Background Recent gains in child survival are being threatened by the RN epidemic. Monitoring child mortality rates is essential to understanding the impact of the epidemic, but is constrained by a lack of data. A community-based survey was used to determine child mortality rates in a rural area with high RN prevalence, located in the Rlabisa subdistrict of the KwaZulu-Natal Province, South Africa. ii. Methods The study was conducted between 1 January 2000 and 31 December 2002 on deaths in children under the age of 15 years. Children were followed up through 4-monthly home visits. Cause of death was ascertained by verbal autopsy. Rates were calculated using Poisson methods. iii. Results Infant and under-5 mortality ratios were respectively, 59.6 and 97.1 deaths per 1000 live births. Infant and under-5 mortality rates were, respectively, 67.5 and 21.1 deaths per 1000 child-years. RN/AIDS was attributed to 41% of deaths in the under-5 age group, with a mortality rate of 8.6 per 1000 person years. Lower respiratory infections caused an estimated 24.9 deaths per 1000 person years in children under 1 year of age. iv. Discussion In rural South Africa, infant and child mortality levels are high, with RN/AIDS estimated as the single largest cause ofdeath. Improving the coverage of interventions known to impact on child mortality is required urgently. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2007.

South Africa is one of the six southern African countries where the HIV levels for childbearing women are 20% or higher. In South Africa, like most countries, behaviours such as multiple sexual partners, unprotected sex and drug use expose individuals to the risk of HIV infection and drive the HIV epidemic. Thus, research on sexual risk behaviours associated with HIV/AIDS is vital in identifying target groups at risk for HIV. Previous research has shown a link between substance use and sexual risk behaviour however in South Africa research within this field is still evolving. Furthermore, research on substance abuse among women in South Africa is limited. In the light of increasing HIV infection in women and the possible influence substance use has on sexual risk behaviours including HIV, exploring the association between substance use and sexual risk behaviours among women would provide valuable information. Socio-cultural and situational factors are explored within substance use and sexual risk behaviours as women's lives occur with realm of individual, family and community. The sample was drawn from an Alcohol and Drug Rehabilitation Centre situated in the Durban area. Study participants included Black/African, White, Indian and Coloured women who were admitted to the treatment centre for alcohol abuse. One focus group discussion and six in-depth interviews were conducted with women to understand the socio-cultural and situational context of substance abuse and sexual risk-taking behaviours (including HIV/AIDS). Substance abuse emerged from women's lack of coping mechanisms to deal with poor relationships and lack of employment which led to financial dependence on their partners. Women reported that within their settings, alcohol can be related to sexual risk behaviours because alcohol tends to lead to unsafe sexual behaviours. Women reported that alcohol use facilitates intimacy and rapport between couples thus some women tended to consume alcohol. Women reported that knowledge of safe and unsafe sex is known however implementation is difficult because condom use requires her partner's co-operation. Women were financially and emotionally dependent on their partners, social norms which determine women's role in society and sexual relationships governed their behaviour. Partner violence was a common feature among women which impacted on women's ability to negotiate condom use. The paper discusses the intrapersonal, interpersonal and contextuall situational factors that influence substance use and sexual risk behaviours in these women's lives. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.

Introduction: The high prevalence of HIV in South Africa was confirmed by Department of Health (2005) which reported an HIV prevalence rate of 40.7 percent amongst antenatal clinic attendees at public facilities in KwaZulu-Natal in 2004. Abstinence is one of the strategies used by many different cultures where young unmarried people are encouraged to abstain from sex until marriage, to prevent young girls from getting pregnant and acquiring sexually transmitted infections (STIs). Aim: The aim of this study was to investigate African rural high school learners' choice of sexual abstinence and to compare abstinent versus non-abstinent African rural high school learners in order to be able to develop tailored educational messages. Abstinence was defined as not having penetrative sex, since this is the accepted definition of abstinence in Zulu culture. Objectives: a) To investigate the prevalence of abstinence from sexual intercourse amongst African rural high school learners, b) To assess demographic, psychosocial, and economic determinants of abstinence from sexual intercourse, c) To make recommendations about abstinence interventions. Method: A descriptive cross-sectional study was carried out in a rural area (Ugu District in southern KwaZulu-Natal). One class of Grade 9 learners, ages 14-20 years, was selected from each often randomly selected rural high schools. An anonymous selfreporting semi-structured questionnaire used the I-Change model to investigate demographic and economic information, attitudes, social influences, self-efficacy and intentions towards sexual abstinence. Chi square and T-tests were used for bivariate analysis and Logistic regression was used to develop a model for abstinence from sexual intercourse. Results: A total of 454 learners participated with a mean age of 16.76 years (SD 1.41) age range 14-20 years. Of the sample 208 (45.8%) were male and 246 (54.2%) female. The majority were Christian (84.6% (n=384)) and of this population, 28.3% (n=127) reported that they had 'ever had sex'. Furthermore, 24.5% (n=91) of learners reported that they were currently sexually active. Fifty six percent (n=252) of learners reported that they abstained from sex. When comparing learners reporting abstinence (n= 252) with those not abstinent (n= 202), abstinent learners were significantly more often females, who had never had sex (p / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2007.

No abstract available. / Thesis (M.Med)-University of Natal, Durban, 1986.

In 1990 the Department of National Health and Population Development of South Africa launched a nationwide immunisation coverage campaign targetted mainly at measles. In order to measure the effect of the campaign on vaccination coverage rates for children pre- and post- campaign vaccination coverage surveys were performed using a modified EPI technique, stratified for race and urban/rural residence. The results in Natal/KwaZulu showed no significant changes in vaccination coverage rates as documented by Road-to-Health cards for any race, although the trend was towards a slight increase. The results bring into question the effectiveness of immunisation campaigns as a strategy for raising vaccination coverage levels, and having a sustained impact on the incidence of measles. Alternative strategies, such as the strengthening and expansion of existing primary health care services, and changes to the immunisation schedule for measles, should be considered. / Thesis (MMed.)-University of Natal, Durban, 1992.

No abstract available. / Thesis (MMed)-University of KwaZulu-Natal, Durban, 2006.

South Africa has had one of the fastest growing HIV epidemics in the world and almost 30% of women attending public antenatal clinics (ANC) are currently infected with the virus. But as the epidemic is starting to level off and antiretroviral therapy (ART) is becoming increasingly available, few methods exist to determine the impact of ART or other interventions on the epidemic in South Africa. This thesis explores the epidemiology and dynamics of HIV infection and investigates the potential impact of ART. Methods Total and age-specific prevalence data are analysed in time and space and are used to investigate patterns of infection in men and women, urban and rural, and low and high risk populations. Dynamical models are developed to estimate incidence from age-specific prevalence and trends over time and are compared to laboratory-based estimates of recent HIV sero-conversion. Incidence is estimated in different populations in South Africa. A dynamical model is developed to estimate the impact of ART on the future course of the HIV epidemic. Results HIV prevalence varies geographically and by age, sex and race. The average female-tomale HIV prevalence ratio is 1.7 and prevalence peaks at an older age among men than women. The age at which prevalence peaks among women has increased from 23.0 to 26.5 years between 1995 and 2002. Four patterns of infection are identified: among pregnant women attending ANCs, among men and women in the general population, and among migrant workers. HIV incidence among ANC attendees peaked in the mid to late 1990s (at 6.6% per year nationally) with variation between provinces. Current estimates of HIV prevalence and incidence among the general population in South Africa (aged 15-49 year) are 18.8% and 2.4% per year, respectively. Age-specific incidence estimates from dynamical models and laboratory methods are in good agreement provided the window period for the laboratory method is increased. Over the next ten years the provision of ART could avert 1 to 1.5 million deaths depending on whether it is provided when the CD4 cell count falls to 200 or 350 cells/ul. By 2015 about 1.1 million people will be receiving ART but this will have little impact on the incidence of HIV and scaling up of prevention efforts remains urgent. Conclusions The thesis explores some of the determinants and patterns of HIV prevalence and incidence in South Africa in order to find better ways to manage the epidemic of HIV, monitor changes and evaluate progress in control efforts. In order to fight the epidemic we need to mobilize the best possible science in support of those people and communities affected by the epidemic. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2007.

No abstract available. / Thesis (MMed)-University of Natal, Durban, 1993.

Introduction: Inadequate water supply and sanitation adversely affects the health and socio-economic development of communities. Since 2003, more than 40 000 households in peri-urban and rural areas within eThekwini Municipality, South Africa, have been provided with urine diversion toilets, safe water and hygiene education. eThekwini Municipality have requested that these interventions be evaluated to monitor their effect on health outcomes. Aim: The aim of the study is to describe the baseline situation in respect of sanitation, safe water and hygiene behaviour in Intervention Areas in eThekwini Municipality and compare these to Control Areas. Methods: An observational analytic cross sectional study design was undertaken. A multi-stage sampling procedure was followed and six study areas were randomly selected. Three Intervention Areas (urine diversion toilets) were matched with three Control Areas (no urine diversion toilets). A total of 1337 households, comprising of 7219 individuals, were included in the study. A Household Questionnaire a and an Observational Protocolb was administered by fieldworkers. Data was entered onto a custom designed EpiData database, processed and analysed using SPSS version 13. Results: The baseline characteristics revealed that Intervention and Control areas were very similar other than the provision of urine diversion toilets, safe water and hygiene education in the Intervention area. The Intervention area scored higher than the Control area (2.31 vs. 1.64) with regard to having a cleaner toilet, with no flies, no smells, having hand-washing facilities and soap provided close to the toilet. Some of the collected data from questionnaire responses were not consistent with the fieldworkers observations. It was reported that 642 households in the Control and 621 in the Intervention areas washed their hands with soap, whilst only 396 households in the Control and 309 in the Intervention areas were observed to have washed their hands with soap. Conclusion: Households in the Control area are at a greater risk of developing diarrhoeal and other related diseases. The provision of safe water, urine diversion toilets and hygiene education in the Intervention area has proved to be successful. Recommendations: eThekwini municipality must expand the package of services c to the Control areas. Sustainable hygiene education programmes must continue to be implemented and be evaluated over time. Plate 1: Inside view of the UD Toilet Plate 2: Ground tank providing 200 litres free water Plate 3: Hygiene education material Plate 4: External rear view of the UD toilet / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2007.

No abstract available. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2006.