Background: Developed in the United Kingdom, the London Measure of Unplanned Pregnancy (LMUP) is a psychometrically valid measure of pregnancy intention developed to capture the multifaceted and complex construct of pregnancy intention. A growing body of evidence suggests that unintended pregnancies are directly associated with poorer maternal and infant outcomes, as well as contributing to poorer longer-tern social, economic, educational and health outcomes for women, children, families and societies. An improved understanding of women's pregnancy intentions in South Africa is essential to reduce adverse consequences associated with unplanned and unwanted pregnancies, and to better prevention on unintended pregnancies. Such information could be used for the development of family planning, pre-conception and pregnancy planning, and ante/post natal care interventions. It could also be used to monitor the effects of interventions aimed at preventing unintended pregnancy. To this end, this research aimed to validate the LMUP for use in both the Afrikaans and Xhosa languages in South Africa. Methods: Three Xhosa and three Afrikaans speakers translated the LMUP, in which one translation was agreed upon for each translation. This translation was then back-translated and pre-tested on five to ten pregnant women using cognitive interviews. The measure was field tested with pregnant women who were recruited at two antenatal clinics and re-tested between one and two weeks after the initial interview. The data were analyzed using classical test theory, principal component analysis and hypothesis testing for both Xhosa and Afrikaans separately. Results: 150 women aged 18-42 (median 26.5), with parities of 0-3 (median 2) completed the Xhosa LMUP and 148 women aged 18-42 (median 28), with parities of 0-7 (median 1) completed the Afrikaans LMUP. There were no missing data for the Xhosa LMUP and less than 0.01% missing data for the Afrikaans LMUP. Scores ranging from 1-12, nearly the entire LMUP range, were captured in both Afrikaans and Xhosa .126 of 150 (84%) of the Xhosa and 105 of 148 (71%) of the Afrikaans were followed up for re-test, well in excess of the 50% target. The scale was internally consistent (Chronbach's alpha: Xhosa= 0.83; Afrikaans=0.72) and the test-retest data showed good stability (weighted Kappa: Xhosa = 0.82; Afrikaans=0.76) for both the Xhosa and Afrikaans LMUP. For the Xhosa LMUP, hypothesis testing confirmed that unmarried women (p = 0.0001) and women who were below 20 or 40+ (p = 0.008) were more likely to report unintended pregnancies. While median LMUP score was lower among women with 2-3 children (median LMUP score=4.5) compared to 0-1 children (median LMUP score=6), this difference was not statistically significant in this sample (p = 0.16). For the Afrikaans LMUP, hypothesis testing confirmed that unmarried women (p = 0.0001), women who were <25 or 40+ (p=0.005) and women with fewer children (p=.003) were more likely to report unintended pregnancies. The LMUP in both languages was re-analysed without the question on contraception use. This reduced the range of LMUP scores from 1-12 to 0-10 for both Xhosa and Afrikaans with median scores of 4 and 6 for Xhosa and Afrikaans, respectively. Cronbach's alpha increased to 0.87 for Xhosa and 0.74 for Afrikaans and all items loaded on to one component with Eigenvalues of 3.3 and 2.6, for Xhosa and Afrikaans respectively. Conclusion: The Xhosa and Afrikaans-language LMUPs are valid and reliable measures of pregnancy intention, which can now be used in South Africa in research, surveillance/monitoring and clinical care.

Includes bibliographical references. / The aim of the study was to evaluate the occupational exposure to benzene amongst filling station attendants and road tanker drivers in the City of Cape Town and to determine factors associated with elevated benzene exposure levels.

Includes bibliographical references. / The principles of Primary Health Care guided health system transformation in South Africa where community health committees represent formal structures for participation in health. While there is evidence to suggest that participation can assist the progressive realization of the right to health, this link is not well established in the literature and Southern African studies underscore a serious deficit in the implementation of meaningful community participation. The present study used multiple methods to explore the relationship between participation and the right to health and to draw lessons on best practice for community participation from three health committees in South Africa's Western Cape Province.

Includes bibliographical references. / Consistent condom use amongst women and men is one of the important safer sexual practices in combating the spread of HIV/AIDS. This dissertation examines factors which hinder or facilitate consistent male condom use, particularly as it relates to women's sexual satisfaction. Findings indicated that women felt that it was important to use condoms during sexual intercourse in order to obtain protection against HIV, STIs and pregnancy. Just over half of the women reported condom use at last sexual intercourse. Women's own sexual dissatisfaction was regarded as one of the main reasons why condoms were not consistently used by women. The results of this study suggest that that while it is important for HIV/AIDS interventions to focus it is also important to better understand a less investigated issue of women's own possible resistance to male condom use.

Includes bibliographical references. / Foetal Alcohol Syndrome (FAS) is a serious public health concern in the Western Cape. However, the burden that this condition places on the health care systems in this region is poorly understood. The research proposed here will evaluate the utilization of health care services by children with FAS and Partial Foetal Alcohol Spectrum Disorders (PFAS) in Cape Town. In addition this study will identify factors that are correlated with increased utilization of health care.

Abstract The prevalence of food allergies is higher in children compared to adults and it is increasing. The factors that influence food allergies in children are not clear. In light of the hygiene hypothesis, vaccinations may contribute towards to a predominant allergen specific response or exposure to the virus or microbe in the vaccine may decrease the risk for allergy. Previous studies have shown that the effect of vaccinations on food allergy and food sensitisation varies. Therefore, the aim of this study is to determine if a relationship exists between vaccinations and food allergies and food sensitisation in children in the first 18 months of life who live in urban Cape Town and in rural Mqanduli in the Eastern Cape. Secondary data analysis of an observational cross sectional study was carried out which involved univariate logistic regression to calculate odds ratios between self-reported immunisation status and food sensitisation and food allergy at a 95% confidence interval in children between 12 and 36 months of age. The same method was employed to investigate the relationship between immunisation and atopy. Multivariate analysis was utilised to adjust for potential confounders. Food sensitisation and food allergy were determined through skin prick tests (SPT) and oral food challenges respectively. The results indicate that, the number of participants positive for food sensitisation and allergy, eczema, hay fever and asthma were significantly greater in the urban sample (n= 708) compared to the rural sample (n= 400) (P<0.05). Further, in 708 urban children, those who had a BCG vaccine at birth were 0.05 (OR 0.05; 95% CI: 0.004 - 0.6) times less likely to have an SPT ≥ 7mm. The BCG unvaccinated cohort consisted of three individuals. There were no other significant associations between childhood vaccinations and food sensitization at SPT ≥ 1mm ,≥ 3mm and ≥ 7mm. There was no significant association between vaccinations and food allergy or other forms of atopy. In conclusion, there was very little evidence of an association between BCG vaccination in children and food allergic sensitisation or food allergy. However, in a small subgroup, there was evidence in an association between BCG and SPT ≥ 7 mm.

Includes abstract. / Includes bibliographical references. / The exposure of workers and farmers to herbicides in middle- and low-income countries is an important public health issue with a significant negative impact on their short- and long-term health status. Besides the possible acute effects, long term exposures to low doses of herbicides leads to accumulation in the body which might lead to chronic health effects. The exposure to herbicides of substances is associated with different types of cancers, Parkinson’s, insulin resistance, obesity and endocrine disruptions. Maternal exposure to herbicides have been associated with the prevalence of small-for-gestational-age and foetal gastroschisis. Farmers and workers from low-income countries are at greater risk of exposure given the spraying techniques used, deficient risk communication tools and the inadequate or lack of Personal Protective Equipment (PPE) use. In addition, underlying factors such as poor nutrition and immune system status might increase the risk to develop acute or chronic illness related to herbicide exposure. The Working for Water (WfW) programme was launched in 1995 to control invasive alien vegetation while simultaneously contributing to alleviate poverty. The programme, which relies on chemical and hand/mechanical removal mechanisms, is now running in all nine South African provinces and is one of the world’s largest programmes addressing removal of invasive alien vegetation. Despite the extensive policy and management efforts of the WfW programme, workers are at risk of harmful exposures to herbicides and therefore new exposure reduction interventions must be implemented. This study is part of a larger project, which is focused on developing a peer-based intervention to improve WfW current prevention strategies.

Bibliography: leaves 99-104. / This report provides a comprehensive evaluation of the factors underlying the evolution, design and implementation of the 1988 fee policy in Lesotho. The chief aim of the study was to conduct a critical appraisal of this policy, focusing on the key factors that might have constrained or facilitated the process. The performance of the policy was assessed in terms of financial sustainability in the health sector as well as promotion of equitable access for economically marginalized groups.

This MPH dissertation undertakes a systematic review on factors associated with patient and health system delay in diagnosing and commencing treatment for pulmonary tuberculosis in Middle East and North Africa (MENA). The dissertation is composed of three main parts: namely parts A, B and C. Part A is the research protocol, which give brief background to research topic and the process of this review. This systematic review aims to assess factors associated with patient and health system delay for diagnosis and initiation of treatment of pulmonary tuberculosis in Middle East and North Africa (MENA). Part B elaborates on the background and highlights the importance of this research by examining the existing theoretical and empirical literature relevant to the topic. Part C presents the entire research project in a format suitable for PLOS journal submission. The background of this research project is summarized and the results are presented and discussed.

Human papilloma virus (HPV) has been shown to be a necessary cause for the development of cervical cancer. Cervical cancer is a progressive disease, going through pathologically distinct stages ranging from normal cytology to malignancy. Precancerous lesions (low and high grade squamous epithelial lesions (SIL)) are detectable and treatable. In addition, women who are infected with human immunodeficiency virus (HIV) have been shown to be more likely to be infected with HPV than their HIV negative counterparts. Cervical cancer precancerous lesions have also been shown to be more commonly detected in HIV positive than in HIV negative women. Cervical cancer is classified as an acquired immunodeficiency syndrome (AIDS)-defining illness. The advent of antiretroviral therapy (ART) has seen an increase in the life span of HIV positive women. The use of ART has also seen a decline in the incidence of other AIDS-defining illnesses, such as Kaposi sarcoma and non-Hodgkin's lymphoma. Thus, a reduction in the incidence of cervical cancer among HIV positive women using ART is expected. However, the research thus far has been controversial, with some studies showing an increase in the incidence of cervical cancer in HIV positive women, others showing a decrease and still others showing no difference in the incidence. The aim of this project was to determine the incidence of precancerous lesions in HIV positive women receiving ART and to compare this to HIV positive women who are not receiving ART. Four hundred HIV positive women were enrolled into the MACH (Management of abnormal cytology in HIV-positive women) study from two primary health care clinics and one colposcopy clinic, in Cape Town, South Africa. Enrolment into the study was dependent on cervical screening naivety. At the time of enrolment, ART was not available to these women. However, as ART was rolled out in South Africa, women meeting ART eligibility criteria (at the time, CD4 count ≤ 200 cells/ml) were started on ART. Women were followed up at 6 monthly intervals, at which point cervical smears were taken and appropriate referral for colposcopy was done. Composite diagnoses were generated using both the visual colposcopy result and the histology result, where available. Women were dichotomized into ART and non- ART groups. Survival analysis was used to determine the time taken from normal cytology to incident SIL. Entrance into the survival analysis was dependent on a baseline cytological/histological diagnosis of normal. Thus 177 out of the 400 women were included. Follow up was censored at the first of SIL detection and treatment for SIL. A Cox model was built to determine the hazard for SIL development. This hazard was adjusted for ART status, CD4 count and age. CD4 count was treated as a time varying covariate. Women older than 40 years had a showed a 58% reduction in the progression of cervical disease from normal to SIL compared to women younger than 40 years. Women with baseline CD4 counts > 500 cells/ml had a 67% decrease in SIL development compared to those with a baseline CD4 count ≤ 200 cells/ml. Similarly, those with CD4 counts between 201 and 500 cells/ml showed a 35% reduction in cervical disease progression. The unadjusted incidence rate of SIL in women not receiving ART was 28.5 per 100 person years and in women who had initiated ART it was 30.82 per 100 person years. There was therefore no difference in the incidence rate of SIL between the 2 groups (RR=1.08; 95% CI 0.64-1.75). The unadjusted hazard ratio for progression to SIL was 1.3 (0.5-3.2) for those receiving ART compared to those not receiving ART. Adjusting for CD4 count and age, the hazard ratio was 0.9 (0.4-2.5). The adjusted hazard ratio for SIL development with a CD4 count > 200 cells/ml was 0.5 (0.2-0.9) compared to a CD4 count ≤ 200 cells/ml. The adjusted hazard ratios for age 30-39 years and ≥ 40 years were 0.9 (0.6-1.5) and 0.4 (0.2-0.9) respectively, compared to age < 30 years. ART has been scaled up and since the start of its roll out, the eligibility criteria has changed from CD4 count ≤ 200 cells/ml to CD4 count ≤ 350 cells/ml. The longevity of HIV positive women can approach that of HIV negative women if ART initiation is started early enough. In light of this and of the fact that cervical lesions are more frequently detected in HIV positive women, cervical screening and referral services should be strengthened.