Ph.D. (Community Nursing Science) / The provision of reproductive health promotion services to females in South Africa is the responsibility of the national and provincial governments, while in primary healthcare (PHC) settings the local government is responsible for the provision of free reproductive health promotion services to females. The prevalence of sexually transmitted infections (STIs), the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) led to the development and provision of noncollaborated vertical PHC reproductive health programmes. The purpose of this study was to develop a model to collaborate the provision of reproductive health promotion services in PHC settings. A qualitative, descriptive phenomenological design, exploratory and descriptive approaches and contextual and theory generating design were used. The study was conducted in three phases. In phase 1, data collection consisted of individual indepth interviews and focus group interviews. Non-probability purposive sampling was used to include three population groups: females who utilised the reproductive health promotion services and reproductive health promotion service providers and those who provide clinical teaching regarding reproductive health promotion in two different PHC settings who were sampled through non-probability convenience sampling methods. Throughout the study, ethical principles were strictly adhered to and trustworthiness was ensured. Data analysis was done according to Tesch’s open coding data analysis method. The findings revealed four emerging themes: service provision factors that impact on reproductive health promotion provision; barrier factors towards safer sex practice; low health literacy of females regarding reproductive health promotion, and disclosure of positive HIV status. In phase 2, the conceptual framework was described according to the survey list of Dickoff, James and Wiedenbach (1968) and the Research Model in Nursing as described in the Theory for Health Promotion in Nursing (University of Johannesburg, 2009). In phase 3, the described conceptual framework served as the guideline for the model development guided by Chinn and Kramer’s (2008) theory and model generating design. Two phases of model evaluation was done: firstly by clinical experts and secondly by academic experts. The model that was developed was based on collaboration, community participation, and cooperative decision making processes and was named: A model to collaborate the provision of reproductive health promotion services in PHC settings. The outcomes from implementing this model envisaged to be the reduction of unintended pregnancy, STIs, and HIV and AIDS among females and males.

The aim of this paper is to explore how the Rwandan state has motivated its increased prioritization of family planning (FP). The paper seeks to understand whether the state’s increased promotion of FP is a result of Rwanda’s strong commitment to gender equality or part of a broader development agenda. By applying theories of substantive representation of women and smart economics, the paper investigates if the state considers enhancing women’s sexual and reproductive health and rights (SRHR) as a goal in itself or as a means to reach their broader development goals. The method which has been selected is text analysis. The texts which are analyzed are government documents from the time of the emergence of the FP programme. The main findings of this paper suggest that the state’s main motive for the increased prioritization of FP is driven by the development agenda rather than a gender-sensitive approach. Nevertheless, there are statements in the texts which the paper connects to theories of substantive representation of women, however, the development rational corresponding with the idea of smart economics is more recurrent. The paper finds that the hypothesis building on the theory of smart economics finds the strongest support and therefore suggests that the Rwandan states consider FP to be a means to achieve broader development goals.

Magister Public Health - MPH / Adolescent pregnancy holds numerous health and social risks for mother and child. Adolescent access to maternal health services is of vital importance to ensure that pregnant adolescents receive timely and effective health care. Evidence suggests that adolescents tend to seek medical care late in their pregnancies and attend fewer than the recommended four antenatal visits. This results in missed opportunities to improve maternal and newborn health due to untreated sexually transmitted diseases and uninhibited mother-to-child HIV transmission, resulting in low birth weight among other poor pregnancy outcomes. Sub-Saharan Africa has the highest rate of adolescent births worldwide, in keeping with evidence that low-to-middle income countries have the highest rates of adolescent pregnancy. Adolescent pregnancy in South Africa remains a public health concern, and the Mitchells Plain sub-district has a particularly high rate of adolescent pregnancy. The aim of this study was thus to explore the barriers to access for maternal health care services amongst pregnant adolescents in the Mitchells Plain sub-district.

Philosophiae Doctor - PhD / This study focused on developing an intervention programme for school health nurses on guiding adolescents in their decision-making on reproductive health. A review of literature shows that this role is necessary, as there is a great need to reduce adolescents' morbidity and mortality rates due to poor decision-making about their reproductive health. School health nurses are strategically positioned to perform this role in ensuring that adolescents are well guided in making responsible decisions about their reproductive health. However, available evidence shows that school health nurses have not been performing this role in the school health service, especially in Nigeria. The provision of guidance for adolescents, on making decisions about their reproductive health is an adaptive role of school health nurses. The literature further shows that school health nurses require adequate preparation before they can perform this role. The study was conducted in the secondary school environment of Ijebu Ode local government area of Nigeria. Work role performance theory, adult learning principles, and experiential learning constituted the theoretical point of departure for this study. The paradigmatic assumptions revolved around intrepretivism/constructionism using the qualitative methodological approach. Semi-structured interviews and focus groups were the means of obtaining information from study participants for the study. The Intervention Design and Development model of Rothman and Thomas (2013) was used to design the study. The participants for the study were eight school health nurses, five school teachers, thirty-six adolescents, and one school health coordinator. They were all purposively selected. The data collected was analysed manually using inductive content analysis. The main findings from the interviews show that school health nurses have a poor awareness of their role and responsibilities, a lack of knowledge on how adolescents make their decisions, a lack of adequate knowledge on how to guide adolescents in their decision-making. The findings also show that there is poor interpersonal communication between school health nurses, and adolescents, and between school health nurses and members of the teaching staff. The findings further show that there are insufficient continuous professional development programmes. Results from integrative reviews regarding the types of intervention programmes that had been developed for school health nurses at different times in the past focused on role orientation, knowledge and skills acquisition, and mutual interaction between school health nurses and adolescents, and members of the teaching staff. The findings reflect a gap in how school health nurses provide guidance to school adolescents in decision-making on their reproductive health, hence the need for a training programme that will assist them in discharging this function effectively. A training programme was designed and developed for school health nurses to assist them on guiding adolescents in their decision making about their reproductive health. The training programme was pilot tested with observational methods, an interview being used as a means of assessing the quality and outcomes of the training programme. The results of the pilot test show the participants' satisfaction with the organisation and the quality of the training workshop. Participants indicated that they had gained more knowledge and understanding of adolescent reproductive issues, and their decision-making processes. They also said that they had gained more interpersonal skills, and greater communication skills. Some expressed the conviction that they had gained more confidence in their ability to communicate with the teaching staff. Some also expressed their readiness to apply the skills obtained during the training to their practice area. It is recommended that the training programme be fully evaluated in phase five of the Intervention Design and Development model of Rothman and Thomas, which will enable full dissemination and implementation of the programme (Rothman and Thomas, 2013). It is further recommended that the training programme be disseminated to end users (school health nurses) by sensitizing the necessary stake-holders on the need to use the training programme for school health nurses in their respective school contexts.

Background: This mixed-methods dissertation is multi-layered and exploratory in nature. It provides methodological contributions to the fields of evaluation and research methods by demonstrating how the root cause analysis (RCA) method can be utilized to evaluate program improvement and assist in the development of research questions and hypotheses. Additionally, it adds to the literature on reproductive genetics decision-making by contributing to the knowledge of this complex process. Research Aims: This dissertation includes the following three aims: 1) to illustrate how the RCA interview method can be a useful tool to improve programs that have not been implemented with fidelity; 2) to demonstrate how the RCA interview method can be adapted for research by elucidating research questions and hypothesis development processes; and 3) to glean information pertaining to reproductive genetics decision-making knowledge, attitudes, and behaviors among genetic counselors and women who were pregnant and had reproductive genetic counseling. Methods: Mixed-methods research took place over a 13-month period in Arizona and across the U.S. between June 2015 and August 2016 among two separate groups. The qualitative research includes semi-structured, in-depth interviews with genetic counselors (n=22), and RCA interviews (n=9) with genetic counselors sampled from 12 southwestern and western states. The quantitative research comprised of piloting two survey instruments. Survey #1 for genetic counselors (n=22) and Survey #2 for women who had genetic counseling and were pregnant between January 1, 2005 and December 31, 2015 (n=104). Results: The results by manuscript are: 1) RCA is a useful evaluation tool for evaluating program improvement when programs have not been implemented with fidelity; 2) RCA is a beneficial methodological approach for researchers for focusing areas of inquiry, generating research questions, and developing research hypotheses; and 3) Women with a master's degree or higher are more likely to have reproductive genetic testing than women with a bachelor’s degree or under. Women who received reproductive genetic testing had significantly higher genetic testing knowledge scores than women who did not have genetic testing. Women who held a master's degree or higher had significantly higher genetic testing knowledge scores than women with a bachelor’s degree or under. Conclusions: RCA is a flexible and adaptive tool that works well for evaluation and research purposes. Reproductive genetic testing is a complex field that is rapidly changing, and there are significant differences in knowledge among women facing testing decisions calling for tailored interventions around genetic testing literacy. Recommendations: Evaluators and researchers alike should be aware of RCA as a useful methodological tool that they can use to help evaluate program improvement as well as facilitate the process of developing research questions and hypotheses. Genetic literacy interventions and decision-making resources must take into consideration the role education has on genetic testing decisions as well as its part in understanding the appropriateness, benefits, and limitations of specific genetic tests. This research further advocates for women to have access to certified genetic counselors to tailor the information to meet the individuals' needs in order to promote informed, autonomous genetics decision-making.

No description available.

South Asia has the highest absolute number of women with an unmet need for contraception in the world. The total number of women with unmet need is 142 million. Of this, Asia accounts for 84 million followed by Sub-Saharan Africa at 32 million. Within South Asia, some countries have seen unmet need decrease and the contraception rate increase; however, Pakistan remains the exception to the rule. Pakistan has a low rate of contraception use, high rate of contraception discontinuation, high unmet need and high rate of unwanted fertility. A number of theories have hypothesized that community-level factors influence a couple’s fertility decisions. Yet until recently, studies of contraceptive use dynamics have focused on individual and household-level determinants. Within Pakistan, this focus on individual and household level has not been able to explain the changes in use, which goes beyond socio-economic and cultural boundaries. As a result, there is impetus on researchers to shift focus and look at the interaction between and within the individual and the community. This study aims to address this gap in the literature by examining the association between community contextual factors and modern contraception use in a developing country using multilevel modeling. The Commission on Social Determinants of Health and the Determinants of Fertility framework were used to test five research questions, on the association between modern contraception use and socioeconomic and political context, social position, social class, health system and overall community contextual factors. Community contextual factors tested were found to be associated with modern contraception use and explained 32% of the variance in the outcome. Specifically, the variables that played a significant role and showed a strong association with modern contraception use were related to public policy; community knowledge of the presence of a lady health worker, community access to a family planning service outlet, and community region of residence, and women’s autonomy; community women’s education, community women’s ability to choose a spouse and own land or home. This study moves the discussion from a focus on individual level factors that impact contraceptive us to community-level factors. Numerous studies and anecdotal evidence have pointed to the importance of community context in contraceptive use; however, there has been a paucity of research investigating this realm. This study bridges this gap by providing evidence for existing programs and policies, strengthening the call for more community-based initiatives and helping to understand individual behavior as it relates to the community in which the person resides.

Philosophiae Doctor - PhD / The reproductive health of individuals is severely compromised by HIV infection, with candidiasis being the most prevalent oral complication in patients. Although not usually associated with severe morbidity, oropharyngeal candidiasis can be clinically significant, as it can interfere with the administration of medications and adequate nutritional intake, and may spread to the esophagus. Azole antifungal agents are commonly prescribed for the treatment and prophylaxis of candidal infections. However, the emergence of drug resistant strains and dose limiting toxic effects have complicated the treatment of candidiasis. Consequently, safe and effective and affordable medicine is required to combat this fungus. Commercial garlic (Allium sativum) has been used time since immemorial as a natural antibiotic, however very little is known about the antifungal properties of two indigenous South African species of garlic, namely Tulbaghia alliacea and Tulbaghia violacea, that are used as folk medicines for a variety of infections. This study compares the in vitro anti-candidal activity of Tulbaghia alliacea, Tulbaghia violacea and Allium sativum extracts. It was found that the greatest concentrations of inhibitory components were extracted by chloroform or water. The IC50 concentrations of Tulbaghia alliacea were between 0.007 - 0.038% (w/v). Assays using S. cerevisiae revealed that the T. alliacea extract was fungicidal, with a killing half-life of approximately 2 hours. This inhibitory effect of the T. alliacea extracts was observed via TLC, and may be due to an active compound called Marasmicin, that was identified using NMR. This investigation confirms that extracts of T.alliacea exhibit anti-infective activity against candida species in vitro. / South Africa

Magister Public Health - MPH / Dual protection is protection against unwanted pregnancy, HIV and other sexually transmitted infections and a means of achieving safer sex and birth control (WHO, 2012). It is one of the essential tools promoted by the WHO for preventing unintended pregnancies and sexual transmitted infections among HIV-positive women to reduce dual risk of unintended pregnancies, re-infections and transmission of HIV in the cases of sero-discordant couples. However, the use of dual method use among HIV-positive women in Zimbabwe is poorly described. Hence to fill in the existing research gap, this study aims to explore the factors influencing dual protection use by HIV- positive women participating in a prevention of mother-to-child transmission (PMTCT) program in an urban setting in Zimbabwe. Methodology: A qualitative exploratory study design with a combination of qualitative research methods including interviews and focus group discussions was conducted. A total of five focus group discussions (FGDs) each consisting of 8-12 participants was conducted with a total of 51 women. Five in-depth interviews were conducted with key informants. All interviews and FGDs were audio recorded using a digital voice recorder. The interviews were conducted in Shona and translated into English. Data analysis was done manually using thematic coding. Codes emerged from the data using an inductive approach. Ethical principles of research and rigour were observed throughout the study. Results: Dual protection use was low among the HIV-positive women. Absolutely non-use of contraceptive was reported by some women. The main methods of contraceptives were the pill, depo provera and condoms. Inconsistent condom use was mentioned among the few women who reported using condoms. Many barriers to contraceptives use among HIV-positive women in Zimbabwe were identified. However there were a few facilitating factors too. Health system factors associated with health care workers (HCWs) related factors and service delivery processes were reported as major barriers to contraceptive use. Women expressed negative attitude towards condom use associating them with unfaithfulness. Facilitators of contraceptive use identified were couples' HIV testing and counselling, women's increase in CD4 count result, fear of vertical transmission and HIV sero-discordance between couples. Conclusion and Recommendations: In conclusion, dual protection use among HIV-positive women in this community was low. Health system factors were the main barriers to contraceptives use whilst health related factors were the main facilitators. HIV-positive women still face challenges in accessing and utilisation of contraceptives. Hence the barriers to contraceptive use needs to be addressed at the same time promoting the facilitators.

This MA thesis examines the decision-making capacity of young women married during adolescence within the context of their sexual and reproductive health in an urban ghetto in the city of Ahmedabad, India. Specifically, the development literature on married female adolescents (MFAs) is characterized by negative health indicators such as higher rates of unwanted pregnancies, reproductive tract infections, sexually transmitted diseases, high infant and maternal mortality and morbidity coupled with the phenomenon of early marriage, poverty and an overall lower social status. The result is a disempowering discourse that constructs and presents them as powerless victims who lack any decision-making capacity and are perpetually oppressed. This research is an effort to move the discussions of “Other third world women” outside the realm of victimization by challenging and destabilizing this disempowering, hegemonic discourse. We must ask what does decision making look like for these women, as exercised within the context of their sexual and reproductive health. This qualitative analysis is informed by primary research through focus groups and semi-structured interviews with young married women, and was conducted with the help of a local NGO, Mahila Patchwork Co-operative Society. The study provides insights on the young married women’s participation and role in determining their own health outcomes (negative and positive) to better inform programs and services offered by the community NGOs.