Includes bibliographical references. / There is paucity of evidence to guide case-finding strategies in field trials of new tuberculosis vaccines conducted in young children. To investigate case-finding and case detection methods for tuberculosis in tuberculosis field trials conducted in young children.

Includes bibliographical references. / Innate cells such as macrophages, monocytes, myeloid dendritic cells and granulocytes recognise mycobacteria and initiate immune responses such as phagocytosis, cytokine production and expression of maturation markers. The type and magnitude of innate responses to mycobacteria may determine the subsequent adaptive responses generated. Our aims were to determine maturational changes in innate immune responses to mycobacteria over the first 9 months of life, and to assess effects of genetic variations in toll-like receptors on host responses to mycobacteria. This knowledge is important for designing rational strategies for vaccination against tuberculosis.

We tested the hypothesis that a lower frequency and profile of specific T cells induced by BCG vaccination at birth is associated with subsequent risk of developing tuberculosis.

Includes bibliographical references. / BCG is the only vaccine against tuberculosis and has been used for over 90 years. BCG efficacy is variable, especially in countries with high TB prevalence, where over a million deaths due to tuberculosis, are still reported annually. New TB vaccines are under development to either replace or boost the BCG vaccine. However, our understanding of the immune response required for protection against TB disease, remains inadequate. Identification of a protective immune response is only possible in a clinical trial of an efficacious vaccine, allowing comparison of vaccine-induced immune responses in protected and unprotected individuals. In the absence of such a vaccine, as is the case with TB, we can only explore biomarkers of risk of disease. The most commonly measured outcomes of anti-mycobacterial immunity in clinical trials, specific Th1 cells, are typically thought to be protective in TB. However, to date, human mycobacteria-specific Th1 responses have not correlated with risk of TB disease. New approaches are urgently required to identify other factors at play in conferring protection against TB. In this thesis, we explored BCG-specific cytotoxic T cells as candidate correlates of risk of TB disease in BCG-vaccinated infants. We hypothesized that reduced production of cytotoxic molecules by T cells in response to BCG are associated with risk of developing TB disease. We designed a case/control study nested within a large trial of newborn BCG-vaccination.Blood was collected at 10 weeks and infants, were followed up for two years.We compared outcomes in infants ultimately diagnosed with TB (at risk of TB disease) and two groups of healthy infants (not at risk of TB disease), the first group had household contact with TB cases, the second group were randomly selected from the community, which is endemic for TB. Amongst these groups, we designated a training and a test cohort to allow validation of candidate correlates of risk of TB.

Globally and in South Africa, university students’ knowledge of sexual and reproductive health (SRH) is low. This study was conducted in response to the dearth of information about the sexual and reproductive health knowledge of postgraduate students. Research conducted to explore the SRH knowledge of undergraduate students suggests that the level of SRH knowledge among undergraduate students is low. The aim of this study was to determine the SRH knowledge of postgraduate students at University of Cape Town (UCT), in South Africa. A cross sectional survey design was utilized, using an adapted and pretested online questionnaire. All postgraduate students enrolled in the first semester of 2017 (9444) were invited to anonymously complete the online survey. Four hundred and six (406) students completed the online survey, of whom 293 were female and 107 males. The age range of respondents was between 18 years and 57 years, with the median age for both male and female respondents being 24 years. Six survey responses were excluded from the statistical analysis because of incomplete data. Post graduate students from the African continent comprised 90.75% of the respondents. Most respondents were white (51.50%) from both Africa and abroad. The results indicated that respondents knew about sexually transmitted infections, and human immunodeficiency virus (HIV) & acquired immune deficiency syndrome (AIDS). Female respondents were more aware of breast examination, and the role of Papanicolaou smear (Pap smear) in SRH. Almost half of the respondents in this study (49%) stated that they had no need for more information about contraceptives. Lecturers were identified as one of the top five sources of information across faculties, which could suggest that the university environment provides students with important SRH-related information. Most postgraduate students had knowledge of sexual and reproductive health with regards to contraception, Pap smear, clinical breast examination, STIs, HIV and AIDS. Further research should focus on the relationship between SRH knowledge and usage among this population. As university lecturers were identified as an important source of information across faculties, the University should consider the incorporation of SRH education in the broader curriculum and as an integral component of student health services.

Includes bibliographical references (leaves 106-112). / Measures of the severity of metabolic acidosis (base excess) and of the severity of the underlying acid-base derangements (levels of lactate, chloride, albumin, and strong ion gap) have been used to differentiate survivors from nonsurvivors in various types of adult critical illness, including states of severe hamodynamic compromise following cardiac surgery on cardiopulmonary bypass (CPB) and in septic shock. prognostic studies of acid-base data for critically ill children in the settings of post-operative cardiogenci shock and septic shock are relatively scarce. It has been suggested that hyperchloraemia migh be a benign phenomenon that should not prompt escalation of therapy. Although it is recognised that hypoalbuminaemia is associated with adverse outcome, and obscrues the extent of underlying metabolic acidosis, the significance of 'unmeasured' anions estimated from the strong ion gap remains controversial. It has been suggested that the admission lactate level is strongly predictive of paediatric intensive care unit (PICU) outcome in both shock states, but it is not known whether calculation of the lactate: pyruvate ratio would add prognostic value in children with either post-operative cardiogenic, or septic shock.

Collecting and aggregating timely and rigorous data for sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) services and outcomes evaluation in humanitarian settings is essential for accountability and transparency. However, reliable SRMCNAH data are scarce in such settings, and the quality of available data often varies across different humanitarian settings. Establishing a core set of SRMNCAH indicators that are feasible to collect in all humanitarian settings is the first step in developing and implementing a common core framework for monitoring SRMNCAH programs in such settings. Led by the World Health Organization, in 2018 a group of global experts in the SRMNCAH field proposed a core list of indicators for inclusion in routine data collection systems. In 2019-2022, a team at the University of Ottawa in partnership with local investigators led multi-method feasibility assessments in Afghanistan, Bangladesh, the Democratic Republic of Congo, and Jordan to understand the feasibility, relevance, and acceptability of the proposed core indictors. In this thesis I report on the results from the multi-methods assessment in Afghanistan. Based on a desk review, key informant interviews, facility assessments, facility observation sessions, and focus group discussions in three provinces, we explored national stakeholders’ perspectives on SRMNCAH data collection, in general, and the proposed indicator list, in particular. The findings of this assessment and the results from the other three countries will help stakeholders reach a consensus on the final list of SRMNCAH indicators that are feasible for collection in all humanitarian settings.

BACKGROUND School‐based interventions hold promise for child obesity prevention. Implemented as a part of the Winning With Wellness obesity prevention project, the “Go Slow Whoa” meal pattern (GSW) was designed to promote healthier foods in school cafeterias. This investigation determined perceived program effectiveness and impact on student's food purchases. METHODS A mixed method design was used, including focus groups with cafeteria staff (CS), quantitative analysis of CS and teacher surveys, and pre‐post analysis of cafeteria sales. A total of 37 CS and 131 teachers from 7 schools in northeast Tennessee participated. RESULTS CS recognized the important role of school nutrition services in influencing student choices, yet perceived lack of administrative support for cafeteria‐based interventions and minimal interaction with teachers were barriers. CS also believed that students choose less nutritious options due to family influence. Cafeteria sales indicated that changes were made in menu planning and production, yet students' choices improved minimally. Teachers expressed moderate levels of confidence in GSW as influential in children's dietary habits. CONCLUSIONS Successful implementation of school‐based nutrition programs requires supportive policies, administrators, and teachers. CS should be included in program implementation efforts and the role of school nutrition services should be maximized.