Falls in the older population have devastating consequences on the psychological and physiological health of the individual. Due to the complexity of interacting factors associated with ageing, pathology and falling episodes, determination of a primary cause or set of causes has been difficult to establish. Deficits in components of neuromuscular control have been widely studied with the coordinated interaction of sensory and motor system components being presented as a fundamental factor in the reduction of falling episodes. A causal relationship between deficits in vitamin D status and falling episodes has also been suggested. Furthermore, a relationship between poor vitamin D status, falling episodes and poor neuromuscular performance has been reported. The aims of the current study were designed to advance understanding in three aspects of the problem of falls prevention. Firstly an examination of the reliability of testing procedures commonly used in assessment of falls risk was undertaken. The Physiological Profile Assessment (PPA) testing procedure was selected as a commonly used tool and the reliability of its various components (sensory, motor and balance) was undertaken as an independent assessment of this approach to assessing falls propensity. Secondly, a case control study of fallers and non fallers was undertaken in which the neuromuscular tests evaluated in the reliability study were used to assess differences in neuromuscular control. The influence of vitamin D status on these measures was also considered. Thirdly, a 12-month randomised controlled trial of vitamin D/calcium supplementation or placebo/calcium was undertaken to identify the effect on falls outcome and individual measures of neuromuscular control.

Thesis (MSc Nutrition Science)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: First-year female students (FYFS), studying at the University of Stellenbosch were previously identified as a high-risk group for gaining weight. A four-year follow-up of these female students indicated that a large percentage experience weight fluctuations throughout their university careers. The unique weight management needs of the FYFS were also identified in the longitudinal study. The integration of these results with an extensive search and assessment of the weight management literature led to the development of a multidimensional weight-management paradigm for application in the development of weight-management interventions for female students. Subsequently, a self-help weight-management manual, which follows the multidimensional approach proposed in the mentioned paradigm, was developed to address the unique weight-management needs of female students. The aim of the current study was to evaluate the impact of the multidimensional self-help weightmanagement manual (the Manual) on the weight status and associated factors of FYFS at the University of Stellenbosch over an eight-month period. For this purpose a non-randomized quasi-experimental design was used, including purposively selected experimental and control groups. Data were obtained during February (Baseline), May (three months after baseline = Follow-up I) and October 2002 (eight months after baseline = Follow-up 2). All students in the experimental group received the Manual at Baseline for use during the eight-month study period. Because this was a low-intensity intervention programme, no further contact was made with either group during the study period, except when Followup I data were obtained. Measures that were taken and instruments that were completed include the following: weight, height, triceps skinfoid, mid-upper ann circumference, hip circumference, waist circumference, Adolescent Self-Concept Scale (self-concept), Body Shape Questionnaire (body shape concerns), Eating Attitudes Test (eating attitudes and behaviours), General Health Questionnaire (general psychological well-being), 90-item Semi-quantified Food Frequency Questionnaire (dietary intake from nine food groups), and the Baecke Questionnaire of Habitual Physical Activity (physical activity). Additional questions on weight related perceptions and practices, dissatisfaction with body parts, reasons for eating and socio-demographic factors were also included. The Baseline characteristics of the FYFS involved in this study, which did not differ between the experimental and control groups for all key variables, identified them as a typical group of young female adults who are healthy but are not realistic about their weight status and who experience numerous problems related to their weight status. The implementation of the Manual was found to be significantly effective in limiting weight gain among the FYFS in the experimental group. The control group experienced almost a full unit increase in BMI (0.93 kg/m²), while the increase found for experimental group was 0.53 kg/m² (p=0.004). Although the weight of both groups increased initially the experimental group went on to lose weight, while the control group continued to gain weight during the last five months of the intervention. The impact of the Manual is further illustrated by the fact that the FYFS in the experimental group who indicated that they did Lise the Manual extensively experienced a significantly lower rise in their weight (change in BMI over study period = 0.37 kg/m²) than those in the experimental group who indicated that they did not use the Manual (change in BMI over study period = 0.89 kg/m²). Factors that are possibly linked to the success attained with the Manual were identified and include more reasonable weight goals; the use of sound weightreduction methods such as a balanced diet and physical activity; improvements in self-concept; maintenance of physical activity levels, especially during the first three months at university; improvement in general psychological well-being; decreased intake of foods from the "other" (includes mainly high fat, sugar based foods such as doughnuts, cookies, cake, tart), beverage and grains food groups; and possibly less concerns with body shape from the start. Factors for which no link with weight management success could be established include changes in body composition; perceptions of own weight; weight loss attempts; foods from the vegetables, fruit, milk and cheese, meat, fish and chicken, fats and fast foods food groups; physical activity over the total eight-month period; reasons for eating; eating attitudes and behaviour; dissatisfaction with body parts; and body shape concerns. It is recommended that the implementation of the Manual on the campus of the University of Stellenbosch to prevent weight gain of FYFS should be considered, bearing in mind some of the recommendations formulated by the FYFS in the experimental group. / AFRIKAANSE OPSOMMING: Eerstejaar damestudente wat aan die Universiteit van Stellenbosch studeer is voorheen geïdentifiseer as 'n hoë risiko groep vir gewigstoename. 'n Vier-jaar opvolg van hierdie damestudente het aangedui dat 'n groot persentasie vir die duur van hul universiteitsloopbane gewigsfluktuasies ondervind. Die unieke gewigshanteringsbehoeftes van die eerstejaar damestudente is ook tydens die longitudinale studie geïdentifiseer. Die integrasie van hierdie resultate met 'n uitgebreide soektog en ontleding van die literatuur wat betrekking het op gewigshantering het aanleiding gegee tot die ontwikkeling van 'n multidimensionele gewigshanteringsparadigma wat gebruik kan word tydens die ontwikkeling van gewigshanteringsintervensies vir damestudente. As 'n volgende stap is 'n self-help gewigshanterings handleiding, wat die multidimensionele benadering voorgestel in die genoemde paradigma volg, ontwikkelom die unieke gewigshanteringsbehoeftes van damestudente aan te spreek. Die doel van die huidige studie was om die impak van die multidimensionele self-help gewigshanteringshandleiding (die Handleiding) op die gewigstatus en geassosieerde faktore van eerstejaar damestudente aan die Universiteit van Stellenbosch oor 'n tydperk van agt maande, te evalueer. Vir hierdie doeleinde is 'n nie-gerandomiseerde kwasi-eksperimentele ontwerp gebruik, wat doelbewus geselekteerde eksperimentele en kontrole groepe ingesluit het. Data is gedurende Februarie (Basislyn), Mei (drie maande na basislyn = Opvolg-I) en Oktober (agt maande na basislyn = Opvolg-2) 2002 versamel. Alle studente in die eksperimentele group het die Handleiding tydens Basislyn ontvang vir gebruik tydens die agt maande studieperiode. Omdat dit 'n lae-intensiteit intervensie program was, is geen verdere kontak gedurende die studieperiode met beide die groepe gemaak nie, behalwe tydens die versameling van Opvolg-I data. Metings wat geneem is en instrumente wat voltooi is, sluit die volgende in: gewig, lengte, triseps velvou, mid-bo-armomtrek, heupomtrek, middelomtrek, "Adolescent Self- Concept Scale" (self-konsep), "Body Shape Questionnaire" (besorgdheid oor liggaamsvorm), "Eating Attitudes Test" (eetgedrag en -houding), "General Health Questionnaire" (algemene sielkundige welstand), 90-item semi-gekwantifiseerde voedselfrekwensievraelys (dieetinname van nege voedselgroepe), en die "Baecke Questionnaire of Habitual Physical Activity" (fisieke aktiwiteit). Addisionele vrae aangaande gewigsverwante persepsies en praktyke, ontevredenheid met liggaamsdele, redes vir eet en sosio-demografiese faktore is ook ingesluit. Die Basislyn eienskappe van die eerstejaar damesstudente wat aan hierdie studie deelgeneem het, het nie tussen die eksperimentele en kontrole groepe vir alle sleutelveranderlikes verskil nie. Hierdie inligting het ook daarop gedui dat die studente 'n tipiese groep jong vroulike volwassenes is wat gesond is maar, onrealisties is oor hul gewigstatus en baie gewigstatusverwante probleme ondervind. Die resultate toon dat die implementering van die Handleiding beduidend effektief was om die gewigstoename by eerstejaar damestudente in die eksperimentele groep te beperk. Die gewig van die kontrole groep het byna 'n volle LMI eenheid (0.93 kg/m²) toegeneem terwyl die toename vir die eksperimentele groep 0.53 kg/m² was. Alhoewel die gewig van beide groepe aanvanklik toegeneem het, het die eksperimentele groep daarna gewig verloor terwyl die kontrole groep se gewig gedurende die laaste vyf maande van die intervensie verder toegeneem het. Die impak van die Handleiding word verder geïllustreer deur die feit dat die eerstejaar damesstudente in die eksperimentele groep wat aangedui het dat hul wel die Handleiding ekstensief gebruik het, 'n beduidend laer toename in gewig (LMI verandering gedurende studieperiode = 0.37 kg/m²) ondervind het as die studente in die eksperimentele groep wat aangedui het dat hul nie die Handleiding gebruik het nie (LMI verandering gedurende studieperiode = 0.89 kg/m²). Faktore wat moontlik gekoppel kan word aan die sukses verkry met die Handleiding is geïdentifiseer en sluit die volgende in: meer redelike gewigsdoelwitte; die gebruik van veilige gewigsverlies metodes soos 'n gebalanseerde dieet and fisieke aktiwiteit; verbetering van self-konsep; handhawing van fisieke aktiwiteitsvlakke, veral gedurende die eerste drie maande op universiteit; verbetering van algemene sielkundige welstand; verlaagde inname van voedsel van die "ander-" (sluit hoofsaaklik hoë vet, suiker gebasseerde voedsels soos oliebolle, koekies en tert in), drankies- en graanvoedselgroepe; en moontlik minder besorgdheid oor liggaamsvorm van die begin af. Faktore waarvoor geen verband met sukses met gewigshantering gevind is nie sluit die volgende in: liggaamsamestelling; persepsies van gewig; gewigsverliespogings; voedselinname uit die groente-, vrugte-, melk en kaas-, vleis, vis en hoender-, vette- en kitskosse-voedselgroepe; fisieke aktiwiteit gedurende die totale agtmaande periode; redes vir eet; eetgedrag en -houding; ontevredenheid met liggaamsdele; en besorgdheid oor liggaamsvorm. Dit word aanbeveel dat die implementasie van die Handleiding op die kampus van die Univérsiteit van Stellenbosch oorweeg word om gewigstoename van eerstejaar damesstudente te voorkom. Dit word ook aanbeveel dat die aanbevelings van die studente in die eksperimentele groep in hierdie verband, in ag geneem moet word.

Health care service providers in South Africa and elsewhere in the world are increasingly faced with an enormous challenge of modeling their approach to health care to meet the needs and expectations of the diverse societies they serve. The norms and customs that are inherent in these indigenous cultures are fundamental to the day-to-day existence of the people concerned and may hold a key to the understanding of many aspects of their lives, including the understanding of disease, in the case of this thesis, those transmitted sexually. A grounded theory study was used based on its theory of symbolic interactionism to explore the indigenous knowledge and health practices of the Vhavenda in sexually transmitted diseases. Data was collected through in-depth interview with traditional healers and key informants. Snowball sampling was used to idenify key informants as categories continued to emerge. Dara was analyzed using three basic types of coding namely, open coding, axial coding and selective coding. The findings of the study revealed a variety of terms used to identify SDs. Also emerging from the results was that cultural gender roles in the Vhavenda society justify women as sole agents of STDs. In accordance with grounded theory the decriptions of types of diseases, disease patterns, signs and symptoms culminated in "dirt" as the core category. It came out clear that dirt in the form of women'svaginal discharges and moral dirt is the main course of a STDs. It was also evident that strategies for combating STDs will have to take into account popular beliefs and attudes regarding views on STDs as well as the role and influence of traditional healers. Based on the above findings guidelines for designing a module for teaching health professionals has been formulated to aid them in understanding the beliefs and practices of people they serve. / Health Studies / D. Litt et Phil. (Health Studies)

This study investigated the health needs of immigrant women from the African Great Lakes living in South Africa in the province of Gauteng, Tshwane Metropolitan city. It described their challenges and related factors compromising their holistic wellness, and identifies their context specific health needs as a gender group. A qualitative approach was utilised concurrently with participatory action research method. Data collection involved triangulation of instruments. A literature study was conducted to select relevant information usable as basis for this study. Data analysis and interpretation revealed factors that make it difficult for immigrant women from the African Great Lakes region to gain access to health care services in South Africa, identifying their specific women’s health needs. Recommendations proposed that policy makers and implementing professionals rendering women’s health care services should consider utilising a holistic and interdisciplinary approach to meet these basic needs. / Health Studies / M.A. (Public health)

Voluntary Counselling and Testing (VCT) is vital in the management of HIV/AIDS as it is the first step in treatment, care and behavioural change. Entrenched economic and gender inequities drive an increasingly feminized HIV/AIDS pandemic. This study investigated factors influencing VCT attendance by women in the Glen View high density suburb in Harare. A survey methodology was followed using a semi-structured, self-administered questionnaire that was distributed to randomly selected women of reproductive ages in the area. The analysis showed that VCT usage is low and that factors such as fear of the consequences of testing positive for HIV, such as violence and rejection by male partners are to blame. Importantly, the findings suggest that if the vulnerability of women is not addressed, then increased VCT uptake and better reproductive health outcomes for women are also unlikely. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

The purpose of the study was to determine the factors that predict women’s risky sexual behaviour and HIV and AIDS knowledge. A quasi-experimental, pre-test-post-test research design, with a non-equivalent comparison group was conducted to determine if there was an association between young women’s sexual behaviour and HIV/AIDS knowledge on aspects of HIV/AIDS transmission and prevention and behaviour change. The study used both quantitative and qualitative approach. Data collection was done using semi-structured interview schedule and focus group discussion guide. The respondents who participated in the study were women between the ages of 15-25 years. Two groups of respondents participated in the study. Women in the quasi-experimental site (N=200) who received the intervention and women in the control site (N=200) who did not receive any intervention. Quantitative data were analysed with the help of a statistician and the Epi Info statistical package was used. Qualitative data obtained from the focus group discussion were analysed using Tesch’s method of analysis. The major inferences drawn from this study are that young women lack knowledge relating to HIV/AIDS and that some young women were engaged in risky sexual behaviours such as having multiple sexual partners and having unprotected sex. The study indicates that peer education strategy has the potential to make an impact on these young women. It has also shown that peer education can play an important role in increasing knowledge and reducing risky sexual behaviour. / Health Studies / D. Litt. et Phil. (Health Studies)

Background: In many developing countries, maternal deaths occur mainly as a result of unsafe abortions, a situation reflecting the inaccessibility of safe abortion services in such countries. In Ethiopia, unsafe abortion accounts for 32% of maternal deaths and almost 60% of gynaecological admissions, and is one of the top ten causes of general hospital admissions. Purpose: The purpose of this study was to assess the views of women about the accessibility of safe abortion services in governmental health centres. Methods: A quantitative cross-sectional descriptive and non-experimental study using structured questionnaires was conducted. 342 women who had received abortion care services in governmental health centres participated. Findings: 46.8% of the participants do not know about the penal code regarding safe abortion care. 52.9% of the participants viewed safe abortion care as inaccessible because there are various and competing factors which make abortion service to be viewed as accessible or inaccessible and these include distance to nearest health centre, the time it takes to receive the service, the cost of the service, and the lack of appropriate skills in the service providers. Conclusion: An improvement in the accessibility of abortion services will prevent deaths resulting from unsafe abortions / Health Studies / M.A. (Public Health)

Background AIDS remains one of the world’s most serious health challenges affecting more females than men. The differences in the spread of Human Immunodeficiency Virus (HIV) among gender groups stem from biology, sexual behaviour and socially constructed gender differences between women and men in roles and responsibilities, access to resources and decision-making power. It could also be due to the females’ status in society which could be justified by lower economic and decision making ability. Purpose The purpose of this study was to explore and describe the role of gender in the spread of HIV among women of reproductive age in Ethiopia; with the view of developing gender sensitive HIV and AIDS prevention strategies. Methods The study used sequential mixed method with quantitative and qualitative paradigm. During first phase of the study, health facility based descriptive cross-sectional study design was used. Data was collected from 422 respondents using a structured questionnaire. Forty participants were recruited by purposive sampling from representatives working in reproductive health or related fields. Results About 83.2% of respondents reported that sexual intercourse discussion should be initiated by male partners. This showed that majority of respondents were dependent on their male partners in decision-making regarding sexual matters in their relationship. Multiple sexual partners were common among the respondents. One third of the respondents reported to have had intercourse with more than one partner during the past twelve months of the study period. Higher proportion of respondents (61.4%, n=259) had never used condom during sexual intercourse with their partner/s. As a result these risky sexual practices are a potential threat for spread of HIV and AIDS among women. Thus developed guidelines would alleviate the existing problems through implementation of strategies of HIV and AIDS prevention to enhance women’s status at household and different administrative structure level. Conclusion Gender disparities in relation to negotiating sexual relations among the study respondents were found to be still relevant. The culture that has placed men at the helm of leadership in sexual matters is strongly upheld and that includes who recommends use of preventive measures and who regulates when and how to enter into a sexual relationship. Guidelines for gender sensitive prevention strategies if applied appropriately would educate women and men to make decision about what directly affects their health / Health Studies / D. Litt. et Phil. (Health Studies)

This thesis examines the trans-border circulation and production of feminist knowledge through translation. More specifically, my research focuses the translation of the U.S. women’s health book, Our Bodies, Ourselves, by a Chinese feminist NGO in 1998. My dissertation studies the social, cultural and political aspects of feminist translation, and examines the relation between translation and feminist praxis. Through the lens of gender and (feminist) health politics in 1990s China, I examine how the 1998 Chinese translation conveys the book’s message about how women should relate to their bodies. Set in the context of Chinese society opening up during the late 1970s, my research outlines the emergence of gender awareness in China with the influx of translated feminist texts, especially in the realm of women’s health research. Medical discourses were then assigned a privileged position in the studies of women’s sexual and reproductive health. However, with increased communications between Chinese and foreign feminists, Chinese women scholars developed new ideas around women’s sexual and reproductive health. The Chinese translation of OBOS addresses the lack of gender awareness in local discussions about women’s health. With a multi-method study, I emphasize the social and linguistic dimensions of translating a feminist health project into post-reform China. This study is based on both interview and comparative textual analysis data. Using feminist translation theories, I examine how the Chinese translators handled the book’s presentation of women’s sexuality and reproductive health. This thesis also highlights the constraints on translating feminism from the local context. This raises questions about the power of (feminist) translation, and emphasizes the need to examine the social-political context of translation practices.

MPH / Department of Public Health / The high maternal mortality ratio is caused by various factors, including avoidable complications which can be reduced by attendance to antenatal care visits. The utilisation of antenatal care has been low in rural areas, especially in Africa. The purpose of this study was to explore the utilisation of antenatal care in Mutasa District of Zimbabwe. This study used a qualitative study approach, adopting the descriptive, explorative design that presented an active image of the research participants’ reality and capture live experiences. Participants of the study were pregnant women and women with children under the age of one. The participant were sampled using purposive and snow-ball sampling techniques. In-depth interviews were conducted. The participants were interviewed in their native language, Shona. The main question was: Can you explain in your own words how you use antenatal care services from the primary health care facility? The researcher clarified questions which the participant failed to understand. The researcher wrote down all responses and used a tape recorder to capture the responses. The researcher analysed data using thematic content analysis where themes and sub-themes were discussed. The main theme was low uptake of antenatal care in rural primary health care facilities. From the main theme there were factors influencing and perceptions of women on uptake of antenatal care services in primary health care facilities. Trustworthiness was ensured through credibility, dependability, transferability and conformability. Permission from the relevant authorities, such as the University of Venda Higher Degrees Committee, the Provincial Medical Director and the District Administrator was sought before conducting this study. Informed consent was also sought before interviewing the participants. The study concluded that socio-demography of participants affected antenatal care attendance. These are age, level of education, low income, high parity and distance to facility. Other hindering factors to utilization of antenatal care were lack of knowledge, religion and acceptability of antenatal care by the women in rural primary health care facilities. Findings will be disseminated through a research report and published in relevant accredited journals with the help of the supervisors. The study recommended that the Ministry of Health and Child Care of Zimbabwe review Antenatal Care policies to ensure friendliness and to increase awareness through health education and continuous dissemination of antenatal care information. / NRF