Tuberculosis (TB) has re-emerged as a major worldwide public health hazard with increasing incidence among adults and children. Although cases among children represent a small percentage of all TB cases, they are a reservoir from which many adult cases will arise. Estimates indicate that 9 million people develop TB annually, out of which 1 million (11 percent) occur in children less than 15 years old. Childhood tuberculosis is on the increase worldwide because of persisting inability to conform the diagnosis, leading to a large number of children dying of undiagnosed tuberculosis. Diagnosis of pulmonary tuberculosis has depended on bacteriological examination of sputum. In most of the developing countries sputum smear microscopy has been used as it has been found to be cheap and relative efficient. As a result of the high TB burden, there is an urgent need for improved methods of laboratory diagnosis of TB. This is especially needed in children were diagnosis is more challenging as mycobacteria is being detected in fewer than 50 percent of the cases. Children cannot produce adequate sputum samples for examination. Their sputum samples, if produced, has a low bacterial yield and making detection of mycobacteria by using the smear microscopy difficult. Therefore, gastric lavages from children are being recommended as the best specimen for culture. In this study, gastric lavages from 408 children suspected of having tuberculosis were examined for the recovery of mycobacteria. Recovery was optimized by the use of the relatively new non-radiometric fully automated BACTEC MGIT 960. BACTEC MGIT 960 produced a positivity rate of 27.2 percent against 17.2 percent that of Lowenstein-Jensen (L-J) media, which is a conventional culture method used widely. The direct microscopy which is the cheapest traditional method used in diagnosis of tuberculosis (TB) yielded a 5.6 percent positive rate. The BACTEC MGIT 960 had also a very high isolate detection rate of 98.2 percent compared to that of L-J media of 61.9 percent, and only 20.4 percent were detected with the direct microscopy. On time taken to detection or mean time to detection (TTD) of v isolates, the BACTEC MGIT 960 technique had a shorter mean time to detection, 12.5 days as compared to 34.3 days shown by the L-J media technique. The study showed that children normally get tuberculosis from adult members of the household. A positive TB case was found in the households of 55.4 percent of the suspects. The study has found that 46.4 percent of the children below the age of 4 years developed the disease, compared to 10.5 percent the older children in the age group 10 to 14 years. The study found that tuberculosis in children is mainly caused by Mycobacterium tuberculosis. Out of the 113 isolates detected, 110 (97.3 percent) were M. tuberculosis. The remaining 2.7 percent were the non-tuberculous M. avium complex and M. kansasii. It was inconclusive whether the 2.7 percent of other species were causing tuberculosis and this need to be studied further.

A matched case-control study was carried out to identify the factors associated with the nutritional status of children in Livingstone district, Zambia. A trained field researcher collected data on demographic, feeding practices and socio-economic factors in matched groups of underweight children and normal weight children from the mothers/caregivers of the children. Interviews, using a structured pre-tested questionnaire, were used to obtain the data. All children aged from six to fifty-nine months admitted at Livingstone General Hospital during the months of October to December, 2003 with a weight for age below &ndash / 2SD from the median of the reference population formed the underweight children (cases). The total was 47 children. The cases were then matched according to sex and age to 47 normal weight children attending the under five clinic at Livingstone General Hospital during the same months, with a weight for age above &ndash / 2SD from the median of the reference population (controls). The final sample was 94 children. Weights were recorded using the same scale in the outpatient&rsquo / s department prior to admission and during the under five clinic session. Interviews then took place in a separate room after the clinic nurse had attended them. A separate visit was then made to the homes of the children on a different day. Odds ratios and 95% confidence intervals were used to measure strengths of associations. Results revealed that the basic causes of underweight were the poor economic state of the country, unfavorable policies and insufficient government support in the areas of health, education, agriculture, housing and employment. Underlying causes were inadequate access to food, inadequate care of children, poor access to health services and unhealthy living environments, while immediate causes were poor food intake and disease. Low educational and literacy levels of the mothers/caregivers, unemployment and lack of sufficient finances to access basic necessities such as food, housing and health contributed to underweight.

A matched case-control study was carried out to identify the factors associated with the nutritional status of children in Livingstone district, Zambia. A trained field researcher collected data on demographic, feeding practices and socio-economic factors in matched groups of underweight children and normal weight children from the mothers/caregivers of the children. Interviews, using a structured pre-tested questionnaire, were used to obtain the data. All children aged from six to fifty-nine months admitted at Livingstone General Hospital during the months of October to December, 2003 with a weight for age below &ndash / 2SD from the median of the reference population formed the underweight children (cases). The total was 47 children. The cases were then matched according to sex and age to 47 normal weight children attending the under five clinic at Livingstone General Hospital during the same months, with a weight for age above &ndash / 2SD from the median of the reference population (controls). The final sample was 94 children. Weights were recorded using the same scale in the outpatient&rsquo / s department prior to admission and during the under five clinic session. Interviews then took place in a separate room after the clinic nurse had attended them. A separate visit was then made to the homes of the children on a different day. Odds ratios and 95% confidence intervals were used to measure strengths of associations. Results revealed that the basic causes of underweight were the poor economic state of the country, unfavorable policies and insufficient government support in the areas of health, education, agriculture, housing and employment. Underlying causes were inadequate access to food, inadequate care of children, poor access to health services and unhealthy living environments, while immediate causes were poor food intake and disease. Low educational and literacy levels of the mothers/caregivers, unemployment and lack of sufficient finances to access basic necessities such as food, housing and health contributed to underweight.

This dissertation is divided into five Chapters. The first chapter provides the background and thereafter justifies the need for this research. It also includes the research questions, the methodology employed in undertaking this research, the literature review, and the limitations of the study. Chapter Two is the theoretical framework of this dissertation. It provides the theories which underpin and explain the interplay between JW guardians’ authority which form the basis of their children’s healthcare decisions on one hand, and children’s RTH on the other hand. Chapter Three examines the legal frameworks for the protection of children’s RTH in the United Kingdom and South Africa and further provides an analysis of the norms and operation of both legal frameworks. This is in order to highlight learning points for possible law reform in Zambia for attaining an effective framework for the protection of children’s RTH. Subsequently, Chapter Four delves into Zambia’s legal framework for the protection of children’s RTH. In view of the comparative study in the preceding Chapter, this Chapter identifies the weaknesses and gaps in Zambia’s children RTH framework by drawing lessons from the foreign laws examined. Subsequently, Chapter Five concludes the study. It summarises the findings and provides the appropriate recommendations for the implementation of effective and adequate children’s RTH framework in Zambia. / Mini Dissertation (LLM)--University of Pretoria, 2021. / Centre for Human Rights / LLM / Unrestricted