Submitted in fulfillment of the requirements of the degree of Master of Applied Science in Food and Nutrition, Durban University of Technology, Durban, South Africa, 2016. / Rational and Objectives The objective of this study was to determine socio-demographic, socio-economic, health status, dietary diversity, nutrition adequacy, food consumption patterns, coping strategies, and agricultural practices in relation to food insecurity and nutritional status of elderly population in Mpharane. Methodology The sample size was n=260 participants with 75 men and 185 women. A variety of variables were used to measure the objectives and different types of questionnaires were used as measuring instruments for all the variables of the study. Socio-demographic questionnaires determined household indicators like age, employment status, and number of dependents, living conditions and assets. Anthropometrics measurements that were conducted included height, weight and blood pressure. Health status questionnaires included indictors such as consumption of alcohol, smoking, food allergies and affected parts of the body. Food frequency score, dietary intake and nutrition adequacy were established. Coping strategies in the household were determined for the period of food insecurity. Agricultural practices questionnaires were to determined household indictors like land, types of crops and livestock. The completed Socio-demographic Questionnaires, Health Questionnaires, Food Frequency Questionnaires, Anthropometric Measurements Forms, Coping Strategies Questionnaires and the Agricultural Practices Questionnaire were captured on a Microsoft Excel® Spreadsheet by the researcher and analyzed using the Statistical Package for the Social Sciences (SPSS), version 21.0, with the assistance of a statistician. Results Results indicated that all participants resided with grandchildren. Majority of grandmothers headed the households. All participants were unemployed and 61.20% often had shortage of money to buy food. Nutrient analysis from 24-Hour Food Recall indicated deficient intake in energy, calcium and vitamin A. There were high levels of food insecurity among the participants since all the participants used all 15 coping strategies. The Body Mass Index (BMI) results indicated 65.50% of participants were overweight, 60.70% obese and 13.60% were underweight. Majority of participants had access to land for plantation. All Participants suffered from various health aliments. The history of health associated with diseases indicating that 24.60% (n=64) of the participants had reported skin diseases, 71.20% (n=185) of the participants suffered from diseases of skeleton or joints and 81.90% (n=213) of the participants indicated affected eyes, ears, nose and teeth. Diseases of the chest or respiratory system were experienced by 50.80% (n=132) of the participants. The total fat intake of all the groups was slightly below the recommended goal by the World Health Organization WHO (15-30%), with men obtaining 13.33% and women 12.55% of energy from fat. Carbohydrates contributed 75.12% for men and 75.41% for women of the daily energy needs in the groups, slightly above the levels recommended by the WHO (55-75%). The contribution of protein to total daily energy intake for all the groups was within the recommendation of 10-15%, men (11.56%) and women (12.07%). As a result this proves that the average participant consumed a balanced diet in terms of the macronutrient intake. Carbohydrates were the main source of food consumption. The highest number of individual foods consumed by the majority of the participants was between 6-10 individual foods (53.46%, n=139) followed by 11-15 individual foods (39.23%, n=102). The mean Food Variety Score (FVS) (±SD) for all the foods consumed from the food groups during seven days was 10.06 (±6.726), which indicated a low food variety score. The food group with the most variety was the cereal group. Seven different cereals were consumed by (1.53%, n=4) participants, a large number of the participants (31.15%, n=81) only consumed 3 different cereals within seven day period and (23.46%, n=61) of the participants consumed 4 different cereals. Conclusion The grandparents were the principle providers for the grandchildren and the demographic pressures, unemployment and old age increased the financial strains which contributed to high levels of poverty resulting in food and nutrition insecurity and poor nutritional status of the elderly people. / M

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This study was designed to determine the effectiveness of Filial Therapy as a method of intervention with families with chronically ill children. Filial Therapy is an intervention that focuses on strengthening and enhancing the parent-child relationship. Parents are trained to become the agents of change for their children's behaviors by utilizing basic child-centered play therapy skills in weekly play sessions. The purpose of this study was to a) determine the effectiveness in decreasing parental stress, b) determine the effectiveness in increasing parental acceptance, and c) determine the effectiveness in decreasing problematic behaviors in the chronically ill child as assessed by their parents.

Background: Hemodialysis patients (HDP) often suffer from kidney failure with comorbidities, such as depression, anxiety and stress. Physical activity (PA) has a positive influence on these comorbidities. Objective: The purpose was to determine the current level of PA and identify potential correlates influencing PA in HDP to deduce prevention approaches. Material and methods: Data were collected in 13 dialysis centers in Bavaria. A standardized questionnaire was used to analyze PA (EHIS-PAQ) and influencing factors in 240 HDP. Gender differences were calculated using the t‑test and the Mann-Whitney U‑test (significance level p < 0.05). For correlation analyses with PA, Spearman’s correlation coefficient rs and multivariate logistic regression analysis were used. Results: The results showed that HDP were on average moderately active for 76.31 min per week (standard deviation, SD 124.02 min). Male HDP were less active and showed significantly more depressive symptoms than female HDP (p < 0.05). The HDP who were more active assessed their subjective health condition on a higher level than HDP who were not active. Depression, stress, and age showed a negative association and sport-specific self-efficacy a positive association with PA (p < 0.05). Multivariate logistic regression revealed that sport-specific self-efficacy increased the chance of becoming physically active while depression reduced the chance of achieving 150 min PA. Conclusion: The majority of HDP were barely active. The results reveal the necessity to further promote PA in patients with chronic renal failure. Physicians should be aware of patients’ self-efficacy as well as depressive symptoms and develop concepts that strengthen the self-efficacy and promote the positive effects of PA on health.

Thesis (M. Pharm. (Pharmacology)) -- University of Limpopo, 2021 / Introduction: Zebediela Hospital in Limpopo Province is running an outreach programme as part of its chronic care initiative. In the programme, pharmacy personnel visit the feeder clinics attached to the hospital to dispense chronic medicines to patients. This study aimed at evaluating how this pharmacy chronic care outreach programme is performing, by looking at pharmacy personnel, nursing personnel and patients’ perceptions. Method: A cross-sectional descriptive study was conducted at the six feeder clinics attached to Zebediela Hospital in the Lepelle-Nkumpi municipality of the Capricorn district in Limpopo Province using a quantitative research method. This quantitative research was administered in the form of a survey. Questionnaires were used to collect data from patients, nursing personnel and pharmacy personnel. A total of 399 participants (n=399) took part in the study. The participants included 337 patients from six different clinics, 18 pharmacy personnel and 44 nursing personnel. Data was analysed using the SPSS version 25.0. Results: The pharmacy personnel showed that an allocation of more than three personnel per duty roster sufficed. Regarding transport used by pharmacy personnel when embarking on the Pharmacy Chronic Care Outreach Programme, 71.4% of pharmacy personnel indicated that they always used hospital transport in 83.3% of the cases. The study findings showed that, 71% of patients agreed they were satisfied with the pharmacy times for collecting medicines apart from the fact that 65.6% of patients travelled for more than two hours from their respective homes to their nearest clinic. Sixty eight percent of pharmacy personnel perceived the PCCOP model to be reducing patient waiting time at the clinics. Both the patients and nursing personnel were however not satisfied with the pharmacy personnel’s arrival time at the clinic. The other negative aspect reported was the space problem at the clinics where, 77.8% of pharmacy personnel and 54.5% of nursing personnel reported this as not user-friendly. The patients’ satisfaction levels regarding the PCCOP model for “very satisfied” stood at 64.2% and 0.6% for “very dissatisfied”. Both pharmacy and nursing personnel recommended that the PCCOP model be continued with recommendations towards improving human resources and infrastructure. Conclusion: In conclusion, both pharmacy personnel and nursing personnel showed that the outreach programme was a good initiative in the health system and it benefitted patients. However, the concerns mentioned by patients included long waiting times at the clinic and medicine stock outs. As the results show, the pharmacy chronic care outreach programme should be continued, as long as patients’ complaints can be attended to. Key words: Evaluation, Pharmacy Chronic care Outreach Programme, Zebediela

This dissertation aims to elucidate the relationships between chronic illness, depression, and developmental assets among adolescents with chronic illness and co-morbid depression. Chapter One describes the current state of evidence on the intersections between chronic illness, depression, and adolescent development, and introduces Positive Youth Development theory and the Developmental Assets Framework. Chapter Two describes an integrative review synthesizing findings from 11 cohort studies examining relationships between depression or depressive symptoms and chronic illness-related disease control, self-management behaviors, illness-related morbidity, and quality of life among adolescents. Chapter Three describes a cross-sectional study comparing the number and types of developmental assets between adolescents with differing health statuses and examining relationships between assets and co-morbid depression using data from the 2016 National Survey of Children’s Health. Chapter Four describes a qualitative study exploring ways that developmental assets were discussed by 16 adolescents and young adults who lived with chronic illness and co-morbid depression during adolescence and uploaded videos to YouTube, a public video-sharing platform. Chapter Five summarizes key findings of this dissertation, outlines strengths and limitations, and discusses implications for future research, policy, and practice.

In the United States, homelessness is often connected to traumatic events such as domestic violence, job loss, or post incarceration experiences, frequently resulting in substance use disorders, medical issues, and related mental illnesses. Although researchers have considered how homelessness and social service interventions affect sexual and gender minority youth, they have not adequately studied the causes and effects of homelessness among transgender women. The purpose of this interpretive phenomenological study was to bridge this gap in knowledge by exploring the experiences of chronically homeless transgender women. The research question focused on the lived experiences of chronically homeless transgender women who try to obtain social services from outreach workers. A purposive sample of 8 chronically homeless transgender women from the southeastern United States completed individual face-to-face interviews. Using phenomenological strategies, the narratives were analyzed and interpreted into codes, categories, and themes. Four central themes were identified, including reasons for homelessness, the lived experience of chronic homelessness, experiences related to transgender identity, and involvement with social services. Participants faced barriers with social services agencies and outreach workers, including administrative demand for binary gender classification, blatant ignorance and discrimination, and a lack of trans-positive treatment facilities and shelters. The findings and recommendations from this study may advance positive social change by guiding the efforts of social service agencies and outreach workers to improve the quality of social services for transgender women.

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