<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>

International organisations such as the World Health Organisation highlight the road crash problem in less motorised (or developing, or low income) countries like those in Southeast Asia and recommend the adoption of Western road safety measures. However, there are many differences between highly motorised and less motorised countries which raise questions about how successfully Western road safety knowledge and expertise can be transferred.----- A review of the statistical information on road crashes shows a great deal of uncertainty about both the scale and likely trajectory of road fatalities globally, in less motorised countries and in Asia. It is generally agreed, however, that Asia accounts for around half of all road fatalities, and analysis of the limited available data shows both that Southeast Asia is not an atypical region of Asia in road safety terms, and that Thailand and Vietnam are not atypical of Southeast Asian countries.----- A literature review of recommended practice approaches to road safety transfer in Asia shows that there are many economic, institutional, social and cultural factors which potentially influence the success of transfer. The review also shows that there is no coherent, comprehensive approach which either conceptualises these factors and their relationship to transfer outcomes, or uses an analysis of these factors to plan or modify transfer. To address this gap, this thesis develops a 'road safety space' model as a tool for conceptualisation and analysis, based on a biological metaphor which views the transfer of road safety measures from one context to another as analogous to the transfer of a species into a new ecological space. The road safety space model explicitly considers economic, institutional, social and cultural factors (from specific to broad) which influence the particular road safety issue which a particular road safety transfer effort seeks to address. A central contention of this thesis is that the road safety space model is both a feasible and useful tool to improve the process of road safety transfer to less motorised countries. Road safety space analysis is seen to have a role in a broader process of selection of road safety measures for transfer, along with knowledge of how the measures are considered to operate.----- The research reported in this thesis is comprised of three studies. Study 1 reviewed evaluations of road safety transfer to Thailand and Vietnam. Studies 2 and 3 were case studies of road safety transfer to Thailand and Vietnam respectively.----- Study 1 was an analysis of existing evaluations of road safety transfer to Thailand and Vietnam. The aims were to analyse the evaluations for their consideration of contextual factors, as described in the road safety space model, and to discuss whether the road safety space model assisted in understanding the reasons for success or failure of transfer. However, very few such evaluations exist, and those that were found generally lacked information on whether contextual factors were considered. This indicated the need for a more detailed, in-depth qualitative investigation of particular cases of road safety transfer, in order to investigate the feasibility and utility of the road safety space model.----- Two case studies (Study 2 and Study 3) were conducted to test whether the road safety space approach was both feasible and useful as a means of improving road safety transfer efforts. Study 2 was a case study of the development and implementation in Thailand of a road safety education program for school children, which involved the transfer of Western research and techniques. The transfer agents (i.e. those who effected the road safety transfer) were Australian consultants working for the Australian Road Research Board (ARRB). The transfer was funded by the World Bank and managed by the Thai Ministry of Education (MOE). Study 3 was a case study of the development and implementation of a motorcycle helmet wearing program in Vietnam, which involved the transfer of Western knowledge, techniques and technology. The transfer agents were staff of Asia Injury (AI), a non-government organisation (NGO), and the program was funded initially by a charitable fund, with the intention of becoming self-funding through operation of a helmet factory.----- The case studies employed background research into existing information on economic, institutional, social and cultural factors relevant to the road safety issues (road use behaviour of school children in Thailand and motorcycle helmet purchase and wearing in Vietnam), and collected data through interviews with key informants, analysis of secondary sources and observations. This information was used to derive the road safety space for each road safety issue, to identify the road safety space recognised and addressed by the transfer agents (ARRB and AI), and to determine which factors they missed, or were aware of but took no action on. The focus of this analysis was on the processes used in transfer, not on the road safety outcomes of transfer, although these provided information on the processes as well. Available evaluation information was used to draw links between the omissions and the success of the transfer processes. It was noted that information on how the transferred measures operate should come from a road safety space analysis in the originating country, although this raised questions about selection of country and time (when the measure was first introduced, or in its maturity).----- The feasibility and utility of the road safety space model were discussed. It was clear that the model provided information on the cases which was missed by the transfer agents. The questions examined next were whether this information could have been obtained from an exercise conducted before the transfer had commenced, whether the required effort and cost justified the potential benefits, and whether the information on the road safety space could have been useful for the transfer agents. Comparisons between the road safety spaces for the two cases showed some areas of commonality, e.g. perceptions of police corruption, but also many differences. It was considered likely that some broad factors could be generic, and the possibility was mooted that less motorised countries share issues with police enforcement. This requires further research, however, and at this stage it is better to treat each road safety space as a unique combination of contextual factors influencing the road safety issue of interest.----- It is concluded that the road safety space model is feasible if used in such a way as to minimise the research involved, and useful, although the degree of utility needs to be further explored in a prospective study. The limitation introduced by restricting informants to those who could speak English are discussed. An approach using road safety space analysis is recommended, emphasising analysis of the country to which the road safety measure is being transferred, supplemented by analysis of the originating country road safety space. Gaps in knowledge are identified for further research and development, in particular the theoretical and practical understanding of road use behaviours and their modification in less motorised countries in Southeast Asia. Elaboration of the model is also recommended, to take into account the influence of the type of measure transferred, the role of the transfer agent, the area of road safety (education, engineering or enforcement), and the time dimension (the time which might be needed for a transfer to show its effects).----- The findings of this research are likely to be applicable to road safety transfer in other less motorised regions of the world, however prospective testing is needed. They may also be relevant to issues of transfer for areas other than road safety, in particular public health and traffic engineering, where similar economic, institutional, social and cultural issues come together.

Face aux pandémies, le droit international s'organise-t-il sous la forme d'un « système de sécurité sanitaire collective» (abandon des mesures unilatérales excessives - garantie offerte par la collectivité par le biais d'une action commune - sauvegarde du droit des États d'adopter les mesures individuelles nécessaires) ? L'étude des instruments adoptés au sein de l'OMS (Règlement sanitaire international et Cadre de préparation en cas de grippe pandémique), des actes unilatéraux de l'ONU (résolutions de l'Assemblée générale, du Conseil de sécurité et du Conseil économique et social), de la coopération entre organisations intergouvernementales et des accords de l'OMC (GATT, Accord SPS et Accord sur les ADPIC) révèle que chaque segment de la question reçoit une réponse positive. Pourtant, on ne peut ignorer le caractère largement imparfait du résultat de la lutte contre les pandémies. S'il existe indéniablement des indices en faveur de la thèse selon laquelle un système de sécurité sanitaire collective serait en formation, le droit international face aux pandémies se caractérise par un agglomérat de fragments aux antipodes d'un édifice juridique cohérent. / In the face of pandemics, is international law organized as a "system of collective health security" (foregoing excessive unilateral measures - guaranteed by the community through joint action - upholding State rights to adopt necessary individual measures)? The study of instruments adopted by the WHO (International Health Regulations, Pandemic Influenza Preparedness Framework), of unilateral acts of the UN (resolutions of the General Assembly, the Security Council and the Economic and Social Council), of cooperation between international organizations and of the WTO's Agreements (GATT, SPS Agreement and TRIPS Agreement) reveals that the answer to each segment of the question is positive. However, one cannot ignore the highly imperfect result of the fight against pandemics. If there are undeniable indices which illustrate the existence of a nascent system of collective health security, international law in the face of pandemics is nevertheless thus far characterized by an agglomerate of fragments at odds with a coherent legal edifice.

Les politiques de lutte contre les maladies plus généralement et celles relatives au paludisme singulièrement, mises en œuvre depuis 1948, ont connu des fortunes diverses dans leur application à l'échelle locale. L'exemple de la Côte d'Ivoire que cette recherche a mis en lumière en est la parfaite illustration. Ainsi, de la politique «d'éradication du paludisme» qui couvre la période 1955-1970, à laquelle succède celle du contrôle du paludisme depuis cette date, les directives de lutte, qui accompagnent les grands programmes de santé de l'institution internationale, ont été diversement appliquées, du moins en ce qui concerne le paludisme. Les raisons de ce décalage entre les indications normatives et les pratiques thérapeutiques sont à la fois exogènes et endogènes. Cette étude illustre ainsi les contradictions entre les politiques de santé décidées en amont, et leur application, en aval. Elle permet de saisir aussi, le rôle central de l'OMS dans la gouvernance de la santé mondiale. Mais, elle n'occulte pas pour autant les énormes difficultés encore pendantes des systèmes de santé des pays en voie de développement comme la Côte d'Ivoire, malgré tous les efforts entrepris par l'OMS pour y remédier. / The policies to fight diseases in general and malaria in particular since 1948 have met different forms in their implementation on a local scale. The example of the Côte d'Ivoire that this study has brought into light perfectly illustrates that point. From an "eradication of malaria" policy that ranges from 1955 to 1970 to a control of malaria since then, the fighting directives, which go along with the main health programs of international institution, have been variously implemented, at least as far as malaria is concerned. The reasons that account for this discrepancy between normative indications and therapeutical practices are both exogenous and endogenous. This study thus illustrates the contradictions between health policies decided upstream and their implementation downstream. It also helps to understand the major role of the World Health Organisation in its govemance in world health. But it does not ignore the huge and still remaining difficulties of health systems of developing countries such as the Côte d'Ivoire in spite of all the efforts undertaken by the WHO to deal with them.

Magister Public Health - MPH / 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 & 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. / South Africa

The thesis titled The quality of life among hearing impaired people focuses on the current issue regarding the assessment of the quality of life in adult hearing impaired people in the Czech Republic. The conceptual basis of the submitted work is the current professional paradigm, with the emphasis on well-being in the lives of individuals with specific needs. The text deals with the multidimensional character of the concepts of the quality of life and the quality of life relating to health. It illuminates the subjective and the objective part of this broad and current concept. One theoretical chapter focuses on the area of hearing impairment in adult people in connection with the aspects which are bound to the quality of life in this part of the population. Mentioned are the personality traits of a hearing impaired person and the current social dilemma, which is connected to hearing loss, and is projected in the overall assesment of the quality of life of the people with this sensory handicap. One of the sub- chapters of this part of the text focuses on the key factors which influence the personal experience of life quality in the case of hearing loss. The research part of the work deals with method, continuation and assesment of the executed quantitative and qualitative research investigation. In...

Philosophiae Doctor - PhD / Injuries, and head injuries in particular, are a common cause of childhood, adolescent and young adulthood morbidity and mortality. The risk factors for injuries in general have been well researched. But it remains uncertain whether these factors are similar for specific injuries, such as head injuries. The inter-relationships between individual and environmental risk factors are difficult to study. Whilst much is know of the short-term consequences of head injuries, relatively little information is available on their long-term conseque~ces. The follow-up period in most research is short (often less than 1 year) and studies are weak in terms of design. Studies generally find a variety of social, cognitive and psychological consequences in children and young adults experiencing head injuries. This study assessed in two large, nationally representative samples, a 1946 birth cohort and a 1997 cross-sectional health survey: 1) the occurrence and risk factors for childhood, adolescent and early adulthood head and other injuries, and 2) the long-term cognitive and psychiatric effects of skull injuries. The overall findings for the risk factors across the two data sets and over 5 decades of data collection were strikingly similar. Maleness was a major risk factor for the head and other injuries. Some of the behaviour and personality factors such as hyperactivity and being neurotic, even after adjusting for sex, socioeconomic status and family type, remained significantly related to injuries, particularly those affecting the head region. A clustering of demographic, socioeconomic, family and behavioural risk factors significantly increased the likelihood of injuries, particularly recurring injuries with at least one being a head injury. In the unadjusted analyses socioeconomic status and family type were less consistently related to injuries. The long-term psychiatric and cognitive consequences of skull injuries causing concussion and skull fractures in childhood and early adulthood were negligible. Other childhood factors such as educational ability, behaviour and personality, and level of education achieved were more predictive of psychiatric symptoms and cognitive problems in adulthood. This study suggests that children and adolescents with behavioural and personality problems were at greater risk of head and other injuries in childhood, adolescence and later in adulthood. Children and adolescents with behavioural and personality problems were more likely to live in manual social class families and families with a single parent or stepparent. This combination of behavioural problems and deprived socioeconomic and family circumstances may increase tendencies for violent behaviour, alcohol dependence and manual occupations later in adulthood, which all increase the risk of injuries. There is therefore a need to identify children and adolescents with behavioural and personality problems as early as possible to prevent the impact in the short- and longterm. This will not only reduce the burden of injuries but also the many other consequence of behavioural and personality problems, particularly when located within deprived socioeconomic and family circumstances.

Doctor Pharmaceuticae - DPharm / Underdiagnosis and undertreatment of asthma in children are barriers to optimal health care delivery and health, incurring substantial costs to both the families and health services. A tailored multifaceted educational outreach intervention ("academic detailing") was designed and implemented among private sector general practitioners (GPs) serving a poor working class urban community in Cape Town, South Africa. The intervention aimed to improve primary care childhood asthma by promoting the adoption of guideline-based key messages. The effectiveness of the intervention was tested in a randomised controlled trial, Chestiness and Asthma in Mitchell's Plain (CHAMP) (Zwarenstein 1999). This thesis describes the design, implementation and qualitative evaluation of the outreach intervention. Methods Qualitative interviews and quantitative sample surveys were conducted among GPs to identify and measure the prevalence of perceived barriers to optimal asthma care in children. A trained pharmacist visited GPs twice, promoting eight evidence-based primary care messages to overcome barriers to optimal care for asthma in children. The messages focused on key diagnostic indicators, a treatment algorithm based on severity, cost of drug therapies, inhaler and spacer use, and preventive treatment. These messages were formatted into attractive promotional material. The first visit promoted use of the messages, the second reinforced adoption in routine practice and assessed GPs' responses using unobtrusive qualitative data collection methods. The dialogue was tailored to each GP's needs. Results Thirty-two GPs received the intervention. All but one consented to both visits. At the first visit responses were varied. A few GPs were confused or suspicious; most were in agreement with the messages but seemed passive towards implementation; a few were keen to adopt the messages into their routine practice. Response at first visit was not predictive of use as assessed at the second. At the second visit, most GPs claimed that they personally agreed with and used the messages, with a large minority less enthusiastic. Conclusion The intervention appears to have been broadly accepted as evident from GPs' acceptance of the outreach pharmacist, but reports of complete adoption of the messages and use of the kit were less prevalent. This finding is consistent with and helps to explain the improved health outcomes of children with asthma in the CHAMP trial. The combination of qualitative and quantitative research methods was effective in identifying and assessing GPs' barriers. Further, the combination helped to confirm the determinants for the intervention. Unobtrusive qualitative methods provided valuable insight into GP behaviour in routine setting. Additional studies conducted in public sector pnmary care settings and for other diseases are needed to confirm the wider acceptability and effectiveness of multifaceted outreach interventions aimed at improving professional practice. Such an intervention in our study setting seemed successful for childhood asthma.

This dissertation is a challenge to the Pentecostal churches, particularly, the Apostolic Faith Mission Church in Tumahole, to take an action in meeting the challenges posed by HIV/AIDS. This disease, HIV/AIDS, is the latest enemy to human life that the nations are faced with. In the newspapers like Sowetan, there is an article almost daily about HIV and AIDS. In this dissertation, I have tried to show shocking figures of how this disease is spreading in Africa. The seriousness of the disease, unlike other diseases, is its in curability. The secular organisations are far ahead of the churches in as far as the relevant programmes on combating HIV/AIDS are concerned. Despite these massive programmes, the disease is spreading like the wild fire. Deducing from this background, it is no longer the question of whether the Pentecostal churches have any role to play, but what specific role should the church play in this challenge. In this challenging times, many people look at the church as one of the most important institute that would play a positive role in bringing hope to the hopeless. / Christian Spirituality, Church History and Missiology / M. Th. (Missiology (Urban Ministry))

This dissertation is a challenge to the Pentecostal churches, particularly, the Apostolic Faith Mission Church in Tumahole, to take an action in meeting the challenges posed by HIV/AIDS. This disease, HIV/AIDS, is the latest enemy to human life that the nations are faced with. In the newspapers like Sowetan, there is an article almost daily about HIV and AIDS. In this dissertation, I have tried to show shocking figures of how this disease is spreading in Africa. The seriousness of the disease, unlike other diseases, is its in curability. The secular organisations are far ahead of the churches in as far as the relevant programmes on combating HIV/AIDS are concerned. Despite these massive programmes, the disease is spreading like the wild fire. Deducing from this background, it is no longer the question of whether the Pentecostal churches have any role to play, but what specific role should the church play in this challenge. In this challenging times, many people look at the church as one of the most important institute that would play a positive role in bringing hope to the hopeless. / Christian Spirituality, Church History and Missiology / M. Th. (Missiology (Urban Ministry))