Proefschrift Universiteit Maastricht. / Met lit. opg. - Met samenvatting in het Engels.

Magister Public Health - MPH / Background and Rationale The World Health Organization (WHO) has shown that the provision of Water Sanitation and Hygiene (WASH) in Health Care Facilities (HCFs) of many low and middle-income countries is poor. This is compounded by the lack of national plans and consolidated data on WASH in HCFs. This study assessed the availability and adequacy of Water Sanitation and Hygiene (WASH) infrastructure in 13 mission hospitals spanning 13 districts in Zambia. The objectives of this study were to identify the different kinds of WASH infrastructure available, and their adequacy, and factors influencing the status of WASH infrastructure and services in the selected hospitals. Methodology This study had a mixed methods design with semi-quantitative, descriptive and qualitative components. Assessments were conducted of the WASH infrastructure on the hospital property, and specifically in the male medical wards and outpatient facilities as two tracer areas, using a WHO checklist adapted and administered by the researcher. Checklist items were assigned scores (0=absent/bad to 2=on target/good) and total WASH scores for each facility compiled. For the qualitative component, individual semi-structured interviews using an interview guide were conducted, also by the researcher, with the facility managers and the head staff of the male medical wards. Results Overall coverage with an improved water source was reasonably good with 11 of the 13 hospitals reporting availability of improved water sources within the facilities. Hand washing basin coverage was similarly good. In contrast, coverage by well-functioning toilets was not as high, with 5 hospitals reporting toilets that were either broken, blocked, or having no running water and no toilet paper. Facility WASH scores varied from 22 (38%) to 57 (97%) out of a possible total of 58 points. Most of the Facility Managers indicated that the hospital WASH infrastructure was old, and with frequent breakdowns. This was worsened by lack of readily available spares and materials for repairing once there was a fault. Conclusion This study reveals an uneven coverage of WASH across facilities and elements, with poor sanitation a challenge across facilities. This is compounded by ongoing challenges in WASH infrastructure maintenance. Moving forward, there is need for government to develop a clear policy on WASH in HCFs. A national plan with resources and a monitoring framework need to be in place for streamlined support and tracking of progress by all stakeholders.

Philosophiae Doctor - PhD / Semen analysis is the cornerstone for the investigation of male infertility. Semen quality can be influenced by geographical location, age, ejaculatory abstinence, and season. In 2010, the WHO published criteria for human semen characteristics that were markedly lower than those previously reported. Many reports have discussed the methodology used by the WHO to set the 2010 reference values. Some of the limitations of the WHO (2010) study included an undefined ejaculatory abstinence period, the limited representation of different age groups, and a limitation in geographical representation as the study did not include any data from Africa and Middle East. Therefore, the current cohort study was designed to provide retrospective data on semen quality (Africa and Middle East) and reproductive hormones (Middle East) in patients who underwent semen analysis and endocrine investigation at Andrology Laboratories in South Africa and Qatar.

Magister Public Health - MPH / Sub Saharan Africa (SSA) single-handedly accounted for approximately two thirds (196 000) of the world maternal deaths. High maternal deaths have been attributed to high prevalence of HIV and low uptake of Antenatal Care (ANC). This made World Health Organization (WHO) to recommend integration of Prevention of Mother to Child Transmission of HIV (PMTCT) services into ANC to improve accessibility and utilization. According to Zambia Ministry of Health (MoH), every pregnant woman should have her ANC registration in the first trimester and achieve eight visits by delivery time. With the extra need of PMTCT services in the women living with HIV, early and regular ANC attendance is emphasized. However, in Zambia, there is limited information on ANC uptake and its associated factors among women living with HIV. / 2023

Masters of Public Health - see Magister Public Health / The World Health Organization (WHO) considers violence to be a global public health problem. It is estimated that 1.6 million people worldwide lost their lives to violence in 2000. This translates to a global rate of 28.8 deaths per 100 000 population. The end of Apartheid in South Africa in 1994 brought about various economic, social and political transitions within the country, resulting in rapid urbanization, increasing unemployment and deepening inequalities. Consequently, these conditions also brought about increased incidences of crime and violence. The South African Police Service (SAPS) recorded approximately 2.58 million crimes in 2000. The SAPS faced many challenges in transforming the eleven South African Police Forces to a combined South African Police Service in 1994. Literature has indicated that while serious crimes increased, the chances of an offender being caught and punished declined between 1994 and 2000. During the 2002-2003 financial year the SAPS recorded a national homicide rate of 47.4 per 100 000 population. The Western Cape and Limpopo province had the highest and lowest provincial homicide rate of 84.8 and 12.1 per 100 000 population respectively. Other studies indicated that city-specific homicide rates for Cape Town increased from 84 to 88 per 100 000 population between 1999 and 2001. A pilot study conducted in Cape Town during 2003 to determine victim-perpetrator relationships and motives for homicide that occurred in 1999 was hampered by difficulties in tracing police dockets, inconsistencies in data capturing, and the absence of perpetrator information due to some court cases not being finalized. It was therefore decided to conduct a qualitative, descriptive, comparative study between two police stations in Cape Town. Semi-structured interviews were conducted with police officers at different ranks to document the procedures and route of reported crimes and to explore the factors impacting on the criminal investigation process. The interviews were audio-recorded, transcribed and analysed using thematic content analysis. The interviews provided an insight to the contextual environment and the attitudes of police officers regarding the transformation of the SAPS, and identified the factors impacting on the criminal investigation process at the two selected police stations. Issues discussed are discipline, restructuring and motivational factors regarding the transformation process, as well as training courses, the court impact and the relationship between the detectives and prosecutors. The main constraints identified at both police stations were human resources, training courses and vehicles. Social support and community factors are also discussed. The interviews with police officers revealed that there are various issues of management at national and provincial level that need to be addressed, such as detective recruitment standards, training courses and the management of different crime types to reduce the workload of detectives. The need for closer collaboration with the courts to avoid the misplacement of dockets and to minimise delays in the finalisation of court cases was also identified. Previous studies have also identified blockages within the South African criminal justice system and it is hoped that this study could highlight those issues that still need to be addressed.

Masters of Science / There is evidence of the rising incidence and prevalence of chronic diseases of lifestyle in developing countries. It is estimated that by 2020 chronic diseases of lifestyle in Sub-Saharan Africa will be almost 50% of the burden of disease. Rapid urbanization with changes in lifestyle, such as physical activity patterns could explain at least partially the ongoing epidemiological transition. The purpose of this study was to assess levels of participation in physical activity among working Rwandan women in Kigali, in relation to socio-economic demographic characteristics. A cross-sectional study design using both quantitative and qualitative methods was used. Participants' level of participation in physical activity and influence of socio-economic demographic factors on questionnaire adapted from Sub-Saharan African Questionnaire. A focus group discussion assessed the need for a health promotion program related to physical activity participation among working women. Data analysis, using Statistical analysis version 8e, was used to obtain frequency tables and histograms. Chisquare tests and Fisher's exact tests were utilized to test for association between variables. Focus group discussion data were transcribed and translated into English. Data were then coded and put into themes and categories. There were 352 participants, with a mean age of 33.4 years. 71.9% of the participants were classified as sedentary and only 28.1 % of the participants were classified as physically active. Participation in physical activity decreased with age, and there were more participants classified as sedentary people in the married group (77%) than in non-married group (63.2%). A lower level of education and income of participants, the higher the level of participation in physical activity. Among the reported prevalence of chronic diseases, high blood pressure and diabetes were only reported by participants classified as sedentary. During the focus group discussion, participants reported facilitators and benefits of physical activity including, routine, relaxation, socialization and fitness, managing obesity and health purposes. Barriers limiting the participants' ability to engage in physical activity included lack of time, lack of knowledge, laziness, domestic helper, lack of motivation and culture. The main themes, which were identified as important in the development of a health promotion program were: The education and encouragement of girl children; education of women in the community, finding facilities and appropriate venues, a suitable environment and the contribution of physical activity program towards unity and reconciliation was emphasised. The findings of this study demonstrate a problem concerning sedentary lifestyle among the working women in Kigali/Rwanda. It is alarming that the participants who are already classified as sedentary and who will probably experience the consequences of sedentary lifestyle in the future are already reporting chronic diseases like high blood pressure and diabetes. There is therefore an urgent need to design, implement and evaluate a health promotion intervention aimed at promoting a physically active lifestyle in Rwanda.

Background. Swaziland adopted the World Health Organization’s (WHO) guidelines for the inpatient treatment of severely malnourished children in 2007 to reduce case -fatality rates for childhood malnutrition. However, no follow-up studies have been conducted to determine the reduction in the case -fatality rate post-implementation of the guidelines. Objectives. To determine the case -fatality rate for childhood malnutrition post-implementation of the WHO treatment guidelines and determine the level of adherence to the guidelines at Mbabane Government Hospital. Methods. A retrospective observational study was undertaken. All children under 5 years admitted for inpatient treatment of malnutrition between January 2010 and December 2011 had their demographic-, anthropometric- and clinical characteristics recorded and analysed, as well as the outcome of admission. Results. Of the 227 children admitted during the study period, 179 (64.6%) were severely malnourished and 98 (35.4%) had moderate malnutrition. One-hundred-and-eleven children died during admission, an overall case -fatality rate of 40.1%. Mortality was significantly higher among severely malnourished children compared to those with moderate malnutrition, (46.9% vs 27.6%, OR 3.0 (95% CI 1.7 to 5.3)). Comorbid pneumonia and gastroenteritis were significant predictors of mortality – , OR 2.0 (95% CI 1.2 to 3.4) and 1.9 (95% CI 1.1 to 3.2) respectively. Conclusion. Case -fatality rates for childhood malnutrition remain high, despite adoption of the WHO treatment guidelines. A need exists for improved adherence to the WHO guidelines and periodic clinical audits to reduce deaths from childhood malnutrition to meet the WHO mortality target of less than 5% and improve child survival. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Clinical Epidemiology / unrestricted

Magister Pharmaceuticae - MPharm / The World Health Organisation (WHO) has stated that “there is no health without a workforce” (Campbell et al., 2013). The health workforce is essential for every health care system. The availability, accessibility and quality of health care workers play an important role in improving and overcoming health system challenges, in particular the call to universal health coverage (UHC) as stipulated in sustainable development goal 3. It has been observed that there is limited collaboration between healthcare systems and academic institutions. According to an article by Frenk et al., 2010, this limited collaboration has resulted in a mismatch between health care graduates’ competencies (such as inter-professional collaboration) and the needs of the population that they serve. One of the problems of health education institutions is the emphasis on curriculum content and learning methods as opposed to social purpose and moral obligations. / 2021-08-30

>Magister Scientiae - MSc / Background: Despite the effort of scientific research on HIV therapies and to reduce the rate of HIV infection, AIDS still remains one of the major causes of death in the world and mostly in Sub-Saharan Africa. To date, neither a cure, nor an HIV vaccine had been found and the disease can only be managed by using High Active Antiretroviral Therapy (HAART) if detected early. The need for an effective early diagnostic and non-toxic therapeutic treatment has brought about the necessity for the discovery of additional HIV diagnostic methods and treatment regimens to lower mortality rates. Antimicrobial Peptides (AMPs) are components of the first line of defence of prokaryotes and eukaryotes and have been proven to be promising therapeutic agents against HIV. Methods: With the utility of computational biology, this work proposes the use of profile search methods combined with structural modelling to identify putative AMPs with diagnostic and anti-HIV activity. Firstly, experimentally validated anti-HIV AMPs were retrieved from various publicly available AMP databases, APD, CAMP, Bactibase and UniprotKB and classified according to super-families. Hidden Markov Model (HMMER) and Gap Local Alignment of Motifs (GLAM2) profiles were built for each super-family of anti- HIV AMPs. Putative anti-HIV AMPs were identified after scanning genome sequence databases using the trained models, retrieved AMPs and ranked based on their E-values. The 3-D structures of the 10 peptides that were ranked highest were predicted using 1-TASSER. These peptides were docked against various HIV proteins using PatchDock and putative AMPs showing highest affinity and having the correct orientation to the HIV -1 proteins gp 120 and p24 were selected for future work so as to establish their function in HIV therapy and diagnosis. Results: The results of the in silica analysis showed that the constructed models using the HMMER algorithm had better performances compare to that of the models built by the GLAM2 algorithm. Furthermore, the former tool has better statistical and probability explanation compared to the latter tool. Thus only the HMMER scanning results were considered for further study. Out of 1059 species scanned by the HMMER models, 30 putative anti-HIV AMPs were identified from genome scans with the family specific profile models after elimination of duplicate peptides. Docking analysis of putative AMPs against HIV proteins showed that from the 10 best performing anti-HIV AMPs with the highest Escores, molecules 1,3, 8 and 10 firmly binds the gp120 binding pocket at the VIN2 domain and at the point of interaction between gp120 and T cells, with the 1st and 3rd highest scoring anti-HIV AMPs having the highest binding affinities. However, all 10 putative anti-HIV AMPs bind to the N-terminal domain of p24 with large surface interaction, rather than the C-terminal. Conclusion: The in silica approach has made it possible to construct computational models having high performances, and which enabled the identification of putative anti-HIV peptides from genome sequence scans. The in silica validation of these putative peptides through docking studies has shown that some of these AMPs may be involved in HIV/AIDS therapeutics and diagnostics. The molecular validation of these findings will be the way forward for the development of an early diagnostic tool and as a consequence initiate early treatment. This will prevent the invasion of the immune system by blocking the VIN2 domain and thus designing of a successful vaccine with broad neutralizing activity against this domain.

No / The current systems of care for dying persons, the people caring for them, and the bereaved operate in ways that frequently lack sufficient sensitivity to their needs. We describe a new model for dying, death, and loss that adopts a public health approach. Specifically, we describe a deliberative process that resulted in a charter for a public health approach to dying, death, and loss. Modeled after the World Health Organization's 1986 Ottawa Charter, our charter includes a call to action. It has the potential to bring about significant change on local, societal, and global levels as exemplified by four projects from three countries. Public health and end-of-life services and organizations need to form partnerships with the community to develop a public health approach to dying, death, and loss. Learning from each other, they will affirm and enhance community beliefs and practices that make death part of life.