Globally, almost 8 million children died in 2010 before reaching the age of 5 largely due to preventable diseases. Analysis of the distribution of child mortality indicators highlights huge differentials that still exist both between and within regions. Prompt seeking of appropriate healthcare by caregivers is critical for effective management of childhood illnesses and ultimately for mortality reduction. Studies have shown that households can draw on social capital, including trust and social networks, to improve health outcomes for children. Other studies have demonstrated that health outcomes may significantly differ across different neighbourhoods of the same community. Therefore, understanding social capital and healthcare-seeking behaviour in the context of neighbourhoods can help in the formulation of responsive health policies and strategies that promote child health and overall well-being for different populations. The objective of this study was to investigate social capital factors that are associated with healthcare-seeking behaviour of caregivers when their children become ill, using the case of neighbourhoods in Khayelitsha TownShip in the Western Cape Province of South Africa.

Unintentional overdose of over-the-counter (OTC) medications has become an increasing global public health concern due to the common and frequent use of painkillers among end users, to self-medicate and medicate others, without fully understanding the associated health risks. While many developed countries have started to implement measures in an attempt to reduce access to large quantities and raise awareness of the dangers of misuse of OTC medications, this is not the case in many middle and low income countries. Instead, many individuals are forced to rely on written information while faced with poor health literacy, inadequate information and limited verbal information from health professionals, all of which contribute to the increase in unsafe behaviours leading to overdosing. In South Africa, most unintentional overdoses from OTC painkillers occur in children, which can often be attributed to incorrect dosing from caregivers. With the common practice of re-packaging medications at a distribution level, individuals are often not provided with adequate information about their medication, appropriate for their level of health literacy. This study explored whether caregivers are able to make informed decisions about the correct and safe administration of popular OTC painkillers (specifically paracetamol) to their children, based on information from labels, medication inserts and/or patient information leaflets (PILs).

Includes bibliographical references. / Background: There are between 20 - 40 million cases of whooping cough annually world-wide, 90% of which occur in developing countries, resulting in an estimated 200 - 300 O00 fatalities each year. Much of the morbidity is due to the paroxysmal cough. Corticosteroids, salbutamol (a β₂- adrenergic stimulant), and pertussis-specific immunoglobulin have been proposed as standard treatment for the cough. Antihistamines have also been administered. No systematic review of the effectiveness of any of these interventions or others has been performed. Objective: in this systematic review we aim to assess the effectiveness of interventions used to reduce the severity of the coughing paroxysms in whooping cough in children and adults. Selection criteria: Randomised and quasi randomised controlled trials of any intervention that reduced the severity of the coughing paroxysms in whooping cough; excluding antibiotics and vaccines. Study selection: All interventions aimed at reducing the severity of the coughing paroxysms in children or adults with whooping cough with any of the following outcome measures met inclusion criteria for the review; i) frequency of paroxysms of coughing (primary outcome), ii) frequency of vomiting, iii) frequency of whoop, iv) frequency of cyanotic spells, v) development of serious complications, vi) mortality from any cause, vii) side effects due to medication, viii) admission to hospital, and ix) duration of hospital stay. Search strategy: We searched the Cochrane Controlled Trials register, Acute Respiratory infectious Disease Group Specialised Trials register, MEDLINE, LILACS, scanned reference lists of identified trials, contacted authors of identified trials and the relevant pharmaceutical companies. Data collection and analysis: Studies were selected, quality assessed and data extracted by two reviewers independently. Results: Nine studies satisfied the inclusion criteria but four had insufficient data for further meta-analysis of our pre-specified outcomes. Studies were old and poorly reported. The largest study had a total sample size of 49 and the smallest study nine. All studies were performed in industrialised settings. Eligible studies assessed diphenhyramine, pertussis immunoglobulin, dexamethasone and salbutamol. No statistically significant benefit was found for any of the interventions. Diphenhydramine was associated with a mean increase of 1.90 coughing spells per 24 hours [95%Cl - 4.66; 8.46] and pertussis immunoglobulin a mean decrease in hospital stay of 0.70 days [95% Cl -3.79; 2.39]. and a mean reduction of 3.10 whoops per 24 hours [95% CI - 6.22; 0.02]. Dexamethasone resulted in a mean decrease in hospital stay of 3.45 days [95% Cl - 15.34; 8.44] and salbutamol in a weighted mean decrease in coughing paroxysms of 0.95 per 24 hours [95% Cl - 6.21; 4.31]. Reviewers' conclusion: Although assessments have been performed on a whole range of interventions, including diphenhyramine, pertussis immunoglobulin, dexamethasone and salbutamol, insufficient evidence exists to draw conclusions about the effects of any of them.

Includes bibliographical references. / Globally, Life Skills Education (LSE) is a component of school curricula that has been of considerable scholarly interest recently, especially in education. Raphael defines LSE as "a methodology for helping children and adolescents cope with their life situation, develop decision-making and problem solving skills, and evaluate risks and respond appropriately" (2006:5). The study aimed at investigating stakeholders' perceptions of factors influencing the adoption, development and implementation of Life Skills Education in post primary school in Lesotho. In this study, "post-primary schools" refers to grades 9-10. The main objectives of this study were: To explore stakeholders' perceptions about factors influencing the adoption, development and implementation of Life Skills education in post-primary pilot schools in Lesotho. To analyze the role and impact of the broader political, social, cultural and economic environment in which Life Skills Education is adopted, developed and implemented in post-primary pilot schools in Lesotho. To carry out this case study, the researcher followed a qualitative approach. To collect data, 22 semi-structured one to one interviews were held with education officers from the government and overseas donors, principals, teachers and parents. LSE training manuals were also analysed. It is evident that the crisis of HIV/AIDS in the country motivated the government's initiative to introduce LSE in the schools. However, the take up of the project was not smooth. The prominent reason was lack of consensus within the MOET, which led to many other unresolved issues that weakened other stages of the curriculum development. Secondly, it took the MOET six months to develop LSE curriculum and thus led to many more gaps in the curriculum planning and development. The project had strong support from the Lesotho government. This suggested more chances for it to have been a success. Nonetheless, omissions were made that weakened the support from other authorities and relevant stakeholders. In addition, lack of supervision, follow-up and retraining of teachers affected negatively the reception and implementation of the project in the pilot schools. Although the project was piloted for sufficient length of time (one year), it had no monitoring package. Moreover, the review that was done (Visser-Valfery 2008) took place long after the piloting period, thus, this is likely to have not benefited the development of the project much. Parents are aware young do engage in premarital sex, and, are at the centre of the pandemic, and thus showed a great support for the project and willingness to support teachers' through assignments. Life Skills Education remains the best option for curbing HIV/AIDS pandemic and protects young people against HIV/AIDS, with a solid research base of practice and theory. It is commendable that the MOET realize the need to reach young people with HIV/AIDS prevention message through the school curriculum. For a sustainable development of this programme, there is a need for the MOET to ensure full participation of relevant stakeholders and give time long enough for advocacy and trainings of stakeholders at both the central and district level.

Includes bibliographical references. / The HIV epidemic continues to be a public health concern with evidence indicating that in South Africa, the epidemic is being driven largely by new infections in adolescents. Behavioural change is key to successful prevention strategies. This study sets out to determine the prevalence and predictors of sexual risk behaviours among adolescents aged 12-18 from low socioeconomic settings in South Africa with the aim of informing future prevention interventions.

Includes bibliographical references. / Within the global burden of the Human Immune Deficiency Virus (HIV) stands a distinct group - HIV infected infants. They are a physically, physiologically, developmentally and socially vulnerable group who differ considerably from their adult and child HIV infected counterparts. Distinguished in part by their multiple age-specific complexities in testing, treatment and monitoring these infants ultimately experience accelerated disease progression and an increased risk of morbidity and mortality. Advances in evidence gained from trials of the benefits of early initiation of ART in infants have resulted in international treatment guidelines changes and an increase in velocity and coverage of infant ART provision. However, there is limited published data on the outcomes of infants starting ART in routine care in Southern Africa. Objectives: To describe the baseline characteristics of infants starting first line ART in routine care setting in Southern Africa. To describe and examine the outcomes of these infants including clinical, immunological and virological responses and to identify the determinants for these outcomes. Method: A retrospective analysis was performed of prospectively collected cohort data of infants that initiated ART in routine care settings at the International Epidemiologic Databases to Evaluate AIDS in Southern Africa (IeDEA-SA) collaborative sites. A description of demographic, clinical, laboratory and program baseline characteristics is provided and longitudinal profiles of response variables are described. The Kaplan-Meier method was used to assess time to outcomes of mortality and virological outcome. Cox Proportional Hazards models identified those baseline characteristics associated with each of these outcomes. Competing Risk Analysis provides Cumulative Incidence Functions for mortality and programmatic outcomes. Multiple imputation was conducted and Rubin’s Rules provided pooled estimates from Survival Analysis.

Includes bibliographical references. / Farm workers and residents living in and around farms are exposed to pesticides. Women are vulnerable to health risks posed by pesticides. To date there are few studies that have investigated the relationship between pesticide residues in human body fluids and neurotoxicity. This study therefore aims to investigate the relationship between urinary pesticide residue levels and neurotoxicity amongst women working in farms in the Western Cape, South Africa.

Background: Alcohol consumption remains one of the leading contributors to the risk of mortality worldwide. While literature sources are clear that alcohol consumption has a major negative impact on society and which is felt more severely amongst low-socioeconomic families, the literature on alcoholrelated harm on individuals and households in South Africa, especially from different socio-economic backgrounds, is very limited. This study represents an initial attempt to assess inequalities and inequity in alcohol consumption, at the household and individual levels, in South Africa using national household data. The objectives of this study are (1) to examine the usability of existing survey data in South Africa for assessing alcohol-related expenditure and impacts; (2) to provide a detailed description of alcohol consumption patterns in South Africa at the individual level using various equity stratifiers and (3) to assess the socioeconomic distribution of expenditure on alcoholic beverages at the household level in South Africa. Methods. For objective 1, all publicly available alcohol data sources for South African populations were scanned to examine their usability. A set of qualitative interviews with 10 key researchers in the alcohol policy and economics field in South Africa were undertaken to capture their experience and perceptions of alcohol data in South Africa. The analysis involved identifying databases known to key informants, exploring challenges in using the datasets for research and further analyzing any recommendations for how routine datasets could be better used to inform policy. For Objectives 2 and 3, this study used publicly available secondary data, including the National Income Dynamics Study (NIDS) and the Income Expenditure Survey (IES). The data have been anonymized and can be accessed from the DataFirst website. Results: There are differences in alcohol consumption patterns and alcohol expenditure among equity stratifiers. The findings show that the burden of alcohol consumption is heavier on the poor. Poorer households spend a significantly larger share of their total household consumption expenditure on alcoholic beverages than richer households—a case of regressivity in spending on alcoholic beverages. Spending on alcohol beverages became less regressive (i.e. a pro-poor ‘shift') between 1995 and 2000; and between 2005/06 and 2010/11. For alcohol consumption patterns, current drinkers are more prevalent among the rich; whereas binge drinkers are more prevalent among the poor. Binge drinking is a problem among the low-income, young individuals, male and African populations. The results also show that there are significant constraints limiting the quality and usefulness of alcohol data in South Africa. These constraints are related to (a) lack of accessibility of survey data, (b) lack of systematic and standardized measurement of alcohol consumption, (c) limited geographic coverage, (d) infrequent survey timing and (e) lack of public availability of industry data on price, production, distribution and consumption of alcohol. Conclusion: This study provides evidence that alcohol consumption in South Africa may be a reflection of genuine differences in consumption patterns among socioeconomic status, and the burden falls most heavily on poorer households and individuals. Based on the results, there is an opportunity to further reduce the regressivity of alcohol expenditure by implementing comprehensive alcohol harm-reduction policies. This study supports recommendations for the South African government to continue to push for evidence-based alcohol policies aiming to decrease alcohol consumption, especially for risky drinkers. However, limited data accessibility in South Africa could potentially impact on the implementation, monitoring and evaluation of relevant policy and interventions to address alcohol-related harms. Thus, for implementing evidence-based alcohol policy in South Africa to be successful, the government must have accessible, reliable and meaningful data for stakeholders and researchers to evaluate interventions and assess whether national alcohol policies aiming to decrease alcohol consumption have achieved their intended objectives.

Includes abstract. / Includes bibliographical references. / South Africa’s National Strategic Plan calls for task shifting of HIV care from doctors to nurses by 2016 to increase access to ART. There is little research demonstrating sustainable success of competent HIV management by nurses after training and mentorship. In February 2011, Medecins Sans Frontieres (MSF) partnered with the City of Cape Town Department of Health to implement a NIMART mentorship programme and assess quality of clinical care provided by nurse graduates. A before-after cross-sectional study was conducted on nurses completing mentorship from February 2011-September 2012. Routine clinical data from 229 patient folders and 21 selfassessment questionnaires was collected to determine the number of patients initiated on ART by individual nurses; quality of ART-management before and after mentorship; patient characteristics for doctor and nurse ART-initiations; and nurse self-assessments. 21 nurses were authorized by one nurse mentor with one part-time medical officer’s support, resulting in nurses initiating 77% of eligible patients. Improvements in ART management were found for drawing required bloods (91% vs 99%, p=0.03), assessing adherence (50% vs 78%, p<;0.001) and WHO staging (63% vs 91%, p<;0.001). Nurse ART initiation indicators were successfully completed 95-100% of the time for 10 out of 16 indicators: clinical presentation, past medical history, prior ART history, WHO stage, STI screening, patient weight, baseline blood work (CD4 count, creatinine, and haemoglobin), treatment plan, and medications prescribed. Doctors initiated more patients with TB/HIV co-infection and Stage 3 or 4 disease than nurses; 24% of patients initiated by nurses were seen or discussed with a doctor in the month prior to initiation. Nurse confidence improved for the management of HIV-infected children and pregnant women, blood result interpretation, and long-term side effects following completion of the mentorship programme.

Limited data and few studies have shown the prevalence of Hepatitis B in the HIV infected population in South Africa, whether these patients are on appropriate antiretroviral therapy and the effect of Hepatitis B on liver function in co-infected persons. The objectives of this study were to determine the prevalence of Hepatitis B surface antigemia (HBsAg) in healthy HIV positive persons screened for a vaccine trial and the proportion of those eligible for antiretroviral therapy that were receiving optimal antiviral treatment, namely tenofovir and/or lamivudine. The relationship between Hepatitis B carriage and liver function was also determined in co-infected persons as measured by liver function tests. A cross sectional study was conducted from 30th August 2011 to 24th April 2013 to determine the prevalence of HIV /HBV co-infection in persons attending a clinical trial site in an urban clinical trials unit of Cape Town. Participants self-presented to the clinic and once consented were enrolled into the study and provided blood for HIV confirmatory test, Hepatitis B sAg, CD4, VL, full blood count, liver function and renal function tests. 638 participants were enrolled into this cross sectional study. 24 (3.8%) were Hepatitis B sAg positive, which was lower than expected. Of the 24 HIV/HBV co-infected participants, 19 (79 .2%) were on antiretroviral therapy, 14 (73. 7%) of these were on a tenofovir/lamivudine regimen the remaining 5 (26.3%) were not on a tenofovir regimen. Five of the co-infected participants were not on ARVs because their CD4 count was above the recommended South African guidelines for treatment i.e. greater than 350 1 QA6/l. Male participants were three times more likely to be HBsAg positive. Elevated Alanine aminotransferase (ALT) and Aspartate Aminotransferase (AST) were associated with HBsAg seropositivity. This study showed a lower HIV /HBV co-infection prevalence rate than reported from other locations in South Africa suggesting geographical variability. Appropriate guidelines are required to ensure that co-infected patients are identified and treated with the most appropriate anti-retroviral regimens. Screening for HBV is also recommended in HIV infected cohorts.