This study explored and described the perception of clinical psychologists regarding thebarriers to the provision of psychological services in urban public health settings for people with first-episode schizophrenia. The qualitative research study utilised an explorative, descriptive interpretive research design. Purposive sampling was utilised to gain access to clinical psychologists, who had at least two years of public health experience working with people recently diagnosed with schizophrenia. Data was gathered from 11 participants from the Nelson Mandela Bay Health District of the Eastern Cape by means of in-depth interviews that were conducted in English by the researcher until data saturation had occurred. A computer-assisted qualitative thematic analysis of the collected data was conducted using NVIVO software. The findings have been categorised according to three broad domains: 1)contextual barriers 2)health care system-related barriers and 3)first-episode schizophrenia syndrome-related barriers. Several specific sub-themes were identified for each of these main domains allowing for recommendations and suggestions to be provided for attending to and overcoming these perceived barriers.

Introdução: na delimitação do escopo educativo, quando as posturas para promover uma alimentação saudável possuem uma formulação predominantemente centrada na perspectiva do que é ensinado e não de quem aprende, são as expectativas do agente-usuário que funcionam como o artefato desvelador dos sentidos da relação educativa. Objetivo: compreender a configuração das expectativas de participação dos usuários de ações em Educação Alimentar e Nutricional, no contexto da América Latina. Métodos: desenvolveu-se um desenho multimétodos de natureza qualitativa, dentro do paradigma crítico. O raciocínio adotou os subsídios teóricos de habitus e campo de Pierre Bourdieu. O acesso às expectativas foi realizado em três etapas: I) reflexão sobre as relações posicionais do outro; II) elaboração de metassíntese qualitativa interpretativa sobre as experiências de participação e III)realização de trabalho empírico em duas metrópoles latino-americanas para acompreensão da configuração das expectativas dos usuários. Resultados: ao inter-relacionar os achados de cada uma das fases, pode-se apontar a regularidade da posição do agente-usuário na posição de paciente, interposta pelas leis do campo da saúde que atravessam o subcampo disciplinar da nutrição. Isto pode ser evidenciado na interface com a dimensão política, materializado nos guias alimentares, que mesmo pretendendo conferir a posição de um cidadão consumidor-cliente universal e homogêneo, se depara com o conflito de transposição à relação hegemônica de paciente. Ao avançar na interface com a dimensão intelectual, representado pelas pesquisas qualitativas da América Latina, encontra-se a confluência de experiências e cenários diversos, mas que se integram pela adversidade e inclui as relações de: gênero, autoridade, pobreza, religião, e com a mídia. Não obstante, aparecem experiências de apoio e de nova construção, baseadas nas relações com as instituições e com os agentes-profissionais que reforçam o compromisso assumido em conquistar uma melhor alimentação. Na interface com o campo da saúde, no nível da Atenção Primária da Saúde, a configuração de expectativas de participação é difusa com relação à dieta, às explicações e à distração, conjugadas por tipo de participação: capturadas, cativadas e céticas. Além disso, estiveram moduladas na sua magnitude por: integração dos sistemas de saúde, instalação de processos educativos, identificação simbólica de locais de encontro, demarcação de competências profissionais e precarização do trabalho do profissional. Dessa forma, mesmo com os usuários tentando assumir uma posição potencial de consumidor-cliente, o campo da saúde insiste sistematicamente na relação posicional de paciente, o que se manifesta nas concepções simbólicas institucionais, além dos sistemas de registro, de informação e de avaliação, assim como na representação política da área, nos espaços de tomada de decisões. Conclusão: as expectativas de participação do agente-usuário e suas propriedades encontram limitação nos seus escopos, pela interferência que exerce o campo da saúde quando professa o desejo de fornecer uma posição de consumidor-cliente, cidadão de direitos, mas que o concebe como um paciente, ideologicamente e sistematicamente. Nesse sentido, isso afeta as suas possibilidades de experiência educativa, o que se mantém apenas na exigência de alcançar a menos uma relação de envolvimento / Introduction: in the delimitation of the educational scope, when the postures to promote healthy eating have a predominantly centered formulation in the perspective of what is taught and not of those who learn, it is the expectations of the user agent that functions as the unveiling artifact of the senses of the education relation. Objective: to understand the configuration of the expectations of participation of users of actions in Food and Nutrition Education in the context of Latin America. Methods: a multimethod design of qualitative nature was developed, within the critical paradigm. The reasoning adopted the theoretical subsidies of habitus and field of Pierre Bourdieu. The access to the expectations was realized in three stages: I) reflection on the positional relations of the other; II) elaboration of qualitative interpretive meta-synthesis on the experiences of participation, and III) carrying out empirical work in two Latin American metropolises to understand the configuration of user expectations. Results: when interrelating the findings in each of the phases, one can point out the regularity of the position of the agent in the position of patient, interposed by the laws of the health field that cross the disciplinary subfield of nutrition. This can be evidenced in the interface with the political dimension, materialized in the alimentary guides, that even intending to confer the position of a universal and homogenous consumer-customer citizen, is faced with the conflict of transposition to the hegemonic relation of patient. As we move towards the interface with the intellectual dimension represented by Latin American qualitative research, we find the confluence of diverse experiences and scenarios, which are integrated by adversity and include the relations of gender, authority, poverty, religion, and the media. Nonetheless, there are experiences of support and new construction based on relationships with institutions and professional agents that reinforce the commitment to better food. In the interface with the health field, at the level of Primary Health Care, the configuration of expectations of participation is diffuse in relation to diet, explanations and distraction, conjugated by type of participation: captured, captivated and skeptics. In addition, they have been modulated in their magnitude by: integration of health systems, installation of educational processes, symbolic identification of meeting places, demarcation of professional skills and precariousness of the work of the professional. Thus, even with users trying to assume a potential consumer-customer position, the health field systematically insists on the positional relation of patient, which is manifested in the institutional symbolic conceptions, in addition to registration, information and evaluation systems, as well as in the political representation of the area, in the decision-making spaces. Conclusion: the expectations of participation of the agent-user and their properties are limited in their areas, by the interference that the health field exerts when it professes the desire to provide a position of consumer-customer, citizen of rights, but who conceives it as a patient, ideologically and systematically. In this sense, this affects their possibilities of educational experience, which keeps it barely in the requirement to reach at least a relation of participation

L’amélioration de la survie des enfants demeure au cœur des préoccupations sanitaires en Afrique subsaharienne où la transition sanitaire est en panne depuis 1990. Ce contexte de crise sanitaire est concomitant à une récession économique et à une forte croissance urbaine. L’expansion rapide de la population citadine constitue aujourd’hui un défi majeur de santé publique. A l’instar de ses pairs africains, la Côte d’Ivoire, qui a expérimenté une forte croissance urbaine depuis 1960, a connu au cours des deux dernières décennies une absence de progrès notable en matière de réduction de la mortalité des enfants. L’analyse des tendances selon le milieu de résidence révèle un recul de la mortalité relativement plus important en milieu rural que dans les villes ivoiriennes. Cette situation amène à s’interroger sur les facteurs explicatifs de l’évolution de la mortalité des enfants vivant en milieu urbain ivoirien. L'objectif principal de la thèse est d’appréhender les facteurs explicatifs du ralentissement de la baisse de la mortalité des enfants vivant en milieu urbain ivoirien. L’analyse, basée sur les données démographiques et sanitaires réalisées entre 1994 et 2005, apprécie les effets de l’environnement contextuel démo-économique et sanitaire sur la dynamique de la mortalité et examine l’hypothèse d’une dégradation de la survie dans les milieux urbains pauvres. Deux constats ressortent des analyses. D’une part, il existe un réel ralentissement des progrès en matière d’amélioration de la survie des enfants dans les villes ivoiriennes, notamment à Abidjan. D’autre part, si les inégalités socio-économiques conduisent à des inégalités sanitaires, la dégradation de la survie concerne davantage les enfants des classes moyennes et aisées que ceux des ménages les plus démunis. En outre, la dimension sociale joue un rôle davantage important dans le comportement maternel en matière de recours aux soins: l’utilisation des services de santé étant relativement plus fréquente chez les mères issues de ménages de grande taille ou chez les migrantes. L’analyse révèle également une accentuation de l’influence des facteurs environnementaux sur la survie des enfants entre 1994 et 2005 et une précarité des conditions d’habitat. / Improving child survival remains at the core of health concerns in sub-Saharan Africa where the health transition is down since 1990. This health crisis is concomitant to an economic recession and a rapid urban growth. The rapid expansion of the urban population is now a major public health challenge. Like its African peers, Côte d'Ivoire, which has experienced a rapid urban growth since 1960 has failed to significantly reduce child mortality over the two past decades. The analysis of trends by area of residence reveals a decline in mortality, which is relatively larger in rural areas than in Ivorian cities. This raises questions about the factors explaining the evolution in the mortality of Ivorian city children. The main objective of this thesis is to understand the factors slowing the decline in the mortality of children who live in urban Ivory Coast. The analysis, based on demographic and health data collected between 1994 and 2005, assesses the effects of demographic, economic, contextual environment and health on the dynamics of mortality and examines the hypothesis of deterioration in the survival in poor urban area. Two conclusions emerge from the analysis. On the one hand, there is a real decrease in the progress regarding the improvement of child survival in Ivorian cities, mainly in Abidjan. On the other hand, if the socio-economic disparities lead to health inequalities, the degradation of child survival concerns more middle and upper classes than those of the poorest households. In addition, the social dimension plays a more important role in the maternal behavior regarding health care: the use of antenatal health services is relatively more frequent among mothers from large-size households or among migrants. The analysis also reveals an emphasis of the influence of environmental factors on child survival between 1994 and 2005 and precarious living conditions.

As the public and government officials become aware of the impact of public health on communities, it is important that relevant public health statistics be available for decision making. Existing web resources have limited visualization options, cannot visually compare a county to all others in the US, and cannot compare the counties in an arbitrary region to all others in the US. The College of Public Health Indicator Visualization Tool (CPHIVT) is a web application providing visualization and ranking for a county in the US in comparison to all counties for a specific health indicator. An iterative development methodology was used to complete major features and refine the features over time. Features divided into small tasks that could be completed within two-week cycles. After the first version of the web application was completed and presented to the client, client feedback on the application was used to refine specifications and was incorporated into planning for future iterations. Iterative development was adopted with a focus on improving and expanding existing features and making the application publicly available online. A suite of automated user interface tests is being developed to verify the application’s functions. Making a complete version of the application publicly available involves significant research and software configuration to deploy the web application in a secure and performant manner. The web application has two major components corresponding to its two major user groups. The first component allows authenticated users from the Department of Public Health to upload and manage sets of data for various health indicators. Tools are included to automatically process uploaded data points. This allows the information presented on the web site to be expanded and kept up to date over time with minimal effort. The second component is accessible to anyone and allows a user to choose to a state or county with text search or hierarchical navigation. The application then provides graphical charts showing that location’s standing for various health indicators compared to all other counties nationally. This is accomplished by applying percentile rankings to the counties and plotting the percentiles against the values for a selected indicator. A user can save a generated chart to a variety of export formats including PNG image or PDF document. The application is expected to serve as a tool for many community members. Staff and students at the College of Public Health will use this tool for presentations and research. County health departments will be able to use the tool when planning community programs. County government leaders can use this tool to determine areas of need in the community. Decision makers will have the ability to visualize their county or region as compared to the nation, not just to neighboring counties or within a state.

Objectifs. Pour augmenter l’activité physique populationnelle et réduire les inégalités relatives à l’environnement bâti, on doit identifier le rôle des profils sociodémographiques individuels dans les niveaux d’activité physique et d’exposition aux environnements bâtis favorables au mode de vie actif. Méthodes. Cette étude combine des données d’accélérométrie et de GPS collectées auprès de 820 participants durant 10 à 30 jours entre 2018 et 2020 dans les études INTErventions urbaines, Recherche-Action, Communautés et sanTé (INTERACT) et Réseau Express Métropolitain (REM). Différents modèles de régressions multiniveaux ‒journées nichées dans des individus‒ testent les associations et les interactions entre les profils sociodémographiques, les niveaux d’exposition à des facteurs environnementaux susceptibles de favoriser le mode de vie actif (infrastructures de transports, commerces, densité bâtie et espaces verts) et la proportion journalière de minutes actives. Les résultats sur l’échantillon de l’application EthicaData sont comparés à ceux sur l’appareil SenseDoc. Résultats. Les participants plus âgés, universitaires ou sans emploi ainsi que les femmes sont moins actifs. Les participants plus âgés, non-universitaires, sans emploi ou à haut revenu ainsi que les hommes sont moins exposés à l’environnement bâti favorable à l’activité physique. Discussion. Les niveaux d’activité physique et d’exposition à l’environnement bâti ainsi que les effets de l’exposition environnementale ne varient pas systématiquement en défaveur des groupes désavantagés systémiquement. Des associations sont inattendues entre l’exposition à l’environnement bâti et le mode de vie actif. Les résultats basés sur le GPS sont concordants entre EthicaData et SenseDoc, mais discordants pour ceux basés sur l’accélérométrie. / Aim. To increase population levels of physical activity and reduce inequalities related to built environment, we must identify the role of individual-level sociodemographic profiles in physical activity levels, and in levels of exposure to built environment that may contribute to active living. Method. This study combines accelerometry and GPS data collected among 820 participants during 10 to 30 days between 2018 and 2020 within the INTErventions, Research, and Action in Cities Team (INTERACT) and Reseau Express Metropolitain (REM) studies. Multiple multilevel models ‒days nested within individuals‒ test associations and interactions between socio demographic profiles, levels of exposure to environmental factors susceptible to promote active living (transport infrastructures, shops, built density and green spaces) and the daily proportion of active minutes. Results on the EthicaData application subset are compared to those on the SenseDoc device subset. Results. Participants who are older, have a university profile or are unemployed, along with women, are less active. Participants who are older, don’t have a university profile, are unemployed or have a higher income, along with men, are less exposed to built environment that may contribute to physical activity. Discussion. The levels of physical activity and exposure to built environment, and the effects of environmental exposure on physical activity, do not vary systematically in disfavor of systemically disadvantaged groups. Some associations between exposed built environment and active living are unexpected. Results based on the GPS are consistent between EthicaData and SenseDoc, but inconsistent for those based on accelerometry.

The purpose of this study was to explore and describe the EcoHealth markers and health promotion interventions in the behaviour and practices of vegetables growers in Addis Ababa. The objectives were to assess the urban and peri-urban community members’ knowledge and practices on the existing environmental health policies/regulations/guidelines, assess the perspectives of women and youth on urban and peri-urban EcoHealth promotions and protections and evaluate the development and implementation of the health promotion activities on waste water use by applying an ecological model aimed at changing behaviour and by providing Bio-sand filter to promote hand wash practice which helps to reduce potential health risks among urban vegetable growers. Both quantitative and qualitative descriptive researches were conducted to identify the urban and peri urban community members’ knowledge and practices of the existing environmental health regulators and the perspectives of women and the youth on EcoHealth. Additional quasi experimental method; multiple baseline survey along with the EcoHealth Stress Process promotion method was employed to identify stressors, measure changes in environmental health promotion intervention and use of hand wash (biosand filter for hand wash). Six woredas from two subcities of the Addis Ababa City Administration were purposely selected, and a total of 845 (98.9% response rate) households participated in the quantitative study, while 142 community members (public sector offices, factories and establishments’ management and employee), participated in the qualitative survey. For quasi experimental method, six settings/blocks (of which 3 sites were provided with a bio-sand filter for hand washing) cultivated by 6 to 8 vegetable growers and their family members, were included in the intervention (multiple baseline survey). The findings revealed that about 77 percent of participants reported, knowledge of one or more of the selected environmental health and EcoHealth regulations. Ownership of assets and education tend to influence the public awareness of selected EcoHealth and environmental health regulations. Women and youth found to be significant contributors to better urban and peri-urban EcoHealth conditions and were the ones primarily affected by environmental hazards. The intervention study results also indicated evidence-based IEC interventions and ecological health promotion methods proved useful in promoting EcoHealth in an urban environment. Moreover, the biosand filter used to provide evidence of health promotion was found to be valuable for wastewater treatment and significantly reduced chemical, physical and biological contaminates from the wastewater. / Health Studies / D. Litt. et Phil. (Health Studies)

O Programa Saúde da Família, proposto em 1994 pelo Ministério da Saúde, definiu-se como uma estratégia de reorganização da Atenção Primária à Saúde no Brasil. Gradualmente, ele foi sendo implantado também em grandes centros urbanos, até que, em 2001, ocorreu a municipalização da saúde na cidade de São Paulo, com a implantação desse modelo no bairro do Bom Retiro, região central da capital paulista. Esse bairro constitui uma paisagem única, marcado, desde sua origem, no final do século XIX, pela presença de diversas etnias, constituindo um microcosmo social, tendo recebido, ao longo de sua história, grandes contingentes de imigrantes com características culturais bastante particulares. Atualmente, entre a população que o frequenta e habita, os coreanos e os bolivianos passaram a constituir os dois grupos de imigrantes com presença marcante no bairro, ambos inseridos na base material da indústria de confecção, uma vez que a produção têxtil é um dos eixos econômicos estruturantes do Bom Retiro. A inserção de uma Unidade de Saúde da Família nesse bairro provocou a reflexão sobre as potencialidades e as dificuldades do Programa Saúde da Família em grandes centros urbanos; trouxe para discussão questões relativas à presença desses imigrantes; e exigiu análises diversas, em torno da interação entre profissionais dos serviços de saúde e seus usuários. Assim, o objetivo deste trabalho é analisar a interação entre o Programa Saúde da Família e os imigrantes coreanos e bolivianos localizados no bairro do Bom Retiro na cidade de São Paulo, redundando em uma experiência particular. Trata-se de uma pesquisa de referencial qualitativo, que utilizou a técnica de entrevistas semiestruturadas com três coreanos, três bolivianos e seis trabalhadores da saúde da Unidade de Saúde da Família do Bom Retiro. Para a análise das entrevistas, utilizou-se a técnica de análise temática de conteúdo, considerando as conjunturas, as razões e as lógicas, bem como as ações e as inter-relações estabelecidas com o coletivo e as instituições. Os resultados exibem as particularidades da inserção desses dois grupos de imigrantes no bairro do Bom Retiro e flagram, particularmente, dimensões do mundo do trabalho e de moradia e grande mobilidade espacial imigratória, exigindo a flexibilização da lógica cartográfica do Programa Saúde da Família, com a ampliação do conceito de família, e as diversas estratégias comunicativas de que a equipe de Saúde da Família lançou mão para implementar a comunicação com os imigrantes coreanos e bolivianos / The Family Health Program, proposed in 1994 by the Ministry of Health, was defined as a strategy for reorganizing Primary Health Care in Brazil. It was gradually implemented in major urban areas. In 2001, health care services in the city of São Paulo were municipalized, with the implementation of this model in Bom Retiro, in the downtown area of the city of São Paulo. Such neighborhood has a unique landscape, marked since its beginnings, at the end of the 19th century, by the presence of several ethnic groups. It is a social microcosm, which received large groups of immigrants throughout its history, bringing their own unique cultural characteristics to the area. Nowadays, Koreans and Bolivians have become the two most significant immigrant groups among the population living and working in the area. Both groups are integrated into the material base of clothing industry, since textile manufacture is one of the economic structural axes of Bom Retiro. The establishment of a Family Health Unit in Bom Retiro, besides evoking a reflection on the potential and difficulties for the Family Health Program in large urban areas, also brings issues related to the presence of these immigrants to the discussion, requiring various analyses on the theme of interaction between health care professionals and users. Thus, the purpose of this work is to analyze the interaction between the Family Health Program and Korean and Bolivian immigrants located in the neighborhood of Bom Retiro, in the city of São Paulo, which results in a unique experience. This is a qualitative research, which used the technique of semi-structured interviews with three Koreans, three Bolivians and six health care workers from the Bom Retiro Family Health Unit. With regard to the analysis of the interviews, the technique of thematic content analysis was used, considering the conjunctures, reasons and logic, as well as actions and interrelations established between the collective and the institutions. The results show the particularities of the insertion of these two immigrant groups in Bom Retiro, and highlight in particular the dimensions of the world of work, housing and the large spatial mobility of immigrants, requiring Family Health Program\'s map-based logic to become more flexible, with the enlargement of the concept of family and several communication strategies used by the Family Health team to establish communication with the Korean and Bolivian immigrants

O Programa Saúde da Família, proposto em 1994 pelo Ministério da Saúde, definiu-se como uma estratégia de reorganização da Atenção Primária à Saúde no Brasil. Gradualmente, ele foi sendo implantado também em grandes centros urbanos, até que, em 2001, ocorreu a municipalização da saúde na cidade de São Paulo, com a implantação desse modelo no bairro do Bom Retiro, região central da capital paulista. Esse bairro constitui uma paisagem única, marcado, desde sua origem, no final do século XIX, pela presença de diversas etnias, constituindo um microcosmo social, tendo recebido, ao longo de sua história, grandes contingentes de imigrantes com características culturais bastante particulares. Atualmente, entre a população que o frequenta e habita, os coreanos e os bolivianos passaram a constituir os dois grupos de imigrantes com presença marcante no bairro, ambos inseridos na base material da indústria de confecção, uma vez que a produção têxtil é um dos eixos econômicos estruturantes do Bom Retiro. A inserção de uma Unidade de Saúde da Família nesse bairro provocou a reflexão sobre as potencialidades e as dificuldades do Programa Saúde da Família em grandes centros urbanos; trouxe para discussão questões relativas à presença desses imigrantes; e exigiu análises diversas, em torno da interação entre profissionais dos serviços de saúde e seus usuários. Assim, o objetivo deste trabalho é analisar a interação entre o Programa Saúde da Família e os imigrantes coreanos e bolivianos localizados no bairro do Bom Retiro na cidade de São Paulo, redundando em uma experiência particular. Trata-se de uma pesquisa de referencial qualitativo, que utilizou a técnica de entrevistas semiestruturadas com três coreanos, três bolivianos e seis trabalhadores da saúde da Unidade de Saúde da Família do Bom Retiro. Para a análise das entrevistas, utilizou-se a técnica de análise temática de conteúdo, considerando as conjunturas, as razões e as lógicas, bem como as ações e as inter-relações estabelecidas com o coletivo e as instituições. Os resultados exibem as particularidades da inserção desses dois grupos de imigrantes no bairro do Bom Retiro e flagram, particularmente, dimensões do mundo do trabalho e de moradia e grande mobilidade espacial imigratória, exigindo a flexibilização da lógica cartográfica do Programa Saúde da Família, com a ampliação do conceito de família, e as diversas estratégias comunicativas de que a equipe de Saúde da Família lançou mão para implementar a comunicação com os imigrantes coreanos e bolivianos / The Family Health Program, proposed in 1994 by the Ministry of Health, was defined as a strategy for reorganizing Primary Health Care in Brazil. It was gradually implemented in major urban areas. In 2001, health care services in the city of São Paulo were municipalized, with the implementation of this model in Bom Retiro, in the downtown area of the city of São Paulo. Such neighborhood has a unique landscape, marked since its beginnings, at the end of the 19th century, by the presence of several ethnic groups. It is a social microcosm, which received large groups of immigrants throughout its history, bringing their own unique cultural characteristics to the area. Nowadays, Koreans and Bolivians have become the two most significant immigrant groups among the population living and working in the area. Both groups are integrated into the material base of clothing industry, since textile manufacture is one of the economic structural axes of Bom Retiro. The establishment of a Family Health Unit in Bom Retiro, besides evoking a reflection on the potential and difficulties for the Family Health Program in large urban areas, also brings issues related to the presence of these immigrants to the discussion, requiring various analyses on the theme of interaction between health care professionals and users. Thus, the purpose of this work is to analyze the interaction between the Family Health Program and Korean and Bolivian immigrants located in the neighborhood of Bom Retiro, in the city of São Paulo, which results in a unique experience. This is a qualitative research, which used the technique of semi-structured interviews with three Koreans, three Bolivians and six health care workers from the Bom Retiro Family Health Unit. With regard to the analysis of the interviews, the technique of thematic content analysis was used, considering the conjunctures, reasons and logic, as well as actions and interrelations established between the collective and the institutions. The results show the particularities of the insertion of these two immigrant groups in Bom Retiro, and highlight in particular the dimensions of the world of work, housing and the large spatial mobility of immigrants, requiring Family Health Program\'s map-based logic to become more flexible, with the enlargement of the concept of family and several communication strategies used by the Family Health team to establish communication with the Korean and Bolivian immigrants

The purpose of this study was to explore and describe the EcoHealth markers and health promotion interventions in the behaviour and practices of vegetables growers in Addis Ababa. The objectives were to assess the urban and peri-urban community members’ knowledge and practices on the existing environmental health policies/regulations/guidelines, assess the perspectives of women and youth on urban and peri-urban EcoHealth promotions and protections and evaluate the development and implementation of the health promotion activities on waste water use by applying an ecological model aimed at changing behaviour and by providing Bio-sand filter to promote hand wash practice which helps to reduce potential health risks among urban vegetable growers. Both quantitative and qualitative descriptive researches were conducted to identify the urban and peri urban community members’ knowledge and practices of the existing environmental health regulators and the perspectives of women and the youth on EcoHealth. Additional quasi experimental method; multiple baseline survey along with the EcoHealth Stress Process promotion method was employed to identify stressors, measure changes in environmental health promotion intervention and use of hand wash (biosand filter for hand wash). Six woredas from two subcities of the Addis Ababa City Administration were purposely selected, and a total of 845 (98.9% response rate) households participated in the quantitative study, while 142 community members (public sector offices, factories and establishments’ management and employee), participated in the qualitative survey. For quasi experimental method, six settings/blocks (of which 3 sites were provided with a bio-sand filter for hand washing) cultivated by 6 to 8 vegetable growers and their family members, were included in the intervention (multiple baseline survey). The findings revealed that about 77 percent of participants reported, knowledge of one or more of the selected environmental health and EcoHealth regulations. Ownership of assets and education tend to influence the public awareness of selected EcoHealth and environmental health regulations. Women and youth found to be significant contributors to better urban and peri-urban EcoHealth conditions and were the ones primarily affected by environmental hazards. The intervention study results also indicated evidence-based IEC interventions and ecological health promotion methods proved useful in promoting EcoHealth in an urban environment. Moreover, the biosand filter used to provide evidence of health promotion was found to be valuable for wastewater treatment and significantly reduced chemical, physical and biological contaminates from the wastewater. / Health Studies / D. Litt. et Phil. (Health Studies)

This thesis analyzes the Cuban medical adaptation in Venezuela called Misión Barrio Adentro (MBA) and seeks to answer the question of whether MBA shows promise as a health system that improves medical accessibility for impoverished and marginalized populations. In many cases MBA succeeds by: utilizing a free universal health care system; locating health centres in previously underserved areas; providing medical education scholarships to populations from non-traditional backgrounds; creating a catchment system based on medical accessibility; scaling up the medical workforce to 60,000 community doctors by 2019; and broadening the very praxis of what health means in a Latin American social medicine approach. However, some challenges remain including issues of corruption, fragmentation, and polarization. Issues regarding internal and external migration of Misión Sucre-trained physicians remain to be comprehensively evaluated. However, the capacitation of non-traditional medical personnel, imbued with conciencia, is significant and could well become an important example for other countries.