Magister Chirurgiae Dentium (MChD) / The dental clinic of the University of the Western Cape provides oral health care for many preschool children. The clinical observation was that these children presented with rampant dental caries. A recent report compi1ed by an international Joint Working Group of the Internationale Dental Federation and the World Health Organisation identified the changes in oral health in children and factors associated with these changes. South Africa presents a unique opportuni ty to study the oral health status of different ethnic and socio-economic groups. A review of the relevant literature indicated that there was a lack of published data, especially on the oral health status of preschool children. A study was designed to investigate the oral health status of a selected group of preschool children ages 2-6 years in the Western Cape. The examinations were conducted at twelve different créches by two calibrated examiners. The examinees' weight and height were also measured. The data was recorded on a revised World Health Organization Basic Oral Health Assessment form. A total of 547 children were examined with an almost equal distribution of males and females. Only 18% of the sample had a compl ete sound primary dentition, dmft = O. The mean dmft was 5.37 which ranged from 2.73 for the 2 year age group to 7.01 for the 5 year age group. The mean dt of 4.09 made up 76% of the dmft, the mean mt of 1.22 made up 23% and the ft was negligible. Seventy-eight percent of the sample had decayed teeth present and 28% had missing teeth recorded. The treatment chosen by or for these children appeared to be extractions. Observations of extensively decayed teeth and the high prevalence of dento-alveolar abscesses suggested that this treatment was of an emergency nature. There was much unmet treatment as only 22% of subjects were free of decay and those with decayed teeth present had an average of 5. The dmft distribution showed 48% had a dmft.)5. There was a statistically significant linear association between the dmf and age for all the tooth types except the cani nes. There was no significant difference in caries prevalence between males and females. The phenomenon of bilateral symmetrical occurrence of dental caries in the primary dentition was demonstrated in the present study. The maxillary central incisors were the most frequently affected teeth (55%), followed by the mandibular second molars (47%) and maxillary second molars (42%). This is contrary to the findings in European communities where the primary second molars are the most susceptible tooth types. The present study found the fifth year of 1ife to be the critical one for the primary dentition. It was at this age that the greatest increment in dmft was observed, the greatest decrease in the number of caries-free subjects, more than a twofold increase in rampant caries, and a twofold increase in the number of subjects with dento-a1veo1ar abscesses. Few hard tissue anomalies were recorded. Localized enamel hypoplasia was quite common especially of the upper incisors and second molars. Most children claimed their teeth were brushed at least once a day. But soft deposits were present in almost all age groups in all the segments. Sixty percent of the sample had the sole responsibility of brushing their own teeth with no assistance from their parents. Parental assistance with toothbrushing was limited to the younger age group. In the present study soft deposits and gingivitis were recorded mostly on the buccal of the upper posterior segments and on the lingual of the lower posterior segments. The anterior segmentshad less plaque than the posterior segments. Thi s may be due to children finding it easier to brush anteriorly than posteriorly when they do brush. Also, the other areas are less accessible and require greater manipulative skill. There was a weak correlation between the total soft deposits and total gingivits. Although 60% of the sample had six segments of soft deposits present, only 4% had )six segments of gingivitis present. However, it was found that the higher the number of segments of soft deposits present, the greater the tendency for the presence of gingivitis. The association between dmft and soft deposits was not significant but between dmft and gingivitis was significant. This may be more preci se as these two are both cumulative measures. Soft tissue lesions were generally uncommon in this age group. The children in this community were generally lighter in weight and shorter in height compared to the NCHS (1979) percentiles. Recommendations regarding ways of redressing the obviously inadequate general and oral health of this sample of children were made.

Master of Public Health - MPH / The World Health Organisation recommendations for breastfeeding in the general population, including mothers living with HIV, emphasise breastfeeding within one hour of birth, exclusive breastfeeding (EBF) during the first six months of life, and continued breastfeeding for up to two years or beyond. However, only 34.8% of infants worldwide are exclusively breastfed for the first six months of life, and as a result, about 1.4 million infants lose their lives due to undernutrition. In South Africa, only 31.6% of infants are exclusively breastfed for the first six months. Despite the benefits of exclusive breastfeeding, many mothers living with HIV do not initiate breastfeeding or discontinue breastfeeding prematurely. It is, therefore, crucial to determine the barriers inhibiting the uptake of EBF and factors promoting mothers living with HIV to adopt exclusive breastfeeding.

>Magister Scientiae - MSc / Physiotherapy services for disabled children and their families have conventionally been received at a hospital or school for children with special educational needs in the main towns and cities of South Africa. Community-Based Rehabilitation (CBR) programmes were proposed and established as an additional approach to Institutional-Based Rehabilitation to address the need for accessible resources for these families. In this study the author evaluated two CBR programmes for disabled children and their main caregivers in two separate low socioeconomic peri-urban areas of Cape Town. The programme, a weekly group meeting, included physiotherapy interventions to assist the development and functional abilities of the children by means of activities that the caregivers could include in daily home care. They handled their own children following demonstrations and correction of handling skills by the author. The majority of the caregivers were mothers. Their children, less than 13 years old, were severely intellectually impaired. Some with concomitant physical disabilities. The author implemented the interventions of the CBR programme and she required to understand the impact on the particpants in a study using qualiative research methods. In the pilot programme the attendant members were individually interviewed, after her withdrawal, for their opinions of the outcomes. Evaluation documentation.ofjheir children and CBR programme records were related to the caregivers' responses. From the pilot study experiences the author felt that additional methods of data collection would result in a greater understanding of the impacts of the interventions. Expanded methods of research were utilised in the study of the second group. During the interventions at group meetings the author used field notes to record observations. Participant observation allowed the author to analysis the responses of the participants. Focus group interviews assisted in understanding external factors influencing the participants as well as their needs. Individual interviews, after the closure of the CBR programme, allowed the participants to express their views of the interventions. Documentation of the individual evaluation of each child was related to the views expressed by the caregivers. Common meanings and themes were explored in the analysis of the various data collected. Analysis revealed that interventions of education and training for the caregivers improved their knowledge and understanding of the impairments and disability of their children. The children benefited functionally from their families increased skills and knowledge. Through discussion with other families at group meetings, the caregivers had an understanding of other disabilities in children and developmental outcomes possible for their own child. The caregivers were more confident to address the negative perceptions of disability in their communities. It is recommended that physiotherapists implementing any interventions for disabled children should ensure that the caregivers are partners in planning and selection of interventions and that their needs are addressed. Community participation in Community-Based Rehabilitation programmes was required for the participants to become self-reliant and solve their own needs as well as for the programme to be sustainable. This was demonstrated in only one of the programmes.

>Magister Scientiae - MSc / This thesis is a quantitative and qualitative study, reflecting the health promotion I needs of individuals with lower limb amputation in Rwanda. Individuals with physical disabilities are at risk of secondary complications due to the impact of the disability, and this may be exacerbated by poor choices of lifestyle. Rehabilitation services have been traditionally designed for those experiencing sudden on-set, traumatic disabling conditions. Although physically disabled persons desire to engage in wellness-enhancing activities, limited programs based on their health promotion needs' assessment have been developed. In this study, participants' health promotion needs and factors that influence their health-related behaviours were examined using a questionnaire survey and in-depth face-to-face interviews. Data analysis, using SPSS version 10.0, was used to obtain frequency tables and histograms. Chi-square tests, Fisher's exact Tests and Pearson's correlation coefficient were utilized to test for associations between several variables. Audiotape recordings and process notes were translated, and then transcribed verbatim. Strong themes that ran through the data were identified. In order to qualify for between method triangulation used in the study, complementally strengths were identified by comparing textual qualitative data with numerical quantitative results and vice versa. Participants were 334, comprising more males (8O%) than females (20%). The most frequently reported cause of amputation was land mines injuries (44.6%). Most participants were either unilateral below-knee (40.7%) or above-knee (40.1%) amputees. The. majority of participants led physically inactivity lifestyles (64.7%), others consumed alcohol (60.5%), used tobacco (33.5%) and drugs (9.6%). In-depth interviews revealed that participants' low psycho-social status and self-perception led to depression and frustration. Negative peer influence and lack of access to relevant information predisposed them to involvement in risky health behaviours. Further interviews indicated that the participants' perceived health-related needs included access to relevant information and new lifestyle habits to improve their health. Participants also desired job opportunities, particularly vocational training programmes and the formation of support groups, to enhance various programmes. The study findings are extremely challenging. Over 50% of participants were engaged in health-risk behaviours, which would certainly result in the deterioration of their health status. This places a greater demand on rehabilitation services, increasing morbidity and mortality rates, thus further straining the national health -- budget. There is therefore an urgent need to develop, encourage and promote - wellness-enhancing behaviours and activities, to improve the participants' health status and ultimate quality of life. Finally, further studies need to focus on barriers and determinants of health-promoting behaviours, and to explore more about issues related to self-perception and risky health behaviours.

This thesis aims to describe how the International Federation of Red Cross and Red Crescent Societies (IFRC) tends to maternal health care in floodings and whether it should be deemed sufficient. Floodings in Pakistan (2010), Bangladesh (2017) and Sudan (2013) are used as units of analysis when conducting a content analysis. The theoretical framework consists of critical success factors for disaster response based in the emergency management literature. A big part of the theoretical framework revolves around the importance of expertise and rationality in disaster response planning and implementation. The three floodings received relief efforts from IFRC which are presented in emergency appeal reports. Lists on essential maternal health care interventions in combination with the theoretical framework create analysis questions that are posed to the appeals. Results are presented in a table naming the prevalence of each intervention in each report. The findings show that maternal health care was seen to and deemed sufficient in only one of the three cases: Pakistan. The conclusion is that the discourse on maternal health care in natural disasters should be developed and that further research on the subject needs to be conducted.

Female genital cutting is a problem that has taken several dimensions and continues to be practiced despite enormous efforts and resources invested by governments,non-governmental organizations (NGOs) and other stakeholders to ensure that the practice is discontinued worldwide. This study was conducted with the primary objective of assessing the views and perceptions of NGOs on the practice of female genital cutting in Nigeria. The study also examines efforts by civil society and the Nigerian government towards combating and eliminating the practice of FMC in Nigeria. Aside from the systematic literature review, a case study of ten NGOs were interviewed on the telephone. Findings indicate that girls being kept pure as virgins, protection of girls' reproductive potential, increase in fertility, aiding marriageability, traditional practice, and keeping with lineage practice are responsibile for the practice in Nigeria. Few theories were reviewed, and research questions were designed in line with the theories. The approaches include the Functionalist theory, cultural relativism, social theory and Feminism.

Magister Chirurgiae Dentium (MChD) / Occupational hazards are common among many professions and dentistry is no exception. Occupational hazards include percutaneous injuries, inhalation of noxious chemicals, noise and musculoskeletal disorders (MSD). Despite the fact that MSD have been documented to be very prevalent among dentists in various countries, there is a paucity of literature from South Africa. Aim The aim of the present study was to determine the prevalence of musculoskeletal disorders among the dentists in KwaZulu-Natal (KZN), South Africa and to identify risk factors associated with it. The study was a cross-sectional, descriptive one and questionnaires were used to elicit information regarding socio-demographic details, medical history, work history and work-related posture information from dentists based in KwaZulu-Natal. A convenience sample of all qualified dentists in this region who were registered members of the South African Dental Association (SADA) was used. Results One hundred and nine dentists responded to the questionnaire. The response rate was 31%. The majority were male; a third aged between 30 - 39 years and the ratio of females to males was 1:3. Almost all the dentists reported pain in the neck, lower back and shoulder. Less than a quarter of the dentists in KZN reported hand pain, numbness in the hands and a tingling sensation in the hands. More than three quarters reported that they had no negative effects when performing restorative work and scaling and polishing, but 3.1% reported having extreme levels of pain. The most common working position reported was the 2 0' clock position. Nearly three quarters rotated their necks while performing clinical dentistry and a third tilted their shoulders towards their dominant hand. There was no relationship between Body Mass Index (BMI) and whether respondents treated patients while seated or standing and neither was there a relationship between pain in the lower back and BMI. There was a strong association between pain in the neck while performing clinical work and the number of years in practice confounded by age. When compared to other countries the prevalence of MSD is very high. The highest occurrence was for neck, back and shoulder pain. Avoiding these injuries is critical and self-recognition is important in either preventing further injuries or in increasing severity of the condition. The findings of this study suggests that it may be valuable to include ergonomic work practice in the training of dentists and dentists should be involved in a proper exercise routine which should include stretching and weight training to prevent injuries. Regular breaks should be taken to perform stretching exercises in-between the management of patients in order to reduce the risk of MSD.

Magister Chirurgiae Dentium (MChD) / The psychological, social, and cultural aspects of facial and dental attractiveness is an integral part of health care. Lay persons perceptions of facial and dental attractiveness are influenced by many factors including age, gender, geographic location (nationally or international), ethnic status, employment status, cultural differences and social class will effect the social impact of the anomalies. In addition, the public response to dental anomalies will vary according to experience of good health or ill health of the individual, relatives and friends. The perception of malocclusion is often seen differently between orthodontists, patients and lay public. The differing perceptions of patients and dental practitioners may influence the delivery of orthodontic care. It has been reported that 70% of orthodontic treatment is dentist induced and that orthodontic treatment may be undertaken without the patient or parents perceiving a problem with the teeth. (DHSS, Schanscheiff Report, 1986). The thresholds of entry and exit for orthodontic care may be different as perceived by orthodontists and lay persons. Orthodontists may pursue full alignment and perfect occlusion whereas lay persons may accept varying degrees of deviation from normal. This current study has assessed and recorded the differences in opinions of professional orthodontists and lay persons on dento-facial aesthetics, orthodontic treatment need and orthodontic treatment outcome. The study was carried out at the Orthodontic Department, University of Wales, College of Medicine, School of Dentistry. The opinions of 56 lay persons (dental technicians, dental nurses and lay persons not involved in the clinical process) and 97 orthodontists was collected by recording judgements using various patient records as stimuli. For each set of records examined, each member of the panel indicated their opinion using Likert scales. Judgements were made by assessments of 68 study casts in respect of:- * the need for orthodontic treatment on dental health grounds. the need for orthodontic treatment on dental aesthetic grounds. deviation from normal occlusion. the decision whether to treat. ** * In addition, judgements were made on a sample of 50 pairs of outline facial profiles before and after treatment in respect of: * * deviation from normal facial aesthetics comparison of aesthetics pre-treatment and post-treatment. Furthermore, assessments on 50 pairs of pre-treatment and post-treatment study casts in respect of: * * degree of improvement as a result of treatment. acceptability of result. Orthodontists subjective judgements are more reliable than lay persons in their assessments of dental aesthetics, dental health and deviation from normal. The level of agreement for the decision to recommend treatment is similar between orthodontists and lay groups ie. lay persons are as reliable as orthodontists in the decision to recommend treatment. Orthodontists tend to recommend 10 - 12 % more treatment than lay persons. The orthodontist group were more reliable than the lay group in assessing degree of improvement and assessment of outcome. Orthodontists reject approximately 25% of cases deemed acceptable by the lay group. Dental aesthetics appeared to be the most important feature in the assessment of treatment outcome by both orthodontists and lay groups.

Introduktion: Enligt World Health Organisation (WHO) definieras hälsa som ett tillstånd av fysiskt, mentalt och socialt välbefinnande och inte endast frånvaro av sjukdom. Utifrån denna definition kan en människa uppleva hälsa och livskvalitet hela livet, oavsett ålder, diagnos eller prognos. Förhållningssättet till livet påverkar den självskattade psykiska, fysiska och sociala hälsan. I Sverige används begreppet existentiell medan begreppet andlig oftast används internationellt. Både existentiell och andlig relaterar till en inre dimension som interagerar med den yttre världen; den egna kroppen, andra människor och de sekulär eller religiösa system som en individ kan relatera till. Syfte: Syftet är att bedöma hur WHO:s åtta faktorer för existentiell hälsa definieras och hur de används i vetenskapliga studier. Metod:Studien bygger på en litteraturstudie i vilken tjugo vetenskapliga artiklar granskats och analyserats. Både kvalitativa och kvantitativa studier, som undersöker existentiell hälsa har inkluderats. För att besvara forskningsfrågan och uppfylla studiens syfte har en kvalitativ metod med induktiv ansats valts för att söka en slutsats utifrån tidigare forskning. De vetenskapliga artiklarna som valts ut har inhämtats via tillförlitliga databaser som PsychInfo, PubMed, SwePub,Google Scholar, och från Socialmedicinsk tidskrift. Resultat: Vid analys av artiklarnas innehåll har vi använt följande teman: andlig kontakt, mening och syfte med livet, upplevelse av förundran, helhet och integration, andlig styrka, harmoni och inre frid, hoppfullhet och optimism samt tro som resurs. Av dessa kom behovet av optimism, inre frid och hopp först. På andra plats kom behovet av mening och syfte med livet. Resultat visade att det är notoriskt svårt att definiera och mäta andlighet på grund av dess omtvistade definition, förhållandet till religiositet och olika kulturer. De olika definitionerna utmanar tillämpningen av begreppen i olika kontexter och kulturer. Slutsats: Då forskning kring existentiell hälsa är begränsad och relativt outforskat behöver framtida forskning fler kvalitativa och kvantitativa forskningsinsatser för att analysera faktorer som påverkar den existentiella hälsan utifrån ett kulturellt och kontextuellt perspektiv. Teorier och metoder kan på så sätt utvecklas för att skapa en evidensbaserad existentiell hälsointervention. / Introduction: According to the World Health Organisation (WHO), health is defined as a state of physical, mental and social well-being and not merely the absence of disease. Based on this definition, a person can experience health and quality of life throughout their life, regardless of age, diagnosis or prognosis. The approach to life affects the self-assessed mental, physical and social health. In Sweden, the term existential is used, while the term spiritual is most often used internationally. Both existential and spiritual relate to an inner dimension that interacts with the outer world; one's own body, other people and the secular or religious systems to which an individual can relate. Purpose: The purpose is to assess how the WHO's eight factors of existential health are defined and how they are used in scientific studies. Method: The study is based on a literature study in which twenty scientific articles were reviewed and analyzed. Both qualitative and quantitative studies investigating existential health have been included. In order to answer the research question and fulfill the purpose of the study, a qualitative method with an inductive approach has been chosen to seek a conclusion based on previous research. The scientific articles that have been selected have been obtained via reliable databases such as PsychInfo, PubMed, SwePub, Google Scholar, and from the Journal of Social Medicine. Results: When analyzing the content of the articles, the following themes were used to categorise findings: spiritual contact, meaning and purpose in life, experience of wonder, wholeness and integration, spiritual strength, harmony and inner peace, hopefulness and optimism and faith as a resource. Out of theseeight themes, the need for optimism, inner peace and hope came first. In second place came the need for meaning and purpose in life. Results showed that it is notoriously difficult to define and measure spirituality due to its contested definition, relationship to religiosity and different cultures. The different definitions challenge the application of the concepts in different contexts and cultures. Conclusion: As research on existential health is limited and relatively unexplored, future research needs more qualitative and quantitative research efforts to analyze factors that affect existential health from a cultural and contextual perspective. Theories and methods can thus be developed to create an evidence-based existential health intervention.

<p>Kangaroo mother care (KMC) was first initiated in Colombia due to shortages of incubators and the incidence of severe hospital infections of new-born infants during hospital stay (Feldman, 2004). Currently it is identified by UNICEF as a universally available and biologically sound method of care for all new-borns, particularly for low birth weight infants (Department of Reproductive Health and Research, 2003) in both developed and developing countries. The Western Cape Provincial Government implemented a policy on KMC as part of their strategy to decrease the morbidity and mortality of premature infants in 2003 (Kangaroo Mother Care Provincial task team, 2003). Essential components of KMC are: skin-to-skin contact for 24 hours per day (or as great a part of the day as possible), exclusive breastfeeding and support to the motherinfant dyad. Successful implementation of KMC requires relevant education of nurses, education of mothers on KMC by nursing staff, monitoring of the implementation of KMC by nurses, planning for a staff mix with varying levels of skill and experience with KMC, the identification of institution specific barriers to the implementation of KMC, and the implementation of institution specific strategies to overcome these barriers (Wallin,et al., 2005 / Bergman &amp / Jurisco, 1994 / Cattaneo, et al., 1998). This study aims to determine the knowledge of and attitude towards kangaroo mother care, of nursing staff and kangaroo mothers in the Eastern sub-district of Cape Town.</p>