Background: Although the prevalence of pneumonia in pregnancy is reported to be less than 1%, the pregnant state and risk factors associated with the development of pneumonia adversely influence the outcome of pregnancy. KwaZulu-Natal is at the epicenter of the dual epidemics of tuberculosis and HIV-1 and the impact of these diseases occurring concurrently in pregnant women at King Edward VIII hospital (KEH), South Africa have been described previously. The impact of antenatal pneumonia in HIV-1 infected and uninfected women however has not been described in the study population and was investigated. Methods: Pregnant women with clinical and radiological evidence of pneumonia were recruited from the antenatal clinic and labour ward at KEH. The study was conducted prospectively between January and December 2000. The clinical profile of these women and the causative organisms were determined. In addition the impact of HIV-1 infection, maternal immunosuppression and maternal pneumonia on obstetric and perinatal outcomes were evaluated. Mothers diagnosed with tuberculosis and multi drug resistant tuberculosis were hospitalised at King George V hospital until delivery. Results: Twenty nine women were diagnosed with antenatal pneumonia (study arm) with Mycobacterium tuberculosis the only causative organism isolated. A control arm of 112 pregnant women was also studied. Maternal and perinatal mortality was restricted to the study arm with a maternal mortality ratio of 99 per 100 000 live births and a perinatal mortality rate of 240 per 1000 births. Pneumonia was significantly associated with a negative overall obstetric outcome in the presence of HIV- l infection, antenatal care, anaemia and second trimester booking status. In addition, the presence of pneumonia was significantly associated with maternal mortality. There was a highly significant association between exposure to pneumonia and poor neonatal outcome. Maternal pneumonia, maternal HIV infection and the presence of medical and obstetric conditions were significantly associated with low birth weight and neonatal pneumonia. Further, maternal pneumonia (p <0.001) and concurrent HIV infection (p=0.002) was significantly associated with neonatal death. Conclusion: The presence of pneumonia in the antenatal period impacts negatively on maternal and neonatal morbidity and mortality. Health care providers must maintain a high degree of suspicion when managing a pregnant woman with unresolving upper respiratory tract symptoms and refer timeously for further investigation. Pneumonia and in particular pulmonary tuberculosis associated with HIV co- infection in pregnancy is a threat to mother and baby. Therefore in areas endemic for TB and HIV infection, it may be prudent to screen HIV positive pregnant women for symptoms suggestive of pneumonia and thereby identify women requiring further investigations such as sputummicroscopy and cultures, and a screening chest radiograph. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2007.

La Fièvre catarrhale ovine (FCO) est une arbovirose émergente en Europe depuis la fin desannées 90. Elle affecte principalement les ruminants par la piqûre de petits moucheronshématophages, les Culicoides (Diptera : Ceratopogonidae). Pendant l’été 2006, l’introductiondu sérotype 8 de la FCO, dans la région de Maastricht (Pays-Bas) a rapidement diffusé dansles Ardennes, générant de lourdes pertes pour les éleveurs de bovins et d’ovins. Cesévènements interrogent sur la capacité des Culicoides de la région paléarctique à transmettrela FCO. Ils révèlent la nécessité de mieux connaître la biologie de ces diptères.Nous avons développé successivement dans ce travail, trois axes de recherche qui se sontappuyés sur un travail de terrain réalisé principalement au sein de deux élevages situés dansles Ardennes françaises.Dans un premier temps, nous avons réalisé une expérimentation de gorgement de Culicoidesde captures et d’émergences, provenant des Ardennes, sur petits ruminants virémiques pour leBTV8. A l’issue des expérimentations, une femelle gorgée de l’espèce Culicoides obsoletus apondu et a été retrouvée faiblement positive lors de la recherche du génome du virus de laFCO. Les résultats obtenus ainsi que les difficultés rencontrées lors de la réalisation de cetype d’expérimentation sont discutés.Le deuxième travail exposé s’est intéressé au comportement trophique des Culicoides parl’étude de l’origine du repas sanguin de femelles de Culicoides piégées dans des biotopesvariés. A cette fin, nous avons utilisé des marqueurs moléculaires pour amplifier l’ADN devertébré présent dans les estomacs de femelles gorgées. Ces analyses ont permis de mettre enévidence que des espèces appartenant aux complexes Obsoletus, Pulicaris, ou encore,Culicoides dewulfi, avaient un spectre d’hôte large. Certaines d’entre elles peuvent se gorger àla fois sur les ruminants domestiques et sur la faune sauvage. De plus, ce type d’étuderenseigne sur l’écologie des différentes espèces de Culicoides.Enfin, nous présentons les résultats d’une étude faunistique fondée sur des captures avec despièges lumineux, mais aussi, des prélèvements de boue pour la recherche des gîtes larvaires.Les résultats de piégeages entre les deux exploitations ont été comparés, notamment en termesde biodiversité, et sont discutés en regard des différences de pratiques d’élevage entre lesdeux exploitations choisies d’une part, et la mise en évidence des gîtes larvaires d’autre part.De nombreuses espèces de Culicoides ont émergé au laboratoire à partir des prélèvements deboues, qui ont été caractérisés macroscopiquement. Les gîtes larvaires de C. obsoletus, peuconnus jusqu’alors, ont été mis en évidence dans les deux fermes. Ils ont fait l’objet d’un suivisur plusieurs mois.L’ensemble de ces études contribue à la meilleure connaissance des Culicoides présents dansles Ardennes et de leur biologie, elles permettent de rendre compte des espèces qui semblenttrès inféodées à l’élevage de bovins, et celles qui sont plus ubiquistes. Certains travauxprésentés pourraient être poursuivis pour mettre en évidence les espèces ou populations deCulicoides plutôt sylvatiques, et pour mettre en place de nouvelles expérimentations sur lacompétence et la capacité vectorielle des Culicoides. / Since the late 90’s, Bluetongue disease (BT) can be considered as an emerging arbovirose inEurope. This disease is mainly transmitted to ruminants by the bites of minute size midges,the Culicoides (Diptera: Ceratopogonidae), also known as biting midges. An outbreak of BTserotype 8 occurred during summer 2006, in the region of Maastricht (Netherlands) andspread quickly to the Ardennes region. The epizooty lead to severe losses in cattle and sheepholdings. These events highlighted the lack of knowledge on the vectorial capacity ofpaleartic Culicoides species, and more generally on their biology.Three approaches are successively treated in this document. They are all based on field workconducted mainly in two holdings located in the Ardennes region.First, an experiment to assess oral susceptibility of Culicoides to Bluetongue virus (BTV) 8was undertaken. Field collected and emerging Culicoides coming from the Ardennes wereengorged on viremic small ruminants. At the end of the experiments, one Culicoides obsoletusfemale was found bloodfed and laid eggs. She was tested for BTV and was found weaklypositive for BTV genome. This result and the difficulties met during the experiment havebeen discussed.The second study focused on the bloodmeal origin of engorged females of Culicoides. Thesewere collected by light traps set in different kinds of environment. Molecular markers wereused in order to amplify the DNA of vertebrates present in the stomach of bloodfed females.Some of the species processed belonging to the Obsoletus or the Pulicaris complex, andCulicoides dewulfi fed on a wide variety of hosts, including domestic ruminants and wildanimals. Moreover, this kind of study brings information on the ecology of different speciesof Culicoides.Finally, a faunistic survey is presented. It was achieved through light trap collections ofmidges and also thanks to the sampling of potential breeding sites. Biodiversity in thecollection of midges captured by light traps between the two holdings were compared.Differences observed are discussed taking into account the differences in breeding practicesbetween the two holdings and the breeding sites investigations. Numerous species ofCulicoides emerged in the laboratory from soil samples which were macroscopicallydescribed. Breeding sites of C. obsoletus, which were not well documentated in the literature,were found in both farms. These were monitored over some months.This work contributes to a better knowledge of the Culicoides present in the Ardennes andtheir biology. It highlights the species which are closely related to the cattle holdingenvironment, and those which are ubiquist. Some of these studies could be continued in orderto highlight the species more related to the forested areas, and to set new experiments onvectorial competence and capacity.

South Africa‘s high prevalence of HIV/AIDS coupled with a high crime rate and incidence of sexual violence necessitated the enquiry and study into the role of criminal law to address the wilful transmission of HIV.1 This study shows that criminal law can be used to punish offenders for wrongdoing and therefore finds application in the wilful transmission of HIV.2 The study distinguishes the dividing line between the justifiable use of criminal law and where use of the criminal law becomes discriminatory in nature and counterproductive to public health measures. The United Nations (hereinafter referred to as the UN) laid down guiding principles for countries to adopt when using the criminal law and stated that countries should use existing criminal law offences to prosecute intentional HIV infections.3 The South African Law Commission (hereinafter referred to as the SALC) endorses this approach. South Africa‘s use of the criminal law, in response to harmful HIV behaviour is in line with the UN recommendations as it uses the existing common law offences to prosecute the wilful transmission of HIV, namely murder, attempted murder and assault. Drawing from the writer‘s comparative study in Chapter Six below, South Africa, members of the Zimbabwean parliament, Canada, as well as the American Bar Association have all concluded that the use of specific HIV-related legislation creates some a form of stigmatization towards people living with HIV and is therefore not warranted. This study shows that criminal law has a role to play in the wilful transmission of HIV; however the creation of HIV specific legislation is not recommended and existing criminal law offences should be used to address harmful HIV related behaviour. Such an approach is in line with the guiding principles laid down by the UN and SALC.

This descriptive study aimed to assess the Infant and Young Child Feeding (IYCF) policy implementation in the Prevention of Mother-to-Child Transmission of HIV (PMTCT) among healthcare workers in the Nelson Mandela Bay Municipality public health care facilities. A convenience sampling method was used to gather information from nurses (n=32) rendering maternal and child health services in nineteen permanent Nelson Mandela Bay public health care facilities (MOU’s, paediatric sections, well baby clinics and PMTCT sites). Recommendations included to the need develop indicators for measuring the IYCF policy objectives and regularly collect data on infant and young child feeding, standardising infant feeding education given by peer educators / lay counsellors from various organisations, capacity building and training of staff on IYCF and scaling up monitoring and evaluation of the IYCF policy impact.

The burden of non-communicable diseases (NCDs) is high in South Africa. Behavioural conducts and lifestyle factors, unhealthy diets and physical inactivity are the major contributors to the development of NCDs among South Africans. Physical activity (PA) is a modifiable risk factor that is also low in cost for preventing and managing NCDs. PA for health outcomes remains low among black South Africans. Regular engagement in PA is influenced by the knowledge and perception that a person has about the influence of PA as a healthy lifestyle. No studies that investigate perceptions and knowledge of NCDs and PA among black South Africans could be found in literature. The main purpose of this study was to explore and determine the knowledge and perceptions of NCDs and PA among black South Africans. A total of 93 black South Africans from the Northern Cape and North West provinces voluntarily participated in the study. The participants consisted of groups of employed and unemployed men and women residing in an urban community, men working in unskilled labour conditions residing in rural areas and unemployed women residing in a deep rural area. The recruitment procedures included flyers, local radio announcements, participants recruited from previous researchers, mass communication, and word of mouth. A mixed method approach was performed that consisted of quantitative and qualitative methods. Quantitative methods were employed to determine the point prevalence of NCD risk factors among 93 participants. Of these participants, 54 participated in a survey to determine knowledge of NCDs and PA. Participants from deep rural areas were excluded from the survey owing to a high incidence of illiteracy. A qualitative exploration of perceptions of NCDs and PA was performed. The quantitative procedures included a survey for heart disease knowledge and PA knowledge questionnaires. This was followed by NCD risk factor profile measurements; weight, height, waist and hip circumference, resting blood pressure, peripheral blood measurements for glucose and total cholesterol and objective PA measurements using combined accelerometry and heart rate (Actiheart®) for seven consecutive days. Qualitatively, focus group discussions (FGDs) were conducted to explore perceptions of the PA and NCDs using an open-ended semi-structured questionnaire. SPSS version 22 was used in all quantitative statistical analyses. Descriptive statistics reporting means and standard deviations and frequencies were performed to determine knowledge of NCD risk factors and PA, and to determine the point prevalence of NCD risk factors. Partial correlation analyses were performed to determine the relationship between knowledge of heart disease, knowledge of PA and current PA and risk factors of heart disease. Statistical significance was set at p <0.05. Qualitative data was analysed. FGDs were audio recorded and transcribed for analysis. The Noticing, Thinking and Coding approach was used to analyse data using Atlas. ti7. Black South Africans have high risk profiles for NCDs. The highest prevalence was for systolic blood pressure (71%), physical inactivity (68%) and markers of overweight and obesity with 67%. NCD knowledge was 59 ± 8 % and the total sample mean for PA was 84 ± 16%. The results of this study found a significant relationship between NCD knowledge and activity levels among males (r = 0.38; p =0.03). Among women PA knowledge positively associated with PA, though not statistically significant (r = 0.29; p = 0.42). The knowledge of NCDs and NCD risk factors results from the qualitative exploration of this study showed that black South Africans have limited knowledge about NCDs and negative perceptions about NCDs. They have an undistinguished knowledge of PA and are unable to apply the PA knowledge for disease prevention or management. It is therefore concluded that among black South Africans there is limited knowledge and misconception about PA. Black South Africans also lack knowledge on NCDs and have negative perceptions about NCD. An improved understanding of the perceptions of the population about physical activity and disease outcomes should be assessed in future studies in order to ensure the adoption of physical activity for the management of risk factors for NCDs. / MSc (Biokinetics), North-West University, Potchefstroom Campus, 2015

The burden of non-communicable diseases (NCDs) is high in South Africa. Behavioural conducts and lifestyle factors, unhealthy diets and physical inactivity are the major contributors to the development of NCDs among South Africans. Physical activity (PA) is a modifiable risk factor that is also low in cost for preventing and managing NCDs. PA for health outcomes remains low among black South Africans. Regular engagement in PA is influenced by the knowledge and perception that a person has about the influence of PA as a healthy lifestyle. No studies that investigate perceptions and knowledge of NCDs and PA among black South Africans could be found in literature. The main purpose of this study was to explore and determine the knowledge and perceptions of NCDs and PA among black South Africans. A total of 93 black South Africans from the Northern Cape and North West provinces voluntarily participated in the study. The participants consisted of groups of employed and unemployed men and women residing in an urban community, men working in unskilled labour conditions residing in rural areas and unemployed women residing in a deep rural area. The recruitment procedures included flyers, local radio announcements, participants recruited from previous researchers, mass communication, and word of mouth. A mixed method approach was performed that consisted of quantitative and qualitative methods. Quantitative methods were employed to determine the point prevalence of NCD risk factors among 93 participants. Of these participants, 54 participated in a survey to determine knowledge of NCDs and PA. Participants from deep rural areas were excluded from the survey owing to a high incidence of illiteracy. A qualitative exploration of perceptions of NCDs and PA was performed. The quantitative procedures included a survey for heart disease knowledge and PA knowledge questionnaires. This was followed by NCD risk factor profile measurements; weight, height, waist and hip circumference, resting blood pressure, peripheral blood measurements for glucose and total cholesterol and objective PA measurements using combined accelerometry and heart rate (Actiheart®) for seven consecutive days. Qualitatively, focus group discussions (FGDs) were conducted to explore perceptions of the PA and NCDs using an open-ended semi-structured questionnaire. SPSS version 22 was used in all quantitative statistical analyses. Descriptive statistics reporting means and standard deviations and frequencies were performed to determine knowledge of NCD risk factors and PA, and to determine the point prevalence of NCD risk factors. Partial correlation analyses were performed to determine the relationship between knowledge of heart disease, knowledge of PA and current PA and risk factors of heart disease. Statistical significance was set at p <0.05. Qualitative data was analysed. FGDs were audio recorded and transcribed for analysis. The Noticing, Thinking and Coding approach was used to analyse data using Atlas. ti7. Black South Africans have high risk profiles for NCDs. The highest prevalence was for systolic blood pressure (71%), physical inactivity (68%) and markers of overweight and obesity with 67%. NCD knowledge was 59 ± 8 % and the total sample mean for PA was 84 ± 16%. The results of this study found a significant relationship between NCD knowledge and activity levels among males (r = 0.38; p =0.03). Among women PA knowledge positively associated with PA, though not statistically significant (r = 0.29; p = 0.42). The knowledge of NCDs and NCD risk factors results from the qualitative exploration of this study showed that black South Africans have limited knowledge about NCDs and negative perceptions about NCDs. They have an undistinguished knowledge of PA and are unable to apply the PA knowledge for disease prevention or management. It is therefore concluded that among black South Africans there is limited knowledge and misconception about PA. Black South Africans also lack knowledge on NCDs and have negative perceptions about NCD. An improved understanding of the perceptions of the population about physical activity and disease outcomes should be assessed in future studies in order to ensure the adoption of physical activity for the management of risk factors for NCDs. / MSc (Biokinetics), North-West University, Potchefstroom Campus, 2015

BACKGROUND:Over the past two decades, international health policies focusing on the fight against the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis (TB), malaria, and those diseases that address maternal and child health problems, among others, have skewed disease control priorities in China and other Asian countries. Although these are important health problems, an epidemic of chronic, non-communicable diseases (NCDs) in China has accounted for a much greater burden of disease due to the ongoing rapid socioeconomic and demographic transition.DISCUSSION:Although NCDs currently account for more than 80% of the overall disease burden in China, they remain very low on the nation's disease control priorities, attracting marginal investment from central and local governments. This leaves the majority of patients with chronic conditions without effective treatment. International organizations and national governments have recognized the devastating social and economic consequences caused by NCDs in low- and middle-income countries, including China. Yet, few donor-funded projects that address NCDs have been implemented in these countries over the past decade. Due to a lack of strong support from international organizations and national governments for fighting against NCDs, affected persons in China, especially the poor and those who live in rural and less developed regions, continue to have limited access to the needed care. Costs associated with frequent health facility visits and regular treatment have become a major factor in medical impoverishment in China. This article argues that although China's ongoing health system reform would provide a unique opportunity to tackle current public health problems, it may not be sufficient to address the emerging threat of NCDs unless targeted steps are taken to assure that adequate financial and human resources are mapped for effective control and management of NCDs in the country.SUMMARY:The Chinese government needs to develop a domestically-driven and evidence-based disease control policy and funding priorities that respond appropriately to the country's current epidemiological transition, and rapid sociodemographic and lifestyle changes.

Aims: Unmet needs have mainly been investigated with formal and informal adult caregivers and ill individuals within psycho-oncology; findings indicate unmet needs are associated with negative affective state and caregiver burden. Research relating to adolescent children’s experiences of unmet needs during parental illness has, in the main, been based upon parental reports or professional opinion, yet research suggests that parental reports can downplay the effects and it is important to ask the adolescent child for their opinion. Adolescence is a transitional time in development; this may make the illness experience and subsequent needs vary from those of formal and informal adult caregivers. This thesis pragmatically investigates adolescent children’s firsthand accounts of unmet psychosocial and supportive care needs when they have a parent with a non-communicable disease. Methods: Systematic Review: To inform the direction of the thesis and capture all relevant published literature, a comparative systematic review was carried on adolescent’s experiences of unmet needs when they have a parent with a NCD, cancer or psychological problem. The review was conducted using standardized procedures and guidance from the Cochrane collaboration. Interpretative Phenomenological Analysis: Qualitative methodology was used to investigate seven adolescent’s experiences of unmet psychosocial and supportive care needs in relation to having a parent with a NCD. Participants were recruited through institutions of further and higher education. Quantitative Research: Pearson’s correlation and multiple regressions were used to test associations between unmet needs, depression, stress, anxiety and quality of life, and to determine the applicability of the revised version of the Offspring Cancer Needs Inventory (OCNI) for individuals who have a parent with a NCD. One hundred and seven adolescent children completed the revised version of the OCNI, the DASS-21 (depression, anxiety, and stress) and AC-QoL (Adult carers’ quality of life) scales. Findings: Systematic Review: In the review 1479 papers were considered. Seven met the inclusion criteria, of these five papers related to cancer, one to chronic illness and one to psychological problems. Results suggest that adolescents had informational, supportive and recreational needs, and did not want to worry parents by asking them questions. The lack of hits and the disparity between illness groups is problematic in making comparisons and drawing definitive conclusions. Interpretative Phenomenological Analysis: Four interdependent themes emerged from the data, two relating to interpersonal needs (Information Needs and Support Needs), and two relating to intrapersonal needs (Need for 4 Acknowledgement and Need to be Them-Self), each had their own number of sub-themes. Adolescent’s had a variety of needs that could be partially met through honest and accurate information, interpersonal support and acknowledgment of their caring role within the family. The interdependence of the needs indicated that the fulfilment of one need has the potential of meeting other needs. Unmet needs were comparable to those of adolescent children who have a parent with cancer; as such it was deemed that the new version of the OCNI would be suitable for use with individuals who had a parent with a NCD. Quantitative Research: Ninety-Three percent of adolescents reported at least one unmet need. Analysis suggests that the unmet needs variables were co-dependent and correlated with depression, stress, anxiety, and quality of life. Certain unmet need variables predicted stress, anxiety, depression, and quality of life. Conclusion: The findings of this thesis indicate that adolescent children who have a parent with a NCD have a variety of unmet needs, and that these are associated with affective state and well-being. It is suggested that counselling psychologists are well placed to provide psychological and needs based interventions based upon the findings within this thesis. More research is required in this area to determine cause and effect; owing to counselling psychologists working with the lifespan they would be well placed to further the knowledge in this area.

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Nursing Studies / Master / Master of Nursing