Magister Artium (Child and Family Studies) - MA(CFS) / Introduction: Malnutrition is the immediate result of inadequate dietary intake, the presence of disease or the interaction between these two factors. It is a complicated problem, an outcome of several etiologies. SAM is one of the leading causes of morbidity and mortality among children under the age of five in developing countries. Although studies in Botswana show some improvement in child malnutrition since the 1980s, severe acute malnutrition still remains a cause for concern in many parts of the country. There is little information on undernourishment situation of children under the age of five years in the urban areas of the country. Aim: The purpose of this study was to determine the risk factors to severe acute malnutrition among children under the age of five years in Francistown, Botswana. The UNICEF conceptual framework was used as a guide in assessing and analysing the causes of the nutrition problem in children and assisted in the identification of appropriate solutions. Methods: The study was conducted on cases who had been admitted and referred at any time between March and July 2015. A quantitative research methodology was used to conduct the study. A case-control study design was utilised. Random selection of cases and controls was done on a ratio of 1:2 case per control. Cases included children under the age of five years admitted to Nyangabgwe Referral Hospital and those referred to the Nutritional Rehabilitation Centre within the hospital in Francistown-Botswana with a diagnosis of severe acute malnutrition. Controls were children of the same age, gender and attending the same Child welfare clinic as the case and with good nutritional status. Data was collected through face-to-face standardised interviews with care-givers. Results: Data collection was done using a combination of a review of records (child welfare clinic registers, and child welfare clinic cards) and structured questionnaires. 52 cases and 104 controls were selected with the primary or secondary care-giver as the respondent. (N=156). Data was collected using a self-developed structured questionnaire and the review of documents. Of all the cases 36.5% (n=19) were diagnosed with MAM, 46.2% (n=24) with SAM, 1.9% (n=1) with moderate PEM and 7.7% (n=4) each for PEM and Severe PEM. All the cases had presented with clinical signs and symptoms of severe acute malnutrition and/or the weight-for-height Z-score of ≤ -3 SD. Following placement of the data in regression models, the factors that were found to be significantly associated with child malnutrition were low birth weight (AOR = 0.437; 95% CI = 0.155-1.231) , exclusive breastfeeding (AOR = 2.741; 95% CI = 0.955-7.866), child illness (AOR = 0.383; 95% CI = 0.137-1.075), growth chart status (AOR =7.680; 95% CI = 1.631-36.157), level of care-giver’s education (AOR = 0.953; 95% CI = 0.277-3.280), breadwinner's work status (AOR = 1.579; 95% CI = 0.293-8.511), mother’s HIV status (AOR = 0.777; 95% CI = 0.279-2.165), alcohol consumption (AOR = 0.127; 95% CI = 0.044-0.369), household having more than one child under the age of five (AOR = 0.244; 95% CI = 0.087-0.682), household food availability (AOR = 0.823; 95% CI = 0.058-11.712), living in a brick type of house (AOR = 13.649; 95% CI = 3.736-49.858), owning a tap (AOR = 1.269; 95% CI = 0.277-5.809) and refuse removed by the relevant authority (AOR= 2.095; 95% CI = 0.353-12.445) were all statistically significantly associated with severe acute malnutrition (p < 0.05). Therefore, all these variables were included in the binary stepwise regression where living in a mud house type was the most significant factor and not being breastfed for at least three months was the least significant. Conclusion: The findings of this study suggested that immediate determinants to SAM were; child born with a low birth weight, appetite and child illness. Underlying contributing factors were; the child not exclusively breastfed for at least three months, growth chart not up to date, care-givers education level, employment status, alcohol consumption, household food availability, type of housing, owning a tap and number of children under the age of five year. Therefore, increasing household food security and strengthening educational interventions for women could contribute to a reduction in the prevalence of SAM in Francistown, Botswana.

Citrus greening or Huanglongbing is a severe disease affecting all citrus cultivars and rootstocks and is responsible for causing severe economic losses in many citrus producing countries. It is caused by various fastidious phloem-restricted, Gram negative bacteria belonging to the “Candidatus Liberibacter” genus. Currently only three species that affects citrus have been identified, “Candidatus Liberibacter africanus” (Laf) found in Africa, Mascarene Islands and the Middle East,“Candidatus Liberibacter asiaticus” (Las) present in Asia, and only recently emerged in Florida USA, São Paulo Brazil and Cuba and a new species “Candidatus Liberibacter americanus” (Lam) found only in São Paulo Brazil. Due to the continuing spread of this serious and destructive disease into areas of South Africa previously regarded as disease-free and disease-managed, the role of alternative hosts in the transmission of the disease is questioned. The aim of this study was to identify possible alternate hosts of Laf amongst plants of Rutaceae indigenous to South Africa. Identification of these alternate hosts forms a critical part of the integrated management and control strategies of the disease. Leaf material from symptomatic and asymptomatic indigenous rutaceous and non-rutaceous plants were collected from various sites in South Africa, from different environments which included vegetation adjacent to citrus orchards, in areas with high incidence of the citrus greening disease, from natural habitats, botanical gardens and private properties. A multiplex polymerase chain reaction (PCR) was developed for the simultaneous detection of Laf DNA and ubiquitous ribulose bisphosphate carboxylase oxygenase (Rubisco) gene which served as an internal control for the presence and quality of extracted DNA and potential amplification inhibition by compounds of the DNA extract. The multiplex PCR oligonucleotide primers were used to amplify fragments of 669bp from the β ribosomal operon of Laf and 179bp of Rubisco gene. Petioles and/or leaf midrib tissues were tested for the presence of Laf using the newly developed multiplex PCR and β operon specific primers of a published conventional PCR method. In this study seventeen Calodendrum capense Thunb. (Cape chestnut) plants from various geographic areas of South Africa were identified to be naturally infected with Liberibacter DNA. Sequence analysis revealed the DNA to be that of “Candidatus Liberibacter africanus subspecies capensis” (LafC). Although this subspecies of Liberibacter has previously been detected on C. capense in the Stellenbosch area of the Western Cape Province, this is the first report indicating the natural occurrence of LafC in C. capense in Gauteng, Limpopo and Mpumalanga Provinces of South Africa. The geographic distribution of the LafC bacterium associated with Cape chestnut appears to be more widespread than initially expected. No Laf DNA was detected from C.capense or any other indigenous plants surveyed. Copyright / Dissertation (MSc)--University of Pretoria, 2010. / Microbiology and Plant Pathology / unrestricted

This thesis explores the experience of parenting with severe mental illness, using qualitative methodologies. It is presented in three parts: a literature review, a report of the empirical research, and a critical reflection of the process undertaken. The literature review provides both a systematic review of qualitative studies exploring the experience of parenting with a severe mental illness (SMI), and a meta-synthesis of the findings from the included studies. The findings demonstrated six overarching themes that were central to the parents' experience. The themes were interlinked and often conflictual in nature and a model of the relationship between the themes is provided. The synthesis revealed how the additional and conflicting pressures faced by parents with SMI can interact with their symptoms to affect parenting behaviours and decisions about engagement with services. The model of themes elicited by the synthesis provides a broad conceptual framework in which parenting with SMI can be considered across the age range of children, parental symptoms and parenting roles. The empirical research provides a specific focus on the views and experiences of parents with Bipolar Disorder (BD). Interpretative Phenomenological Analysis was used to explore the lived experience of parenting with BD, to provide insight into the parents' perspective and the influence that this may have on outcomes for parents as well as their children. The analysis resulted in six overarching themes, each of which consisted of a number of sub-themes. There were important interactions between the themes and these are illustrated for the reader. It was found that the parents identified a number of challenges in being a parent with BD and experienced feelings of inadequacy, guilt and worry relating to the impact that their illness had on their children and family. Strategies for managing these feelings and limiting the impact of BD could have an inadvertent negative effect on their own well-being, and that of their child. Learning to accept their diagnosis and developing strategies for managing their symptoms were crucial for positive parenting, although the changing needs of their children often presented new challenges. Contextual factors, including the stigma associated with mental illness, could also either mediate or exacerbate the challenge of parenting with BD. The clinical implications of these findings are discussed. The critical reflection provides a consideration of qualitative methodologies and a personal reflection on the qualitative process in relation to the empirical research. It details the critical debates around qualitative methodology, the application of qualitative methodologies, and the challenges this presented for the researcher. The report was written on completion of the investigation and reflects the process by which, as a novice, the author was able to develop an understanding of qualitative methodology and carry out an insightful piece of research.

No description available.

Introduction: Severe mental illness (SMI), Human immunodeficiency virus (HIV) infection and hazardous alcohol use are global epidemics. Each condition is independently associated with significant adverse health outcomes. The presence of two or more of these conditions in one individual may result in worse health outcomes. A key mediator of poor health outcomes are factors such as medication adherence. In resource-limited countries like South Africa, the impact of psycho-social factors may contribute further to worse health outcomes. These factors include poverty and unemployment; as well as gender. In South Africa, proportionately more women are infected with HIV than men; and they are also vulnerable to the problems of trauma and interpersonal violence. The main aim of this study was to investigate the prevalence of a triple co-morbidity of SMI, HIV infection and hazardous alcohol use in a female population at a community psychiatric clinic in Cape Town South Africa; and the impact of this triple comorbidity on medication adherence. Furthermore, we set out to identify demographic and clinical variables that are predictors of poor adherence to both psychotropic medication and ART where applicable. Methods: We conducted a cross-sectional study of female patients presenting to Gugulethu psychiatric clinic over a ten-month period. Demographics and clinical variables were explored using the Alcohol Use Disorders Identification Test (AUDIT); the adapted Morisky Scale to Assess Adherence to Psychotropic Medications; and an adherence to HIV antiretroviral treatment self-assessment instrument. A descriptive analysis of the demographic and predictor variables was undertaken to explore the prevalence of concurrent HIV infection and hazardous alcohol use in out-patients with SMI; as well as to investigate whether co-morbidity is associated with poor levels of adherence to psychotropic medication, as well as antiretroviral treatment (ART) in HIV positive patients. Results: We interviewed 127 patients, of whom 55 were HIV positive (43.3%). The overall prevalence of a triple comorbidity in this population was 7.9%. Only 20% within this triple comorbidity group were adherent to their psychotropic medication. Out of the 10 participants with a triple comorbidity, only five were on ART. Of these 5 participants, only two were adherent. Individuals with hazardous alcohol use were less adherent to psychotropic medication compared to those without. The seven respondents in the dual diagnosis group (SMI and hazardous alcohol use) had the lowest overall psychotropic adherence levels compared to the other subgroups (0%). Furthermore, concurrent hazardous alcohol use predicted poorer levels of compliance to ART for those with HIV infection. Conclusion: The presence of a triple diagnosis was not found to be a predictor of poorer medication adherence, compared to having one or two diagnoses. Nevertheless, there was evidence that concurrent hazardous drinking in SMI patients predicted poor compliance to both psychotropic and ART treatment regimens (for those living with HIV). These patients should be supported in future interventions to improve medication adherence and reduce hazardous drinking.

This thesis deals with the severe accident of the gas-cooled fast reactor GFR. At the beginning of the study there is a review of the gas-cooled fast reactor subject. Next part is focused on description of possible solutions for severe accidents with emphasis on the solution applied in the Generation III+ reactors. Chapters that deal with material and thermal balance with severe accident of GFR demonstration unit, along with the chapter which analyses features of the corium, create a basis for the conceptual design of core catcher of GFR demonstration unit, which forms the final part of this thesis.

This study explored teachers’ perspectives of AT use, effectiveness of AT, elements teachers’ take into consideration when selecting AT, barriers, and resources needed for effective use of AT with students with severe intellectual and developmental disabilities. In order to answer this study’s research questions, I employed a sequential explanatory mixed methods design. I conducted a self-administered online survey and online interviews to collect data from participants. This study consisted of two phases, quantitative followed by qualitative interviews. A total of 92 special education teachers from four special education institutes were surveyed, and five teachers in the second phase were interviewed to provide interpretations for the data analyzed from the first phase. Results demonstrated that there was a lack of AT use, with teachers reporting higher use of low-tech than mid-tech and high-tech. The most reported barriers were lack of AT devices, lack of funding, and lack of training. The results also demonstrated that there were statistical differences in the use of AT between the four special education institutes, teachers with AT training, and teachers’ familiarity with AT. In the second, qualitative, phase, four major themes emerged from the interviews, as well as several sub-themes. The four themes were (a) the use of AT, (b) considerations, (c) barriers, and (d) professional development. These themes and sub-themes made it possible to interpret and elaborate on the data collected in the first, quantitative, phase.

Magister Curationis / Undiagnosed and untreated medical illnesses are more predominant in patients with mental illnesses, compared to the general population. Concerns have risen about the observed lack of regular screening for Metabolic Syndrome potentially increasing the prevalence rate of the disease especially in young adolescents on anti-psychotics. Recognizing the recurrent co-morbidity between mental and physical health conditions, specific commendations addressing the physical conditions causing the increased morbidity and mortality of people with severe mental illness are needed. In some instances, treatment recommendations for the general population may need to be modified for people with SMI.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Artemisinin resistance was first observed in Southeast Asia (SEA) and could pose a threat to malaria treatment all over the world. Recently mutations in the propeller region of Pfkelch13 gene have been used as a genetic marker for resistance observed in SEA. We investigated the presence of mutations in the Pfkelch gene in children in Kampala, Uganda with severe malaria (SM) treated with intravenous quinine, or with asymptomatic P.falciparum infection (AP) treated with artemether-lumefantrine. We sequenced the Pfkelch gene (2178bp) in 157 children with SM and 49 children with AP infection. In children with SM and AP we identified 106 (60.8%) and 27 (55.1%) parasites with mutations upstream of the Pfkelch13 propeller region. The two most prevalent mutations were 142NN (26.1% in SM, 33% in AP) and K189T (16.5% in SM, 12.2% in AP). In SM, only a single infection had a mutation in the propeller region (A578S), while in AP, mutations in the propeller region included A578S (n=1) and S522C (n=1). In children with SM, parasites with 142NN insertion compared to 3D7 Pfkelch13 parasites had lower parasite density (p=0.02) and lower parasite biomass (p=0.03). Children with SM who either had 142NN or K189T mutation cleared parasites after quinine treatment faster than those with the 3D7 Pfkelch13 genotype (P<0.001 for both mutations compared to 3D7). In this cohort mutations, upstream of the Pfkelch13 propeller region were common. Future studies will assess the presence of Pfcrt and Pfmdr mutations in this cohort, and how these relate to the Pfkelch13 mutations and to parasite clearance.