Schistosomiaisis, commonly referred to as bilharzia is a neglected tropical parasitic water borne disease prevalent in developing countries and is endemic in KwaZulu-Natal, South Africa. The World Health Organisation (WHO) aims to eliminate bilharzia as a public health problem by the year 2020 and as a measure to work towards this goal, the South African Department of Health (DoH) Ugu District, KwaZulu-Natal commenced a Mass Treatment Campaign (MTC) targeted at rural schools to decrease bilharzia infection intensity and prevalence levels. The DOH MTC utilises communication materials to communicate with stakeholders and the public to create awareness of the campaign and bilharzia. This study specifically explored the perceptions of learners towards the communication materials used by the DOH MTC to communicate with the learners in order to generate improvements for the current communication strategy. The ability of an individual to receive information is commonly impacted by the community, social networks and the environment and infrastructural settings of the community. The Social Ecological Model of Communication and Health Behaviour (SEMCHB) acknowledges that such factors may have an impact on how the individual receives information. The study utilises the broader social ecological perspective, and particularly the SEMCHB as a framework for understanding and exploring the perceptions of learners. The study made use qualitative data through focus group discussions, semi- structured interviews and participant observations to gain insights from learners. The study discovered that many incorrect perceptions about bilharzia still surround the learners. The perceived messages communicated through the DoH MTC still need to be communicated with learners, since some learners face challenges in understanding the preferred message. The encoding of the communicated messages through the poster, pamphlet and consent forms is influenced by the individuals social networks hence this study recommends that future communication message are designed with reference to the SEMCHB. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2013.

A multifaceted Schistosoma haematobium study aimed at assessing five different diagnostic techniques of surveillance was conducted. Their use in varying operational circumstances with particular reference to Primary Health Care was conducted in three areas of varying prevalence of disease namely; Mpolweni Mission (44.1%), Empangeni (30.3%) and Verulam (72.0%), KwaZulu-Natal, South Africa. This study incorporated both theoretical and applied components. The theoretical components included freshwater snail surveys, review of literature of S. haematobium diagnostic techniques and an assessment of five diagnostic techniques with particular emphasis on diagnostic performance and cost analyses. Added to these components was migration and the assessment of the prevalence of disease amongst occupants of informal settlements in and around the greater Pietermaritzburg city centre. The applied component included the initiation of a holistic S. haematobium control programme based along the World Health Organisation Guidelines. The study provided insight into several of the countries health issues relevant to both schistosomiasis and other diseases and highlighted weaknesses that may hinder the successful implementation of the current National Framework for Parasite Control. The presence of urban schistosomiasis was noted for the first time in the city of Pietermaritzburg. The present schistosomiasis distribution could be influenced by the rural-urban migration that is impacting upon major metropolitan areas. Without intermediate host snail surveys and schistosomiasis prevalence surveys amongst members of the population, the real geographic distribution of the disease will not be known. The diagnostic methods that were compared included sedimentation, filtration, three brands of chemical urinalysis strips, urine colour scales and an indirect questionnaire. Sensitivity, specificity, positive predictive, negative predictive and efficiency values were determined. Using these values, diagnostic performance ranges were established. The ranges were influenced by the cut-off values used, technique and prevalence and intensity of infection of the study area. The chemical urinalysis strips at cut-off 10erythrocyes/μl (73.7% - 93.2%) were highly sensitive whereas urine colour scales (97.1% - 99.4%) and indirect questionnaire (80.4% - 90.3%) were highly specific. The relationship between the community prevalence rates measured by all five techniques varied significantly. A cost-analysis of the techniques/sample demonstrated a wide price range (20c - R4.32). Therefore their use would be dictated more by the availability of funding than by any operational advantages each individual technique may have demonstrated. Within the public health services a need for: (1) staff training programmes, (2) core staff based within the PHC system that is dedicated to parasite control and (3) a strengthening of infrastructure was demonstrated. These may be achieved via workshops, improved communication, education courses, specific time allocation to parasite programmes i.e. parasite week, project co-ordinators and the designation of tasks. / Thesis (M.Sc.)-University of Natal, Pietermaritzburg, 1998.

The health restructuring taking place within the health sector is a direct result of the unfolding socio-political processes presently sweeping across the country's very young democracy. The adoption of a Primary Health Care approach and the transition to a district-based health system is an attempt to bring the health services closer to the people and to correct or redress the way in which money is spent to keep people healthy. Given that 'in South Africa more people die from preventable diseases, a Primary Health Care approach is more appropriate to deal with the country's health needs. However, many also die from degenerative diseases such as heart disease, stroke and cancer and are dependent upon curative hospital-based care. Their health needs have to be catered for as well. Since the declaration of Alma Ata in 1978, the concept of Primary Health Care has been broadened to include other determinants of health such as water, sanitation and health education. As a result, collaboration with other service sectors became essential to support such a holistic view of health. The District Health System is the unit of management of the health system that is best able to compliment an intersectoral collaboration. The technology that is best suited to analyse health resources within a District Health System is a Geographical Information System. The delineation of the boundaries for the proposed New Hanover District Health System was essentially a consultative process. An assessment of the health resources within the proposed district revealed spatial inequalities between the areas of the former Republic of South Africa and the areas of the former Kwa-Zulu. The former Kwa-Zulu areas are disadvantaged in term of health care facilities, health care personnel, health services, water, sanitation, roads and economic opportunities.In collaboration with the Department of Health and the New Hanover Primary Health Care and Development Programme, five potential fixed clinic sites and two mobile clinic points were identified using a Geographical Information System. This study goes beyond considering population as the only and most important variable in the identification of potential sites. Other important variables such as the road network density, the number of primary schools and the number of mobile clinics within a 10 kilometre radius of each site were taken into consideration. The siting of the Khanyile and nKululueko mobile clinic points has demonstrated yet another way by which primary health care services could be made more accessible. Community participation was crucial in identifying and confirming each potential site. A mathematical formula named Pregan's PCs formula was specifically devised to determine the 'potentiality' of each site. For example, if the PCs value was less than one then the site was not considered. In the proposed New Hanover District Health System all sites were considered. The lack of health care facilities and lack of personnel along the densely populated eastern border of the proposed New Hanover District Health System were two major factors that affected access to primary health care services . It is envisaged that the five potential fixed clinic sites and the two mobile clinic points which were identified would help to improve access to primary health care services and at the same time redress the spatial inequalities that exist within the proposed health district. This study concluded that a Geographical Information System is a useful tool for addressing questions of access to primary health care services within a district-based health system. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 1997.

The Natal/KwaZulu Health Services Liaison Committee (HSLC) has been established to co-ordinate health care delivery in Natal and KwaZulu. This body has defined eight geographical Health Planning SubRegions (HPSRs) (Annexure E) of which each is a unit for planning and prioritising health service delivery in respect of its resident population. The HSLC considered that a study of inpatient catchment populations of hospitals under the control of the statutory Health Authorities would provide information which was essential to the planning processes of those authorities. The Department of Community Health was requested by the HSLC to undertake this study. A previous study, co-ordinated by the Department of Community Health (September 1987), dealt with "Outpatient Catchment Populations of Hospitals and Clinics in Natal and KwaZulu" (E DADA). No previous similar study on inpatients has been undertaken in South Africa. The expansion and improvement of basic services - particularly health care, water supply and basic education - should be perceived as essential elements in a strategy designed to enable all residents of a region to meet basic human needs and enjoy a minimum standard of living. Thus increased efforts have to be made to utilise health care resources effectively and efficiently and to plan future facilities carefully with regard to accessibility and appropriateness . This will require careful and objective management by all Authorities responsible for delivering health care to the people of Natal and KwaZulu. Accurately predicting the utilisation of hospital inpatient facilities is critical to efficient resource allocation in Health Services management. Catchment population studies and cross boundary flow characteristics provide valuable information on the utilisation of available facilities. This information is of value in the development of existing health services and the planning of additional health facilities with regard to size, situation and service type. Studies in other areas on utilisation of health service facilities, suggest that distance strongly influences hospital choice in both rural and metropolitan areas (Inquiry 1984 21(1) : 84-95) and this could explain some of the findings of this study with regard to cross boundary flow between Magisterial districts and HPSRs. For the efficient planning of resources, particularly with regard to situation and size, knowledge of the population size and demographic composition are important, as is a knowledge of the profile of disease in a community. The objectives of this study are directed to making available this information to each of the health authorities responsible for health care delivery and thus, to facilitate the management process. / Thesis (M.Med.)-University of Natal, Durban, 1988.

The National Health Act (Act 61 of 2003) defined Municipal Health Services and gave full responsibility for this function to district municipalities and metropolitan municipalities. District municipalities were required, by law, to provide municipal health services which were previously rendered by local municipalities and the Provincial Department of Health. This, therefore, required the transfer of staff, assets and liabilities from local municipalities and the Provincial Department of Health to district municipalities. The purpose of the study was to identify barriers to and facilitating factors for the transfer of municipal health services from the seven local municipalities and the Provincial Department of Health to the uMgungundlovu district municipality. A cross-sectional, descriptive study design was employed. A structured questionnaire was used to collect quantitative data from local municipalities and the Provincial Department of Health on the package of environmental health services offered and the available human resources. Qualitative data was collected through in-depth interviews and focus group discussions with key role players in the provision of environmental health within the district. The key findings of the study were: There were no changes to the package of environmental health services offered by local municipalities and the Provincial Health following the definition of Municipal Health Services. The Provincial Department of Health continues to play an important role in the provision of Municipal Health Services in the district There was a lot of awareness-raising on the integration process; however planning for the integration was very poor. The lack of progress in integration has had a negative impact on service delivery and on the environmental health personnel involved. The relationship between district and local municipalities, a lack of understanding of environmental health, budget allocation, communication, lack of commitment, capacity, and lack of a champion were seen as the main barriers to the integration process. The study was able to identify possible gaps in the planning process that, if revisited could assist the district municipality in better handling the process. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2011.

Three recent Randomised Controlled Trials (RCTs) have been able to deduce that Medical Male Circumcision (MMC) can reduce a heterosexual man’s chances of acquiring HIV through vaginal sexual intercourse by approximately 60% (Auvert et al. 2005; Gray et al. 2007; Bailey et al. 2007). In 2010, based on WHO recommendations, South Africa commenced a nationwide roll-out of MMC services. However, in the wake of these findings have come concerns that decreases in men’s perceived risk of contracting HIV could spark increases in risky sexual behaviour (risk compensation), in turn, driving up HIV incidence as opposed to abating it (Cassell et al. 2006). Accordingly, the World Health Organisation has identified social change communication as one of the ten key elements critical to the success of a wide scale MMC roll out (WHO & UNAIDS, 2010). Aside from creating demand, the role of MMC health communication efforts in crafting messages delineating the scope of MMC’s protective ability is paramount; especially in South Africa, a country hamstrung by a weak public health sector that can ill afford any regression in the fight against HIV and AIDS. This thesis provides a small-scale qualitative study that investigates both the motivating and discouraging factors impacting on men’s choices to undergo MMC, as well as exploring how and what ‘key messages’ of Medical Male Circumcision media and information initiatives are being received. In this way, my study hopes to bring insight into not only risk compensation associated with MMC, but also to provide a glimpse into the condition of health communication for MMC in the South African context. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Durban, 2012.