Submitted in fulfilment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, 2013. / South Africa is one of 12 countries where the under-five child mortality rate has increased. In response to this challenge, the WHO and UNICEF in the 1990s developed Integrated Management of Childhood Illness (IMCI), a strategy to reduce child mortality and morbidity. IMCI training was launched in South Africa in 1998. Health care workers trained in IMCI face many challenges when applying the new integrated case management approach. Training settings tend to differ from the actual work environment. Simulation is practiced in an enclosed environment and certain assessments are not possible for example chest in drawing, level of consciousness, oedema amongst others. In South Africa, there has been limited research on IMCI in-service and pre-service training and no research has been conducted regarding the training of student nurses on IMCI and follow up of these learners in the clinical field. Purpose of the study The purpose of this study was to evaluate the IMCI training of learners in the use of IMCI Guidelines in the KwaZulu-Natal College of Nursing (KZNCN). Methodology This study followed a descriptive quantitative approach and evaluates the training of the learners and the facilitation and training of lecturers with regards to IMCI in the KZNCN campuses. Data was collected using questionnaires for facilitators and learners on the three campuses. Results The findings of this study revealed that teaching and learning approaches used to facilitate IMCI were adequate except for clinical practice and theory which was reported to be insufficient.

My diploma thesis deals with Low-threshold services for children and youth and with fulfilling of the standards for quality in social services. Firstly I analysed problems of leisure time, historical events in the development in Low-threshold services for children and youth and binding documents for social workers. These problems are also discussed in relevance to the social services law. I mentioned the principles of low-threshold, aims of these establishments, target group and the whole process of this programme. One chapter deals with the management and financing and with social workers, their qualities, competences and supervision as the aide in self-education, and beneficiaries of social services and their characteristics. What threatens these beneficiaries are socio-pathological phenomenons, the most important ones are listed and I added the prevention. I described one mentioned establishment, which employs volunteers. For the evaluation of fulfilling of standards in social services I have chosen two low-threshold services for children and youth from Hradec Králové, where I have found if the standars are fulfilled or not by means of studying of methodology, observations and interviews with workers and beneficiaries. For conclusion I suggested some improvements which could be used in these establishments.

This dissertation consists of three empirical essays investigating different aspects of health care for children and families. The first essay examines the effectiveness of adherence to American Academy of Pediatrics guidelines for preventive pediatric health care. Using a national longitudinal sample of children age two years and younger, we investigate whether compliance with prescribed periodic well-child care visits has beneficial effects on child health. We find that increased compliance improves child health. In particular, higher compliance lowers future risks of fair or poor health, of some history of a serious illness and of having a health limitation. The second essay examines child health care utilization in relation to maternal labor supply. We test the hypothesis that working-mothers trade off the advantages of greater income against the disadvantages of less time for other valuable tasks, such as seeking health care for their children. This tradeoff may result in positive, negative, or no net impacts on child health investment. We estimate health care demand regressions that include separate variables for mother’s labor supply and her labor income. Our results indicate that higher maternal work hours reduce child health care visits; higher maternal earnings increase them. In addition, wage-employment, as opposed to self-employment, is detrimental to child health investment. A further finding is that preventive care demand for younger children is less sensitive to maternal time and income changes. We also find that detrimental time effects dominate beneficial income effects. The third essay studies intra-household resource allocation as it pertains to its demand for preventive medical care. We test the income-pooling hypothesis of the common preference model by using individual specific medical care consumption data and present evidence on the allocation of household resources to the medical needs of the child, husband and wife. Our results are in line with the findings of previous studies that emphasize the ongoing importance of the traditional gender role of woman as the primary caregiver. We find that the resources of the wife have a greater positive impact on child’s and her own preventive care demand than does the resources of the husband. In contrast to most studies from developing countries, we find that US families do not exhibit differential health care demand based on child gender. It is also noteworthy that the wife’s education level has a greater positive impact than that of her husband does on both the husband’s and her own preventive care utilization. / text

Statistics on HIV/AIDS are alarming. Very little is known about how communities are actually coping with this disease and what methods seem to be working to empower them to deal with it. Psychosocial distress is one of the dimensions of the impact of AIDS on children and families, and stresses the necessity to enhance the capacities of extended families and friends to be able to deal with these psychosocial issues. Using qualitative research and a case study as the strategy of inquiry, this dissertation of limited scope explores and describes the factors influencing the capacity of extended families in providing psychosocial support to AIDS orphans. A literature study was done to give a theoretical overview on the following aspects: * AIDS orphans * The extended family and HIV/AIDS To reach the first objective of this study, an empirical study was done and semi-structured interviews were used to obtain information from four extended families in the Mukwe area of the Kavango Region in Namibia. The literature study and the empirical study enabled the researcher to draw conclusions on the factors which influence the capacity of extended families to provide psychosocial support to AIDS orphans. The information was analysed, interpreted and published in this research report so as to reach the other objectives of this study. / Social Work / M. Diac. (Play therapy)

A distressing consequence of the HIV/AIDS pandemic and of the increasing numbers of orphans and decreasing numbers of caregivers is the emergence in ever larger numbers of child-headed households (CHHs). The complexity of issues affecting CHHs and the lack of research on this subject means that CHHs are not well understood. This sometimes prompts support agencies to provide emotionally driven recommendations suggesting that it is better for a child to be in an orphanage than to live in a CHH. This exploratory study, involving heads of 105 CHHs over a 12 month period and 142 participants in various focus group discussions (FGD) and interviews, suggests the need for a change in perspective. It addresses the question of CHH quality of life, coping strategies and household functioning and attempts to bring this into a productive dialogue with community child care activities, NGO and statutory support and child care and protection policies. Research data suggests that the key determining factor contributing towards the creation of a CHH is `pre-parental illness' family conflict. Another contributing factor is that siblings want to stay together after parental death. Quality of life assessments indicate that despite significant adversities, over 69% of CHHs reported a 'medium' to 'satisfactory' quality of life and demonstrate high levels of resilience. As regards vulnerability to abuse, it is found that while CHH members are more vulnerable to external abuse, they experience little within their household. Contrary to public perceptions about CHHs lacking moral values, CHH behaviour might actually be more responsible than non-CHH peer behaviour as their negative experiences appear to galvanize them into adopting responsible behaviour. Community care and neighbourhood support in older townships are better established compared with newer suburbs. Sufficient community care capacity enables CHHs to function, thus avoiding a situation where households disintegrate and household members end up as street children. CHH coping responses seem to be mainly influenced by individual and community factors, and by social, spiritual and material support. The interplay between these and the CHH's ability to engage in the required coping task impacts on the coping outcome at household level. National and international government and non-governmental child service providers in Southern Africa need to recognize that an adequately supported CHH is an acceptable alternative care arrangement for certain children in communities with high adult AIDS mortality and where adult HIV-prevalence exceeds 10%. / Development Studies / D. Ltt. et Phil. (Development Studies)

The study explored the psychosocial needs of Orphans and Vulnerable Children (OVCs) affected by HIV and AIDS in Gokomere, a rural area of Masvingo Province, Zimbabwe. The participants of the study included OVCs, caregivers and members of non-governmental organisations (NGOs) and faith-based organisations (FBOs). The data was gathered using semi-structured in-depth interviews and a focus group discussion. The audio-taped data was transcribed, coded and interpreted to generate themes, categories and sub-categories. The main psychosocial needs of OVCs affected by HIV and AIDS were found to be the need for relationships, succession planning, social protection and emotional and spiritual support. Kinship care emerged to be the most important form of care for OVCs while home-based care and child-headed households emerged as new forms of care for OVCs. This study recommends that coordinated efforts by the government, NGOs/FBOs/CBO and the community at large is needed to address the challenges facing OVCs affected by HIV and AIDS. / Health Studies / M.A. (Social Behaviour Studies in HIV/AIDS)

Placement of orphans under kinship foster care is a common occurrence in social work practice, especially around Bushbuckridge in Mpumalanga Province. Social workers are facing the challenge of an alarming increase in foster care cases due to the HIV and AIDS pandemic in the area. Thus the social workers are trapped in a situation of having to place orphans in kinship foster care, without adequate preparation nor the opportunity to explore the feelings and experiences of being in a child-headed household. This study aimed at exploring and describing the experiences and expectations of orphans who were in charge of child-headed households, regarding their preparation for being placed in kinship foster care and their subsequent placement in such care. Research findings revealed that some orphaned children who had previously been heading a child-headed household and were now placed in kinship foster care were continuing to head the households despite the fact that an order had been issued by the children’s court for them to be under the care and guidance of kin foster parents. The non-involvement of orphaned heads of households in any decisions that affect them emerged in the findings of the study as a critical issue. Another important finding was that some orphaned children in kinship foster care experienced the abuse of the foster care grant by their kin foster parents. The research study has made provision for conclusions and recommendations to all role-players responsible for placing child-headed households in kinship foster care in order to enhance the efficacy of kin foster care placement. / Department of Social Work / M.A. (Social Science (Mental Health))

Statistics on HIV/AIDS are alarming. Very little is known about how communities are actually coping with this disease and what methods seem to be working to empower them to deal with it. Psychosocial distress is one of the dimensions of the impact of AIDS on children and families, and stresses the necessity to enhance the capacities of extended families and friends to be able to deal with these psychosocial issues. Using qualitative research and a case study as the strategy of inquiry, this dissertation of limited scope explores and describes the factors influencing the capacity of extended families in providing psychosocial support to AIDS orphans. A literature study was done to give a theoretical overview on the following aspects: * AIDS orphans * The extended family and HIV/AIDS To reach the first objective of this study, an empirical study was done and semi-structured interviews were used to obtain information from four extended families in the Mukwe area of the Kavango Region in Namibia. The literature study and the empirical study enabled the researcher to draw conclusions on the factors which influence the capacity of extended families to provide psychosocial support to AIDS orphans. The information was analysed, interpreted and published in this research report so as to reach the other objectives of this study. / Social Work / M. Diac. (Play therapy)

A distressing consequence of the HIV/AIDS pandemic and of the increasing numbers of orphans and decreasing numbers of caregivers is the emergence in ever larger numbers of child-headed households (CHHs). The complexity of issues affecting CHHs and the lack of research on this subject means that CHHs are not well understood. This sometimes prompts support agencies to provide emotionally driven recommendations suggesting that it is better for a child to be in an orphanage than to live in a CHH. This exploratory study, involving heads of 105 CHHs over a 12 month period and 142 participants in various focus group discussions (FGD) and interviews, suggests the need for a change in perspective. It addresses the question of CHH quality of life, coping strategies and household functioning and attempts to bring this into a productive dialogue with community child care activities, NGO and statutory support and child care and protection policies. Research data suggests that the key determining factor contributing towards the creation of a CHH is `pre-parental illness' family conflict. Another contributing factor is that siblings want to stay together after parental death. Quality of life assessments indicate that despite significant adversities, over 69% of CHHs reported a 'medium' to 'satisfactory' quality of life and demonstrate high levels of resilience. As regards vulnerability to abuse, it is found that while CHH members are more vulnerable to external abuse, they experience little within their household. Contrary to public perceptions about CHHs lacking moral values, CHH behaviour might actually be more responsible than non-CHH peer behaviour as their negative experiences appear to galvanize them into adopting responsible behaviour. Community care and neighbourhood support in older townships are better established compared with newer suburbs. Sufficient community care capacity enables CHHs to function, thus avoiding a situation where households disintegrate and household members end up as street children. CHH coping responses seem to be mainly influenced by individual and community factors, and by social, spiritual and material support. The interplay between these and the CHH's ability to engage in the required coping task impacts on the coping outcome at household level. National and international government and non-governmental child service providers in Southern Africa need to recognize that an adequately supported CHH is an acceptable alternative care arrangement for certain children in communities with high adult AIDS mortality and where adult HIV-prevalence exceeds 10%. / Development Studies / D. Ltt. et Phil. (Development Studies)

Text in English / Child-headed households are a reality in South Africa, and extensive research has advanced its causes and the children’s coping mechanisms. Social workers identify children in need, refer them to SASSA for social grants, facilitate foster care placements and offer psychosocial support services. This study sought to determine the nature of social work services rendered to children in such households in Virginia in the Free State. Qualitative exploratory, descriptive and contextual research was used to reach the goal of the study. Thirteen semi-structured interviews were conducted with thirteen participants who were selected through purposive sampling. The data collected was analysed using the eight steps of Tesch (in Creswell, 2009) and verified through Guba’s method of trustworthiness (Krefting, 1991). The services rendered to child-headed households (CHHs) through individual, group and community work were inadequate due to lack of resources including a shortage of social workers due to a general dissatisfaction with salaries. Participants suggested the need to build the capacity of the available staff through staff training and improved access to available resources in order to strengthen the nature of services rendered to CHHs. / Social Work / M.A. (Social Work)