A thesis submitted in fulfilment of the requirements for the degree Master of Technology: Diagnostic Radiography in the Faculty of Health and Wellness Sciences at the Cape Peninsula University of Technology, 2012 / Complete, accurate and justified radiological examination requests are prerequisite to radiological exposures. However, global research shows evidence of high numbers of incomplete and inaccurate requests as well as that up to 77% radiological exposures are unjustified. Plain lumbar spine and plain skull radiology examinations are reported as being procedures that generate high dose and a low diagnostic yield. This study was designed to objectively measure the completeness, accuracy and justification of these two examinations in an effort to make inferences that will contribute to an improved radiology service. This research could therefore have positive effects on optimisation of radiation protection in Zimbabwe. Methodology A non participatory prospective descriptive analytical document review of quota sampled radiological request forms for 200 plain skull and 200 plain lumbar spine examinations was employed. Data was captured using structured data collection instruments designed and tested by the researcher for this study. The instrument was designed using the IAEA-HHS4 (2010) minimum prescribed request data as a framework and adding additional form fields found to be relevant through a review of all identified radiological request template forms in use at the research site. Data analysis involved central tendency measures and inferential statistics. Results: The central tendency demonstrated for the two examinations was that generally referrers for plain lumbar spine and for plain skull radiology would respectively provide 38.9 +/- 0.6% and 40.2+/-0.5% overall examination request information. This information was significantly below expectation. There was however no significant difference between the samples’ means for the two examinations. The tendency demonstrated in patient information for lumbar spine and skull requests was that generally referrers would respectively provide 48.4 +/- 0.8% and 49.5+/- 0.8% patient information. These values were inclusive of each other and they were significantly (p=0.00 Sig.) below expectation. There was however no significant difference between the two examinations’ data. The tendency demonstrated for examination information was that referrers for the research site would generally provide 29.8+/-0.8% (lumbar) and 32.6+/-0.8% (Skull) examination information. These values were significantly (p=0.000 Sig.) below expectation and demonstrated a significant difference between the sample means for the two examinations. With respect to referrer information, the tendency demonstrated was that generally referrers for plain lumbar spine and for plain skull examinations would respectively provide 38+/- 1% and 38.5 +/- 0.8% referrer identification information. These were significantly below expectation (p= 0.000 Sig.) but there was no significant difference between the samples’ means with respect to referrer information. With respect to accuracy of request data, it was observed that 5% plain lumbar spine and 3% plain skull requests were specific in so far as information documented on request forms could unambiguously identify the area to be imaged. It was also observed that 22.5% (lumbar spine) and 12% (skull) examination requests were indicated and therefore justified. All requests forms were found to be legible. Conclusions: Generally, referrers to this research site tend to provide incomplete, inaccurate and unjustified radiological request data. The observed levels of completeness, accuracy and justification of requests were generally consistent between the two examinations relative to expectation. These levels had medico-legal implications and negative effects on optimisation of radiation protection to patients. Further research to establish causes of this variance in referral behaviour is recommended. The researcher also recommends further research to establish whether there is an association between requested examination and completeness, accuracy and justification of diagnostic radiology examination requests. Keywords: Radiation protection, radiological request, complete request, accurate request, justified request, plain skull imaging, plain lumbar spine imaging.

The southern African region is beset with numerous security concerns: pervasive poverty, deepening inequality, starvation, contamination of essential natural resources, violent crime and state oppression. However, the most vital of the region’s security concerns in the 21st century is the spread of infectious disease. The region shoulders a disproportionate amount of the continent’s infectious disease burden, with diseases such as HIV/AIDS, tuberculosis and malaria claiming more lives every year than any other factor. The nature of these diseases and their propensity to spread, coupled with inadequate regional public health structures pose a significant threat to regional security and stability. The study asserts that southern Africa’s security concerns are most appropriately characterised under the paradigm of Human Security. It further asserts that if such vital threats to human security are not adequately managed they have the ability to permeate across state borders, spelling numerous negative ramifications for the region. To this end, the study details the public health crisis in Zimbabwe and its effects on regional security and stability in southern Africa. An enduring political and economic collapse in Zimbabwe led to the dramatic deterioration of its public health sector, the concomitant mass migration of Zimbabwean nationals across the region presented a unique and complex challenge to the Southern African Development Community (SADC) and its member states. As the premier regional governance institution, SADC has failed to adequately mobilise its structures and member states to respond to the challenges resulting from the public health crisis in Zimbabwe. The study explores the factors accounting for this regional inertia, and asserts that while infectious diseases are at present the most vital of the human security threats, similar threats to human security have the potential to affect the region if SADC fails to recognise and prioritise threats to human security as legitimate regional security concerns.

Health and well-being are the central concerns for most African people. If health and well-being (utano) is the top priority for most Africans, the general and almost complete breakdown of the Zimbabwean public health care system in the past decade (2000-2010) has had far-reaching repercussions on the whole populace. Whereas African theology and religious studies have expended considerable energy in addressing the theme of health and well-being, there have been limited attempts at developing indigenous theologies. This study plugs the gap in the available scholarly literature by proposing a Karanga theology of health and well-being paying particular attention to a specific community‘s responses to the health delivery systems in Zimbabwe. Through an examination of indigenous responses to health and well-being and critiquing the collapse of the health delivery systems in the period 2000-2010, the study argues that understanding health agency in contemporary Zimbabwe enables appreciating the centrality of utano (health and well-being). This study also seeks to establish the agency of the community in responding to the national health care crisis, focusing specially on the Karanga community in Murinye district. It explores the Karanga healthworlds and documents the agency of the Karanga health-seekers and health-care providers in responding to the health-care crisis. The major focus of the study is to establish how the Karanga navigate the existing religious and medical facilities (Modern scientific bio-medicine; Traditional healing and Faith-healing) in their search for healing by conducting fieldwork research which entailed the use of interviews and participant observation. The study was also influenced by oral theology based on the community‘s underlying faith experiences. It also relied upon the life history approach and narrative theology to establish trends and patterns in the Karanga medical system. The study concludes by exploring some useful and life-giving Karanga indigenous resources that can be utilized in constructing a Karanga theology of health and well-being in contemporary Zimbabwe. A Karanga theology of utano places emphasis on a liberative motif which is life-giving and life-enhancing. This includes acknowledging the agency of health-seekers who are actively involved in their own welfare. It argues that utano is achieved when, on the basis of indigenous beliefs and Christian beliefs regarding health, individuals and families invest in refusing to accept ill-health. Information drawn from study participants demonstrated how they sought the opinions of traditional healers, prophet healers and modern health practitioners whenever they felt that their condition was compromised. The study foregrounds the fact that for the Karanga people, issues of health and well-being cannot be separated from their religious perspectives. There are diverse religious traditions among the Karanga people and these inform their understanding of utano. As such, the three health delivery systems should not be viewed as competitors for clients but more importantly, they should be viewed as complementing each other. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2013.

MPH / Department of Public Health / See the attached abstract below

Results Based Financing (RBF) models are results oriented, linking performance indicators to incentives to motivate health workers to deliver quality care in anticipation of rewards attached to service delivery. The study sought to explore nurses’ views and experiences regarding the implementation of RBF in Zimbabwe with the aim of recommending measures to strengthen the programme. The researcher used a qualitative, exploratory and descriptive design in this study. The population of this study comprised 21 nurses. Non-probability purposive sampling was used to select professional nurses involved in implementing RBF in Mrewa District, Mashonaland East Province, Zimbabwe. Data were collected through focus group discussions using an interview guide. Three (3) focus group discussions were conducted during this study, following a pilot study consisting of six (6) conveniently sampled nurses in Mashonaland East Province. Interviews were tape recorded and transcribed verbatim. Permission to proceed with this study was granted by the Ministry of Health and Child Care and the University of South Africa. Measures to ensure credibility, dependability, conformability and transferability were followed. Data were analysed using Creswell’s data analysis steps. Data were transcribed and thematically analysed, and emerging patterns were noted. The researcher examined these categories closely and compared them for similarities and differences, identifying the most frequent or significant codes in order to develop the main categories. These were summarised in narrative form. Four themes emerged from data: interpretation of RBF; role of nurses in the implementation of RBF; evaluation of RBF; and strengthening implementation of RBF. The study revealed various interpretations of RBF that converged to definitions of RBF in literature. Nurses viewed themselves as key and important players in the successful implementation of RBF. The successes and challenges of RBF were presented. Several measures that could strengthen the implementation of donor funds were highlighted, including subsidisation of low catchment health facilities, inclusion of district hospitals on the RBF programme, increasing financial autonomy of health facilities and the review of procurement guidelines. The study assumed that these measures will enhance nurses’ work experience in donor funded health care delivery, and improve health outcomes. / Health Studies / M.P.H.

MHealth is an upcoming area promising to contribute benefits to health service delivery. The purpose of this study was to identify and describe the rate of mHealth utilisation as well as opportunities for mHealth and the barriers to use at one central hospital in Zimbabwe. A quantitative, descriptive, cross-sectional study was undertaken at the central hospital. Data collection was done using structured questionnaires. The entire population of medical doctors at the hospital (N=42) were the respondents of the research. The 18 mHealth activities were chosen from a possible of 101 available. The most used as well as the least used mHealth activities were identified and the reasons for use or lack of use were identified. The study revealed that 75% of the activities were currently being used and 95% had the potential of future use by medical doctors. This study highlights the potential of mHealth from medical doctors’ perspective. / Health Studies / M. A. (Public Health)

This study sought to examine linguistic and discursive strategies used to construct messages reflective of the implementation of the HIV and AIDS policy for Zimbabwe of 1999 by government and private newspapers. Such analysis was perceived to be important since media content has a bearing on Zimbabweans‘ perception and attitudes regarding HIV and AIDS prevention, treatment and control. The study was aimed at comparing messages from newspapers with views by the people of Zimbabwe regarding the implementation of the policy. Findings reveal that empowerment programmes particularly those targeting women and children are lagging behind as Zimbabweans, literature and newspaper data sources testify. In addition, information sources concur that cultural (For example, stigmatisation, polygamy, religious practices, spouse inheritance) and structural (For example, patriarchy, masculinity, bureaucracy, politics) are stumbling blocks that negatively affect the implementation of the policy. Further, even though private and government newspapers do not fully agree on the portrayal of human agents, there is a general consensus between newspaper reports and Zimbabweans that people still face socio-economic and econo-political challenges that militate against the smooth implementation of the HIV and AIDS policy. Government newspapers tend to downplay aspects which reveal inadequacies of government activities. The study notes this as betrayal of use of ideological squares both by government and private newspapers whereby certain aspects regarding the implementation of the policy are either downplayed or highlighted to influence perception. The study reveals that newspaper reports used nominalisation, quantification, positive politeness, thematisation, rhematisation, intertextuality, euphemism, proverbs, idioms, action verbs, metaphors and citation of experts as linguistic and discursive strategies both for agenda setting and building purposes regarding the implementation of the HIV and AIDS policy. Other devices used particularly in the encoding of Operation Murambatsvina are, claptraps, deictic referencing, personal pronouns, adjectives and direct speech. The study attributes problems regarding the Zimbabwean HIV and AIDS intervention model to the top – down approach inherent in the policy. Hence, the call for an adoption of an unhu/hunhu/ubuntu inspired bottom – up HIV and AIDS intervention model in Zimbabwe. This would inculcate pro-family, pro-village, pro-nation/people and ―servant leadership‖ (Mangena and Chitando, 2011) values in the fight against the pandemic through the embracing of Indigenous Knowledge Systems (IKS). Unfortunately, such values largely continue to elude the radar of the current top – down HIV and AIDS intervention model cuurently in use in Zimbabwe. / African Languages / D. Litt et Phil. (African Languages)

Background: Accessibility to health care in rural areas is globally impeded by physical, material, human, financial and managerial resources and societal barriers in the health care system. The Systems Model formed the backbone to developing a strategic action plan to address the challenges experienced by all stakeholders involved. Purpose: The purpose of this study was to describe accessibility to health care in rural areas to develop a strategic action plan to enhance accessibility to health care in these areas of Zimbabwe. Methods: A multiple methods approach combining qualitative and quantitative components during 4 phases. Phase 1 collected quantitative data with questionnaires from professional nurses and health care users who were conveniently sampled. Phase 2 collected qualitative data with a nominal group from national health directors who were conveniently sampled. Phase 3 was based on the findings from Phases 1 and 2 with a literature control to develop a draft strategic action plan. During phase 4 the strategic plan was amended and validated with a validation tool by members of the parliamentary portfolio committee on health in Zimbabwe with all-inclusive sampling. Framework: The Systems Model Framework was adopted for this study as outcomes and impact on people’s health is determined by inputs, processes and outputs. This model was relevant and applicable to accessibility to health care. Research findings: Accessibility to health care in rural areas of Zimbabwe is affected by inadequate distribution of physical resources, shortage of material and human resources, and a lack of financial resources. The strategies identified contributed to the strategic action plan which was amended and validated. The strategic action plan includes improving the health infrastructure, providing appropriate medical drugs, training and retention of health workers, providing medical equipment at the rural health facilities, reviewing the health worker workload and addressing staff shortages, providing free health care services in rural areas, and improving the capacity of the health care system. Conclusion: The strategic action plan was developed based on the inputs of the relevant stakeholders and the System Model. The inclusion of the parliamentary portfolio committee on health (members of parliament of Zimbabwe) might enhance the possibility for implementation which can enhance the accessibility to health care in rural areas of Zimbabwe. / Health Studies / D. Litt. et. Phil. (Health Studies)

MHealth is an upcoming area promising to contribute benefits to health service delivery. The purpose of this study was to identify and describe the rate of mHealth utilisation as well as opportunities for mHealth and the barriers to use at one central hospital in Zimbabwe. A quantitative, descriptive, cross-sectional study was undertaken at the central hospital. Data collection was done using structured questionnaires. The entire population of medical doctors at the hospital (N=42) were the respondents of the research. The 18 mHealth activities were chosen from a possible of 101 available. The most used as well as the least used mHealth activities were identified and the reasons for use or lack of use were identified. The study revealed that 75% of the activities were currently being used and 95% had the potential of future use by medical doctors. This study highlights the potential of mHealth from medical doctors’ perspective. / Health Studies / M. A. (Public Health)

MPH / Department of Public Health / The high maternal mortality ratio is caused by various factors, including avoidable complications which can be reduced by attendance to antenatal care visits. The utilisation of antenatal care has been low in rural areas, especially in Africa. The purpose of this study was to explore the utilisation of antenatal care in Mutasa District of Zimbabwe. This study used a qualitative study approach, adopting the descriptive, explorative design that presented an active image of the research participants’ reality and capture live experiences. Participants of the study were pregnant women and women with children under the age of one. The participant were sampled using purposive and snow-ball sampling techniques. In-depth interviews were conducted. The participants were interviewed in their native language, Shona. The main question was: Can you explain in your own words how you use antenatal care services from the primary health care facility? The researcher clarified questions which the participant failed to understand. The researcher wrote down all responses and used a tape recorder to capture the responses. The researcher analysed data using thematic content analysis where themes and sub-themes were discussed. The main theme was low uptake of antenatal care in rural primary health care facilities. From the main theme there were factors influencing and perceptions of women on uptake of antenatal care services in primary health care facilities. Trustworthiness was ensured through credibility, dependability, transferability and conformability. Permission from the relevant authorities, such as the University of Venda Higher Degrees Committee, the Provincial Medical Director and the District Administrator was sought before conducting this study. Informed consent was also sought before interviewing the participants. The study concluded that socio-demography of participants affected antenatal care attendance. These are age, level of education, low income, high parity and distance to facility. Other hindering factors to utilization of antenatal care were lack of knowledge, religion and acceptability of antenatal care by the women in rural primary health care facilities. Findings will be disseminated through a research report and published in relevant accredited journals with the help of the supervisors. The study recommended that the Ministry of Health and Child Care of Zimbabwe review Antenatal Care policies to ensure friendliness and to increase awareness through health education and continuous dissemination of antenatal care information. / NRF