The attitude of the African male to contraception and the role he plays in the acceptance of contraceptives by his racial group is presented. Over a period of one month the researcher interviewed 220 African males at a primary care private practice. In this study 186 (85%) were aware of contraceptives and 34 (15%) had no knowledge of contraception; 111 (60%) were married and 75 (40%) were unmarried. The 26 - 35 year age group were the most familiar with contraception (57%). The unemployed were the least users of contraceptives (8%), whereas 69% of the professional group were using contraceptives. The average ideal family size of the group was 4 children. No significant cultural barriers to contraception were found. Religion was found to have little effect on contraceptive practice by the African male. Fifty-three percent of the Urban dwellers were using contraceptives compared with only 30% of the Rural inhabitants. Modern methods of contraception are not yet sufficiently known by the African male to be useful to him. Health workers should educate the African male in matters of contraception to achieve the desired objectives of family planning campaigns among this racial group. / Thesis (M.Prax.Med.)-University of Natal, Durban, 1986.

INTRODUCTION All waste generated at health care facilities in the past was regarded as hazardous and needed to be incinerated first before it was disposed. The purpose of this study was to investigate health care waste (HCW) management practices employed in public health clinics in the iLembe District, with a view of developing a HCW management intervention strategy. METHODOLOGY The study design was observational, descriptive, and cross-sectional. Data was collected using a structured individual questionnaire, which was administered to key informants from 31 rural and urban government fixed public clinics in the iLembe District Municipality. RESULT Thirty public clinics in iLembe district participated in the study. A total of 210 kg/day (0.06 kg/patient/day) of HCW was estimated to be generated in public clinics, 69% was health care general waste (HCGW) and 31 % was health care risk waste (HCRW). The district's generation rate was 0.04 kg/patient/day and 0.018 kg/patient/day, for HCGW and HCRW, respectively. The study found that HCW was improperly managed in the district. DISCUSSION The findings are different when compared to World Health Organisation norms and this was attributed to improper segregation of waste categories other than sharp waste, which was given special treatment. Factors such as the number of patients, size of the clinic, types of health care services rendered, and socio-economics status of the patient played a pivotal role in the waste volume generated. It is evident that no proper HCW management plan was being implemented in the district public clinics. CONCLUSION The management of health care risk waste is of great concern. There is a need for development of a health care waste management intervention strategy that must be implemented consistently and universally in the district. RECOMMENDATIONS It is recommended that a proper health care waste management intervention strategy be developed and implemented in the whole district. This strategy must incorporate training programmes and a waste management plan. / Thesis (MPH)-University of KwaZulu-Natal, 2007.

Indoor air quality has become an important health concern due to the number of indoor pollutants and the realization that even minimal exposures to volatile organic compounds may produce direct or indirect adverse health outcomes. Young people are most vulnerable to these poisonous chemicals as they spend much of their times indoors at homes, schools, nurseries and in day care centers. Exposure to volatile organic compounds indoors has been related to asthma and other respiratory symptoms. The adverse effects of air pollution on respiratory health in South Durban have been described in a number of studies. In 2000, a study in the South Durban Basin at Settlers Primary School demonstrated both a high prevalence of respiratory diseases amongst schoolchildren as well as an association between ambient air pollutants and other adverse health outcomes. The South Durban Health Study subsequently undertook a health risk assessment and an epidemiological study investigating this association further on behalf of the eThekwini Municipality. The study highlighted that relatively moderate ambient concentration of N02, NO, PMIO and S02 were strongly and significantly associated with a reduction in lung function among children with persistent asthma. Moreover, attending primary school in South Durban was significantly associated with increased risk from persistent asthma when compared to schools in North Durban. METHODS The descriptive study measured the total volatile organic compound levels within selected homes and schools of asthmatic children in South and North Durban. Recommendations for reducing or mitigating indoor total volatile organic compound exposures were made. The study involved a secondary analysis of data obtained from the South Durban Health Study. The monitoring for total volatile organic compounds within homes and classrooms was undertaken using passive samplers during a 72-hour period and analyzed using a gaschromatography/ mass spectrometry method. Temperature and humidity was assessed using temperature and humidity sensors. Statistical analysis was performed using SPSS version 13. The dataset comprised 140 total volatile organic compound samples from homes and 14 from classrooms. Total volatile organic compounds were measured in microgram per cubic meter (g/m3), temperature in degrees Celsius and relative humidity in percentage of moisture. RESULTS Total volatile organic compounds with levels in households ranging from 17g/m3 to 1440g/m3 and in classrooms ranging from 48g/m3 to 5292g/m3 were measured. The mean levels detected were significantly different in homes and classrooms / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2008.

Introduction. The demand for comprehensive Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) services is greater than the available supply, particularly for the provision of antiretroviral therapy. The resulting bottleneck in service delivery has considerable implications for people living with HIV and for resource management. Aim. The purpose of this research was to investigate loss-to-care and associated variables of adult HIV-infected people who were eligible for antiretroviral therapy, from July 2004 to December 2007 at Sinikithemba HIV Clinic in Durban, KwaZulu-Natal. Methods. An observational descriptive and analytic cohort study design was used. Secondary data sourced from Sinikithemba were collated. All HIV-infected adults, 15 years and older when registered on the TrakCare database, who were eligible for antiretroviral therapy were included in the study. Data were extracted to describe the preparation of HIV infected adults who were eligible for antiretroviral therapy. Variables were first summarised and described before the confirmatory analytic steps were taken to measure associations at the p<0.05 significance level. Results. Of the 10 424 HIV-infected adults registered at Sinikithemba, 5470 (52%) were eligible for antiretroviral therapy from July 2004 to December 2007 and 2979 (54%) of these were lost to care prior to initiating antiretroviral therapy. Six exposure variables were significantly associated with this loss-to-care, (gender, baseline CD4 count, pre-eligibility care, antiretroviral therapy delay, preparation step and waiting time). These variables remained significantly associated with loss-to-care even after controlling for confounding with logistic regression. Discussion and Recommendations. With the rapid scale-up of antiretroviral therapy programmes, the outcome of those people living with HIV lost to care before commencing therapy have not been adequately documented. This large cohort enrolled over three-and-a-half years demonstrates that the loss-to-care prior to initiation of antiretroviral therapy is a significant problem that needs to be further investigated. Focusing retention strategies at the pre-antiretroviral therapy stage of HIV care will improve overall programme outcomes. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

International mass sports gatherings like the FIFA (Federation Internationale de Football Association) World Cup Soccer and Olympics can cause great challenges to local healthcare systems and emergency medical services. History has shown that disasters do occur during these events, whether on a small or large scale. Disaster Management Practitioners from the public health perspective widely recognize that poor planning and a range of other underlying factors, create conditions of vulnerability. These result in insufficient capacity or measures to reduce hazards’ potentially negative consequences. The eThekwini District has to be prepared in the event of a mass disaster. Pre-empting and planning for disasters will lead to the safety and security of our citizens. The aim of this study was to undertake a baseline survey (in a total number of eleven public sector hospitals) to assess the state of hospital readiness, medical preparedness, and emergency care in preparation for the 2010 FIFA World Cup Soccer in the eThekwini District. A general assessment tool in the form of a standard questionnaire, and a walkthrough visit with a checklist, was used to collect data. There is no previous study conducted at the eThekwini District to assess requirements for an international event in terms of a mass disaster. South Africa is a developing country, and this was the first time any developing country had hosted a sporting event on such a large magnitude thus there are no international standards on sports disaster management by any other developing countries to generalise to eThekwini District. The current disaster management operational plan that is being used for the World Cup is based on a United Kingdom integrated management philosophy tool. The study herein adopted a public health approach and incorporates the Yokohama Strategy within its tool along with the use of HMIMMS and MIMMS in the assessment of the clinical criteria. The perceived minimum requirements suggested by the hospitals and a Provincial Task Team, from the Provincial Health Disaster Management office, was used as a guideline. The study showed that although disaster plans and policies are in situ, there still exists a need for resources to be directed toward skills training, attraction and retention of healthcare professionals, revitalisation of emergency and theatre areas and the commissioning of more isolation units. The results of the study would enable the District Office to note any shortcomings and lack of resources in public sector hospitals. The study outcome would be important for the implementation of any strategic planning to aid the hospitals in preparation for mass disasters that may occur during the 2010 FIFA World Cup Soccer. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2010.

The physical, psychological and social development of school children has been neglected - partly because they were seen as healthy "survivors" of the ravages of childhood illnesses, and partly because of the way in which health services are organized (such as the traditional under-five maternal and child health (MCH) services and the curative PHC clinic services). From the age of five years children undergo rapid and profound bio-psycho-social development, to emerge in adolescence as the next generation of leaders and workers. Securing their future growth and development is vital for any society to be economically and socially productive. A substantial body of national and intemational literature has recognised the detrimental impact of helminthic infections and micronutrient deficiencies on the physical and psychological health and development of school children; which requires appropriate nutritional interventions. Concern has been expressed that these adverse biological, physical and social deprivations have a cumulative impact on several dimensions of children's growth. Most important, apart from stunting physical growth, is the inhibition of educational development of school children. Recent evidence strongly suggests a powerful interaction between physical and psychosocial growth and development of children. Inhibition of either component of a child's well-being has adverse implications. Conversely, investments in the physical and psychological development of children are likely to generate substantial health and educational benefits and are a worthy investment to secure a healthy future generation. In summary, there are a number of reasons for, and benefits of, investing in school-based health and nutrition interventions. They are likely to improve learning at school and enhance educational outcomes; create new opportunities to meet unfulfilled needs; redress inequity; build on investments in early child development and promote and protect youth and adolescent development. Health and nutrition interventions such as school feeding programmes, micronutrient supplementation and deworming aim to improve primary outcomes of macro and micro-nutrient deficiencies, parasitic and cognitive status; as well as secondary outcomes of developing integrated comprehensive school health policies and programmes. This rationale served as the conceptual framework for this study. This theoretical framework views improvements of the health, nutritional, cognitive and scholastic development status of school children as the primary focus of policies, strategies and programmes in the health and education sector. This focus constitutes the central core of this thesis. Optimum social development requires investments in both the health and educational development of school children, so as to maximise the synergies inherent in each sector and to operationalise national and international strategies and programmes. As part of the larger RCT study a comprehensive nutritional, health and psychological profile of rural school children was established through a community-based cross-sectional study. Eleven schools were randomly selected from the Vulamehlo Magisterial District in southern KwaZulu-Natal (KZN). Within each school, all Standard 1 pupils, aged between 8 - 10 years, were selected giving a final study sample of 579 children. Some of the observed prevalence's were stunting (7.3%), wasting (0.7%), anaemia (16.5%) (as measured by haemoglobin below 12 g/dl), vitamin A deficiency (34.7%) (as measured by serum retinol below 20 ug/dl) and serum ferritin below 12ng/ml (28.1%). This study established that micronutrient deficiency, parasitic infestations and stunting remain significant public health problems among school-aged children in South Africa. Combining micronutrient supplementation and deworming are likely to produce significant health and educational gains. To determine the impact of single and combined interventions (anthelminthic treatment and micronutrient supplements) on nutritional status and scholastic and cognitive performance of school children, a double-blind randomised placebo controlled trial was undertaken among 579 children 8-10 years of age. There was a significant treatment effect of vitamin A on serum retinol (P<0.01), and the suggestion of an additive effect between vitamin A fortification and deworming. Vitamin A and iron fortification also produced a significant treatment effect on transferrin saturation (P<0.05). Among the dewormed group, anthelminthic treatment produced a significant decrease in the prevalence of helminthic infections (P<0.02), but with no significant between-group treatment effect (P>0.40). Scholastic and cognitive scores and anthropometric indicators were no different among the treated or the untreated children. Fortified biscuits improved micronutrient status among rural primary school children; vitamin A combined with deworming had a greater impact on micronutrient status than vitamin A fortification on its own; while anthelminthic treatment produced a significant reduction in the overall prevalence of parasite infection. The prevalence's of Ascaris lumbricoides, Trichuris trichiura and Schistosoma haematobium declined significantly sixteen weeks post-treatment. The levels of both prevalence and intensity in the untreated group remained constant. The cure rates over the first two weeks of the study were 94.4% for Ascaris lumbricoides, 40% for Trichuris trichiura, and 72.2% for Schistosoma haematobium. The benefits of targeted school-based treatment in reducing the prevalence and intensity of infection supports the South African government's focus of using school-based interventions as part of an integrated parasite control programme. These strategies and programmes were found to be consistent with the recommendations of WHO and UNICEF. The nutritional transition facing developing and middle-income countries also has important implications for preventive strategies to control chronic degenerative diseases (Popkin B, 1994; WHO 1998; Monyeki KO, 1999). This descriptive study, comparing BMI data of school children over three time periods, found a rising prevalence of overweight and obesity among South African school children. Obesity as a public health problem requires to be addressed from a population or community perspective for its prevention and management. Environmental risk factors such as exposure to atmospheric pollution remain significant hazards for children. Lead poisoning is a significant, preventable risk factor affecting cognitive and scholastic development among children. The prevalence of elevated blood lead (PbB) levels in rural and semi-urban areas of KwaZulu-Natal (KZN) as well as the risk factors for elevation of PbB among children in informal settlements were examined. This study investigated over 1200 rural and urban children in two age groups: 3-5 and 8-10 years old. Average PbB level in peri-urban Besters, an informal settlement in the Durban metropolitan region, was 10 ug/dl with 5% of the children showing PbB level of greater than 25 ug/dl. By comparison, average PbB value in Vulamehlo, a rural area located 90-120 km from Durban, was 3.8 ug/dl and 2% of the children's PbB levels were greater than 10 ug/dl. Since the cognitive and scholastic performance of school children was a primary outcome measure in this study, it was important to explore other factors that influenced this variable. The performance scores of all four tests in the battery, among the cohort of a thousand rural and urban children, were in the lower range. The educational deficit identified in this test battery clearly indicates the impact of the inferior "Bantu" educational system that African children have experienced in South Africa. Aspects of the School Health Services that were investigated in this descriptive study included the services provided and their distribution; assessment of health inspection; health education and referral processes undertaken by the School Health Teams; perceptions of managers, providers and recipients of the service; as well as the costs of the provision of the service in KwaZulu-Natal. In KwaZulu-Natal, there were School Health Teams In all the 8 health and education regions in the province. In total, there were 95 teams in the province, consisting of nearly 300 staff members. The School Health Teams were involved in a wide range of activities - 74% of all teams were involved in health inspection and 80% were involved in health education. The total annual cost of delivering School Health Services in the province in 1995 was estimated to be approximately R8 750 000. Given the rise of HIV and AIDS in the province, School Health Services need to play a central role not only in prevention, but also in assisting with the acceptance of HIV-positive children within schools. It is recommended that the current and future draft SHS policy guidelines be approved by the relevant authorities for immediate implementation. Districts should consider developing "Health Promoting Schools", with School Health Teams being a central resource. This thesis has explored several aspects of the epidemiological profile of school children in rural and urban settings in KwaZulu-Natal. It has established that school children are exposed to a range of risk factors ranging from nutritional deficits, parasitic infections, atmospheric lead poisoning and a rising prevalence of overweight. All of these risk factors may compromise their physical, psychological and social development. A number of health interventions have been identified, which have the potential to address these problems. Such investments are essential to secure the health of future generations. / Thesis (M.D.)-University of Natal, Durban, 2001.

Introduction Being an effective communicator is a core competency required of all health care practitioners. Some undergraduate medical students at the Nelson R. Mandela School of Medicine (NRMSM), University of KwaZulu-Natal, Durban, are unable to communicate in isiZulu, the mother tongue of nearly 80% of the 10.2 million people in the province, and the most common home language spoken in South Africa. A one-year isiZulu course to teach communicative competence in the language, and assessed in the first three years of the 6-year MBChB programme, is currently offered at the first year level to medical students. Aim This study was conducted in 2012 to assess how isiZulu clinical communication was perceived by a third year cohort of medical students, and whether current teaching in the period 2010-2012 had prepared them to communicate with their patients. Methods An observational, cross-sectional study design was used to assess the knowledge, attitude and practice of the study group through a self-completed questionnaire. Their knowledge of isiZulu was assessed in a written test, and the students’ marks were compared with their marks in 2010. Oral competence was assessed in an isiZulu history-taking station in the objective structured clinical examination. Students’ comments on their experiences and their recommendations were recorded. Ethics approval was obtained to conduct the study, and informed consent was obtained from participants. Results & Discussion Medical students’ competence in isiZulu had improved. They were largely positive about learning the language of their patients but seldom used the language in the clinical setting. Many students indicated that the current teaching of isiZulu in the programme was inadequate for their needs. Conclusion & Recommendations Although isiZulu is taught to non-isiZulu students, this does not convert into an ability to use the language in the clinical setting. In order for medical students to acquire a satisfactory and safe level of communicative competence in isiZulu, and in line with the UKZN Language Plan to emphasize language training specific to various vocational groups, it is recommended that the teaching, learning and assessment of isiZulu language and culture be integrated into all levels of the undergraduate medical programme in the form of vocation-specific isiZulu for medical students. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2013.

The demand for deep fried chips by public and the number of people entering the fast food industry in the form of fast food outlets has increased tremendously. Frying oils are very expensive and are the most important ingredient used in the preparation of fried foods. Due to high oil costs and lack of knowledge, frying oils are used to their maximum. This has resulted in the abuse of deep fried chip cooking oils. The overall quality of the deep fried chip cooking oil used in the South Central Operational Entity of the eThekwini Municipality is not known but abused cooking oils have been identified by Environmental Health Practitioners (EHP's) during routine inspections of fast food outlets. Considering all of the above, the objectives of the proposed research were: (l) Determine the overall prevalence of the use of abused deep fried chip cooking oils at fast food outlets in the South Central Operational Entity of the eThekwini Municipality. (2) Determine in which supervision areas in the South Central Operational Entity the use of abused cooking oil is most prevalent. (3) Determine current/reported practices in preserving the quality of chip oil. (4) Make appropriate recommendations to owner/managers of the fast food outlets and to Environmental Health Practitioners. The study design was observational utilizing a Rapid Epidemiological Assessment (REA) technique, with both a descriptive and analytical component. All fast food outlets making deep fried chips in the South Central Operational Entity registered with the eThekwini Health Department at the time of the study were included in the study population. The Lot Quality Assurance Sampling (LQAS) method was used to determine the overall prevalence of the use of abused oil and to determine supervision areas reached the predetermined service target. A total of 100 fast food outlets were sampled. An oil sample from each fast food outlet, which was taken and sent to a laboratory where an Oxifrit Test was done on every oil sample taken. The Oxifrit Test was the benchmark in this study. EHP's of eThekwini Municipality collected further data by means of an observational checklist and a closed-ended questionnaire, which aimed to establish cooking oil preservation practices. The study revealed that 60 of the outlets had oil that was acceptable whereas 40 had oil that was unacceptable (abused oil). In the multivariate analysis the only factors significantly associated with abused oil were the condition of the fryer and frequency of oil change. Supervision Areas 6, and 4 had more abused deep fried chip cooking oil than average in the South Central Operational Entity. For further prioritization, Supervision Areas 6 and 4 fell below the decision rule for majority of acceptable oil preservation practices, thus Supervision Areas 6 and 4 will be targeted for intervention. Intervention will include education, monitoring and ultimately enforcing the law by EHP's to ensure safe use of deep fried chip cooking oil in the South Central Operational Entity within eThekwini Municipality. / Thesis (M.P.H.)-University of KwaZulu-Natal, 2006.

Introduction. The Human Immunodeficiency Virus (HIV) is the main contributor to rising child mortality in South Africa. Although prevention of mother-to-child transmission programmes have been implemented in the country, little is known about the clinical and loss to follow-up outcomes of infants born to HIV-infected women attending these programmes. Purpose. The purpose of the study was to describe the clinical and loss to follow-up outcomes of HIV-exposed infants whose mothers had received antiretroviral therapy or prophylaxis during their pregnancy at the Prevention of Mother-to-Child Transmission programme at McCord Hospital. Furthermore, maternal socio-demographic characteristics associated with these outcomes were determined. Methods. An observational retrospective cohort study design was used. The study population consisted of infants whose mothers had received antiretroviral prophylaxis or therapy at McCord Hospital, and were delivered at McCord Hospital, and/or were brought back to McCord Hospital, following delivery from 1 May 2008 to 31 May 2009. Results. Data on 265 infants was analysed. Of the 220 infants who were tested, the HIV transmission risk was 2.7% (n=6; 95% Cl: 1.0% to 5.8%) at 6 weeks of age. Overall, 40.4% of infants in the cohort were lost to follow-up (n=105, 95% Cl: 34.4 to 46.6). In the multivariable model (n=253), late booking for first antenatal visit at or after 28 weeks of gestation (adjusted hazard ratio (AHR) 2.3; 95% Cl: 1.0 to 5.1, p=0.044) was a risk factor for loss to follow-up. Compared to having an emergency caesarean section, having an elective caesarean section (AHR 1.9; 95% Cl: 1.1 to 3.5) or normal vaginal delivery (AHR 2.5; 95% Cl: 1.4 to 4.5) was significantly associated with loss to follow-up of infants. Discussion. The substantial attrition of infants born to HIV-infected mothers in the Prevention of Mother-to-Child Transmission programme at McCord Hospital undermined the goals of the programme, and underestimated the effect of infectious disease morbidity, mortality and HIV transmission risk associated with these infants. Recommendations. Counselling mothers on the health benefits to their HIV-exposed infants of attending the follow-up clinic and tracing of infants who have been lost to follow-up is vital to the operational effectiveness of the Prevention of Mother-to-Child Transmission programme at McCord Hospital. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

Introduction. Stone crushing in Dar-es-Salaam Tanzania is largely an informal occupational activity, with approximately 7000 workers exposed to varying level of respirable dust. A highly marginalized, self employed, informal stonecrusher is prone to multiple work related risks, particularly dust related respiratory diseases. Aim. This study, the first to be done among informal stone crushers in Southern Africa, aimed at determining the prevalence of dust related respiratory outcomes and relationships between these health endpoints and exposure to respirable dust in this sample of stonecrushers. Methods. This was primarly a cross-sectional descriptive study with analytic components. This study analysed a subset of data collected in a health survey of stone crushers in Kigamboni informal stone quarry in Dar-es-Salaam, Tanzania in 2007. All 200 workers working in the quarry were interviewed. A subset of 86 and 59 workers underwent exposure assessment and health assessments (spirometry and chest radiography) respectively. Associations were investigated between exposure measures and respiratory outcomes. Results. The average age of the workers was 36.3 years with 51.5% males participating in the study. Smoking was common with 30.1% male, 8.25% female smokers, with 2% ex-smokers. Personal dust sampling showed varying dust levels ranging from 0.5-2.8mg/m3 with geometric mean of 1.2gm/m3. The exposure duration of workers in the quarry ranged from 1-62 years with mean of 7.8 years. No single worker was found to use personal protective equipment at work. Reported prevalence of doctor diagnosed respiratory diseases was low: pulmonary tuberculosis (2%), chronic bronchitis (2%), asthma (3%), pneumonia (3%). In contrast, there was high prevalence of respiratory symptoms: chronic cough (13.5%), phlegm production (14.5%), productive cough (10%), wheezing (14%), mild breathlessness (9.5% ) and coughing blood (7.5%). Mean forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) adjusted for age, height and sex was 2.6L/min and 3.7 L respectively, among males and 2.1L/min and 3.0L respectively among females. Adjusted exposure odds ratios for symptoms were statistically significant for mild and moderate breathlessness with odds ratios of 3.4 and 3.1 respectively. Linear regression showed statistically significant decline of 2.3mls in FEV1 with years of exposure while controlling for sex, age, height , doctor diagnosed TB and smoking showing that with prolonged exposure in the quarry, workers are at a risk of developing obstructive lung disease. This trend was not evident for FVC. The majority of films were normal (60.9%), with 19.6% read as 1/0 and 19.9% as 0/1. Discussion. This study identified adverse respiratory outcomes among informal stonecrushers, particularly a high prevalence of respiratory symptoms and clinically important lung function deficits. These are in keeping with other environment studies where workers were exposed to respirable dust. Recommendations. Urgent policy initiatives for developing cost effective hazard control, engineering interventions to protect these marginalized self-employed informal sector stonecrushers are needed. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2010.