MPH / Department of Public Health

This qualitative study explored and described the experience of African women diagnosed with both HIV/AIDS and cervical cancer in order to gain an understanding of the experience of both illnesses as lived by these women. Phenomenological research methods were employed using in-depth semi-structured interviews. Communication as a strategy facilitating diagnosis, disclosure, acceptance and support for women with HIV/AIDS and cervical cancer emerged as the main theme, followed by the experience of physical symptoms and emotional experiences. The study shows the importance of communication in the management and support of these women attending public health institutions and in the community. For communication to occur the relationship between healthcare professionals and women diagnosed with HIV/AIDS and cervical cancer is very important. Treatment approaches in radiation therapy need to be developed for women diagnosed with HIV/AIDS and cervical. More research is needed in this area (HIV/AIDS and cervical cancer). / Health Studies / M.A. (Public Health)

Thesis (MA)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The HIV-epidemic that is evident in South Africa today is infecting more women than men. This is mostly due to the vulnerability that women are facing in sexual relationships, where they are not able to negotiate the terms and conditions of their sexual engagement. Patriarchy, the culture of masculinity and a general male dominance influence women’s dependency on their man and agency inside and outside of the home, and contribute to the oppression of women both generally in society and sexually. Women have by this not the control over their own bodies and are for this reason in a high-risk position of contracting HIV. The vulnerability is further linked to the stigmatisation that women experience if they do try to negotiate preventative measures to reduce the risk of transmission. The fear of being stigmatised as ‘loose’ or HIV-positive by both men and women if suggesting condom use, inhibits women to propose the necessary actions for protection. Stigmatising behaviours also impact on a person’s fear of becoming HIV-positive and reduces the likelihood of getting tested, disclose one’s status to sexual partners and receive treatment. This thesis examines cultural and socio-economic issues that contribute to gender inequality in South Africa, and can generate stigma towards women on the basis of HIV and AIDS. This is done by using radical feminism as the theoretical framework for contextualising how women are situated in the South African society, in terms of general and sexual agency. Through the method of content analysis and the findings from the theoretical framework, the thesis further analyses how the three HIVprevention campaigns loveLife, Brothers for Life and TAC manage to address the issues related to stigma based on HIV/AIDS, which are directed towards women. Race, class and gender are all factors that influence the likelihood of becoming HIV-infected and of becoming stigmatised. Women’s low social status situates women in a position where they are more probable to be the object of stigmatisation since they already are considered lower in rank. If the women also are of colour, poor and low educated the chances of becoming stigmatised on the basis of HIV and AIDS are even more likely, the same is the chances of becoming HIV-infected. This indicates that poor, uneducated black women are the group that is most vulnerable towards stigmatisation as well as towards HIV-transmission. Socio-economic and cultural factors have a strong influence on the gender inequality in sexual relationships found in South Africa, which cause HIV to spread and can generate stigmatising behaviours. Stigmatisation on the basis of HIV/AIDS is therefore important to address in order to reduce the number of new HIV-infections. The three campaigns analysed for this thesis did neither directly address stigma on a general level nor directed towards women. The campaigns are therefore considered to be missing an important feature of HIV-prevention in South Africa. / AFRIKAANSE OPSOMMING: Die huidige Suid-Afrikaanse Vigsepidemie infekteer meer vroue as mans. Dit is die geval weens die kwesbaarheid wat vroue ervaar in seksuele verhoudings, waar vroue nie die mag het om die omstandighede van hul seksuele interaksies te onderhandel nie. Patriargie, die kultuur van manlikheid en ‘n algemene manlike dominansie beïnvloed vroue se mag en dra by tot die onderdrukking van vroue, beide in die samelewing in die algemeen en in seksuele verhoudings. Om hierdie rede het vroue nie beheer oor hul eie liggame nie en daarom ervaar hulle ‘n hoë risiko om MIV op te doen. Hierdie kwesbaarheid word ook verbind aan die stigmatisering wat vroue ervaar wanneer hulle probeer om voorkomende aksie te neem ten einde die risiko van Vigsoordrag te verminder. Die vrees om deur mans en ander vroue gestigmatiseer te word as iemand met ‘losse sedes’, of as iemand wat MIV-positief is wanneer hulle kondoomgebruik voorstel, weerhou vroue daarvan om die nodige voorkomende aksie vir selfbeskerming te neem. Stigmatiserende gedrag het ook ‘n impak op ‘n mens se vrees om MIV-positief te word en verminder die waarskynliheid dat jy jouself vir die virus sal laat toets, dat iemand hul status aan seksuele maats sal verklaar, of behandeling sal ontvang. Diegene wat reeds MIV onder lede het is bang om hul status te verklaar weens die gepaardgaande stigma. Hierdie tesis ondersoek kulturele en sosio-ekonomiese kwessies wat bydra tot geslagsongelykheid in Suid-Afrika, en wat stigma kan veroorsaak teenoor vroue met betrekking tot MIV and Vigs. Die studie analiseer dan of Vigsveldtogte hierdie stigma kan aanspreek. Dit word gedoen deur radikale feminisme toe te pas as ‘n teoretiese raamwerk om vroue se plek in die Suid-Afrikaanse samelewing te kontekstualiseer, beide in terme van algemene en seksuele mag. Die metode van inhoudsanalise word toegepas om drie Vigsvoorkomingsveldtogte (loveLife, Brothers for Life en TAC) te analiseer en vas te stel of en hoe hulle kwessies wat betrekking het op stigma teenoor vroue aanspreek. Sosio-ekonomiese en kulturele faktore het ‘n sterk invloed op die geslagsongelykeid in seksuele verhoudings in Suid-Afrika; dit lei daartoe dat MIV versprei word en kan stigmatiserende gedrag vererger. Om hierdie rede is dit belangrik dat MIV/Vigsvoorkomingsveldtogte stigmatisering aanspreek ten einde gedrag te wysig en om die getal nuwe Vigsbesmettings te laat daal. Die drie veldtogte wat in hierdie tesis geanaliseer is het beide nagelaat om stigma direk aan te spreek op ‘n algemene vlak, en was ook nie direk gerig op vroue nie. Die veldtogte kan daarom beskou word as ontoereikend deurdat hulle belangrike komponente van MIV-voorkomig in Suid-Afrika misgekyk het.

The study is informed by inadequate information on factors associated with the prevalence, incidence and mortality of cervical cancer cytological abnormalities in Swaziland. The aim of the study was to explore and describe factors associated with cervical cancer among women of reproductive age between 15 and 49 years in Swaziland. Quantitative descriptive design with a data extraction tool was used to retrospectively generate observational data from 1748 patients’ records in Mbabane Government Hospital from January 2014 through to December 2014. Bivariate logistic regression was used to establish relationship between cervical cancer and each explanatory variable. The overall prevalence of cervical cytology test results was 24.9%. The combination of marital status, HIV status, ART status, age at sexual debut have been identified as factors associated with cervical abnormalities. Most importantly, the results will also serve as evidence for the development of a national cervical cancer screening policy and also strengthening the cancer registry in Swaziland. / Health Studies / M.A. (Public Health)

This qualitative study explored and described the experience of African women diagnosed with both HIV/AIDS and cervical cancer in order to gain an understanding of the experience of both illnesses as lived by these women. Phenomenological research methods were employed using in-depth semi-structured interviews. Communication as a strategy facilitating diagnosis, disclosure, acceptance and support for women with HIV/AIDS and cervical cancer emerged as the main theme, followed by the experience of physical symptoms and emotional experiences. The study shows the importance of communication in the management and support of these women attending public health institutions and in the community. For communication to occur the relationship between healthcare professionals and women diagnosed with HIV/AIDS and cervical cancer is very important. Treatment approaches in radiation therapy need to be developed for women diagnosed with HIV/AIDS and cervical. More research is needed in this area (HIV/AIDS and cervical cancer). / Health Studies / M.A. (Public Health)

A incontinência urinária é considerada um problema mundial. Estima-se que ela afeta 30% da população feminina adulta, comprometendo a qualidade de vida destas mulheres. Os tratamentos conservadores de incontinência urinária, no geral, têm custo menor e não apresentam efeitos colaterais. A partir da proposta de um estudo multicêntrico, definiu-se a presente pesquisa com o objetivo de verificar a efetividade das técnicas de estimulação elétrica por neuromodulação do nervo tibial posterior e exercícios pélvicos no tratamento da hiperatividade vesical incontinência de urgência/mista. O equipamento utilizado foi desenvolvido pela equipe do Hospital de Clínicas de Porto Alegre e tem a capacidade de armazenar em memória os períodos de utilização bem como a intensidade ajustada pela paciente em ambiente domiciliar. Por meio do equipamento, estimula-se eletricamente, de forma intensiva, o nervo tibial posterior; já os exercícios pélvicos foram elaborados a fim de comparar a efetividade das técnicas. Para o ensaio clínico, foram selecionadas 26 mulheres, divididas em dois grupos que foram submetidas a um protocolo de dezesseis semanas (Grupo A: as primeiras oito semanas para a aplicação da estimulação tibial e as demais oito semanas para a realização dos exercícios da musculatura do assoalho pélvico; e Grupo B: as primeiras oito semanas para a realização dos exercícios da musculatura do assoalho pélvico e oito semanas para a estimulação tibial), em ambiente domiciliar. A cada período de oito semanas do tratamento, as voluntárias preencheram um questionário de qualidade de vida e um questionário de gravidade da incontinência urinária. Constatou-se, por meio do questionário de gravidade de incontinência urinária, uma redução das perdas urinárias, nas primeiras oito semanas do Grupo A que correspondiam ao tratamento com estimulação elétrica. 78,6% das voluntárias melhoraram, enquanto 21,4% não perceberam nenhum qualquer resultado. Nas últimas oito semanas que correspondia ao tratamento com exercícios do assoalho pélvico 78,6% não perceberam qualquer efeito e 21,4% relataram piorara nos sintomas de incontinência urinária. No Grupo B, nas primeiras oito semanas, de exercícios terapêuticos, 50% das voluntárias relataram piora nos sintomas, 33% não perceberam qualquer efeito e 16,7% melhoraram dos sintomas de incontinência urinária. Ao final das oito semanas, que correspondia ao tratamento com estimulação elétrica, 8,4% não perceberam qualquer efeito e 91,6% relataram melhora nos sintomas da incontinência urinária. Ao comparar-se as duas técnicas, verificou-se que enquanto as pacientes foram submetidas ao tratamento com estimulação elétrica, houve melhora significativa a percepção de incontinência urinária. A técnica de estimulação por neuromodulação do nervo tibial posterior com a nova instrumentação desenvolvida para uso domiciliar mostrou-se eficiente na minimização dos sintomas de incontinência urinária. / The urinary incontinence is a worldwide problem. Statistical data indicates that it affects 30% of the adult female population, compromising the quality of life of these women. Conservative treatments for urinary incontinence, in general, are cheaper and they do not cause side effects. For the proposition of a multicenter study, this research was defined aiming to investigate how effective the electric stimulation technique by using neuromodulation of the posterior tibial nerve and pelvic exercises is in the treatment of urgency/mixed bladder hyperactivity incontinence. The equipment used in the research had been developed by the biomedical engineering team of the Hospital de Clínicas at Porto Alegre. It can store in memory the period of time in which the equipment has been used as well as the stimuli intensity adjusted by the patient. By means of the equipment, we intensively stimulated electrically the patient’s posterior tibial nerve. Pelvic exercises were prescribed in order to assess the effectiveness of the neuromodulation technique. For the clinical trial, 26 women were selected and they were divided in two groups, both submitted to a sixteen weeks protocol, applied at home. During the first eight weeks, Group A was submitted to the electrical stimulation and on the remaining eight weeks, to exercises of the pelvic floor muscles. Differently, volunteers of Group B performed exercises during the first eight weeks and electrical stimulation on the last eight weeks. In each period of eight weeks of treatment, the volunteers answered the King’s Health Questionnaire and the Incontinence Severity Index Questionnaire. The analysis of the Incontinence Severity Index Questionnaire results presented a reduction in the urinary output. For Group A, in the first eight weeks (electrical stimulation), 78.6% of the volunteers reported improvement while 21.4% reported no effects. In the last eight weeks (exercises), 78.6% perceived no effects and 21.4% have the symptoms worsened. In the first eight weeks of the Group B (exercises), 50% of volunteers reported the worsening of symptoms and 33% felt no effects and 16,7% reported a reduction in the symptoms. In the last eight weeks (electrical stimulation), 8.4% perceived no effects and 91.6% reported improvements. By comparing the two techniques, we verified that while the patients were submitted to the application of electrical stimulation, there was significant improvement on the perception of urinary incontinence. The technique of stimulation by neuromodulation of posterior tibial nerve with the novel instrumentation developed for homecare was efficient and the participants of the study reported significant improvement in their condition.

A incontinência urinária é considerada um problema mundial. Estima-se que ela afeta 30% da população feminina adulta, comprometendo a qualidade de vida destas mulheres. Os tratamentos conservadores de incontinência urinária, no geral, têm custo menor e não apresentam efeitos colaterais. A partir da proposta de um estudo multicêntrico, definiu-se a presente pesquisa com o objetivo de verificar a efetividade das técnicas de estimulação elétrica por neuromodulação do nervo tibial posterior e exercícios pélvicos no tratamento da hiperatividade vesical incontinência de urgência/mista. O equipamento utilizado foi desenvolvido pela equipe do Hospital de Clínicas de Porto Alegre e tem a capacidade de armazenar em memória os períodos de utilização bem como a intensidade ajustada pela paciente em ambiente domiciliar. Por meio do equipamento, estimula-se eletricamente, de forma intensiva, o nervo tibial posterior; já os exercícios pélvicos foram elaborados a fim de comparar a efetividade das técnicas. Para o ensaio clínico, foram selecionadas 26 mulheres, divididas em dois grupos que foram submetidas a um protocolo de dezesseis semanas (Grupo A: as primeiras oito semanas para a aplicação da estimulação tibial e as demais oito semanas para a realização dos exercícios da musculatura do assoalho pélvico; e Grupo B: as primeiras oito semanas para a realização dos exercícios da musculatura do assoalho pélvico e oito semanas para a estimulação tibial), em ambiente domiciliar. A cada período de oito semanas do tratamento, as voluntárias preencheram um questionário de qualidade de vida e um questionário de gravidade da incontinência urinária. Constatou-se, por meio do questionário de gravidade de incontinência urinária, uma redução das perdas urinárias, nas primeiras oito semanas do Grupo A que correspondiam ao tratamento com estimulação elétrica. 78,6% das voluntárias melhoraram, enquanto 21,4% não perceberam nenhum qualquer resultado. Nas últimas oito semanas que correspondia ao tratamento com exercícios do assoalho pélvico 78,6% não perceberam qualquer efeito e 21,4% relataram piorara nos sintomas de incontinência urinária. No Grupo B, nas primeiras oito semanas, de exercícios terapêuticos, 50% das voluntárias relataram piora nos sintomas, 33% não perceberam qualquer efeito e 16,7% melhoraram dos sintomas de incontinência urinária. Ao final das oito semanas, que correspondia ao tratamento com estimulação elétrica, 8,4% não perceberam qualquer efeito e 91,6% relataram melhora nos sintomas da incontinência urinária. Ao comparar-se as duas técnicas, verificou-se que enquanto as pacientes foram submetidas ao tratamento com estimulação elétrica, houve melhora significativa a percepção de incontinência urinária. A técnica de estimulação por neuromodulação do nervo tibial posterior com a nova instrumentação desenvolvida para uso domiciliar mostrou-se eficiente na minimização dos sintomas de incontinência urinária. / The urinary incontinence is a worldwide problem. Statistical data indicates that it affects 30% of the adult female population, compromising the quality of life of these women. Conservative treatments for urinary incontinence, in general, are cheaper and they do not cause side effects. For the proposition of a multicenter study, this research was defined aiming to investigate how effective the electric stimulation technique by using neuromodulation of the posterior tibial nerve and pelvic exercises is in the treatment of urgency/mixed bladder hyperactivity incontinence. The equipment used in the research had been developed by the biomedical engineering team of the Hospital de Clínicas at Porto Alegre. It can store in memory the period of time in which the equipment has been used as well as the stimuli intensity adjusted by the patient. By means of the equipment, we intensively stimulated electrically the patient’s posterior tibial nerve. Pelvic exercises were prescribed in order to assess the effectiveness of the neuromodulation technique. For the clinical trial, 26 women were selected and they were divided in two groups, both submitted to a sixteen weeks protocol, applied at home. During the first eight weeks, Group A was submitted to the electrical stimulation and on the remaining eight weeks, to exercises of the pelvic floor muscles. Differently, volunteers of Group B performed exercises during the first eight weeks and electrical stimulation on the last eight weeks. In each period of eight weeks of treatment, the volunteers answered the King’s Health Questionnaire and the Incontinence Severity Index Questionnaire. The analysis of the Incontinence Severity Index Questionnaire results presented a reduction in the urinary output. For Group A, in the first eight weeks (electrical stimulation), 78.6% of the volunteers reported improvement while 21.4% reported no effects. In the last eight weeks (exercises), 78.6% perceived no effects and 21.4% have the symptoms worsened. In the first eight weeks of the Group B (exercises), 50% of volunteers reported the worsening of symptoms and 33% felt no effects and 16,7% reported a reduction in the symptoms. In the last eight weeks (electrical stimulation), 8.4% perceived no effects and 91.6% reported improvements. By comparing the two techniques, we verified that while the patients were submitted to the application of electrical stimulation, there was significant improvement on the perception of urinary incontinence. The technique of stimulation by neuromodulation of posterior tibial nerve with the novel instrumentation developed for homecare was efficient and the participants of the study reported significant improvement in their condition.

MCur / Department of Advanced Nursing Science / Cervical cancer remains one of the major public health problems globally, despite the fact that it is preventable and curable if identified at an early stage. Currently, cervical cancer is the leading cause of death among women in Sub-Saharan Africa where the knowledge about the disease is scarce among the affected population. Methods A quantitative cross-sectional survey was conducted in Thulamela Municipality of Limpopo Province. The purpose of the study was to assess the knowledge of cervical cancer prevention among women in four villages in Thulamela Municipality. The population of the study was composed of all women aged above 30 in the villages Malamulele, Mhinga, Muledane and Phiphidi. A sample of one thousand five hundred and forty-six (1546) was drawn using random sampling. Quantitative data were collected using a twenty-six-item questionnaire. The data were coded and then processed using the Statistical Package for Social Sciences to produce frequency tables and descriptive statistics such as chi-square and correlation. Results A number of findings were made in this study. The majority of the women in this study had little or no knowledge about cervical cancer, human papilloma virus and vaccines. The majority of the women had little or no knowledge on cervical cancer risk factors and how the disease is spread. These findings were confirmed by chi-squared values at p<0.05 and showed significant association between variables: that young women were likely to be aware of cervical cancer compared to elderly women, educated women were more likely to be knowledgeable about cervical cancer than those with low education attainment, elderly women were more likely to be not worried about cervical cancer compared to young women. Correlation, Pearson rho scores at p<0.05 showed significant correlations knowledge of cervical cancer and age (negative), knowledge and education (positive). The findings signified the need for cervical cancer prevention education in Vhembe District, and the need for primary health care nurses to promote access to such services through robust health education. vi Recommendations The study made a number of practical recommendations likely to educate women about cervical cancer, human papilloma virus and its prevention. These include: The possibility of large hospitals having their own small broadcasting stations that will frequently disseminate information throughout the local municipalities, road shows and use of informal sector like politicians and traditional healers in disseminating information.

MPH / Department of Public Health / See the attached abstract below

Diseases of Women, Book I, is part of the Hippocratic Corpus of approximately seventy treatises, although different authors contributed to the writings, as is evident by slight changes in text. It is the first of three works by Hippocrates on gynaecological problems. Fifth century BC doctors did not dissect either humans or animals, so their theories were based purely on observation and experience. Book I deals with women who have problems with menstruation, either the lack of it or an excess, infertility and, when conception does take place, the threat of miscarriage and dealing with the stillborn child. Various remedies are given, including herbal infusions, vapour baths and mixtures that the modern day patient would shudder at, e.g. animal dung and headless, wingless beetles. One remedy, hypericum, or St John's Wort, used for depression, has become popular today as an alternative medicine. / Old Testament and Ancient Near Eastern Studies / M.A. (with specialisation in Ancient Languages and Cultures)