Literacy includes many skills involving the use of language to read, write, listen, and speak. The ultimate goal in acquiring literacy skills is to function as independently, and in as integrated a manner as possible, in a literate society. Literary skills are critical skills for all students, both with and without disabilities. Since the 1990s, literacy has moved closer and closer to the forefront of our collective awareness regarding students who are at risk of not acquiring sufficient literacy ability. However, students with moderate and severe intellectual disability (MSID) have not always been included in this group of students. In recent years, there has been a greater effort to examine how to provide literacy instruction in a more complete and comprehensive manner for students with MSID. At the present time, there is limited research obtained directly from classroom teachers on their knowledge, beliefs, and practices about students with MSID and literacy. If we are to make effective and meaningful changes in literacy instruction for students with MSID, it is important to further investigate these variables as reported by teachers themselves. This research study examined, through the collection of survey data, teachers’ perceptions about literacy skills for students with MSID. The research questions were: (a) What do classroom teachers of students with MSID in Kentucky report as having learned in their university/college teacher preparation programs about literacy? (b) What do special education teachers in Kentucky believe about their students with MSID and literacy? and (c) In which literacy skill areas (phonemic awareness, phonics, vocabulary, fluency, and comprehension) do teachers of students with MSID in Kentucky report they are providing instruction?

L’asthme sévère de l’enfant est une pathologie respiratoire chronique dont le traitement est difficile. L’épithélium bronchique à l’interface de l’organisme et de l’environnement, est un pivot central dans la maladie asthmatique. Le but de ce travail a donc été d’étudier l’épithélium bronchique de l’enfant asthmatique sévère.Dans un premier temps, j’ai développé un modèle de reproduction d’épithélium bronchique in vitro obtenu à partir de cellules épithéliales bronchiques issues de biopsies bronchiques d’enfants asthmatiques sévères. J’ai comparé ces épithélia obtenus chez l’enfant à ceux obtenus chez l’adulte. Nous avons spécifiquement étudié un marqueur inflammatoire important dans l’asthme sévère, le TSLP. J'ai montré 2 isoformes de TSLP ayant un rôle contraire, anti inflammatoire et proinflammatoire. Dans un deuxième temps, j’ai mis au point un modèle d’exacerbation d’asthme viro-induite. J’ai utilisé le modèle de culture et soumis les cellules à une stimulation Poly I:C. Les différentes cytokines sécrétées lors d’une exacerbation asthmatique virale ont été retrouvées augmentées dans notre modèle : CXCL8, CXCL10, CCL2, CXCL9 et RANTES. Enfin, j’ai étudié le propionate de fluticasone dans le modèle d’exacerbation asthmatique. Nous avons montré que l’effet de la fluticasone est différent entre les cellules épithéliales bronchiques issues de témoins et celles issues d’asthme sévère. Le modèle de stimulation viro-induite a permis d’étudier l’effet des corticoïdes inhalés sur l’épithélium bronchique et va permettre d’étudier les voies mécanistiques en jeu dans les exacerbations viro-induites, de tester d’autres molécules et proposer d’autres pistes thérapeutiques. / Severe childhood asthma is a chronic respiratory disease difficult to control despite treatment. Bronchial epithelium, at the interface between the body and the environment, is a central pivot in the asthmatic disease. The aim of this study was to examine the bronchial epithelium of severe asthmatic children. Initially, I developed a bronchial epithelium in vitro reproduction model obtained from bronchial epithelial cells from bronchial biopsies of severe asthmatic children. I compared these epithelia obtained in children with those obtained in adults. We specifically studied an important inflammatory marker in severe asthma,TSLP. I have highlighted the presence of two isoforms of TSLP which have an opposite role, anti-inflammatory for the short form and the long form for proinflammatory.Secondly, I developed an asthma exacerbation model of virus-induced. I used the culture model and challenged bronchial cells with poly I:C to. Different cytokines secreted upon viral asthma exacerbation were found increased in our model: CXCL8, CXCL 10, CCL2, RANTES and CXCL9.Finally, I have studied fluticasone propionate in the exacerbation asthmatic model. I studied cells from asthmatic and from non asthmatic children. Interestingly, we have shown that the effect of fluticasone is different between bronchial epithelial cells from non asthmatic children and those from severe asthma.The model of virus-induced stimulation was used to study the effect of inhaled corticosteroids on bronchial epithelium and will allow studying the mechanistic pathways involved in virus-induced exacerbations, testing other molecules and propose other therapeutic approaches.

Depuis plusieurs années, il s’avère de plus en plus clair que le microbiote digestif a un impact remarquable sur la santé humaine. Il est affecté par de nombreux facteurs dont l’alimentation. En effet, en fonction du macronutriment majoritaire d’un régime alimentaire, certaines populations et fonctions bactériennes sont stimulées ou inhibées. Plusieurs pathologies de l’intestin ou liées à des troubles nutritionnels ou métaboliques ont un lien causal avec une altération du microbiote digestif parmi lesquelles la malnutrition sévère aigue. En effet, il a été récemment montré que le microbiote digestif des enfants malnutris était différent et colonisé par des Proteobacteria, des Enterococci, des bacilles Gram-négatifs et des espèces pathogènes. Au cours de nos travaux, une dysbiose est également observée chez nos patients malnutris par métagénomique et par culturomics avec un enrichissement en bactéries aérobies, en Proteobacteria et en espèces potentiellement pathogènes telles que Streptococcus gallolyticus et une perte notable en bactéries anaérobies associée à une perte de la capacité antioxydante du tractus gastro-intestinal révélée par une absence totale de Methanobrevibacter smitii, archeae méthanogène et un des procaryotes les plus sensibles à l’oxygène du tractus gastro-intestinal ainsi que un potentiel redox fécal accru. De plus, une perte de la diversité globale, connue et inconnue, est observée. Enfin, par culturomics et métagénomique, nous avons établi un répertoire des bactéries manquantes chez les malnutris dont treize présentent un potentiel probiotique et pourront être testées comme probiotiques dans un modèle expérimental dans un futur proche. / For the last decade, it has become increasingly clear that the gut microbiota has a tremendous impact on human health. It is affected by several factors among which diet that has a big impact. In fact, according to the major macronutrient in a diet type, specific bacterial populations and functions are stimulated or inhibited. Several pathologies of the gut or linked to nutritional or metabolic disorders among which severe acute malnutrition are causally linked to an alteration of the diversity of the human gut microbiota. In fact, it has recently been shown by several studies that the gut microbiota of malnourished patients was different and colonized by Proteobacteria, Enterococci, Gram-negative bacilli and pathogenic species. The analysis of our data regarding the fecal microbiota of children afflicted with severe acute malnutrition from Niger and Senegal showed a dysbiosis observed through metagenomics and culturomics with an increase of aerobic bacteria, Proteobacteria and pathogenic species such as Streptococcus gallolyticus, and a depletion of anaerobic species associated with a loss of the antioxidant capacity of the gastro-intestinal tract exhibited by a total absence of Methanobrevibacter smithii, a methanogenic archaeon and one the most oxygen sensitive prokaryote of the gut microbiota alongside an increased fecal redox potential. Moreover, a loss of the overall diversity, known and unknown, was observed. Finally, through culturomics and metagenomics, we were able to identify a repertoire of missing microbes in malnourished children among which thirteen presented a probiotic potential and will be tested as such in an experimental model in the near future.

Depuis plusieurs années, les procédés à grandes déformations plastiques (SPD) sont développés pour affiner la microstructure de métaux afin d’obtenir des tailles de grains submicroniques. Cet affinement confère au matériau des propriétés améliorées (ex : limite élastique). Durant ces procédés, la géométrie globale du matériau reste inchangée. C’est pourquoi les procédés sont spécifiques pour une géométrie donnée. Dans cet objectif, un procédé récemment inventé au sein du LEM3, nommé HPTT - High Pressure Tube Twisting – permet de nanostructurer des échantillons tubulaires. Un tube est confiné par l’application d’une pression hydrostatique de plusieurs GPa et de grandes forces de frottement sont ainsi générées. Une déformation en cisaillement (> 4) dans l’épaisseur du tube est ensuite appliquée. Dans le cadre de cette thèse, un dispositif expérimental a été développé et utilisé pour la production d’échantillons à grains ultrafins (UFG). Des études analytiques et par éléments finis ont permis de comprendre l’état de contrainte et de déformation dans la paroi du tube. Un acier IF (Interstitial-Free) rendu nanostructuré a fait l’objet de caractérisations approfondies pour déterminer l’évolution de la microstructure (MEB-EBSD), des textures (rayons X) et du comportement mécanique (compression). Dans le but de mieux comprendre les phénomènes de fragmentation, un code polycristallin impliquant la courbure du réseau comme élément principal conduisant à l’affinement de la microstructure a été utilisé et comparé aux mesures expérimentales. Ce travail est conclu par une étude de la taille limite atteignable par ces procédés / For several years, Severe Plastic Deformation (SPD) processes have been developed to refine the microstructure of metals in order to obtain ultrafine grains (UFG). This refinement attributes improved properties (ex: yield stress) to the material. The overall geometry of the material remains unchanged. That is why these processes are specific for a given geometry. For this purpose, a process recently initiated at the LEM3, the so called HPTT – High Pressure Tube Twisting – is designed to nanostructure tubular samples. A tube is confined by applying a hydrostatic pressure of several GPa and large friction forces are generated. A shear strain (> 4) is finally applied in the tube thickness. In this thesis, an experimental device was developed and used to produce UFG materials. Finite element and analytical studies have been carried out to understand the stress and strain state in the tube wall. The obtained ultrafine grains IF (Interstitial-Free) steel was characterized to determine the evolution of the microstructure (SEM-EBSD), textures (X-rays) and the mechanical behavior (compression tests). For a better understanding of the fragmentation phenomena, a polycrystal code involving lattice curvature as the main element leading to refinement of the microstructure was used and compared with experimental measurements. This work is concluded by a study on the limited grain size achievable by SPD processes

Orientadores: José Guilherme Cecatti, Rodolfo de Carvalho Pacagnella / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T18:17:52Z (GMT). No. of bitstreams: 1 Polido_CarlaBetinaAndreucci_D.pdf: 9580415 bytes, checksum: 7a66fbe0b5c7b89a2918fd10375d6d95 (MD5) Previous issue date: 2015 / Resumo: Introdução: Morbidade materna grave e near miss materno são indicadores de saúde mais abrangentes, quando comparados à razão de morte materna. Esse conceito recente permite não apenas a identificação do número de mulheres que morrem durante gestação e/ou parto, mas também o estudo da prevalência de condições potencialmente ameaçadoras de vida. No entanto, pouco se conhece sobre as possíveis consequências em longo prazo após esses episódios nos diversos aspectos da vida das sobreviventes. A gestação e o parto podem modificar a resposta sexual feminina, mas poucos estudos avaliaram esse desfecho após eventos de morbidade materna grave. Objetivos: Realizar uma revisão sistemática sobre aspectos de sexualidade, incluindo função sexual, em mulheres que apresentaram qualquer tipo de complicação durante gestação ou parto. Avaliar aspectos da resposta sexual feminina em mulheres com e sem morbidade materna grave. Métodos: Revisão sistemática nas bases de dados PubMed, EMBASE e SciELO, avaliando a associação de morbidade materna geral e grave com alterações da função e/ou resposta sexual feminina. A revisão seguiu o protocolo do método proposto para estudos observacionais (PRISMA). A resposta sexual feminina foi estudada como um dos desfechos da Coorte de Morbidade Materna Grave (COMMAG). O questionário Female Sexual Function Index (FSFI) foi aplicado às mulheres expostas (com antecedente de morbidade grave) e não expostas (com antecedente de gestação sem complicações). Além do FSFI, questões gerais sobre saúde geral e reprodutiva complementaram o estudo. Resultados: Lesões perineais maiores (terceiro e quarto graus) foram avaliadas como desfechos de morbidade geral em 12 estudos, e a morbidade materna grave foi analisada em 2 estudos. A morbidade geral e a grave foram associadas com maior tempo para a retomada da atividade sexual após o parto. A morbidade também se associou a uma maior frequência de dispareunia após o parto. Escores totais do FSFI não foram significativamente diferentes entre grupos de exposição e controle. Pela heterogeneidade entre eles, os estudos individuais permitiram apenas uma síntese qualitativa dos resultados, mas não metanálise. Para avaliação da resposta sexual feminina no COMMAG, foram incluídas 638 mulheres previamente internadas durante gestação ou parto na maternidade do CAISM/UNICAMP. Dessas, 315 tinham antecedente de morbidade materna grave, e 323 eram mulheres sem complicações durante gestação ou parto. Os escores totais médios do FSFI encontrados foram abaixo dos valores de ponto de corte para suspeita de disfunção, sem diferença entre os grupos estudados. Mulheres com antecedente de morbidade materna grave retomaram atividade sexual mais tardiamente após o parto do que as do grupo controle, porém sem diferença entre os grupos a partir do terceiro mês pós-parto. A análise múltipla identificou associação de valores mais baixos de FSFI com baixo de peso materno e ausência de parceria. Conclusões: Alterações da resposta sexual feminina podem ser consequências em longo prazo da ocorrência de episódios de morbidade materna grave. Com o crescimento da população de mulheres que sobrevivem a esses episódios, a abordagem da sexualidade no seguimento dessa população se faz premente / Abstract: Introduction: Severe maternal morbidity and maternal near miss currently are better health indicators than maternal mortality ratio. Together with the identification of women who died during pregnancy and/or childbirth, the new concept allows also to investigate the prevalence of potential life-threatening conditions. However, little is known about possible long-term consequences after those episodes over several aspects of the lives of survivors. It has already been described that uncomplicated pregnancy and childbirth might modify female sexual response. Notwithstanding, only few studies have evaluated aspects of sexuality of women after episodes of severe maternal morbidity. Objectives: To perform a systematic review of aspects of sexuality, including sexual function, in women who had had any kind of complication during pregnancy or childbirth. To evaluate aspects of female sexual response in women with and without severe maternal morbidity. Methods: Investigation included a systematic review through the databases PubMed, EMBASE, and SciELO, assessing general and severe maternal morbidity associated with altered female sexual response. The review followed the protocol method proposed for observational studies (PRISMA). The female sexual response has been studied as one of the outcomes at a retrospective cohort study on maternal severe morbidity (COMMAG). The Female Sexual Function Index questionnaire (FSFI) was applied at exposed women (severe morbidity) and unexposed (pregnancy without complications). Along with FSFI, the survey included also questions on general and reproductive health. Results: Major perineal injuries (3rd and 4th degree) were evaluated as general morbidity outcomes at 12 studies, and severe maternal morbidity was analyzed at 2 studies. Compared to control group, both women exposed to general and severe morbidity delayed resumption of sexual activity after childbirth. The exposed group had also more frequently dyspareunia after childbirth. The mean total FSFI scores were similar at both groups. The heterogeneity of the studies allowed only a qualitative synthesis, and meta-analysis was not feasible. To assess female sexual response at the cohort study, 638 women who delivered at UNICAMP's maternity unit were included. 315 of them were severe maternal morbidity cases, and 323 were women who had had uncomplicated pregnancy or childbirth. The mean total scores of FSFI were similar in both groups, though below cut-off values for suspected dysfunction. Women after severe maternal morbidity resumed sexual activity after birth later, when compared to control group. However, there was no significant difference at three months. Multivariate analysis showed association of lower FSFI scores with maternal low maternal weight and no partner. Conclusions: Altered female sexual response might be a long-term consequence after episodes of severe maternal morbidity. Since there is a growing population of women who survive these episodes, proper evaluation of sexual functioning among those women should be conducted / Doutorado / Saúde Materna e Perinatal / Doutora em Ciências da Saúde

Os genes var de Plasmodium falciparum codificam a proteína PfEMP1 expressa na superfície de eritrócitos infectados e que medeia os fenômenos de citoaderência e \"rosetting\". Ambos os fenômenos estão diretamente associados à malária grave, e seu domínio mais N-terminal, DBL1alfa, media especificamente \"rosetting\". Análise de seqüências DBL1alfa de isolados brasileiros e de outros países revelou que a similaridade entre elas não pode predizer origem geográfica. Com o objetivo de determinar se existem seqüências DBL1alfa associadas à malária grave, analisamos as seqüências DBL1alfa expressas em parasitas obtidos de pacientes brasileiros com esta manifestação clínica e encontramos que as seqüências predominantemente expressas apresentavam uma ou duas deleções de cisteínas. Significativamente, apesar de freqüentes no genoma de parasitas de pacientes com malária não grave, essas seqüências foram raramente expressas. Esses dados demonstram a primeira associação de seqüências PfEMP1 expressas e malária grave em pacientes da Amazônia Brasileira. / Plasmodium falciparum var genes code for PfEMP1, a protein expressed on the surface of infected erythrocytes, and which mediates cytoadherence and rosetting. Both phenomena are directly associated with severe malaria and the most N-terminal domain, DBL1alfa, specifically mediates rosetting. DBL1alfa sequence analysis from Brazilian and worldwide isolates revealed that sequence similarities cannot predict geographical origin. To determine whether there are DBL1alfa sequences associated with severe malaria, we examined expressed var DBL1alfa sequences in patients with severe malaria from the Brazilian Amazon and found that the predominantly expressed DBL1alfa sequences from these parasites lacked 1-2 cysteine residues. Significantly, these sequences were amply found on the genomic repertoire of parasites from patients with mild malaria and yet they were rarely expressed. These data demonstrate the first association of particular PfEMP1 expressed sequences and severe malaria in patients from the Brazilian Amazon.

Notre sujet repose sur l'hypothèse qu'il existe un "appareil esthétique" présent en chacun de nous, constitué de trois états de présence (physique, psychique et artistique) soulignant la spécificité de la qualité de présence dans la relation art-thérapeutique. L'émotion esthétique en est le centre. Notre méthodologie se construit d’une démarche centrale : terrain de recherche auprès de trois personnes adultes avec autisme sévère. Nous utilisons la vidéo comme outil d'observation pour visualiser le subtil et l'inénarrable dans la relation avec ces personnes. La deuxième démarche : entretiens de recherche auprès de 25 patients psychotiques et 25 professionnels (artistes, art-thérapeutes, soignants, éducateurs) qui ont tous participé ou animé dans des ateliers d'art et thérapie. Notre souci est de partir de la parole des personnes concernées pour faire lien avec l'expérimentation vécue sur le terrain de recherche. Nous utilisons un logiciel d'analyse du discours pour en faire une analyse ciblée sur notre hypothèse. Tout notre questionnement repose sur la question de la présence, présence à soi, présence à l'autre par le détour de l'art. Nous abordons les grands courants théoriques autour de la question de la présence thérapeutique, pour poser notre démarche dans une approche intégrative. / Our subject is based on the hypothesis that there exists an "aesthetic device" present in each of us, consisting of three states of presence (physical, psychic and artistic) emphasizing the specificity of the quality of presence in the art-therapeutic relationship. Aesthetic emotion is the center of it. Our methodology is based on a central approach: a field of research involving three adults with severe autism. We use video as an observation tool to visualize the subtle and the inenarrable in the relationship with these people. The second approach: research interviews with 25 psychotic patients and 25 professionals (artists, art therapists, caregivers, educators) who all participated or facilitated in art and therapy workshops. Our concern is to start from the speech of the people concerned to link with the experimentation lived on the research ground. We use discourse analysis software to make an analysis focused on our hypothesis. All our questioning rests on the question of presence, presence to oneself, presence to the other by the detour of art. We approach the main theoretical currents around the question of the therapeutic presence, to pose our approach in an integrative approach.

Background: According to the WHO, in 2019, of the 384,000 deaths due to malaria globally, Uganda has accounted for 5% of total deaths. This study aims to estimate the fraction of severe malaria cases, and socio-demographic characteristics associated with severe malaria among children aged 0–59 months who are positive for malaria in Uganda. Methods: This is a population based cross sectional study conducted among 1627 children aged  0-59 months who were positive for malaria Rapid Diagnostic Test. Data for this analysis was extracted from Uganda Malaria Indicator Survey 2019. Multivariate logistic regression was used to investigate the prevalence of severe malaria and its association with different background characteristics. The study was conducted using SPSS software version 27. Results: The prevalence of severe malaria symptoms was in 11.7% of included children. Multivariate logistic regression revealed significantly increased odds for children aged 12-23 months (aOR: 2.0;95% CI: 1.3 – 3.3)  and 24 – 35 (aOR: 1.93;95% CI: 1.2 – 3.1) months, children living in urban settings (aOR: 4.9;95% CI: 2.2 – 10.7) , and children belonging to the middle (aOR: 1.9;95% CI: 1.3 – 2.9)  wealth quantile also had significantly higher odds of having one or more symptoms of severe malaria Conclusion: Ages 12–35 months, living in urban areas, and belonging in the middle wealth quantile were significantly associated with increased odds of having one or more symptoms of severe malaria. The results of which suggest a need for malaria intervention policies to address the needs of younger children and urban communities in Uganda.

Research shows that people with severe mental illness (SMI) have extensive trauma histories and higher rates of post-traumatic stress disorder (PTSD) than the general population. However, research also shows that both the trauma history and PTSD in people with SMIs are vastly unrecognized and untreated. Additionally, the relationships between SMI, trauma, PTSD, substance use, and other psychosocial factors is still not well understood, as there has been limited experimental research examining these relationships despite an awareness of their connections. The SMI-PTSD descriptive model was originally proposed by Mueser et al. (2002) to better understand these variables, and is often referenced in the literature, yet there is very little empirical evidence and understanding of how this model may differ by gender in people with SMI. Assertive Community Treatment (ACT) is an evidence-based treatment for those with SMI, yet the extent to which trauma is addressed within the ACT model is not consistently known, nor how the team’s practitioners work with their clients on trauma-related issues and PTSD. By definition, all ACT clients have an SMI and represent a population with complex and intensive needs; therefore, a better understanding the population ACT serves, as well as how the teams work with the trauma present in their clients, will aid in providing better and more consistent treatment and care. This dissertation examines gender differences in the relationship between SMI, substance use, trauma, PTSD, psychosocial factors, the SMI-PTSD descriptive model, and attempts to ascertain the perspectives of ACT providers in working with trauma and PTSD in clients. In Study 1, I conducted retrospective chart reviews to extract information on trauma histories, PTSD, substance use, and psychosocial factors in 282 clients from four ACT teams (178 men, 104 women) to assess the gender differences in types of trauma, instances of PTSD, substances of choice, problematic substance use, and the SMI-PTSD model. Findings indicate that rates of sexual trauma, emotional abuse, serious suicide attempts, rates of trauma in adulthood, and PTSD are higher among women, whereas rates of alcohol, marijuana, and stimulant use as well as lifetime problematic substance use are higher among men. For the SMI-PTSD model, results suggest that the model better corresponds to the experiences and possible trajectory of men with SMI. In Study 2, I employed thematic analysis through interviewing ACT providers to better understand their perspectives on working with trauma and PTSD in clients. Five overarching themes with 21 sub-themes emerged. The five themes were the role and scope of ACT teams and model regarding trauma; discussions of trauma with clients; current treatment of trauma; barriers to working with trauma; and recommendations for enabling trauma discussions and treatment. These two studies have important implications for further research. Research should take gender identity into consideration when proposing and testing models, as Study 1 has demonstrated that two genders experience a well-accepted proposed model differently; this finding may be applicable to people of all genders, as well as other models. Further research could be done to gather perspectives from workers on the strengths and challenges of the ACT model. Future work should also include the views of ACT clients to get a fuller picture of their experience with receiving care for their trauma experiences. Clinically, health care providers should better recognize and treat PTSD and traumatic-stress symptoms of people with SMI. Doing so will ensure that health-care is moving towards trauma-informed practice on a systemic level.

Philosophiae Doctor - PhD / The current study was, in part, prompted by the high case fatality rates for severe acute malnutrition in two district hospitals in the Eastern Cape Province in South Africa. These case fatality rates were being attributed to Human Immunodeficiency Virus infection rather than to mismanagement by nurses involved in the hospital management of SAM cases. There were also some anecdotes from clinicians in the same hospitals that, depending on the clinical stage of HIV infection, the World Health Organisation's ten-step protocol may show no effect. This left some uncertainties as to whether these guidelines are suitably designed for use during the management of HIV positive children who are severely malnourished and at different HIV clinical stages. This study sought to reinforce the design of a longstanding facility-based intervention originally developed to improve the management of severe acute malnutrition in two district hospitals in South Africa. The aim was to design an improved intervention which was implemented and evaluated to determine its potential effect on treatment outcomes, specifically in the context of high HIV comorbidity. The study also sought to provide the context for the effectiveness of this intervention, in terms of its implementation fidelity and associated moderating factors. Lastly, the study evaluated the sustainability of the intervention after it was discontinued. Methods The current study reports on the development, implementation and evaluation of an intervention to improve the management of severe acute malnutrition in two district hospitals in the Eastern Cape Province. A Sequential Explanatory Mixed Method Design was used. During the study, the effect of HIV infection, disease stage and other clinical characteristics on the survival of children with severe acute malnutrition was assessed. The relationship between the rate of weight gain and duration of hospitalisation based on HIV status and disease stage were also examined. The data were collected prospectively during the study using retrospective record review of a total of 450 severely malnourished children who were admitted and treated at the two facilities from 2009 to 2013.A pre-tested 76- item patient evaluation form was used to collect data on patient characteristics on admission, treatment processes and outcomes. Data analysis was performed using STATA13.0 and involved simple descriptive computation of quantitative variables as well as non-parametric tests to compare groups between and within hospitals. Kaplan-Meier curves and Cox proportional hazard modelling were used to analyse time to event data. The study also assessed the impact of the intervention at time intervals on outcomes of interest. The analysis focused on modelling and plotting monthly mortality statistics collected over a period of 69 months. This was done to detect related trend and level changes before, immediately (after the first two months) and after (following the two months) the removal of the intervention. Lastly ethnographic and focus group enquiries were used to explain the quantitative results. Two focus group discussions were held in each hospital with clinicians and the management staff. This was done at the end of phase three. The focus group data were analysed using the framework analysis approach.