Thesis (Ph.D.)--University of Maryland, 1990. / Includes bibliographical references (leaves 227-235).

Thesis (Ph.D.)--University of Maryland, 1990. / Includes bibliographical references (leaves 227-235).

Magister Public Health - MPH / Background: Adverse Drug Reactions (ADRs) contribute to potentially expensive hospital admissions and are regarded as a major public health priority. ADRs in South Africa are mainly detected by a spontaneous reporting system but it is plagued by under-reporting. Previous records indicated under-reporting of ADRs in the Cape Winelands District amongst healthcare workers. Pharmacists, in particular, did not report ADRs compared to other healthcare cadres whilst they are generally considered to be the custodians of medicines. Study Aim: This study aimed to explore and describe the perceptions and experiences of rural public sector pharmacists’ reporting of ADRs and to understand why pharmacists in this rural health district under-reported ADRs. Study Design: A qualitative study design was appropriate for this research question as the researcher wanted to gain an in-depth understanding of human behavior related to the phenomena of under-reporting. Study Population and Sampling: The primary study population consisted of 24 public sector pharmacists in the Cape Winelands District. A purposive sampling strategy enabled the selection of 16 pharmacists ranging in gender, age, experience and rank. Eight pharmacists were supervisor pharmacists while the rest were production pharmacists, including a community service pharmacist and an intern pharmacist. Supervisor pharmacists are more involved with managerial tasks and the attendance of meetings compared to production pharmacists that focus on patient care and dispensing of medication. Two key informants involved in the Western Cape Pharmacovigilance System were included in the study. One key stakeholder was a policy specialist pharmacist working at Directorate: Pharmacy Services and primarily involved with the Provincial Pharmacy and Therapeutics Committee. The other key policy stakeholder, at the time of the study, was the manager of the Medicines Information Centre which forms part of the University of Cape Town’s (UCT) Pharmacology Division. Both were highly experienced pharmacists familiar with the pharmacovigilance system. Data Collection: In-depth interviews were conducted using a semi-structured interview guide consisting of open- ended questions. The semi-structured interview guide was tested on a participant outside the primary study population. Interviews were conducted in English and Afrikaans. Interviews were tape-recorded and the interviewers made field notes to supplement the data recorded. Two researchers with experience in qualitative data collection, briefed by the investigator, interviewed the pharmacists who worked in the district and the investigator interviewed the two key stakeholders. Data Analysis: The tape recordings were translated, where applicable, and all were transcribed verbatim by the investigator. The transcribed recordings were analyzed by the investigator by assigning codes to material on an Excel spreadsheet. This approach enabled the identification of themes which aided the understanding of the research phenomena. Ethics: Ethical approval was obtained from the University of the Western Cape Senate Research Committee and permission from the Western Cape Department of Health Research Committee. Written informed consent (See Appendix 1, page 73) was obtained from each participant prior to conducting the interviews and interviewees were assured of confidentiality throughout the research. Key Results and Discussion: Pharmacists in the study strongly acknowledged the importance of ADR reporting which is linked with pharmacists seeing themselves as the custodians of medication. Pharmacists in the study associated the reporting of ADRs with medication safety and felt responsible for ensuring it. In spite of this acknowledgement of the importance of ADR reporting, pharmacists rarely reported an ADR themselves. This finding was in line with previous research conducted and linked with barriers pharmacists faced in practice. The study revealed that pharmacists identified ADR reporting opportunities during their normal clinical work and enabled other health care professionals (HCPs) to confirm the occurrence of an ADR and report it. Pharmacists primarily identified ADRs when they scanned patient folders for clues that could indicate that an ADR had occurred. Other research conducted confirmed that the use of patient records could be used in the identification of ADRs. This finding was important to inform future training workshops to promote reporting of ADRs. Some pharmacists in the study associated an ADR with a therapeutic or clinical intervention. In general, therapeutic interventions usually involved a clinical action more closely associated with medical officers and were viewed by pharmacists in the study as being outside their legal and clinical scope of practice. A clinical intervention could include a change of medication, change of dose, and other prescription changes or might involve the medical officer referring the patient to a higher level of care depending on the severity of the suspected ADR experienced. A clinical intervention could include performing complex diagnostic tests, observations and laboratory investigations. Pharmacists’ association of an ADR experience with a clinical intervention was an important factor limiting their reporting of ADRs. The implication of this belief is that patients were referred from the pharmacy back to medical officers for the clinical intervention. In this way, although pharmacists do not directly report an ADR, their referral to medical officers would help improve reporting of ADRs. An unexpected and contrasting finding compared to previous research was the strong belief of some pharmacists in this study that common ADRs should be reported. Pharmacists believed that by reporting common ADRs en masse, authorities might decide to remove the problematic medication from the approved public sector formulary. This was in contrast to previous research where pharmacists either acknowledged that authorities only want novel or serious ADRs from newly marketed medication or believed that reporting well-known ADRs was a waste of time. Pharmacists reported that they faced several barriers in reporting ADRs. The main barriers that were mentioned were a lack of adequate feedback, heavy workload and time constraints, uncertainty in identifying the cause of an ADR and issues pharmacists had with the reporting process. These barriers were consistent with previous research conducted. Finally, pharmacists suggested various means of facilitating ADR reporting including use of electronic reporting aids, creating increased awareness amongst healthcare professionals, conducting continuous training and making amendments to the reporting form, some of which were in line with previous research conducted. Conclusion: Exploring the perceptions and experiences of pharmacists with respect to the under-reporting of ADRs revealed key knowledge about the spontaneous reporting system that could be applied to strengthen the current reporting system and enable more reporting. Whilst it was clear that pharmacists play an important role as the gatekeepers and drivers of the reporting process enabling other HCPs to report ADRs, more should be done to empower pharmacists in managing ADR reporting opportunities. This could benefit the healthcare system in ensuring that more ADRs are reported, as well as decrease the waiting time of patients and the workload of medical officers. In addition, engaging with pharmacists and HCPs to overcome barriers to reporting would facilitate increased ADR reporting. Recommendations: Several recommendations emerged from the study. Future circulars, training workshops and awareness posters about the ADR reporting process should inform all HCPs to report any medication suspected of being the cause of an ADR and not waste time in trying to identify the medication that caused it. A training workshop should be conducted with pharmacists to improve their skills in terms of identifying ADRs, how and what to report and of the appropriate referral of patients to the medical officers. An annual assessment on the availability of reporting forms in all health facilities should be conducted. In addition, the MIC should conduct a survey on the user-friendliness of the reporting form and enable HCPs to provide recommendations to help improve the reporting form template. Pharmacovigilance should be a standing item on the agendas of sub-district PTC meetings at which supervisor pharmacists should give quarterly updates to sub-district management on ADRs reported. As this study focused primarily on the experiences and perceptions of pharmacists in a rural health district, a follow-up study should explore perceptions and knowledge of medical officers and nurses of ADR reporting, specifically on the availability and complexity of the reporting form. Finally, the MIC should explore the development of a basic ADR causality assessment tool that could assist pharmacists and other HCPs in identifying a possible ADR and improve confidence amongst pharmacists and HCPs in reporting ADRs.

This thesis explores questions of gender equality in social welfare theory; methodologies; approaches and policymaking in the Global South in the context of land reforms. This stems from the realisation that gender equality issues in social welfare are increasingly receiving greater attention in the context of the Global North and less in the South. By adopting a Transformative Social Policy framework, the research departs from hegemonic livelihoods, poverty reduction and the ‘classical models’ of land reforms often designed from the mould of the neoliberal discourse of individual tenure to focus on land reform as a relational question. Empirical data was gathered using a sequential explanatory mixed-methods approach involving survey questionnaires; in-depths interviews; focus group discussions; key informant interviews and field observations. A total of 105 randomly selected households, comprising 56 male-headed households (MHHs) and 49 female-headed households (FHHs) participated in the quantitative component of the study, comprising a control group of nonland reform beneficiaries. Additionally, 30 purposively selected in-depths interviews comprising 20 FHHs and 10 MHHs were conducted in resettlement study sites. Findings from this this study indicates that despite the country’s depressed economic environment and the effects of climate change, transfer of land enhanced the productive capacities of individuals and rural households, including those headed by females. At micro-level, in-kind transfer of land to rural households proved to be a more superior social protection measure compared to either food or cash transfer. However, social relations and institutions proved resistant to change, posing a greater obstacle to social transformation. And more importantly, from a social reproductive perspective, the same land reform that enhanced the productive capacities of women, inadvertently, increased their social reproductive work with implications on the welfare of women relative to men. The thesis makes a contribution to social policy debates in Africa, which hitherto have been dominated by the introduction of cash transfers as witnessed in many countries across the continent. The transformative social policy approach brings novelty to the study of land reforms. By Conceptualising gender as a relational and social construct, the study adds knowledge on the nexus between gender, land reform and welfare using the Fast Track Land Reform Programme (FTLRP) as reference. With the FTLRP––as a leftist policy in a liberalised economy––there is a need for the government to re-align its social and economic policies to avoid inconsistencies in the country’s development path. On the gender front there is need to legislate resettlement areas as outside the jurisdiction of traditional structures; promulgate statutory instruments dealing with land and setting up designated land claims courts linked right up to the Constitutional Court. Specifically, for Chiredzi, there is a need to establish a corporate body to administer the affairs of Mkwasine following the pulling out of the Estate. Keywords: gender, land reforms, water reforms, transformative / Sociology / Ph. D. (Sociology)

This study sought to determine factors that militate against men’s participation in the current Zimbabwean functional literacy programme. The research utilized the case study design and the data collecting instruments included in-depth interviews, focus group discussions, and observations. Twelve adults, seven males and five females aged between thirty-nine and sixty-five years of age were interviewed by the researcher on “Why men were not participating in the functional literacy programme”. No similar research had ever been conducted in Zimbabwe since the inception of the programme in 1992. The definitive findings of the study include a grounded research theory which was extrapolated from the data. After a thorough scrutiny of the data collected, it was possible to conclude that while many of the barriers to literacy participation are similar, the bread and butter issues need to be acknowledged by literacy providers when aiming to attract men into and retain them within the programme. The research also found that poverty, past negative experiences during the early school days, and stigma related issues, were the major inhibiting factors against men’s participation in the programme in the Mazowe district. Although the research had time related and operational limitations, these were however, repulsed by controls effected by the researcher. The diversity of qualitative data collecting instruments played a positive role in ensuring checks and balances in the type and authenticity of data collected. In order to retain male participants in the programme, a supportive environment is recommended. This can be achieved if voluntary literacy tutors are trained in design and delivery of instruction as well as in mobilizing strategies, so that they are sensitive to male participants’ circumstances. The income generating projects in which men are currently involved, need to be made more viable in order to boost their morale. / Educational Leadership and Management / D. Ed. (Education Management)

This study sought to determine factors that militate against men’s participation in the current Zimbabwean functional literacy programme. The research utilized the case study design and the data collecting instruments included in-depth interviews, focus group discussions, and observations. Twelve adults, seven males and five females aged between thirty-nine and sixty-five years of age were interviewed by the researcher on “Why men were not participating in the functional literacy programme”. No similar research had ever been conducted in Zimbabwe since the inception of the programme in 1992. The definitive findings of the study include a grounded research theory which was extrapolated from the data. After a thorough scrutiny of the data collected, it was possible to conclude that while many of the barriers to literacy participation are similar, the bread and butter issues need to be acknowledged by literacy providers when aiming to attract men into and retain them within the programme. The research also found that poverty, past negative experiences during the early school days, and stigma related issues, were the major inhibiting factors against men’s participation in the programme in the Mazowe district. Although the research had time related and operational limitations, these were however, repulsed by controls effected by the researcher. The diversity of qualitative data collecting instruments played a positive role in ensuring checks and balances in the type and authenticity of data collected. In order to retain male participants in the programme, a supportive environment is recommended. This can be achieved if voluntary literacy tutors are trained in design and delivery of instruction as well as in mobilizing strategies, so that they are sensitive to male participants’ circumstances. The income generating projects in which men are currently involved, need to be made more viable in order to boost their morale. / Educational Leadership and Management / D. Ed. (Education Management)

O Estado de São Paulo centraliza, hoje, a maior e mais complexa rede urbana do hemisfério sul, apresentando uma rica e diversificada gama de formas de urbanização. Os principais estudos sobre a constituição e o desenvolvimento do interior do Estado privilegiaram aspectos dominantes como o ciclo do café, os imigrantes, as ferrovias e, mais recentemente, a industrialização das cidades médias, relegando para segundo plano a heterogeneidade que ocorre na forma de ocupação de um território, mesmo dentro de uma pequena região. O objetivo deste estudo foi apresentar as formas de desenvolvimento urbano que ocorreram nas áreas que ficaram à margem do ciclo econômico cafeeiro na região de Botucatu. Nestas áreas, ocorreram formas diferentes de urbanização, raramente estudadas, fruto de um desenvolvimento local lento e influenciado por fatores advindos da vizinhança economicamente dinâmica. Como conclusão e discussão foram apresentadas as formas de urbanização resultantes deste processo e os desafios no planejamento de longo prazo nas áreas estudadas. / The São Paulo State focus today, the greater and more complex urban net of South hemisphere, showing a rich and diversified variety of urbanization forms. The main studies about the hinterland of São Paulo State usually privileged the dominant aspects as the coffee cycle, the immigrants, the railways and more recently, the industrialization of the medium size cities, relegating for second plain the heterogeneity that occurs in the form of territory occupation even in a little region. The aim of this study was to present the forms of urban development occurred in the areas that had been scorned by the coffee plantations economic cycle, in the Botucatu region. In this areas, different forms of urbanization had occurred, results of a local slow development and influenced by external factors caused by the economically dynamic neighborhood. As results and discussion had been showed the urbanization forms of this process and the challenges in long term planning for studied areas.

O Estado de São Paulo centraliza, hoje, a maior e mais complexa rede urbana do hemisfério sul, apresentando uma rica e diversificada gama de formas de urbanização. Os principais estudos sobre a constituição e o desenvolvimento do interior do Estado privilegiaram aspectos dominantes como o ciclo do café, os imigrantes, as ferrovias e, mais recentemente, a industrialização das cidades médias, relegando para segundo plano a heterogeneidade que ocorre na forma de ocupação de um território, mesmo dentro de uma pequena região. O objetivo deste estudo foi apresentar as formas de desenvolvimento urbano que ocorreram nas áreas que ficaram à margem do ciclo econômico cafeeiro na região de Botucatu. Nestas áreas, ocorreram formas diferentes de urbanização, raramente estudadas, fruto de um desenvolvimento local lento e influenciado por fatores advindos da vizinhança economicamente dinâmica. Como conclusão e discussão foram apresentadas as formas de urbanização resultantes deste processo e os desafios no planejamento de longo prazo nas áreas estudadas. / The São Paulo State focus today, the greater and more complex urban net of South hemisphere, showing a rich and diversified variety of urbanization forms. The main studies about the hinterland of São Paulo State usually privileged the dominant aspects as the coffee cycle, the immigrants, the railways and more recently, the industrialization of the medium size cities, relegating for second plain the heterogeneity that occurs in the form of territory occupation even in a little region. The aim of this study was to present the forms of urban development occurred in the areas that had been scorned by the coffee plantations economic cycle, in the Botucatu region. In this areas, different forms of urbanization had occurred, results of a local slow development and influenced by external factors caused by the economically dynamic neighborhood. As results and discussion had been showed the urbanization forms of this process and the challenges in long term planning for studied areas.

The significance of reproductive health and rights cannot be overemphasised. Investment in the rights of rural women, specifically their reproductive health rights, is a fundamental determinant of their empowerment and social development. Access to reproductive health services enables rural women to make informed choices in their reproductive lives. This is of paramount significance because the exercise of choice in one domain opens possibilities for choices in others. International and regional human rights treaties recognise the significance of reproductive health rights for women's wellbeing and survival and require that State Parties provide access to reproductive health services. Zimbabwe has ratified the relevant human rights treaties and has domesticated many of their provisions through the Constitution and other laws. Zimbabwe has obligations to respect, protect, promote and fulfil the right to reproductive health. Despite these obligations, rural women face a plethora of challenges in accessing reproductive health services, and their right to reproductive health continues to be infringed. The infringement is in violation of Zimbabwe's international and domestic human rights obligations. The purpose of this study was to examine and establish the challenges confronting rural women when accessing reproductive health care services in Hwange Rural District Zimbabwe. Using a phenomenology qualitative research design, data were gathered through structured face-to-face interviews with 20 women of reproductive age and five health care providers. Data from the field were bolstered with reviews of extant literature. Collected field data were thematically analysed and presented. The research findings revealed that although most of Zimbabwe's legislative, policy and institutional frameworks have provisions that comply with international obligations, the frameworks also contain restrictive provisions which perpetuate the challenges women face in accessing reproductive health care services. Furthermore, the human-rights compliant legislative and policy frameworks are often not properly implemented, thus leading to a violation of the right to reproductive health in practice. The study's empirical research revealed that in Hwange Rural District, women's capabilities to exercise their reproductive rights are limited by factors such as physical barriers like distance to the nearest health facility, availability of services, quality of care given at health facilities, poverty, religion and patriarchal tradition. A major challenge unearthed by the study was that rural women in Hwange District are not aware of their reproductive health rights. This lack of knowledge is disempowering because women who do not know their rights are not knowledgeable enough to demand their rights or defend them when violated. To redress the challenges faced by rural women, the study found that women can use judicial and extra judicial mechanisms ─ including the courts, human rights institutions, nongovernmental organisations, and civil society organisations ─ for litigation, exertion of political pressure, awareness raising and grassroots mobilisation. Such strategies are essential for ensuring that women hold the State accountable for violations of their reproductive rights. The study concludes that there is need to raise awareness on the right to reproductive health and the enacted laws and policies so as to equip women with the necessary information that will allow them to exercise their rights. It recommends that intensive human rights education programmes for both the formal and informal sector should be prioritised. It recommends the provision of adequate resourcing of various state institutions responsible for women's rights issues. Further, there should be a situational analysis of challenges faced by rural women in Zimbabwe based on the intricate factors of location within rural areas, religion, gender, human rights knowledge, culture and tradition. After such situational analysis, there is need to enact laws and policies that respond directly to the unique challenges faced by rural women, without using a ‘one size fits all' approach.

<p> <p>&nbsp / </p> </p> <p align="left">This study aims to analyse the clinical and immunological responses and survival pattern of HIV/AIDS patients receiving ART in Nyangana District.</p>