of alternative HIV-treatment strategies in the public health care system. The framework is built through asking three key questions. The first question -- what is the good (value or benefit) of health care -- considers what ought to be in the evaluative space of distributive justice in relation to this dissertation and in health economics more generally. The second question considers the factors that might constitute claims on this good, including personal responsibility, need, the social context as well as the impact of allocations of the good on the health of society and the social fabric. The final question -- how should the good be distributed -- examines alternative social choice rules for distributing the good and develops an approach grounded in procedural justice that legitimizes the choice of one rule over another. To apply this framework, patient and population-level costs and consequences associated with alternative HIV-treatment interventions are analysed in Markov models. These are extensively validated and uncertainty is assessed through probabilistic and multi-way sensitivity analyses. Results of these analyses are key inputs into mathematical programming algorithms that allow an assessment of the implications of choosing one social choice rule over another in terms of gains in the good and the proportion of need that can be met through one or more treatment strategy across a range of budgets. In discussing and concluding, these empirical results are reintegrated into the conceptual framework where the notion of claims on the good and a decision-making approach grounded in procedural justice is further developed. It is argued that the proper implementation of this framework will result in allocations of the good that are fair even if this is at a level of less than universal access to the most effective treatment strategy.

Includes bibliographical references (leaves 199-213). / Unsafe abortion is a preventable phenomenon and continues to be a major public health problem in many countries especially in the developing world. Despite abortion being legally available in South Africa after a change in legislation in 1996, barriers to accessing safe abortion services continue to exist. These barriers include provider opposition to abortion, and a shortage of trained and willing abortion providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning.

The purpose of this study was to analyze the relationship between family structure, SES, and condom use and hookup rates among a sample of N=1,346 African American college students. In addition, the moderating role of sexual attitudes in the association between the relationship of family structure and sexual behaviors and also between SES and sexual behaviors was examined. Gender differences in sexual behaviors and attitudes were also explored. There were significant gender differences in the number of hookup partners, sex attitudes and condom usage. SES was a strong predictor of the number of hookup partners men and women had as well as condom usage. With women from higher SES reporting hooking up with more partners that they knew prior as well as lower condom use. Family structure was not a significant predictor of sexual behaviors. Women were 1.2 times more likely to use condoms than men. Men also reported over three times as many hookup partners compared to women. Women reported more conservative sexual attitudes than men. Overall, sexual attitudes buffered the association between family structures and hookup partners and SES and hookup partners. This study found that African American college students are partaking in normative sexual behaviors and that several factors work together to influence their sexual behaviors and attitudes. Future implications are discussed. / A Thesis submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Master of Science. / Spring Semester 2016. / March 23, 2016. / african american, college students, condom use, hookups, sexual attitudes / Includes bibliographical references. / Melinda Gonzales-Backen, Professor Directing Thesis; Marsha Rehm, Committee Member; Karin Brewster, Committee Member.

BACKGROUND: In the early parts of the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) were implemented worldwide including sub-Saharan Africa to prevent and control transmission of SARS-CoV-2. This mixed methods study aims to examine adherence to and enforcement of NPIs implemented to curb COVID-19 in Nigeria, Rwanda, and Zambia, leading up to the 10,000th case of COVID-19 in each country. Additionally, we aim to broadly evaluate the relationship between levels and changes of NPIs over time and changes in COVID-19 cases and deaths. METHODS: This mixed methods analysis utilized semi-structured interviews and a quantitative dataset constructed using multiple open data sources, including the Oxford COVID-19 Government Response Tracker. Quantitative data were analyzed using four case windows (0 cases, 1-100 cases, 101-1,000 cases, and 1,001-10,000 cases). To understand potential barriers and facilitators in implementing and enforcing NPIs and how other epidemics within the countries may have affected compliance with NPIs, qualitative data were collected from those involved in the COVID-19 response and analyzed using NVivo. Quantitative results were analyzed using descriptive statistics, plots, ANOVA, post hoc Tukey, and correlation analyses. RESULTS: Individual indicator scores varied with the COVID-19 response in all three countries. Nigeria had sustained levels of strict measures for containment and closure NPIs, while in Rwanda there was a lot of variation in NPI score as it transitioned through the different case windows for the same measures. Zambia saw moderate stringency throughout the pandemic with gathering restrictions and business/school closure measures but maintained low levels of strictness for other containment and closure measures. Rwanda by far had the most consistent and stringent measures compared to Nigeria and Zambia. Their success in implementation was partly due to strong enforcement and having a population that generally obeys their government. CONCLUSION: Various forces either facilitated or hindered adherence and compliance to these measures. There were several lessons learned which highlight the need to engage communities early and create buy-in, as well as the need for preparation to ensure that response efforts are proactive rather than reactive when faced with an emergency. / 2024-05-18T00:00:00Z

Introduction: Sexually transmitted infections (STIs) are of major public health concern in South Africa. STIs contribute largely to the burden of disease in South Africa and are recognized as major contributors to the Human Immunodeficiency Virus (HIV) epidemic. Du Noon is a small township situated in Milnerton, Cape Town, South Africa. Du Noon CHC has a large HIV population of approximately 8000 people and recent data obtained from Du Noon CHC statistics, from Nov 2019-Feb 2020 showed 1760 people being treated for STI as per the headcount. Aim: This study intends to explore the factors which may be responsible for the high prevalence of STI among the population of Du Noon Township in Cape Town, South Africa. Methodology: A cross- sectional study with 40 respondents aged between 18 and 45 years was conducted. One-on-one patient interviews using open-ended questions, as well as structured questionnaires, were used to gather data. The questionnaires were analysed using the Likert Scale and open-ended questions were analysed using exploratory descriptive methods. Results: Cultural beliefs, having multiple partners, lack of partner notification, alcohol consumption and lack of condom usage were found to be the main contributing factors to the high incidence of STIs. Sex education at schools appear to be lacking or not in sufficient detail to inform students. The study's findings echoed themes and larger ideas from previous research. It reflects the other well-known cultural and socioeconomic issues confronting South African rural communities e.g., poverty and sex, age -disparate relationships, polygamous relationships. Conclusion: This study fills a gap in the local literature by highlighting how health education challenges, interpersonal relationships, and socioeconomic barriers are still important factors in STI transmission. Although the study's findings may only be applicable to this community, they may have an impact on other communities with comparable populations. The widespread preliminary understanding and framing of HIV as a STI and how it is transmitted needs further investigations and research. As a result, there is an urgent need to shift cultural ideology and norms within the youth of the Du Noon community.

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