Abstract   Back ground: Home based care is a meaningful activity giving patients and their families a chance to live their lives as close to normal as possible. Advanced palliative care is today provided at home, although geography does play a role in shaping that care. A rural setting can mean that conditions for such care differ from those in urban areas. Purpose: To describe the experiences of district nurses in palliative home care settings in a rural community. Method: Semi structured interviews with seven district nurses. The interviews were recorded digitally and transcribed in a precise fashion. A method of qualitative analysis of the contents, inspired by Burnard, was used to analyze the material. Results: Palliative care places high demands on the competency and experience of district nurses. The conditions of a rural setting contribute to the structure of such care in so far as its organization and prioritization. The work of the district nurses involved was marked by cooperation and peer support. The fact that the care for patients varied between communities was however, seen as unfair. Conclusion: The study expands the body of knowledge of the experiences of district nurses. It also clarifies the conditions that influence palliative care in a rural community. Hopefully this study will contribute to further development of palliative home care, and enable those affected to receive care on more equal terms.

Thesis (MSc. (Geography)) -- University of Limpopo, 2018 / In spite of the widespread scientific debate on the impacts of climate variability, not much is known about smallholder farmers’ perceptions towards climate variability and the impacts thereof on their agricultural practices. This is especially true for smallholder farmers in Sub-Saharan Africa in general and South Africa in particular. Literature contends that an understanding of the farmers’ perceptions of climate change and variability is indispensable for effective policy formulations and adaptive strategies. This current study posits that discrepancies between farmer perceptions and climatological evidence will negatively impact on farmer adaptation options and outcomes. The objectives of the study were to; (1) assess climate variability in Molemole Local Municipality, Limpopo Province, (2) investigate farmers’ perceptions of climate variability, (3) compare farmers’ perceptions of climate variability with climatological data and (4) appraise farmers’ adaptive strategies to climate variability. A total of 125 farmers from Botlokwa Village participated in the study. The village was selected because it is the largest village in the municipality and it comprises mainly of rural farmers that are involved in rain-fed subsistence agriculture. In addition, the village receives limited government intervention and is in close proximity to a functional climate station (Polokwane Airport Weather Station). Based on purposive sampling, focus group discussions and a three-part closed ended questionnaire was administered to the farmers. Mean annual temperature and rainfall data (30 years) was used to assess climate variability in the study area. Farmers’ perceptions to climate variability was assessed using descriptive statistics based on summary counts of the responses with Statistical Package for Social Science (SPSS) program. Logistic regression analysis was used to compare differences in perception (mean responses). Comparison of farmers’ perceptions of climate variability against climatological evidence was restricted to mean annual temperature and rainfall data over the past 5 – 10 years). To appraise farmers’ adaptive strategies, the Adaptation Strategy Index (ASI) and the Weighted Average Index (WAI) were employed. vi Farmers’ perceptions of climate variability were consistent with recorded meteorological data. Based on the ASI and WAI computations, use of indigenous knowledge systems (IKS) and crop management approaches were highly important adaptation strategies while the use of insurance and subsidies were least employed by the farmers. The results from the study also showed that the age of the household head, gender, level of education, farming experience and access to information on climate variability were crucial factors in influencing the likelihood of farmers to perceive climate variability. Given the overwhelming dependence on IKS for weather forecast, and adaptation to climate variability, it is recommended that IKS take centre stage in government initiatives and policies on climate change and variability, especially for smallholder farmers in rural settings. Sensitisation on the use of technology such as cellular phones to receive weather forecast is also recommended.

In Burkina Faso, evidence-based knowledge on mental health disorders, their prevalence and the characteristics of people living with these disorders is scarce. Without these data, the government can not properly allocate sufficient human and financial ressources to mental health services. The available information in the country was collected in urban settings, where most mental health services are concentrated. Therefore, information on mental health prevalence outside of urban settings is limited. A single preliminary study demontrated a substancial presence of mental health symptoms in rural settings, especially in an indigent population. The present study therefore aimed to evaluate the prevalence of three types of mental health symptoms (anxiodepressive, somatic, psychotic) in indigents living in a rural setting in Burkina Faso. Furthermore, it aimed to identify the sociodemographic, physical and psychological determinants pertaining to each type of symptoms. The participants of this study (n = 1314) belong to four health districts of the country. Data were gathered about their physical and mental health by local, trained interviwers. / Au Burkina Faso, les informations sanitaires sur l’état de santé mentale des indigents vivant en région rurale est presque inexistante. Ce manque de données probantes a des impacts négatifs sur les services offerts dans ce domaine et ce, particulièrement sur les groupes vulnérables. Objectifs : Parmi une population indigente vivant en région rurale au Burkina Faso, le but de cette recherche est d’évaluer la prévalence de trois types de symptômes de santé mentale, soit les symptômes anxiodépressifs, somatiques et psychotiques. Ensuite, les déterminants individuels, physiques et psychologiques reliés à chaque type de symptômes seront identifiés. Méthode : Au cours d’entrevues guidées par des enquêteurs formés, les indigents (n = 1314) provenant de quatre districts sanitaires ont rempli un questionnaire qui évaluait leur état de santé physique et mentale. Des données sociodémographiques ont également été recueillies lors de ces entrevues. Résultats : Les symptômes se regroupent sous trois types distincts : anxiodépressifs, somatiques et psychotiques. Un total de 1234 (n = 93,9%) participants ont répondu avoir ressenti au moins un symptôme anxiodépressif dans le dernier mois. Les déterminants liés à ce type de symptômes sont les suivants : le district sanitaire, l’âge, l’état de santé, le besoin en nourriture, un événement dramatique survenu dans la dernière année, le fonctionnement global, le sentiment d’exclusion, les symptômes somatiques et les comportements stigmatisés. Au moins un symptôme somatique a été ressenti dans le dernier mois par 1087 (n = 82,7%) répondants. Ce type de symptômes est en lien avec les déterminants suivants : le district sanitaire, la cohabitation, un problème de santé, l’état de santé perçu, le manque de moyens financiers pour obtenir des soins de santé, le fonctionnement global, le sentiment d’exclusion et les comportements stigmatisés. Finalement, 256 (n = 19,5%) indigents ont répondu avoir vécu au moins un symptôme psychotique au cours de leur vie. Les déterminants en lien avec ces symptômes sont ceux-ci : le district sanitaire, le sentiment d’exclusion et les comportements stigmatisés. Conclusion : Les résultats montrent que la prévalence de symptômes de troubles de santé mentale est élevée chez les indigents interrogés et que ceux-ci se sentent exclus de leur communauté. Pour assurer l’équité d’accès aux soins de santé, les indigents atteints de symptômes de santé mentale doivent bénéficier d’un processus spécifique de prise en charge. Cette problématique doit être encadrée par des politiques de santé et des ressources sont nécessaires pour répondre au besoin présent dans cette population.

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