A research report submitted to the Faculty of Management, University of Witwatersrand, in 50% fulfilment of the requirements for the degree of Master of Management (in the field of Public and Development Management) September 2016 / The objective of the South African Integrated School Health Programme is to improve health status of learners at schools. Health programmes have been implemented through the integrated school health programme at schools in South Africa since 2012. Targets were set to monitor the implementation of the programme in provinces. The North West Province did not reach its targets for the health programme between 2014 and 2015. A qualitative study was conducted to investigate barriers to implementation of the programme in Ditsobotla sub district. A sample of twenty five participants was selected from a group of teachers, principals and school governing body at ten schools, nurses, education managers, and NGO. In-depth interviews and focus group discussions were conducted. The main findings were that learners were not able to utilize the integrated school health programme service because parents did not give consent. The programme did not have enough dedicated school health programme service providers. Consequently the study recommends that more advocacy sessions should be conducted with the key stakeholders. This study can form a basis for further research seeking to improve the integrated school health programme in the North West Province. / GR2018

The physical, psychological and social development of school children has been neglected - partly because they were seen as healthy "survivors" of the ravages of childhood illnesses, and partly because of the way in which health services are organized (such as the traditional under-five maternal and child health (MCH) services and the curative PHC clinic services). From the age of five years children undergo rapid and profound bio-psycho-social development, to emerge in adolescence as the next generation of leaders and workers. Securing their future growth and development is vital for any society to be economically and socially productive. A substantial body of national and intemational literature has recognised the detrimental impact of helminthic infections and micronutrient deficiencies on the physical and psychological health and development of school children; which requires appropriate nutritional interventions. Concern has been expressed that these adverse biological, physical and social deprivations have a cumulative impact on several dimensions of children's growth. Most important, apart from stunting physical growth, is the inhibition of educational development of school children. Recent evidence strongly suggests a powerful interaction between physical and psychosocial growth and development of children. Inhibition of either component of a child's well-being has adverse implications. Conversely, investments in the physical and psychological development of children are likely to generate substantial health and educational benefits and are a worthy investment to secure a healthy future generation. In summary, there are a number of reasons for, and benefits of, investing in school-based health and nutrition interventions. They are likely to improve learning at school and enhance educational outcomes; create new opportunities to meet unfulfilled needs; redress inequity; build on investments in early child development and promote and protect youth and adolescent development. Health and nutrition interventions such as school feeding programmes, micronutrient supplementation and deworming aim to improve primary outcomes of macro and micro-nutrient deficiencies, parasitic and cognitive status; as well as secondary outcomes of developing integrated comprehensive school health policies and programmes. This rationale served as the conceptual framework for this study. This theoretical framework views improvements of the health, nutritional, cognitive and scholastic development status of school children as the primary focus of policies, strategies and programmes in the health and education sector. This focus constitutes the central core of this thesis. Optimum social development requires investments in both the health and educational development of school children, so as to maximise the synergies inherent in each sector and to operationalise national and international strategies and programmes. As part of the larger RCT study a comprehensive nutritional, health and psychological profile of rural school children was established through a community-based cross-sectional study. Eleven schools were randomly selected from the Vulamehlo Magisterial District in southern KwaZulu-Natal (KZN). Within each school, all Standard 1 pupils, aged between 8 - 10 years, were selected giving a final study sample of 579 children. Some of the observed prevalence's were stunting (7.3%), wasting (0.7%), anaemia (16.5%) (as measured by haemoglobin below 12 g/dl), vitamin A deficiency (34.7%) (as measured by serum retinol below 20 ug/dl) and serum ferritin below 12ng/ml (28.1%). This study established that micronutrient deficiency, parasitic infestations and stunting remain significant public health problems among school-aged children in South Africa. Combining micronutrient supplementation and deworming are likely to produce significant health and educational gains. To determine the impact of single and combined interventions (anthelminthic treatment and micronutrient supplements) on nutritional status and scholastic and cognitive performance of school children, a double-blind randomised placebo controlled trial was undertaken among 579 children 8-10 years of age. There was a significant treatment effect of vitamin A on serum retinol (P<0.01), and the suggestion of an additive effect between vitamin A fortification and deworming. Vitamin A and iron fortification also produced a significant treatment effect on transferrin saturation (P<0.05). Among the dewormed group, anthelminthic treatment produced a significant decrease in the prevalence of helminthic infections (P<0.02), but with no significant between-group treatment effect (P>0.40). Scholastic and cognitive scores and anthropometric indicators were no different among the treated or the untreated children. Fortified biscuits improved micronutrient status among rural primary school children; vitamin A combined with deworming had a greater impact on micronutrient status than vitamin A fortification on its own; while anthelminthic treatment produced a significant reduction in the overall prevalence of parasite infection. The prevalence's of Ascaris lumbricoides, Trichuris trichiura and Schistosoma haematobium declined significantly sixteen weeks post-treatment. The levels of both prevalence and intensity in the untreated group remained constant. The cure rates over the first two weeks of the study were 94.4% for Ascaris lumbricoides, 40% for Trichuris trichiura, and 72.2% for Schistosoma haematobium. The benefits of targeted school-based treatment in reducing the prevalence and intensity of infection supports the South African government's focus of using school-based interventions as part of an integrated parasite control programme. These strategies and programmes were found to be consistent with the recommendations of WHO and UNICEF. The nutritional transition facing developing and middle-income countries also has important implications for preventive strategies to control chronic degenerative diseases (Popkin B, 1994; WHO 1998; Monyeki KO, 1999). This descriptive study, comparing BMI data of school children over three time periods, found a rising prevalence of overweight and obesity among South African school children. Obesity as a public health problem requires to be addressed from a population or community perspective for its prevention and management. Environmental risk factors such as exposure to atmospheric pollution remain significant hazards for children. Lead poisoning is a significant, preventable risk factor affecting cognitive and scholastic development among children. The prevalence of elevated blood lead (PbB) levels in rural and semi-urban areas of KwaZulu-Natal (KZN) as well as the risk factors for elevation of PbB among children in informal settlements were examined. This study investigated over 1200 rural and urban children in two age groups: 3-5 and 8-10 years old. Average PbB level in peri-urban Besters, an informal settlement in the Durban metropolitan region, was 10 ug/dl with 5% of the children showing PbB level of greater than 25 ug/dl. By comparison, average PbB value in Vulamehlo, a rural area located 90-120 km from Durban, was 3.8 ug/dl and 2% of the children's PbB levels were greater than 10 ug/dl. Since the cognitive and scholastic performance of school children was a primary outcome measure in this study, it was important to explore other factors that influenced this variable. The performance scores of all four tests in the battery, among the cohort of a thousand rural and urban children, were in the lower range. The educational deficit identified in this test battery clearly indicates the impact of the inferior "Bantu" educational system that African children have experienced in South Africa. Aspects of the School Health Services that were investigated in this descriptive study included the services provided and their distribution; assessment of health inspection; health education and referral processes undertaken by the School Health Teams; perceptions of managers, providers and recipients of the service; as well as the costs of the provision of the service in KwaZulu-Natal. In KwaZulu-Natal, there were School Health Teams In all the 8 health and education regions in the province. In total, there were 95 teams in the province, consisting of nearly 300 staff members. The School Health Teams were involved in a wide range of activities - 74% of all teams were involved in health inspection and 80% were involved in health education. The total annual cost of delivering School Health Services in the province in 1995 was estimated to be approximately R8 750 000. Given the rise of HIV and AIDS in the province, School Health Services need to play a central role not only in prevention, but also in assisting with the acceptance of HIV-positive children within schools. It is recommended that the current and future draft SHS policy guidelines be approved by the relevant authorities for immediate implementation. Districts should consider developing "Health Promoting Schools", with School Health Teams being a central resource. This thesis has explored several aspects of the epidemiological profile of school children in rural and urban settings in KwaZulu-Natal. It has established that school children are exposed to a range of risk factors ranging from nutritional deficits, parasitic infections, atmospheric lead poisoning and a rising prevalence of overweight. All of these risk factors may compromise their physical, psychological and social development. A number of health interventions have been identified, which have the potential to address these problems. Such investments are essential to secure the health of future generations. / Thesis (M.D.)-University of Natal, Durban, 2001.

This study identifies the Integrated School Health Programme’s implementation constraints in (Ekurhuleni Metropolitan Municipality, Southern Region), and describes how these constraints have affected the implementation of school health services. This predominantly qualitative study employed the structured interview-based research design and focus group discussion approaches, with the target population consisting of school health nurses and educators working with them in Ekurhuleni Metropolitan Municipality, Southern Region. The criterion-referenced sampling strategy was opted for, because of the researcher’s knowledge of the research environment. The focus group discussions, structured interviews and participant observations complement the study’s data collection methods. The principal findings depicted the Integrated School Health Programme was not as effective as expected in its implementation. The main constraints were identified as lack of resources and knowledge; and poor teamwork of the Department of Health, the Department of Basic Education, and parents. Emanating from these findings, the study recommends innovative collaboration mechanisms between the two government departments, and that relevant and sufficient resources should be allocated for effectively implementing the Integrated School Health Programme. / Health Studies / M. P. H.

The purpose of this study is to explore and describe the nature and extent of school health nurses’ roles and responsibilities in the prevention of drug abuse by learners in schools. The study was conducted at two high schools in Eldorado Park Extension 4 (Region G), in Johannesburg West. A mixed-methods (triangulated) research approach was opted for, in terms of which structured focus group interviews, self-administered questionnaires, and participant observations optimised and complemented the data collection process. The non-probability simple random sampling technique was utilised to select 35 research participants consisting of 9 (nine) educators, 1 (one) school health nurse and 25 community healthcare workers. The 1 (one) school health nurse and the 25 community-based healthcare workers were involved in the study by means of structured self-administered questionnaires, while the nine (9) educators (who were not part of the 26) only participated in the study’s two focus group interview sessions. Among others, the study’s findings indicate that the distribution of professionally trained and registered school health nurses is not yet proportionally commensurate to addressing the problem of drug and substance abuse in schools. There has been a need to augment the shortage of school health nurses with community-based school health workers. / Health Studies / M.A. (Nursing Science)

The problem this research seeks to address is the support educators receive in teaching HIV and AIDS topics in the classroom. The reason for the choice of topic is to contribute to the revival of HIV and AIDS education in all schools in South Africa. This exploratory study uses the empowerment theory and presents the qualitative research findings based on in-depth interviews with six educators, four school managers and two parents. Thematic content analysis is used to analyse the data. The study found out that the Department of Education had in the past two years provided training workshops for principals of schools, educators and peer educators in the last two years yet the findings from the two schools under study painted a different picture all together. Findings from the interviews show that any support from the Department of Education or any other stakeholder involved in education, such as the Teacher Unions, happened some years ago. Some of the respondents were not very comfortable on this topic as to most of them HIV and AIDS education is not really being taught as it used to years ago. Finally, the research made some recommendations to these two schools on what could be done as a way of reviving HIV and AIDS education to help children and youths to grow up better able to challenge HIV and AIDS. This is in line with the Southern and Eastern Africa Consortium for Monitoring Educational Quality (SACMEC) 2011 report that the education sector has a critical role to play in terms of the delivery of effective HIV and AIDS prevention and awareness programmes. The findings were important as they highlighted the need for the Department of Education to monitor and evaluate the implementation of HIV and AIDS policies in all public schools. They also they gave recommendations on the way forward on HIV and AIDS education in primary schools. / Health Studies / M.A. (Social Behaviour Studies in HIV and AIDS)

The problem this research seeks to address is the support educators receive in teaching HIV and AIDS topics in the classroom. The reason for the choice of topic is to contribute to the revival of HIV and AIDS education in all schools in South Africa. This exploratory study uses the empowerment theory and presents the qualitative research findings based on in-depth interviews with six educators, four school managers and two parents. Thematic content analysis is used to analyse the data. The study found out that the Department of Education had in the past two years provided training workshops for principals of schools, educators and peer educators in the last two years yet the findings from the two schools under study painted a different picture all together. Findings from the interviews show that any support from the Department of Education or any other stakeholder involved in education, such as the Teacher Unions, happened some years ago. Some of the respondents were not very comfortable on this topic as to most of them HIV and AIDS education is not really being taught as it used to years ago. Finally, the research made some recommendations to these two schools on what could be done as a way of reviving HIV and AIDS education to help children and youths to grow up better able to challenge HIV and AIDS. This is in line with the Southern and Eastern Africa Consortium for Monitoring Educational Quality (SACMEC) 2011 report that the education sector has a critical role to play in terms of the delivery of effective HIV and AIDS prevention and awareness programmes. The findings were important as they highlighted the need for the Department of Education to monitor and evaluate the implementation of HIV and AIDS policies in all public schools. They also they gave recommendations on the way forward on HIV and AIDS education in primary schools. / Health Studies / M.A. (Social Behaviour Studies in HIV and AIDS)

The problem this research seeks to address is the support educators receive in teaching HIV and AIDS topics in the classroom. The reason for the choice of topic is to contribute to the revival of HIV and AIDS education in all schools in South Africa. This exploratory study uses the empowerment theory and presents the qualitative research findings based on in-depth interviews with six educators, four school managers and two parents. Thematic content analysis is used to analyse the data. The study found out that the Department of Education had in the past two years provided training workshops for principals of schools, educators and peer educators in the last two years yet the findings from the two schools under study painted a different picture all together. Findings from the interviews show that any support from the Department of Education or any other stakeholder involved in education, such as the Teacher Unions, happened some years ago. Some of the respondents were not very comfortable on this topic as to most of them HIV and AIDS education is not really being taught as it used to years ago. Finally, the research made some recommendations to these two schools on what could be done as a way of reviving HIV and AIDS education to help children and youths to grow up better able to challenge HIV and AIDS. This is in line with the Southern and Eastern Africa Consortium for Monitoring Educational Quality (SACMEC) 2011 report that the education sector has a critical role to play in terms of the delivery of effective HIV and AIDS prevention and awareness programmes. The findings were important as they highlighted the need for the Department of Education to monitor and evaluate the implementation of HIV and AIDS policies in all public schools. They also they gave recommendations on the way forward on HIV and AIDS education in primary schools. / Health Studies / M.A. (Social Behaviour Studies in HIV and AIDS)

Text in English / Learner pregnancy in secondary schools of South Africa is a public health problem that requires the involvement of parents, teachers and health workers in order to promote maternal and child health and retain learners in school. The aim of this study was to explore and describe the experiences of teachers, parents and pregnant learners regarding facilitation of health for pregnant learners and then develop a model to facilitate social support for pregnant learners attending secondary schools in order to attain and maintain health for the mother and her newborn baby and prevent school dropout. A qualitative, exploratory, descriptive and contextual theory generating study was conducted using semi-structured interviews to collect data from ten pregnant learners, ten teachers and five parents who were purposely selected and voluntarily participated. Data was analysed using Tesch’s open coding method where six themes emerged. The themes were then discussed with literature control. The findings revealed that pregnancy amongst secondary school learners in Limpopo Province is a challenge to teachers, parents and pregnant learners regarding social support for pregnant learners to continue attending school and remaining healthy. A concept analysis was performed and revealed facilitation of social support as the main concept, and then other concepts related to it were identified and classified. The model was developed through the steps of theory generation and was then submitted to a panel of experts for evaluation who found it useful to nursing practice and society in general. The model promotes interaction between the role players in education to address learner pregnancy and can also be useful in addressing other challenges in the schools. It is facilitated by a school health nurse but can also be facilitated by a teacher or a social worker in cases where a school health nurse is not available. The guidelines for the implementation of the model were formulated and described. Pregnant learners, as recipient of social support, should submit themselves to the support offered by the social network and communicate their needs openly to the professional nurse, their parents and teachers, so that they can receive adequate social support. / Health Studies / D. Litt. et Phil. (Health Studies) / 1 online resource (xv, 206 pages) : illustrations (some color), maps (some color)

Injuries, illnesses and deaths happening in schools are a growing menace in Gauteng province, South Africa. This qualitative research study sought to evaluate the administrative efficacy of first aid (FA) provisioning in Gauteng schools in the wake of rampant injuries, deaths and disfigurement among learners and teachers, as documented in the local print and electronic media. An emergent research design underpinned by a phenomenological theoretical perspective unravelled the administrative efficacy of the provisioning of FA in two pre-schools, two primary schools and two high schools in Gauteng province. Observations in one school, semi-structured face-to-face interviews with one pre-school manager, three FA appointed persons, one deputy headmaster and a subject head of department, as well as focus group discussions with learners and teachers in two schools, were the data-gathering tools. A thematic analysis approach was the method adopted to analyse data. Research findings indicate very low levels of FA literacy and competency among learners, teachers, pre-school managers and principals in the sampled schools. I recommend and advocate a national conversation aimed at instituting a massive drive to make it mandatory for all learners and teachers to be trained in FA. / Educational Leadership and Management / D. Ed. (Education Management)

This study evaluates a sex education programme administered in an Indian high school. To this end, a literature search, empirical study and qualitative data were used to measure the effectiveness of the Education for Living programme. Adolescents are blamed for having pennissive attitudes, or for indulging in amoral sexual behaviour without considering the consequences. The fact is, sexual development of young people is affected in a fundamental sense by what is taking place around them. Many of the taboos, which operated in society years ago, have disappeared. This study looks into the history of the South African Indian community. In particular, this study focuses on the community's values, attitudes and traditional practices toward sexuality, sex and marriage. It further highlights how the processes of westemisation and modernisation have eroded many of these aspects of traditional Indian culture. The study concludes by examining the emergence of new-found patterns of behaviour and attitudes. It is not the intention of this study to provide any conclusive documentation on the subject of the Indian adolescent. However the major findings of this study have been fommlated as recommendations and implications for further research. Since sexuality is an ever-changing, life-long experience, there is a need for continuous acquisition of accurate sexual knowledge. Carefully designed programmes may serve to allay fears, dispel myths, diminish confusion, enhance communication within families and promote health and wellbeing across generations. / Social Work / M.A. (SS) (Mental Health)