The US Bureau of the Census (1999) projected that by 2004, 14 million people in sub-Saharan Africa will develop full blown AIDS, making this region by far the largest disease burden in the world (World Health Organization, 2002). The United Nations AIDS Programme judged South Africa to have the leading number of people living with HIV/AIDS worldwide (World Health Organisation, 2002). To date there has been extensive research conducted on the socio-economic impacts of HIV/AIDS on families in Africa. However an area of investigation that has remained largely underreported is the inquiry into the psychological impacts of HIV/AIDS on elderly caregivers. In African families older women increasingly have to provide care to their adult children with AIDS and their orphaned grandchildren. However few research studies have assessed the experience of parental caregiving and its psychological impacts on these women. This qualitative research study hypothesised that the role of primary parental caregiver in fact causes a range of psychologically distressing states, which serve to compromise the psychological well-being of these caregivers. To investigate this hypothesis three Xhosa speaking women living in informal settlements in Grahamstown, in the Eastern Cape Province of South Africa were selected for the study. The women were interviewed by means of semi-structured interviews, which consisted of questions related to their caregiving experiences, their experiences of loss, their choice of coping strategies, the role of support networks and their experiences of foster care responsibilities. The interviews were transcribed and analysed using a grounded hermeneutic approach. The research results confirmed the working hypothesis. The research revealed that although it was considered culturally appropriate for older women to care for their children and grandchildren, their caregiver roles caused significant psychological distress. Their distress was related to: emotional and physical exhaustion, complicated grief reactions and ongoing emotional and physical upheaval related to foster care responsibilities. Based on the results, the research recommendations emphasised the need for continual awareness of the psychological implications of caregiving for older African women with the aim to preserve their capacity to function as the primary caring resource to families struck by HIV/AIDS.

There are many inequities that exist in health-care that stem from culture related communication misunderstandings. In most cases where doctors and patients from different cultural and linguistic background interact, doctors use medical language which is different from everyday language used by patients. Patients enter this communication context with anxiety because they depend on the physicians to give them accurate information concerning their health, but they do not always understand all the terms used by physicians to inform them about their conditions. In some cases interpreters are used but their expertise is often inadequate and the interpreting of the patient’s statements to the health staff is also prone to distortion by interpreter / doctor because of the lack of proper understanding of the messages / languages. This may result in a deterioration of the patient’s health condition and unavoidable complications.

South Africa's HIV prevalence rate is estimated to be 5.7 million and at the end of2007 a total of 45845 HIV/AIDS adult patients were taking antiretroviral therapy (ART). The global incidence of HIV/AIDS has been slowly decreasing over the years but is still widespread. This disease is still more prevalent in sub-Saharan Africa than in other parts of the world, with more than 60% people living with HIV/AIDS. Highly active antiretroviral therapy (HAART), the treatment of choice, slows the progression of the human immunovirus but demands a high adherence rate in excess of 95%. Patients who are poorly informed about antiretrovirals (ARVs) and misunderstand medicine-taking instructions or experience unexpected side effects may interrupt therapy, predisposing them to the development of resistance. Such patients need information but, given the poor literacy skills prevalent in South Africa, written information is often not fully comprehended and is often written at too high a reading level. The objectives of this research project were to design, modify and evaluate HIV / AIDS patient education materials for low-literate isiXhosa speaking adults residing in Grahamstown and to examine their impact on the understanding of various aspects of the disease and its treatment. Pictograms illustrating common side effects of ARVs (e.g. stavudine, efavirenz, lamivudine), as well as various sources 'for purchasing nonprescription medicines, storage and medicine-taking instructions were designed and evaluated both qualitatively, using group discussions, and quantitatively through individual interviews where interpretation of the pictograms was assessed. These pictograms were incorporated in a patient information leaflet (PIL) which had been specifically designed for people with limited reading skills and was a simple document containing the minimum of essential text. A previously developed PIL was modified in collaboration with the target population and two versions were produced, one incorporating pictograms illustrating side effects, the other with none. Pictograms were used in both to illustrate other medicine-taking instructions. The PILs were tested objectively to assess the readability, format, content, and general design. They were translated into isiXhosa prior to being qualitatively and quantitatively evaluated in a low-literate isiXhosa speaking population. Understanding of the PILs was assessed by asking a series of questions about the PIL content. Participant opinion of the readability and appearance of the PIL was recorded. The relationship between PIL understanding and selected demographic variables was investigated. Findings from this study illustrated that well designed pictograms assist in the location of information in written leaflets and they may enhance understanding of the information. It was further demonstrated that education influences total understanding of PIL content thus emphasizing the need for tailor-written information in accordance with the education level of the target population. A desire to receive PILs incorporating pictograms was expressed by the majority of participants. Collaboration with the intended target population is essential to design culturally acceptable, easily interpreted pictograms and to produce user-friendly, easy-to-read, comprehensible patient education materials. The rigorous, iterative design, modification and testing process described in this study is one that should be adopted in producing all health-related education materials.

Text in English / Cervical cancer remains the leading cause of cancer mortality among women worldwide, a burden in the developing countries and commonly detected through symptoms at later invasive stages. The study aimed at establishing knowledge and awareness of the importance of cervical cancer screening in the Makhuduthamaga Sub-district by exploring the perceptions of women and professional nurses and through the review of the National Cervical Cancer Screening Policy (2013). Recommendations to address the gap in knowledge and to inform the National Cervical Cancer Screening Policy were developed based on the study findings. A mixed-method approach was used in this study through a sequential explanatory design, which is quantitatively driven was used. Quantitative data were obtained by using a researcher developed checklist. The checklist was developed from variables stated in the National Cervical Cancer Screening Policy and was used to review its implementation. Qualitative data was obtained through in-depth interviews with individual women and focus group discussions with professional nurses. The study was conducted in ten randomly selected clinics of Makhuduthamaga Sub-district. Purposive sampling was done to obtain qualitative data. An average score of 9.7 was obtained for all ten clinics that participated in the study with regard to the evaluation of the implementation of the National Cervical Cancer Screening Policy. Only 6 (60%) clinics implemented the policy whereas 4 (40%) clinics did not implement the policy. Women and professional nurses perceived cervical cancer screening as important. Lack of knowledge among women regarding cervical cancer screening contributed to the majority of women not screening for cervical cancer. Lack of resources, the 10 year interval of normal cervical cancer screening, the use of disposable vaginal speculums and brushes, lack of standardized cervical cancer screening training, centralization of cytology laboratories came out as factors that negatively influence the uptake of cervical cancer screening. Cervical cancer screening awareness campaigns, availability of resources and standardized in-service trainings on cervical cancer screening were recommended to enhance the cervical cancer screening uptake. Key concepts: / Health Studies / D. Litt. et Phil. (Health Studies)

An increase in diarrhoea and upper respiratory tract infection has been noted for the past five years and this is associated with the prevalence of Human Immune-deficiency Virus and Acquired Immune Deficiency Syndrome. HIV infection is an increasingly common cause of childhood morbidity and mortality in South Africa. In some areas of the country, like the Eastern Cape, more than 30 percent of the women attending antenatal clinics are HIV infected. Without intervention, approximately one third of the babies born to these HIV infected mothers will get infection from their mothers (WHO, 2003). Aim and Objectives of the study: The study was meant to assess the specific knowledge and skills of professional nurses at the primary health facilities regarding management and integration of childhood illnesses, evaluate the quality of training of professional nurses on aspects of IMCI including integration of HIV within IMCI programme for children under five years in Primary Health Care facilities in Mdantsane Township. Methods: A quantitative descriptive method was used for this study. The questionnaire developed by the researcher was used for data collection. The items on the questionnaire were divided into four (4) subsections. The questionnaire was administered to all professional nurses on duty and those available at the time of data collection. A checklist for IMCI was used to collect data from Road to Health files of children who were HIV positive admitted in the pediatric ward at Cecilia Makhiwane Hospital. Results: The results of this study for all the variables examined showed that the highest score was 56 percent and the lowest was18 percent.These results indicated that the knowledge and skills of professional nurses were inadequate.

Infant feeding in the context of HIV/AIDS poses a challenge among mothers. The implementation of UNICEF guidelines on infant feeding, which state that “when replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended” (WHO, 2003:12) are not easy to meet. In more developed countries, where these criteria are met, almost all HIV-infected mothers have ceased to breast feed. Consequently, infants of mothers in these countries are less likely to be infected with HIV postnatally. In South Africa, more specifically in the Eastern Cape, infant feeding is a challenge as a number of UNICEF criteria cannot be met. The Eastern Cape is one of the poorest Provinces in South Africa, with a number of rural communities. Earlier studies have shown that, if mothers select either exclusive breast feeding or exclusive formula feeding, this reduces mother-to-child transmission of HIV. A limited number of studies on adherence to the method of infant feeding selected before delivery were found in the literature, hence the need for the current study. The purpose of the study was to explore adherence to exclusive breast feeding and exclusive formula feeding among mothers with HIV infection and to determine the problems that mothers may be facing in implementing their pre-selected methods.

This qualitative study explored traditional healers’ perceptions on collaborating with bio medical professionals. Purposive sampling was used to select study participants, and individual in-depth interviews were used to collect data. Thematic data analysis was conducted. The main findings of the study were that healers are very popular and highly respected amongst African communities. Traditional healers experienced mistrust and disrespect by biomedical health professionals who demonstrated ignorance on traditional medicine. Lack of motivation, incentives and financial support to conduct collaboration activities was another key finding including lack of clear policies and management structures for collaboration. Due to concern for their patients, healers resorted to practising covert collaboration such as not using official referral slips. Positively, healers experienced transformation in terms of knowledge gained from the training on basic HIV-TB epidemiology. There was clear evidence of high ethical practices amongst healers where they put their patients’ welfare ahead of their business interests / Health Studies / M.A. (Public Health)

Department of Advanced Nursing Science / MCur

PhD (Health) / Department of Public Health / The Government of South Africa in response to a prevalent human immunodeficiency virus (HIV) has adopted an approach of integrating HIV/AIDS service into primary health care, as a key to achieving universal access to antiretroviral treatment (ART). Despite the government’s efforts of integrating HIV service into Primary Health Care (PHC), insufficient numbers of PHC staff and inadequate infrastructure is challenging when integrating HIV/AIDS service into PHC. This study explored the extent of HIV service integration into PHC and whether the clinic/health centre’s environment is enabling to integrate HIV service into PHC. Barriers to HIV/AIDS services integration as well as attitudes of PHC nurses were assessed. The overall purpose of this study was to develop guidelines to facilitate the integration of HIV/AIDS services into PHC in Vhembe district of Limpopo province, South Africa. An exploratory sequential mixed methods design was used. The qualitative data was collected and analysed before and results for qualitative approach used to build a subsequent quantitative phase. The current study revealed that HIV/AIDS services are integrated into every existing programme at the PHC clinic and health centres; these include: Immunisation programme, Family planning, PMTCT and ANC programmes, STIs, minor ailments and chronic illness and TB. The study further revealed that the environments at PHC clinics and health centres are not enabling the integration of HIV/AIDS services into PHC due to insufficient staff and inadequate infrastructure. Guidelines to facilitate the integration of HIV/AIDS services based on the findings was developed. The study recommendations comprise; increasing knowledge of HIV serostatus, accelerating HIV prevention, accelerating the scale-up of HIV treatment and care, creating of enabling environment for the integration of HIV/AIDS services into PHC, nursing education and training and nursing education and training.

MCur / Department of Advanced Nursing Sciences / See the attached abstract below