Drawing on developments in the public health field, this exploratory study applies the ideas of Health Promotion (HP) to the University of Cape Town (UCT). It defines UCT as a setting within which HP can and should take place. Following the World Health Organisation (WHO), health is seen as encompassing physical, mental, social, and other environmental factors (WHO, 1978). Sociological perspectives that acknowledge the relationship between social action/behaviour and the social context, hence the relationship between students' wellbeing and the UCT environment are employed. Data and information for this study were collected through focus group discussions, in-depth interviews, participant observation, and a sample of information gathered by first year sociology students. The fear of failure, housing problems, limited social integration, and availability of cigarettes and junk food on campus were found to be some of the factors that influence and constrain students' weIIbeing. It was also found wellbeing is not an explicit consideration in the university plans and policies, even though implicitly these are meant to enhance wellbeing. Strategies to promote health in UCT need to be guided by a commitment to wellbeing in the university's policies. This thesis recommends that the university be required to pass a 'wellbeing test'.

Background: Effective communication is key to team working in healthcare. It can be negatively impacted upon by existing cultures, logistical challenges, role confusion, and a lack of collaborative approaches to practice. Clinical guidelines recommend using the International Classification of Functioning, Disability and Health (ICF) to aid communication within stroke teams. Yet no empirical evidence exists on the process or outcomes of such implementation. Aims: This project aimed to explore ways the ICF could be used with an acute stroke service and identify key learning from the implementation process. Methods: Using an action research framework, iterative cycles were used within exploratory, innovatory and reflective phases. Content analysis was used to map patient notes’ entries to ICF categories. Thematic analysis was undertaken, using a model of immersion and crystallisation, on data generated via interview and focus group, e-mail communications, minutes from meetings, field notes and a reflective diary. Descriptive statistics were used to analyse quantitative questionnaire data. Data from all sources were combined to determine key findings. Findings: Participants chose to develop an ICF-based team transfer of care report with an ICF glossary to aid completion. Five overall themes were determined; the need to: (1) adopt the ICF in ways that met local service needs; and (2) adapt the ICF language and format. Once implemented, the ICF: (3) fostered communication within and beyond the stroke team; (4) promoted holistic thinking; and (5) helped to clarify team roles. Conclusions: These are the first empirical findings within stroke services that demonstrate how to make the ICF a clinical reality. Participants needed to adapt and own the ICF to adopt it. When implemented, it enabled specific team communication challenges to be overcome. The use of action research to implement the ICF has facilitated sustained change and improvements to communication, thus benefiting patient care.

Magister Chirurgiae Dentium (MChD) / The World Health Organisation estimated that in 2002 more than 13,772 000 deaths in developing countries were caused by infections. This accounted for more than 45% of all deaths, making up 7 of the top 10 causes of death (World Health Organisation, 2004). Sub-Saharan Africa is the epicentre of the devastating HIV pandemic. The country leading with the highest HIV rate in the world is South Africa, with approximately 5.5 million people infected(UNAIDS, 2008; South Africa Country Progress Report, 2008).The development from HIV to AIDS progressively weakens the immune system, making the individual more susceptible to numerous infections, e.g.various forms of orofacial sepsis (Mindel, and Tenant-Flowers, 2001). HIVpositive individuals are eighteen times more likely to become infected with community-acquired methicillin-resistant Staphylococcus aureus than the general population. (Crum-Cianflone et al., 2006). The management of sepsis is of great concern with regard to human morbidity and mortality, as well as its financial implications, especially in cases of antibiotic resistance (Kimleck et al., 1976; Panlilo et al., 1992; Kirkland et al., 1999). Currently, there is no published peer-reviewed literature assessing the impact of HIV on orofacial sepsis. This study aimed to assess the impact of HIV on orofacial sepsis, investigating the clinical and microbiological profiles of the population. These results were used as a guide in the adaptation of current treatment protocols.The study population consisted of patients with orofacial sepsis (requiring incision and drainage or admission) who were referred to the Maxillo-Facial and Oral Surgery Units at either Groote Schuur or Tygerberg Hospitals. These patients were examined, diagnosed and treated as per standard protocol. The empiric antibiotic treatment was tailored according to microscopy and sensitivity results when it became available. The exclusion criteria of the study were refusal of HIV testing or unwillingness of patients to participate in the study.The ratio of HIV positive patients treated was much higher than the population prevalence (2.4:1.1). Odontogenic infections (71.11%), followed by septic jaw fractures (15.56%) were the most common causes of sepsis. The most common causative teeth were the mandibular posterior teeth (43.75%)(excluding the mandibular 3rd molars). The most common fascial spaces involved in the HIV positive group were the submandibular spaces (36%),followed by the submasseteric and canine spaces (27% each). In the HIV negative group, the buccal (41%) and submandibular spaces (33%) were the most common fascial spaces infected.The HIV negative group had the most multi-fascial space involvement, with 35% having more than one fascial space involved. In comparison, the HIV positive group had only 18% involvement of more than one fascial space. This was also reflected by the HIV negative group, which included five cases of Ludwig’s Angina as compared to one case in the HIV positive group. The Gram Stain showed a predominance of Gram positive cocci for both the HIV positive and negative groups. Gram positive bacilli were significantly more prevalent in the HIV negative group (p = 0.0409). Pre-treatment antibiotics were associated with sterile abscesses in 20% of the cases. No growth on culture occurred only in the HIV negative group (statistically significant with p = 0.00488).A statistically significant increased length of admission was found for the cases with penicillin-resistant bacteria (Wicoxin Rank Sum Test p =0.0072). Penicillin resistance was found in 17.78% (8 cases) with ten strains of five types of bacteria (S. aureus, K. pneumonia, Enterobacter, E. coli,Alpha-haemolytic Streptococcus). Eight percent (5) of these cases were also resistant to co-amoxiclav®.In the HIV positive group the following trends (p>0.005) were found:• The average platelet counts of this group was 112.34 x108/L (lower than the HIV negative group);• The length of admission for the HIV positive group was slightly longer by 0.25 days even though this group had fewer fascial spaces infected;• A larger number of bacteria with penicillin-resistance was more prevalent in the HIV positive group (six resistant bacteria in four cases compared to four resistant bacteria in four cases).Greater numbers of orofacial infections were seen in HIV positive subjects relative to their population prevalence rates. Added to this, was the higher rate of antibiotic resistance and longer hospital admissions.These findings may warrant further investigation of the relationship between HIV positive and negative groups with regard to orofacial sepsis.

Background: The World Health Organisation (WHO) Africa region experiences multiple public health emergencies (PHEs) annually. PHEs have been documented to affect the provision of health services including immunisation. To our knowledge, there is a scarcity of studies characterising PHEs and the performance of national immunisation programmes (NIPs) in countries within the WHO Africa region that have experienced PHEs. This study assessed PHEs (armed conflicts, disasters, and disease outbreaks) and the performance of NIPs in the context of PHEs using global and regional immunisation targets. Methods Countries in the WHO Africa region that were reported to benefit from the African Public Health Emergency Fund (APHEF) were used as case studies. Data on PHEs and immunisation indicators recorded between 2010 and 2019 in the study countries were extracted from different electronic PHE databases (the Emergency Events database, the Uppsala Conflict Data Program, the WHO Emergency Preparedness and Response, and the Program for Monitoring Emerging Diseases Mail) and the WHO/UNICEF immunisation database, respectively. The PHEs and immunisation indicators were stratified by country and summarised using descriptive statistics. The Mann-Whitney U test was carried out to determine the association between the frequency of PHEs and the performance of NIPs in the selected countries from 2010 to 2019. Statistical significance was defined at p-value < 0.05. Results Thirteen countries were included in this study. A total of 175 disease outbreaks, 288 armed conflicts, and 318 disasters were reported to have occurred within the 13 countries from 2010 to 2019. The Democratic Republic of Congo had the highest total PHE count (n=208), while Liberia had the lowest (n=20). Only three of the 13 countries had a median coverage value for the third dose of the combined Diphtheria, Tetanus, and Pertussis vaccine (DTP3) that had attained the target for ≥90% immunisation coverage. Higher counts of armed conflict and total PHEs were statistically significantly (p=0.03) associated with not attaining MNT elimination. Conclusion PHEs are prevalent in the WHO Africa region, irrespective of the level of a country's immunisation maturity. In absence of effective interventions, PHEs have the potential to derail the progress of NIPs in the WHO Africa region. As we enter the Immunisation Agenda 2030 era, this study advocates for the prioritisation of interventions to mitigate the impacts of PHEs on the NIPs.

Philosophiae Doctor - PhD (Nursing) / The number of healthcare institutions that has embraced Kangaroo Mother Care (KMC) as an effective and efficient method of neonatal care especially in Edo State, Nigeria has not multiplied even after more than a decade of its recommendation by the World Health Organisation (WHO) in 2003. Nigeria ranks seventh among the ten African countries where newborns have the highest risk of dying with over 700 newborn deaths per10, 000 live births. This is worrisome because Edo State is one of the 36 states in Nigeria that contribute about 6,700 neonatal deaths to the 255,500 mortality rate recorded in Nigeria annually. This has led to a concern about the knowledge and attitude of the key drivers in neonatal care of simplified methods aimed at reducing neonatal mortality despite previous training efforts. The development of a strategy to enhance the early implementation of the WHO KMC guidelines in all healthcare facilities across the state was therefore conceptualized. Strategies to increase implementation are considered important to the success of KMC because reducing neonatal mortality rate is contextual. This research aimed to explore and describe the application of the KMC guidelines by the nurses, administrators and parents of preterm infants in the care of premature babies and to develop strategies to enhance its early implementation in healthcare facilities in Edo State, Nigeria.

The concept of global governance is nowadays commonly used for studying international relations. The goal of this thesis is to analyze the nature of global governance in health sector, to discover how the main participants involved in international relations react to new challenges that arise, specifically how they react to the case of obesity. Global governance occurs on multiple levels; WHO occurs at the global level whereas individual national states occur at the lower level. This thesis answers the questions to topics such as: how the global health governance's politics are made, whether obesity represents a threat and how various participants that are involved in international relations coordinate their steps towards fighting obesity, on which levels they coordinate their agenda and for whom they are working for when fighting obesity.

Philosophiae Doctor - PhD / The incidence of Diffuse large B cell Lymphoma has been increasing lately at an alarming rate especially, in developing countries like Sudan. The standard therapy in Sudan is based solely on the R-CHOP chemotherapy regimen, yet it has been noticed that Diffuse Large B cell Lymphoma prognosis remains unfavorable. The late diagnosis and the consequent side-effects of the therapy directly affected the disease’s poor outcome. There is a scarcity of scientific publications regarding DLBCL in Sudan, but the increased burden necessitates the need for further research.

Health policy comprises a sum of political activities affecting quality of life and health of people and social groups. The health policy exceeds activities of health-service institutions and covers intended manners of the public, private, public and voluntary organisations and individuals who impact the health. Among them e.g. WHO, one of the biggest and most important specialised institutions of UN. The health policy concentrates on personal, environmental and socioeconomic impact on health and on complicated and complex providing of health care. The long-range strategy of health improvement of the population of the Czech Republic ``Health for Everyone in the 21st Century{\crqq} is a rational and well structured model of complex societal care of health and its development; created by teams of prominent world experts in health policy and economics. In the Czech Republic the Health 21 programme has been applied as the National Action Plan on Health and Environment. Community programmes focused mainly on mapping of the situation in the Czech Republic and consequent continuing prevention. The single programmes are Healthy Town, Healthy School, Healthy Company and Healthy Hospital. Media represent both more and more important form of social, political and cultural life of present societies and condition of economic successfulness of many branches and their role of informant, vehicle of information and public opinion maker can be absolutely key element of propagation and explaining of health policy aspects.

Magister Scientiae Dentium - MSc(Dent) / The Human Immunodeficient Virus (HIV) is escalating in South Africa at an alarming rate. The impact of HIV today and in the future could have grave consequences for the South African population as it affects adults in their most productive years. To ease costs on the health system, health workers should be familiar with HIV patients needs in general, and specifically in areas such as oral disease which can contribute to the wellness or ill health of the patient. This could facilitate more appropriate and cost effective care ofHIV patients. World-wide reports indicate that the HIV virus is more prevalent in females than males. Women are also experiencing greater virulence of HIV and therefore greater severity of the disease. This research assessed whether there were differences in the prevalence and severity of oral symptoms ofHIV positive men and women. Oral health practices were also examined. As oral disease is very prevalent in HIV positive persons and has been a neglected area for research and program development, it was included in this study. This study also aimed to assess the perceived needs of patients affected by HIV. Such a study presents HIV positive patients an opportunity to participate in a process which allows patients to voice their needs and problems, as well as be involved in setting priorities. The study sought to assess whether needs differed according to the patients gender, age and symptom levels. A needs questionnaire with five domains which included medical and oral needs, social, economic, psychological and informational domains of needs was developed. The measure also included a section on demographics and oral health questions, and was administered as a structured interview. The sample consisted of 338 HIV positive males and females residing in Cape Town and its environs and attending the Out Patients' Departments of three major provincial hospitals, as well as two community clinics during May to November of 1995.

Magister Chirurgiae Dentium (MChD) / The South African population is made up of Blacks, Whites, Coloureds and Asians. Since each population group is distinct in its culture and habits and have widely differing life styles and socioeconomic levels an ideal oppurtunity exists for the study of environmental influences on the aetiology of particular cancers. In addition accurate epidemiological data is essential in order to assess changing .patterns of the disease and the efficacy of the prevention programmes. The aim of this study was to etermine age standardised incidence rates and age specific morbidity rates of intra-oral squamous cell carcinoma for Blacks on the Witwatersrand. All new cases of intra-oral cancer during the period (1971-1980) were traced. The population at risk was determined from the National Population Censuses of 1970 and 1980. According to the method used in the International Union Against Cancers (U.I.C.C.) publication (Waterhouse et al 1976 and 1982) age standardised incidence rates and age specific morbidity rates were calculated for tongue, floor of mouth, buccal mucosa, hard and soft palates and gingivae and alveolar ridge using standard World, European and African populations. These results indicate that in the population group studied intra-oral cancer is much more common in males and than females (5,55:1 standardised rates) most commonly affects the tongue followed by the floor of mouth, palate, buccal mucosa and gingivae and alveolar ridge and is a disease of the elderly occurring most commonly in the seventh decade in males and in the sixth decade in females. When compared with standardised rates reported, either for Blacks in other geographic locations in South Africa, or for other population groups in this country, or for selected countries elsewhere in the World, important differences have emerged which probably reflect differences in exposure to specific aetiological agents amongst the various population groups compared.