Nutrition education is recognised as being of value in the prevention of malnutrition. However, in order for it to be effective, an in-depth study of the community prior to the implementation of any nutrition education programme is essential. A study of the nutritional status of pre-school children in Malukazi (an informal, unplanned Black township in the greater Durban area) together with background information on the household and the childminder was therefore undertaken, so that recommendations for a nutrition education programme in the area could be made. The relationship between nutritional status and certain ecological variables was also studied in order to determine which of these, if any, was a significant factor in the development of malnutrition. Nutritional status was assessed by using anthropometric measures (height and weight) and dietary intake (24-hour recall and food frequency). Background information obtained included socio-economic status; food purchasing, preparation and storage patterns; intrafamilial pattern of eating; food taboos; clinic attendance; and the childminder's sage, educational level, body size, nutritional knowledge and attitude towards nutrition education. Information was obtained by means of face-to-face interviews using a single, trained interviewer. The incidence of low weight-for-age was relatively low and that of low height-for-age ("stunting") considerably higher (14,2% and 47,3% below the 3rd percentile respectively), indicating that chronic malnutrition is a serious problem in this community. Information on dietary intake showed that intakes of several nutrients notably energy, calcium, vitamin A, ascorbic acid and vitamin D were low for the study population. The percentage of total energy provided by the various macronutrients was however in line with recommendations, which tends to indicate that the greatest need is for an overall increase in food intake. Of the ecological variables studied, only two were found to be significantly associated with the incidence of malnutrition. These were the number of children cared for by the childminder (p=0,04) and whether or not the household grew their own vegetables (p=0,02). The degree of malnutrition found to exist in this community, together with the unsatisfactory level of nutritional knowledge of the childminders and their apparent willingness to learn more, revealed the desirability for further nutrition education in this area. Recommendations regarding future nutrition education programmes for this community based on the findings of the study are submitted. / Thesis (M.Med.)-University of Natal, Durban, 1991.

Introduction Tuberculosis (TB) causes approximately 2 million deaths every year. The problem is escalating explosively in sub-Saharan Africa and is directly related to the increase in the prevalence ofHuman Immunodeficiency Virus infection. South Africa was ranked as having the fourth highest global incidence of TB in 2006. In 1993, the World Health Organization introduced the Directly Observed Treatment Short-Course strategy to increase efficiency of national TB programmes. The Direct Observation of TB therapy element of the strategy has been contentious. An ideal method of direct observation remains elusive and its role in improving adherence is questionable. Aim The purpose ofthis research is to detennine the most effective directly observed method for pulmonary TB offered in an urban area of South Africa. Methods A retrospective cohort analysis was conducted at the Prince Cyril Zulu Communicable Diseases Centre in Durban, KwaZulu-Natal. The study population consisted of adult patients who commenced a course of TB therapy between July 2005 and June 2006. The effect of clinic based, family member, community health worker, lay community health volunteer and workplace based direct observation on TB treatment outcomes, and frequency of recurrence was detennined. A sub analysis was perfonned of the effect of the different methods ofdirect observation in employed patients. Results Workplace based direct observation resulted in a higher frequency of successful treatment outcomes than the other methods of Direct Observation. Being a re treatment patient was the only significant factor associated with recurrence, both for the entire study population and for those who were employed. Discussion The findings of this study are generalizable to other developing countries where challenges in implementation ofan effective TB programme such as poverty, high burden of HIV infection, a migrant population with strong rural ties and reliance on traditional practices to cure illness play a major role. Recommendations There is often no best treatment observer. Every case has to be individually evaluated and the most acceptable and accessible treatment observer chosen. The findings ofthis study strongly suggest that workplace Direct Obse ation can have a significant impact in improving TB treatment outcomes. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.

BACKGROUND For many years, the Durban south community has raised concerns about ambient air pollution including particulate matter. The Durban South Industrial Basin (DSIB) may be high risk for exposure to significant levels ofPMI0 due to its geographic relationship with two major petroleum refineries, together with a pulp and paper manufacturing facility. While potential sources of elevated levels of PMlOin the south are industrial, the north is likely to be exposed to controlled burning of vacant fields and use ofbiomass fuels, particularly in informal settlements. Adverse health effects from particulate matter (PM) were well documented by extensive epidemiological observations by animal and human studies, following laboratory exposures. Studies across a variety of environmental settings have demonstrated a strong association between ambient air particulate matter (PMlO) and cardiopulmonary morbidity and mortality. Studies have reported that particulate matter is associated with adverse health effects resulting from inflammatory responses in the lower respiratory tract. Exposure to particulate matter may increase the risk of lung cancer. Some studies suggested that small temporal increases in ambient particulate matter are sufficient to cause health impacts. Other studies attributed strong seasonality to temperature inversions associated with temperature changes. Studies also illustrated the impact of temporal variation on PMl 0 levels across regions. OBJECTIVES The main objectives of this study were to determine and compare the levels of ambient PMIO in industry exposed and non-industry exposed communities, to determine temporal variation and to make recommendations. METHODS This study focused on determining the 24-hour ambient PMI0 levels in the Durban south community. The PMIO levels in Durban south (industry exposed) were compared with the PM10 levels in an area north of Durban (non-industry exposed). Relevant data obtained from the monitoring program of the South Durban Health Study (SDHS) was reviewed for the purposes of this study. The different techniques used to measure PMI0 are gravimetric sampling and tapered elemental oscillating microbalance (TEaM). Both methods were used to collect PMI0 data. The data comprised of quantitative and categorical variables. The dependent variable was the PM10 values and the independent variable was the sampling sites. Non-parametric tests were used to analyse the data. RESULTS PMI0 was recorded in all sites in north and south areas. The levels varied across all sites. Both the north and south areas recorded high PMI0 values at regular intervals. No particular trend was observed when the 24 hour PM10 concentration was compared against the standard. All sites recorded medians that were generally in the region of 40-S0,ug/m3. The site with the highest median (SIA,ug/m3 ) was Assegai. Briardale recorded the lowest median (34.9,ug/m3 ). Exceedances of the South African National Standard code 1929 maximum 24-hour concentrations of7S,ug/m3 were observed across all sites. Overall there were 163 (16.7 % of all samples) exceedances, and these ranged widely between the various sites, with no particular regional trend. Overall .June experienced the highest PMl 0 values. No differences in seasonal trends were observed in north and south. CONCLUSION On average the levels ofPMI0 do not exceed national or international standards. The findings did not reveal any statistical difference in exposure levels between the industry exposed and non-industry exposed areas. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2008.

The vast majority of paediatric HIV occurs in sub-Saharan Africa and could be averted through implementation of effective Prevention of Mother to Child Transmission (PMTCT) strategies. At the United Nations General Assembly Special Session on HIV/AIDS in 2001, members committed themselves to the goal of reducing paediatric HIV by 20% by 2005 and by 50% by 2010. In South Africa, rates of HIV infection range between 28% in KwaZulu-Natal and 16% in the Western Cape. The South African National Department of Health has, over the past few years, phased in a comprehensive package for PMTCT of HIV. KwaZulu-Natal implemented its programme in 2002. The South African private healthcare sector follows guidelines of those of developed countries for PMTCT. Not much data is available of the outcome of infants born to HIV positive mothers managed in private practice. In view of this, the present study aimed to assess success or otherwise of PMTCT in private paediatric practice in South Africa. Eight of the 20 private paediatricians, in the central region of Ethekweni Metro of KwaZulu-Natal (Durban Central Area), agreed to participate in a retrospective study. Data for all their HIV exposed infants between January 2004 and June 2005 were reviewed. One hundred and one Black African infants were born to 100 HIV positive women aged 29.85 years (SD 5.38; range 18-44 years). The median CD4 count was 426 (IQR 244-613). The median viral load at first presentation was 3.97 logs (IQR 1.6-5.8) or 11 391 copies/ml (IQR 2 013-41 502). Eighty six women had HAART, nine had other antiretroviral therapy and five had no prophylaxis. Treatment started before 34 weeks in 72 women. There were 93 caesarean sections. There were 20 low birth weight neonates, 18 were preterm and all had been formula fed and received AZT for six weeks. Of the 92 tested, two (one preterm) were positive. Although caesarean deliveries, both these mothers had not adhered to the optimal treatment protocol. Of the rest, eight did not return for HIV testing and one died (the only neonatal death). This death was unlikely to have been HIV related. The transmission rate of less than one percent in those women who followed the protocol optimally is much better than that in the SA public sector, and is consistent with transmission rates in the developed world. / Thesis (M. Med.)-University of KwaZulu-Natal, Durban, 2009.

This study aimed to review the use of lay counsellors and rapid HIV tests in a voluntary testing and counselling (VCT) service in the UGU South health district of KwaZulu Natal. The study ran from September 1999 to April 2001. In early 1999, UGU South was selected as a pilot site as part of an international initiative. This initiative aimed to promote testing for HIV by using VCT service as an entry point into a range of HIV/AIDS and TB prevention and care programmes and was termed the ProTEST Initiative. Four such ProTEST sites were developed in South Africa and all offered rapid HIV testing and prophylactic drugs (Isoniazid and Cotrimoxazole) for HIV infected people. VCT was prioritised at all sites, however UGU South was unique in providing lay counsellors. Traditionally a lay counsellor (who is not a trained health care worker), offered only pre and post- test counselling. Lay counsellors had been used in South Africa, however their impact had not been formally assessed. In accordance with the Health Professional Council ruling on testing blood, lay counsellors could not carry out a rapid HIV test procedure. The decision to use lay counsellors in UGU South, was based on a review of the capacity of existing health care workers to expand a VCT service. Ten female lay counsellors, who fulfilled pre-employment selection criteria, were employed. In 1999, VCT was prioritised by the South African Department of Health and a Strategic Plan on HIV/AIDS & STDs was developed. The aim was to test 12.5% of the adult population for HIV before the year 2005. The proposed VCT service was to be based at health facilities and was to utilize existing health care workers. The capacity of existing health care workers to cope with an expansion in VCT services had not been explored. The reasons why clients accessed VCT and the demographic profiles of such clients were poorly understood. The Department of Health also planned to use rapid HIV tests at health facilities. Literature on the use of rapid HIV tests in South Africa was limited. This study aimed to address gaps in knowledge around VCT in South Africa and specific objectives were to: * Assess the capacity of existing health care workers to expand a VCT service *Review the need for rapid HIV tests *Develop and evaluate a training, support and mentorship programme for lay counsellors *Review the reason why clients use a VCT service and the demographic profiles of such clients *Monitor the impact of lay counsellors on numbers of cases of TB diagnosed and treated *Make recommendations for the use of lay counsellors and rapid HIV tests in an expanded integrated HIV/TB Control Programme. The study was prospective, descriptive and was based at ten health facilities in UGU South. The health facilities offered counselling, rapid HIV tests and prophylaxis for HIV infected people (Isoniazid or Cotrimoxazole). The study population was all nurses, lay counsellors and clients involved with the VCT service at these sites. Both qualitative and quantitative methods of study were employed in this study including: *Postal survey * Interviews *Focus group discussion *Review of patient records, literature and questionnaires * Analysis of registers from the National TB Control Programme. Results from three independent reviews clearly indicated that nurses in UGU South did not have the capacity to offer an expanded VCT service due to a heavy workload commitment. The nurses considered that VCT was a necessary service and supported the introduction of lay counsellors. Quantitative reviews concluded that a third of people tested for HIV using a hospital based testing system never returned for their results and that the turn-around time for an HIV test result was as much as three weeks. Rapid HIV tests increased access to an HIV test result and were acceptable to health care workers. There was no review of the opinions of clients on the rapid HIV tests. A training, support and mentorship programme was developed for lay counsellors and both nurses and counsellors considered that the programme was largely effective. The lay counsellors were trained to offer a more comprehensive service than traditional lay counsellors; in particular lay counsellors were expected to screen clients for symptoms of TB disease and support clients taking TB medication. Evaluation of the programme concluded that the content should be more practical and there should be a dedicated supporter for the lay counsellors available at their place of work. Results suggested that access to VCT services increased due to the presence of lay counsellors. The lay counsellors were acceptable to health staff, however there was no review of the opinions of clients on the lay counsellors. Half of the 7 475 people tested were infected with HIV. Most clients were medically referred for VCT and had "AIDS defining" illnesses. The clients who self-referred were ill or knew someone who had died recently. The proportion of clients who self-referred increased and health education was the main reason why people self-presented. More women than men were tested and women were more likely to test HIV positive. Review of the TB registers indicated that the TB Control Programme in UGU South was not optimal. The impact of lay counsellors on numbers of TB cases diagnosed and on treatment could not be determined from this study. Before the use of lay counsellors is expanded, there should further review of the capacity of other health care workers to offer VCT. Issues such as conditions of employment, salaries and a job description for lay counsellors should be clarified. There should be an independent assessment of the quality of counselling offered and a review of the cost of the lay counsellors. The impact of using men and younger lay counsellors should be reviewed. VCT services should be based at clinics, rather than hospitals and consideration should be given to developing freestanding VCT sites. Education programmes on VCT should be expanded beyond health facilities. Prior to expanding the use of rapid HIV tests, there should be a review of the cost of rapid HIV tests and systems should be in place for ordering, delivery and for stock control. The opinions of clients on rapid HIV testing should be ascertained. Consideration should be given to lay counsellors performing the rapid HIV test or an alternative method of testing (not involving blood) should be introduced. There should be ongoing training in TB and monitoring of the TB Control Programme in UGU South. Specific indicators should be developed to monitor the impact of lay counsellors on the diagnosis and treatment of TB and to measure collaboration between HIV/AIDS and TB Control Programmes. / Thesis (M.Med.Sc.)-University of Natal, Durban, 2002.

Tuberculosis is a disease of global importance and remains the leading cause of death in the developing world. In South Africa a weak notification system and poor occupational health services for health care workers has resulted in little information being available about the incidence of tuberculosis and the groups at highest risk of contracting tuberculosis amongst health care workers, the clinical presentation and management of workers infected with tuberculosis. The purpose of this study was to describe the incidence of tuberculosis, and the clinical and public health aspects of the management of tuberculosis among health care workers in eight public sector hospitals in the Ethekwini Municipality of KwaZulu-Natal. Data was collected through a retrospective review of hospital records for the study period January 1999 to June 2004. Study findings: Five hundred and eighty three (N=583) health care workers were diagnosed with tuberculosis for the period under review. The mean age of the HCWs was 38 years (95% Cl: 37-39). The mean cumulative incidence for the study period was 1040/100 000 HCW population (95% Cl: 838-1242). The mean cumulative incidence of TB was highest in males (1544/100 000 HCW population; 95% Cl 1228 -1859), the age group 25 to 34 years (1043/100 000 HCW population; 95% CI: 650 -1436) and in paramedical staff (1675/100 000 HCW population; 95%CI: 880-2470). The majority of health care workers presented with pulmonary tuberculosis (77%, n=322) and 3% (n=13) had multidrug resistant tuberculosis. Successful treatment outcomes were achieved in 63% (n=334) of health care workers. Only one hospital has a work place policy with regard tuberculosis in health care workers. Compensation for this occupational disease was sought as follows. Submissions of a first medical report were made in 107 (18%) of the 583 health care workers. In the 107 cases initially reported submission of progress reports (n=75; 70%) and final reports (n=60; 56%) decreased considerably. In conclusion, the incidence of tuberculosis in health care workers has increased annually since 1999 and the treatment outcomes among health care workers do not reach the targets set by the National Tuberculosis Control Programme. Recommendations based on the study findings include establishing a uniform provincial policy for the prevention and reduction of tuberculosis infections among health care workers for implementation in hospitals; the implementation of a medical surveillance system for health care workers with respect to tuberculosis and a provincial training programme for staff on the clinical and administrative management of TB in health care workers. / Thesis (M.Med.)-University of KwaZulu-Natal, 2006.

No abstract available. / Thesis (M.Med.)-University of Natal, 1981.

It was suspected that about 2 cases of parasuicide were admitted daily to RK Khan Hospital and this suspicion was confirmed by this study. Most of the cases were female, and in the 15 - 24 year age group. Patients were admitted mainly in the evenings and on Sundays. The majority earned less than R500 per month and were mainly manual-skilled and semi-skilled workers predominantly from Chatsworth. Non-violent means were the common mode of parasuicide, the causes being family, marital and romantic problems. The hospital social worker dealt with the cases and referred patients to relevant organisations outside the hospital for management. Certain patients were referred to the Psychiatric Outpatient Clinic at the Hospital as there was no resident psychiatrist. / Thesis (MMed-Community Health)-University of Natal, 1984.

The first twelve months operation of a five-bed rehydration unit at Osindisweni Hospital is described and data related to admissions presented. Osindisweni hospital is situated in a rural area north of Durban and has approximately 300 general beds with 60 000 outpatient attendances per year. A profile of children admitted to this unit was obtained and results are analysed according to the objectives of this study. The main findings of the study showed that 269 children were admitted to the unit during the study year and the majority of children were black African children, below three years of age, coming from rural areas. The children presented with acute diarrhoeal dehydration mostly of mild to moderate degree and were normally managed by oral rehydration therapy. Eighty-four percent of these children were successfully managed on the rehydration unit and only 13,7% received IV fluids. The majority of children requiring transfer to the ward had either persistent dehydrating diarrhoea or other complications such as malnutrition or septicaemia. No child died on the unit and no child died as a result of dehydration but 4 children died later as inpatients on the children's ward. The mortality of children admitted to the unit was therefore 1,5%. One hundred and nine patients were followed up (41,6% of questionnaires) and of these only 76 (69,7%) actually came for review the others presenting for other illnesses or else interviewed on the wards after transfer. However, most of these children had either no or minor complaints on follow up. Seventeen and a half percent of children were below the 3rd centile for age on discharge. Children with marasmus and/or kwashiorkor were not admitted to the unit. The availability of health care was poorly assessed but indicated a general lack of facilities for the rural population served. Also it was noted that the principles of G.O.B.I. had been poorly taught at Osindisweni in the past, particularly growth . charts. Mothers received health education on the unit and were found to have a good understanding of G.O.B.I. after their stay on the unit. On the whole the unit was well accepted by the mothers. It is thought that this short-stay oral rehydration unit offers a more appropriate and more cost effective alternative to previous methods of in-patient management of children with diarrhoeal dehydration and that it offers an excellent opportunity for health education. / Thesis (MMed)-University of Natal, Durban, 1988.

Introduction Sputum smears stained by the Ziehl-Neelsen method are the least expensive tool for diagnosing patients with infectious tuberculosis. However, false positive and false negative results have serious implications for treatment of patients. Therefore, controlling the quality of sputum microscopy services is important to ensure that the laboratory produce results that are accurate, reliable and reproducible. Aim The aim of the study was to determine the quality of tuberculosis smear microscopy in public health laboratories in KwaZulu-Natal between the years 2001 and 2006, and to assess the current knowledge and attitude of laboratory workers and laboratory managers to proficiency testing as a quality assurance technique. Methods A secondary analysis of laboratory proficiency testing results, from the KwaZulu-Natal reference laboratory (2001 to 2004) and from the National Health Laboratory Services reference laboratory (2006), was performed. Key informant interviews were conducted to determine the role proficiency testing played as a quality assurance technique. Results Overall laboratory performance was 93% from 2001 to 2004 and 98% in 2006. High false negative results were the predominant error. Sensitivity and specificity improved from 91% (for both) in 2001 to 2004 to 97% (for both) in 2006. Overall performance of primary, district and tertiary health care levels were 92%, 93% and 73% respectively in the period 2001 to 2004 and 98%, 98% and 94% respectively in 2006.There was significant (p<0.01) improvement in both urban (97%) and rural (98%) laboratory performance in 2006. The overall scores by year ranged from 89% (2002) to 98% (2006), but the annual overall scores (2001 to 2006) only achieved the acceptable level twice. Key informants indicated that proficiency testing was an essential exercise, however, they reported challenges such as inconsistent feedback, high workload and need for training. Discussion Overall performance improved from an unacceptable level of 93% (2001-2004) to a satisfactory level of 98% (2006). Likely reasons include improvement in technical skills of microscopists and improvement in preparation of proficiency testing slides. Proficiency testing is considered an essential exercise to improve laboratory performance, however, participants know that they are being tested and may give 'special attention' to proficiency testing slides resulting in a social desirability bias. Recommendations A blinded rechecking programme should be established in conjunction with the use of a standardised checklist during support visits. Feedback, communication and staff training should be improved while the workload should be evaluated. / Thesis (MMed.)-Univerity of KwaZulu-Natal, Durban, 2009.