Includes bibliographical references (leaves 75-85). / The aim of this study was to determine how Swazi mothers initially respond when their children develop diarrhoea and the factors that could influence their response.

Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a progressive form of inherited heart muscle disease characterized by ventricular arrhythmias and sudden cardiac death. Often the pathogenesis is linked to deleterious mutations in the desmosomal gene plakophilin-2 (PKP2). We extended investigations of the pathogenic PKP2 c.1162C>T founder mutation which had previously been reported to occur within four 'unrelated' probands (6.2%) who selfidentified as Afrikaners and who also carried a common haplotype. Common evolutionary history suggests common haplotypes are linked to a common founder and today the Afrikaner populations are a unique ethnic group in South Africa identified with various founder effects for a range of heritable disorders. Aim: This study aimed to identify the common founder using genealogical and molecular methods for the PKP2 c.1162C>T mutation in ARVC families of Afrikaner descent in South Africa. Methods and results: DNA was collected from 46 participants (7 probands and 39 relatives) from the ARVC Registry of South Africa. Probands and relatives were screened for the PKP2 c.1162C>T mutation using High Resolution Melt and Sanger sequencing. The genetic results indicated that 65.2% (30/46) of the family members harbored this mutation. High Resolution Melt, Sanger sequencing and microsatellite typing were used to create a haplotype which encompassed the c.1162C>T mutation and three microsatellite markers (M1, D12S1692 and M2) spanning the PKP2 gene. A common haplotype emerged that segregated amongst all of the affected members of the seven Afrikaner families. Genealogical tracing went back, through multiple generations, into the implicated ancestral lines of the present day Afrikaner families. Four of the seven families attained their 17th century progenitors. Through genealogical analyses of the two largest families, ACM 19 and ACM 38, we identified 116 couples which we reduced to ten candidate South African founder couples who were then subjected to further analyses. After the ACM 12 family was added to the analysis there were five candidate founder couples. Unfortunately, the ACM 71 family did not progress past the 20th century due to tracing difficulties associated with poor record keeping of mixed ancestry data in South Africa and hence, could not be linked back to any other family tree without finding ACM71.5's grandparents. Additionally, ACM 8 and 57 families were recent finds and completion of their genealogical tracing still has to done. Conclusions: Our genetic data showed that not only were 30/46 individuals positive for the PKP2 c.1162C>T mutation but that all 30 individuals also shared the same common haplotype. Our preliminary genealogy tracing data suggests that the PKP2 c.1162C>T mutation segregates at a higher frequency in the Afrikaner population possibly due to a founder effect. The genealogical evidence supports the hypothesis that the PKP2 c.1162C>T mutation is a founder mutation and that descendants of the common founders are at risk of developing ARVC. At least three more families need to be recruited to make a clear conclusion and achieve genealogical evidence based saturation, ideally, a common founder.

Includes bibliographical references (leaves 54-59). / Central nervous system involvement contributes significantly to the morbidity and mortality of paediatric HIV infection. The spectrum of CNS morbidity varies from minor developmental disabilities to severe, progressive encephalopathy. Therefore regular developmental evaluation should be regarded as an essential component of the overall care of HIV-infected children. Antiretroviral therapy may arrest or even reverse neurocognitive and motor deficits associated with HIV infection.

This study was undertaken to assess HIV-prevalence, uptake of HIV-care, general clinical characteristics and risk factors among a population visiting a mental health clinic in a rural Malawian district hospital.

Includes bibliographical references. / TB was declared a priority disease in South Africa ten years ago. Despite efforts to manage this illness, South Africa ranks as one of 22 high burden countries globally. TB is an important cause of childhood morbidity and mortality, but much of the emphasis of the NTP is on smear positive (adult) TB, as this is perceived to be the greater public health problem. The presence of HIV infection exacerbates both the incidence of TB, and the progress of TB from infection to the development of disease in both children and adults. The diagnosis of childhood TB has proved to be difficult and continues to challenge clinicians, despite technological advances in various spheres of medicine. Several guidelines and recommendations are available for diagnosing TB in children, including combinations of clinical criteria, special investigations, laboratory methods and score systems, but no gold standard exists.It is not clear how well the SANTCP guidelines for diagnosis of childhood TB are being implemented at Emmaus Hospital, or whether these guidelines are still appropriate within the context of high HIV prevalence. Not enough is known about the epidemiology of childhood TB in the Okhahlamba local municipal area surrounding Emmaus hospital to guide optimal management of children. Given the likely magnitude of the problem of childhood TB in this rural area and the difficulties of diagnosis, research into the epidemiology and diagnosis of childhood TB in this context is necessary.

Bibliography: leaves 112-123. / Cervical cancer is integrally associated with the problems of poverty in the developing world. It is the most common cancer cause of death among women in these regions. In South Africa, the lifetime risk for black African women developing this cancer is 1 in 26. Rates for white women are 1 in 80. Cervical cancer is largely preventable by screening for its precursor stages. However, cervical cancer screening in low-resource settings has only rarely been initiated and sustained. There are many barriers to the establishment of mass, organised screening programmes. This study focuses on one aspect of the screening process: the clients' receiving of their screening results. For the most part, health providers in resource-poor settings rely on the clients themselves to return to the health service to receive their results and consequent arrangements for further care. Understanding those factors that impact upon clients' returning is therefore crucial to the success of the screening. The Khayelitsha Cervical Cancer Screening Project (KCCSP) was established in 1996 to evaluate alternative screening tests to cytology. In addition, the Project has evaluated alternative screening algorithms to the traditional approach of cytology, colposcopy, biopsy and treatment, specifically, a "screen and treat" approach. This approach is expected to overcome some of the many barriers to women participating in screening programmes. This study aims to investigate the phenomenon of the high spontaneous return rate in the setting of the KCCSP. Motivating and deterring factors are sought, both logistical and psychological, in the clients' personal contexts, as well as those related to their experiences of the Project. Exploratory study in the interpretive research paradigm located in a peri-urban informal settlement outside Cape Town, South Africa. Volunteer sample of women enrolled in the KCCSP returning for their first set of screening results. Four focus groups were conducted in Xhosa, facilitated by a Xhosa-speaking social worker from Khayelitsha who has experience in focus group work. Discussion guidelines were followed. The discussions were tape recorded and later transcribed before being translated into English by the facilitator. Analysis of the data draws on elements of both the grounded theory and the systems theory paradigms. The findings reveal that, for the most part, women present to the KCCSP in order to have general gynaecological problems addressed. Returning for results represents an extension of this need. Obstacles to returning include problems with access to the clinic, the need to care for dependents at home and the competing priorities of housework and generating income. Factors that promote the returning for results are the imperative to understand the cause of, and have treatment for pre-existing gynaecological symptoms which cause high levels of anxiety. Related to this, women are motivated to have confirmed or refuted the diagnosis of a fatal disease, including cancer and HIV. Certain qualities and design features of the KCCSP facilitate women returning fOr their results. These include the perceived superior quality of interpersonal communication between Project staff and clients and the efficient manner in which results are made available to clients. Other promotive or obstructive factors that playa role in cervical screening service utilisation include; client attitudes towards traditional healers, a prevalent fear of hysterectomy, concern about privacy and gossip and a suspicious attitude toward caring health workers. Women enrolled in the KCCSP have a personal health agenda with a different focus to that of the Project. Chronic gynaecological problems are frequently experienced and give rise to levels of anxiety about their being signs of serious pathology. Women have not had these fears or the symptoms adequately addressed at other health services. The need to have these issues properly managed represents a large enough motivating force to overcome many of the practical and psychological obstacles to utilisation of the KCCSP. The Project represents for women a general women's health service.

Includes abstract. / Includes bibliographical references. / Child abuse in different forms, ranging from domestic violence against children to sexual abuse, is a worldwide phenomenon with a dramatic influence on the future of the abused child. In African countries, the number of reported cases is rising which may be a result of increased awareness amongst medical staff and parents. In sub-Saharan Africa, outside South Africa, there has been limited research on child abuse, in particular on child sexual abuse, and little is known about the extent of health services offered to the victims.

AIM: This thesis examines the adherence to therapy as part of a clinical trial to determine the effectiveness of fully intermittent therapy for childhood tuberculosis. OBJECTIVES: These were to determine 1) the effectiveness of fully twice weekly therapy in childhood pulmonary tuberculosis, 2) whether adherence rates would be affected by twice weekly dosing and 3) whether certain socio-demographic factors influenced adherence.

Introduction Autism spectrum disorder (ASD) is an important global health problem. It has been shown that early diagnosis and intervention can improve the outcomes in affected children. Lack of knowledge about ASD among health care practitioners can delay the identification of children with ASD as well as early intervention. Currently, a dearth of epidemiological information exists regarding ASD in Africa. The aim of this study was to assess the knowledge of general practitioners (GPs) in Libya regarding ASD and to identify perceived challenges by GPs to early diagnosis and intervention of children with ASD in Libya. The study included the working GPs in the city of Tripoli. Methodology This cross-sectional descriptive study was conducted between 1st June 2017 to 31st August 2017 and utilized an electronic platform, the Research Electronic Data Capture (REDCap) from the University of Cape Town to collect study information. The Knowledge about Childhood Autism among Healthcare Workers (KCAHW) is validated questionnaire that explores health care worker knowledge about ASD across four domains. The KCAHW was used in combination with a more detailed questionnaire which explored challenges to early identification and interventions by GP’s in Libya. Descriptive statistics are reported in percentages and the Wilcoxon rank sum test was used to explore relationships between domain knowledge scores with age and gender as well as years of experience as a GP. Results The number of surveys returned to the REDCap application survey site was 215 which represent a response rate of 58.1%. However, the number of complete responses which could be included in data analysis was found to be only 62, indicating an overall response rate of 16.7%. The median age of the participants was 30 years old, IQR (29-33) years with a female predominance amongst participants (n= 55, 89%). The total median score from the knowledge questionnaire was 10, IQR (8- 12). No statistical differences could be found between domain knowledge scores and participants' age, gender and work practice. Participants showed good knowledge about stereotypical movements and repetitive behaviours in ASD, but 48% were not aware of comorbidities associated with ASD. The main challenges identified by GPs in the management of ASD were lack of awareness, insufficient experience, and health infrastructure in Libya as well as social stigma associated with developmental disorders. Conclusion and recommendations GPs in Libya have limited knowledge about certain aspects of ASD. A number of challenges were identified by GPs which hamper the early identification and management of ASD in Libya. There is a need to improve undergraduate medical training about ASD as well as to offer ongoing medical education to GP’s to improve recognition and management of ASD in Libya. Further research is indicated to explore the epidemiology, clinical spectrum and severity of ASD as well as intervention in Libya

OBJECTIVE: To assess the knowledge of Doctors and Clinical Nurse Practitioners (CNPs) with regard to the case management of ARI in children under the age of 5 years in the Khayelitsha District of Western Cape Province. METHODS: The study was a descriptive survey of all the doctors and CNPs in Khayelitsha district. A questionnaire with closed and open-ended questions was self-administered. The international WHO case management guidelines were used as the gold standard except where the Paediatric Handbook was used as the reference with respect to questions on tuberculosis, bronchiolitis and croup. A comparative analysis was carried out on the knowledge scores of the doctors in the public sector, the private General Practitioners (GPs) and the CNPs. Correlation between years of experience and scores were measured. A further comparison was performed between doctors with and those without a post-graduate qualification in Paediatrics. The association of the use of WHO/ARI/90.5 manual and the Red books (University of Cape Town Paediatric handbooks) with the knowledge scores was also evaluated. RESULTS: 34 Doctors and 34 CNPs participated in the study. All the questionnaires administered were returned - 100% response rate. The median percentage scores of the doctors and the CNPs were 68.5 % and 63.0% respectively, p = 0.007. Twenty six percent of CNPs scored less than 50%. The median scores of the doctors with and of those without a post-graduate qualification in Paediatrics were 78.5% and 67.0% respectively, p = 0.005. The median scores of the doctors in the public sector and the private GPs were 71.0% and 65.0% respectively, p = 0.03. The median scores of participants who had seen and made use of the WHO/ARI/90.5 manual and of those who had not were 68.5% and 66.5% respectively, p = 0.13. The median scores of participants who had seen and made use of the University of Cape Town Paediatric handbooks and of those who had not were 67.0% and 64.0%, respectively, p = 0.37. The rank correlation co-efficients of doctors' and CNPs' scores with years of experience were 0.26 (p = 0.13) and -0.01 (p = 0.94) respectively. CONCLUSIONS AND RECOMMENDATIONS: (i) There was a wide range in knowledge scores, with approximately one quater of CNPs scoring less than 50%. Training in management of ARI is therefore necessary. (ii) The poor correlation between years of experience and knowledge indicates that experience is not by itself associated with improvement in knowledge, and supports the need for a service - oriented training programme. (iii) The impact of the recommended training programmes should be evaluated using this study as a baseline for comparison. (iv) There is a need for similar Knowledge, Attitude and Practice (KAP) studies on ARI in other areas to inform local trainers and to enable prioritisation of training.