Background: Tobacco use is associated with exacerbation of tuberculosis (TB) and poor TB treatment outcomes. Integrating tobacco use cessation within TB treatment could improve healing among TB patients. The aim was to explore perceptions of health workers on where and how to integrate tobacco use cessation services into TB treatment programs in Uganda. Methods: Between March and April 2019, nine focus group discussions (FGDs) and eight key informant interviews were conducted among health workers attending to patients with tuberculosis on a routine basis in nine facilities from the central, eastern, northern and western parts of Uganda. These facilities were high volume health centres, general hospitals and referral hospitals. The FGD sessions and interviews were tape recorded, transcribed verbatim and analysed using content analysis and the Chronic Care Model as a framework. Results: Respondents highlighted that just like TB prevention starts in the community and TB treatment goes beyond health facility stay, integration of tobacco cessation should be started when people are still healthy and extended to those who have been healed as they go back to communities. There was need to coordinate with different organizations like peers, the media and TB treatment supporters. TB patients needed regular follow up and self-management support for both TB and tobacco cessation. Patients needed to be empowered to know their condition and their caretakers needed to be involved. Effective referral between primary health facilities and specialist facilities was needed. Clinical information systems should identify relevant people for proactive care and follow up. In order to achieve effective integration, the health system needed to be strengthened especially health worker training and provision of more space in some of the facilities. Conclusions: Tobacco cessation activities should be provided in a continuum starting in the community before the TB patients get to hospital, during the patients’ interface with hospital treatment and be given in the community after TB patients have been discharged. This requires collaboration between those who carry out health education in communities, the TB treatment supporters and the health workers who treat patients in health facilities.

Background: South Africa accounts for more than a seventh of the global population living with HIV/AIDS and TB, and ranks highest in HIV/TB co-infection worldwide. Consequent high child mortality is exacerbated by child malnutrition, which is an important indicator of health status and is associated with morbidity as well as mortality. Rural areas usually present with the greatest burden of morbidity and mortality, yet the extent of geographical disparities in child mortality, malnutrition and HIV/TB has hardly been explored. This is a reservoir of information useful for effective public health interventions. In this thesis we investigated the factors associated with childhood HIV/TB mortality and malnutrition, how they interrelate and their spatial distribution in the rural Agincourt sub-district located in north-east South Africa close to the border with Mozambique. Rationale: Africa at large lacks data that are routinely and reliably collected then validated, to guide policy and intervention programmes. Causes of deaths and even death counts are often misclassified and underestimated respectively, especially for children. To bridge this gap, a health and socio-demographic surveillance systems located in the rural Agincourt sub-district hosts which annually collects and collates data on vital events including fertility, mortality and migration. These data have been collected since 1992 to-date and now cover 80,000 people living in more than 16,000 households situated in 27 villages; all households are fully geo-coded. These hierarchical data allow us to address several epidemiological questions on how person, place (spatial) and time (temporality) have impacted on mortality and malnutrition patterns in children living in the rural Agincourt sub-district. Objectives: The aims of this thesis were both methodological and applied: Methodological (1) To investigate the presence of spatial autocorrelation in the Agincourt sub-district and model this using geographical and geo-statistical procedures (2) To model large spatial random effects accurately and efficiently (3) To model hierarchical data with zero inflated outcomes Applied (1) To investigate childhood HIV/TB mortality determinants and their geographical distribution using retrospective and cross-sectional data (2) To determine factors associated with malnutrition outcomes adjusting for their multivariate spatial random effects and selection bias for children under five years (3) To model how the associated factors were interrelated as either underlying or proximate factors of child mortality or malnutrition using pathway analysis. Methods: We conducted a secondary data analysis based on retrospective and cross-sectional data collected from 1992 to 2010 from the Agincourt sub-district in rural northeast South Africa. During the period of our study 71,057 children aged 0 to 9 years from 15,703 households were observed. All the data in the thesis were for children aged 1 to under 5 except for the chapter 6 (last paper) who were aged from 0 to 9 years of age. Child HIV/TB death and malnutrition were the outcome measures; mortality was derived from physicianbased verbal autopsy. We investigated presence of spatial autocorrelation using Moran’s and Geary’s coefficients, semi-variograms and estimated the spatial parameters using Bayesianbased univariate and multivariate procedures. Regression modelling that adjusted for spatial random effects was done using linear regression and zero inflated variants for logistic, Poisson and Negative Binomial regression models. Structural equation models were used in modelling the complex relationships between multiple exposures and child HIV/TB mortality and malnutrition portrayed by conceptual frameworks. Risk maps were drawn based on spatial residuals (posteriors) with prediction (kriging) procedures used to estimate for households where no data were observed. Statistical inference on parameter estimation was done using both the frequentist; maximum likelihood estimation and Bayesian; Markov Chain Monte Carlo (MCMC) directly and sometimes aided with Metropolis Hastings or Integrated Nested Laplace Approximations (INLA). Results: The levels of child under-nutrition in this area were: 6.6% wasted, 17.3% stunted and 9.9% underweight. Moran’s (I) and Geary’s (c) coefficients indicated that there was global and local clustering respectively. Estimated severity of spatial variation using the partial-sill-to-sill ratio yielded 12.1%, 4.7% and 16.5%, for weight-for-age, height-for-age and weight-for-height Z-scores measures respectively. Maternal death had the greatest negative impact on child HIV/TB mortality. Other determinants included being a male child and belonging to a household that had experienced multiple deaths. A protective effect was found in households with better socio-economic status and where older children were present. Pathway analyses of these factors showed that HIV had a significant mediator effect and the greatest worsening effect on malnutrition after controlling for low birth-weight selection bias Several spatial hot spots of mortality and malnutrition were observed, with these regions consistently emerging as areas of greater risk, which reinforces geographical differentials in these public health indicators. Conclusion: Modelling that adjusts for spatial random effects, is a potentially useful technique to disclose hidden patterns. These geographical differences are often ignored in epidemiological regression modelling resulting in reporting of biased estimates. Proximate and underlying determinants, notably socioeconomic status and maternal deaths, impacteddirectly and indirectly on child mortality and malnutrition. These factors are highly relevant locally and should be used to formulate interventions to reduce child mortality. Spatial prediction maps can guide policy on where to best target interventions. Child interventions can be more effective if there is a dual focus: treatment and care for those already HIV/TB infected, coupled with prevention in those geographical areas of greatest risk. Public health population-level interventions aimed at reducing child malnutrition are pivotal in lowering morbidity and mortality in remote areas. Keywords: HIV/TB, Child mortality, Child malnutrition, Conceptual framework, Spatial analysis, MCMC, Path analysis, South Africa

Using data collected in 2007 for Addis Ababa Mortality Surveillance, the paper examines the effect of cause of death/type of illness on choice of health care in adults 12 years and above. The multinomial logit model using bootstrapped standard errors is used to investigate the relationship between dominant type of treatment and the covariates: cause of death, gender, age, education, occupation, ethnicity and religion. Availability of water, television and telephone in the household are used as a proxy for economic status. After controlling for duration of illness (exposure), type of illness, gender and marital status are significant. Those who die of HIV/TB and cancer behave similar in way they seek help, and have high likelihood of using traditional healers as the first point for help compared to those who died as a result of other illnesses. Thus the study concludes that cause of death; gender and marital status affect choice of health service.

Gas separation membranes are proving to be a sustainable method to mitigate climate change given the rising energy demand. Polymers of intrinsic microporosity (PIMs) have emerged as a novel material class for such application. Physical aging is a major concern for the growth and commercialization of these glassy polymers. Several factors play an important role in determining the effects of physical aging for a PIM film; one important parameter is its thickness. Gas transport properties of PIM-Trip-TB films of thicknesses between 20-150 µm were monitored over 150 days for physical aging and its dependence on film thickness. Over this period, thicker films had generally higher permeability, and thinner films aged faster. Although fresh films showed higher selectivity during the initial tests, no correlation was found between film thickness and selectivity after aging. In addition, physical aging was more severe and independent of film thickness for larger-sized gases. Film storing environment affected the physical aging of multiply tested samples significantly, whereas films which were not tested periodically showed very minimal aging. A more systematic approach is required to fully analyze and comprehend factors yielding this phenomenon.

Thesis (M. A. (Communication Studies)) -- University if Limpopo, 2021 / This study was prompted by the number of people who die daily from tuberculosis (TB) in the study area. The study investigated the perceptions of Mokopane residents, and their level of understanding and knowledge of the disease, tuberculosis (TB). The aim of the study was to profile people’s perceptions of health beliefs, the causes of the increase and spread of TB and its prevention and their knowledge about TB awareness campaigns in the Mokopane area. Data was collected by means of both qualitative and quantitative methods. Ten (10) medical doctors who operate private practices in the Mokopane area were interviewed. Data was collected from four hundred and one (401) participants from both Sandsloot and Tshamahansi villages outside Mokopane. The major findings of this study showed that firstly residents have a firm belief that traditional methods cure TB; secondly, they are largely ignorant of TB, its prevention, and consequences; and lastly that there is a lack of TB related education.

Thesis (Ph. D. (Physics)) -- University of Limpopo, 2020 / Titanium dioxide is among the most abundant materials and it has many of interesting physical and chemical properties (i.e., low density, high thermal and mechanical strength, insensitivity to corrosion) that make it a compound of choice for electrodes materials in energy storage. There are, however, limitations on the theoretical side to using the main electronic structure theories such as Hartree-Fock (HF) or density functional (DFT) especially for large periodic and molecular systems. The aim of the theses is to develop a new, widely transferable, self-consistent density functional tight binding SCC-DFTB data base of TiO2, which could be applied in energy storage anodes with a large number of atoms. The TiO2, LiTiO2 and NaTiO2 potentials were derived following the SCC-DFTB parameterization procedure; where the generalized gradient approximation (GGA) and local density approximation (LDA) exchange-correlation functional were employed yielding Slater-Koster DFTB parameters. The results of derived parameters were validated by being compared with those of the bulk rutile and brookite polymorphs. The structural lattice parameters and electronic properties, such as the bandgaps were well reproduced. Most mechanical properties were close to those in literature, except mainly for C33 which tended to be underestimated due to the choice of exchange-correlation functional. The variation of the bulk lattice parameter and volume with lithiation and sodiation were predicted and compared reasonably with those in literature. The newly derived DFTB parameters were further used to calculate bulk properties of the anatase, which is chemically more stable than other polymorphs. Generally, the accuracy of the lattice structural, electronic and mechanical properties of the bulk anantase were consistent with those of the rutile and brookite polymorphs. Furthermore, nanostructures consisting of a large number of atoms, which extend beyond the normal scope of the conventional DFT calculations, were modelled both structurally and electronically. Structural variations with lithiation was consistent with experimental and sodiation tends to enhance volume expansion than lithiation. Anatase TiO2 and LiTO2 nanotubes of various diameters were generated using NanoWrap builder within MedeA® software. Its outstanding resistance to expansion during lithium insertion and larger surface area make the TiO2 nanotube a promising candidate for rechargeable lithium ion batteries. The outcomes of this study will be beneficial to future development of TiO2 nanotube and other nanostructures. Lastly, our DFTB Slater-Koster potentials were applied to recently discovered trigonal bipyramid (TB), i.e. TiO2 (TB)-I and TiO2 (TB)-II polymorphs, which have enormous 1- D channels that provide suitable pathways for mobile ion transport. All structural, electronic properties were consistent with those in literature and all elastic properties agreed excellently with those that were calculated using DFT methods. Finally, the bulk structures of the two polymorphs, were lithiated and sodiated versions and electronic and structural properties were studied, together with the lithiated versions of associated nanostructures consisting of a large number of atoms. Generally, the TiO2 (TB)-I structure was found to be mechanically, energetically more stable and ductile than TiO2 (TB)-II. Hence, it will be beneficial to use TiO2 (TB)-I as an anode material for sodium ion batteries (SIB), due to its unique ductility and larger 1D channels. / National Research Fund (NRF), the Department of Science and Innovation (DSI) Energy Storage Research Development and Innovation initiative and Materials Modeling Centre

Philosophiae Doctor - PhD / Tuberculosis is a bacterial infection which is a major cause of death worldwide. TB is a curable disease, however the bacterium can become resistant to the first line treatment against the disease. This leads to a disease called drug resistant TB that is difficult and expensive to treat. It is well-known that TB disease thrives in communities in overcrowded environments with poor ventilation, weak nutrition, inadequate or inaccessible medical care, etc, such as in some prisons or some refugee camps. In particular, the World Health Organization discovered that a number of prisoners come from socio-economic disadvantaged population where the burden of TB disease may be already high and access to medical care may be limited. In this dissertation we propose compartmental models of systems of differential equations to describe the population dynamics of TB disease under conditions of crowding. Such models can be used to make quantitative projections of TB prevalence and to measure the effect of interventions. Indeed we apply these models to specific regions and for specific purposes. The models are more widely applicable, however in this dissertation we calibrate and apply the models to prison populations.

Multi-drug resistance is increasingly becoming a challenge to tuberculosis control programmes globally. Treatment of multi-drug resistance tuberculosis (MDR-TB) includes aminoglycoside antibiotics which are known to cause hearing loss. Ototoxicity monitoring services are often provided to patients undergoing treatment for MDR-TB for early detection of ototoxic hearing loss to facilitate alerting the patients and relevant medical staff about the presence and progression of any hearing loss. Previously, models of managing patients with MDR-TB required mandatory hospitalization for at least 6 months. This made it relatively easy to monitor the hearing status of patients during their stay in the hospital. However, with recent introduction of policy guidelines that support management of patients with MDR-TB on an outpatients basis, ototoxicity monitoring for these patients will need to be reorganized to align with the new policy guidelines. The extent of the uptake of these services when patients are accessing them as outpatients is however, unknown. This study therefore aimed to describe the patterns of utilisation and explore the barriers and factors that facilitate the use of ototoxicity monitoring services when provided on an outpatient basis in the Cape Town Metropolitan area, Western Cape, South Africa.

Tuberculosis (TB) is a leading public health problem across the world. For various reasons, TB and multidrug-resistant tuberculosis (MDR-TB) have increased. Clarification on TB/HIV co-infection and homelessness as risk factors for TB and MDR-TB is required to inform policy interventions to reduce TB-related morbidity, mortality, and healthcare costs. In this quantitative study, data from the Houston Health Department (N = 341) were analyzed to explore the relationship between TB and MDR-TB outcomes and TB/HIV co-infection and type of housing/homelessness. Foreign-born persons are disproportionately affected in the United States. The socio-ecological model provided a theoretical framework for the investigation. Multiple and logistic regression analyses were conducted to investigate the relationships between variables, controlling for age and gender. Results indicate that HIV infected persons were more likely than non-infected persons to contract TB, and homeless persons were more likely than non-homeless persons to contract TB/MDR-TB, suggesting that high TB/HIV co-infection rates increase prevalence of TB and MDR-TB while improvements in housing reduce prevalence of TB and MDR-TB. However, no significant associations between variables were found. The odds ratio, Exp(B) = 0.000, p -?¥ 0.90, 95% Cl [0.000, with no upper bound values] was observed for both independent variables. Regular screening for TB/HIV co-infection among persons with high TB and MDR-TB risk profiles is recommended. Further investigation is required. Inclusion of more covariates could further elucidate more evidence of an association between variables. Study findings may support interventions to reduce TB-related morbidity, leading to positive social change.

Mycobacterium tuberculosis (Mtb) is the causative agent of Tuberculosis (TB), a life-threatening disease primarily affecting the lungs that infects about one third of the world's population and causes 1.3 million deaths annually. It is estimated that TB has been infecting humans for around 70,000 years and has killed more people than any other infectious disease. The highly effective, persistent, and multifaceted virulence strategies that have allowed Mtb to continue to spread and thrive for so long are still poorly understood at the molecular level. This lack of knowledge contributes to ongoing challenges to curing TB. Although drugs capable of killing Mtb exist, even strains that are susceptible to these drugs remain so difficult to treat that stringent six- to nine-month courses of four-drug cocktails are required. Practical difficulties in administering full treatments and patient noncompliance have contributed to a rise in drug-resistant TB cases globally. To combat this increasing world health problem, new antibiotic treatments that kill Mtb and drug-resistant Mtb more effectively via new mechanisms of action are necessary. Discovering these antibiotics expediently requires that innovative Mtb-specific drug-screening assays are developed. An ideal and innovative TB drug screening method would target validated protein-protein interactions (PPI) essential to Mtb's pathogenesis and would be performed on whole Mtb cells under relevant in vivo-like conditions. This project focused on engineering several tools relevant to creating an ideal TB drug screen. A protein fragment complementation assay capable of studying PPI of the TB gyrase complex was created, and this assay was assessed for future HTS applications. To streamline the readout, this assay was re-engineered to include green fluorescent protein.