The southern African region is beset with numerous security concerns: pervasive poverty, deepening inequality, starvation, contamination of essential natural resources, violent crime and state oppression. However, the most vital of the region’s security concerns in the 21st century is the spread of infectious disease. The region shoulders a disproportionate amount of the continent’s infectious disease burden, with diseases such as HIV/AIDS, tuberculosis and malaria claiming more lives every year than any other factor. The nature of these diseases and their propensity to spread, coupled with inadequate regional public health structures pose a significant threat to regional security and stability. The study asserts that southern Africa’s security concerns are most appropriately characterised under the paradigm of Human Security. It further asserts that if such vital threats to human security are not adequately managed they have the ability to permeate across state borders, spelling numerous negative ramifications for the region. To this end, the study details the public health crisis in Zimbabwe and its effects on regional security and stability in southern Africa. An enduring political and economic collapse in Zimbabwe led to the dramatic deterioration of its public health sector, the concomitant mass migration of Zimbabwean nationals across the region presented a unique and complex challenge to the Southern African Development Community (SADC) and its member states. As the premier regional governance institution, SADC has failed to adequately mobilise its structures and member states to respond to the challenges resulting from the public health crisis in Zimbabwe. The study explores the factors accounting for this regional inertia, and asserts that while infectious diseases are at present the most vital of the human security threats, similar threats to human security have the potential to affect the region if SADC fails to recognise and prioritise threats to human security as legitimate regional security concerns.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Chronic non-communicable diseases, including cardio-vascular diseases and stroke, cancer, type 2 diabetes and chronic pulmonary disorders, are rapidly emerging as leading causes of morbidity and premature mortalities globally. The majority of the populations worldwide have experienced major transformations in disease profiles and health status characterized by a shift from infectious diseases and nutritional deficiencies to a predominance of chronic diseases of lifestyle. This epidemiological transition is regarded as an outcome of the environmental and socioeconomic changes following urbanization.Common behavioral health risk factors, such as smoking, risky alcohol consumption,sedentarism, overweigh/obesity and hypertension, have consistently been attributed to the development of chronic non-communicable diseases among populations.This thesis seeks to describe the epidemiology of the major common risk factors for noncommunicable diseases among people living in Mombasa, Kenya. The study responds to the WHO’S recommendations on comprehensive and continuous risk factor surveillance as an essential component of the public health information system and a vital health promoting strategy in the control and prevention of non-communicable diseases.A cross-sectional study design using the WHO STEPwise protocol was employed.Convenient stratification of the Mombasa population was done according to gender, age and setting categories. Using the Yamane formula n = N/1+ N(e²), a sample of 500 participants aged 15 to 70 years was arrived at. The researcher then conveniently selected public high schools, tertiary institutions, workplaces and a marketplace as the study settings.The WHO STEPS instrument (Core and Expanded Version 1.4) was used for data collection. Step 1 involved gathering information on socio-demographic characteristics and health-related behaviors of the participants using close-ended structured questions. Step involved the taking of simple anthropometrical measurements pertaining to height, weight, waist circumference, blood pressure and pulse rate.Data were captured, cleaned and analyzed using the Statistical Analysis System (SAS) and SPSS version 16.0. Chi-square and Spearman correlation tests were used to determine associations between socio-demographic variables and behavioral health risk factors.The results indicated that 61% of the study participants possessed at least one of the investigated risk factors. 17% of the participants had a multiple risk factor profile, with 54% more females having a higher mean risk factor score compared to 46% of their male counterparts.Physical inactivity, hypertension and overweight/obesity were the most common registered risk factors, accounting respectively for 42%, 24% and 11%. Physical inactivity and hypertension formed the commonest cluster of multiple risk factor patterns; they co-occurred in 68% of the participants with a multiple risk factor profile.Increasing age, female gender and a low level of educational attainment were factors seen to be significantly associated with the development of risk factors for non-communicable diseases among the participants. It was observed that the burden of risk factors was unequally distributed among Mombasa residents; intervention programs based on our findings should therefore be used to ensure effectiveness. Future studies using nationally representative samples are further suggested to provide a more comprehensive analysis of a national risk factor profile.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Hypertension is one of the most common non-communicable diseases, and it is the leading cause of cardiovascular diseases, death and disability worldwide, especially in developing countries. Physical activity has been regarded as a commonly accepted modality for preventing and treating hypertension. However, despite its known benefits, this modality of treatment and prevention of hypertension continues to be underused.The present study aimed to determine the demographic, social and health-related factors that are associated with levels of physical activity participation among adults with hypertension in Kigali, Rwanda. This cross-sectional study was conducted with 252 adults with hypertension and 87 healthcare professionals through the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and Physical Activity Exit Interview (PAEI). Two thirds of the participants (69.44%) were classified as sedentary. The following factors were found to be significantly (P<0.05) associated with the levels of physical activity:age, marital status, and level of education, residence, tobacco; past and current users, alcohol; current user, diabetes mellitus, BMI, perceived health status, self-efficacy, and blood pressure. None of the healthcare professionals were considered good physical activity counsellor. The findings of the present study highlight the need for the implementation of health promotion strategies aimed at promoting physical activity lifestyle among individuals with hypertension in Rwanda. Efforts should be made in educating people with hypertension on the benefits of integrating regular physical activity in their daily lives. Furthermore, healthcare professionals should be educated concerning how to promote physical activity to all patients especially those with hypertension.

Zoonotic diseases are diseases that are transmitted from animals or vectors to humans and vice versa. The public together with veterinarian authorities should readily access disease information as it is vital in rapidly controlling resultant zoonotic outbreak threats through improved awareness. Currently, the reporting of disease information in South Africa is predominantly limited to traditional methods of Information Communication Technologies (ICTs) like faxes, monthly newspaper reports, radios, phones and televisions. Although these are effective ways of communication, their disadvantage is that the information that most of them offer can only be accessed at specific times during a crisis. New technologies like the internet have become the most efficient way of distributing information in near-real-time. Many developed countries have used web-based reporting platforms to deliver timely information through temporal and geographic visualisation techniques. There has been an attempt in the use of web-based reporting in South Africa but most of these sites are characterised by heavy text which makes them time consuming to use or maintain. As a result most sites have not been updated or have ceased to exist because of the work load involved. The success of web reporting mechanisms in developed countries offers evidence that web-based reporting systems when appropriately visualised can improve the easy understanding of information and efficiency in the analysis of that data. In this thesis, a web-based reporting prototype was proposed after gathering information from different sources: literature related to disease reporting and the visualisation of infectious diseases; the exploration of the currently deployed web systems; and the investigation of user requirements from relevant parties. The proposed prototype system was then developed using Adobe Flash tools, Java and MySQL languages. A focus group then reviewed the developed system to ascertain that the relevant requirements had been incorporated and to obtain additional ideas about the system. This led to the proposal of a new prototype system that can be used by the authorities concerned as a plan to develop a fully functional disease reporting system for South Africa.

The HIV and AIDS epidemic continues to affect communities worldwide particularly so in South Africa. Youth, also the so-called Coloured youth, continue to remain at risk of infection, in spite of having been exposed to information about HIV and AIDS. This study explores the views of Coloured secondary school youth in a rural town in the Eastern Cape, on HIV and AIDS. Fifteen secondary school learners, both boys and girls, from Grades 10 to 12 were purposively selected. This qualitative study, framed within an interpretivist paradigm, draws on a phenomenological methodology. The data was generated from using drawing and focus group interviews and analysed using thematic analysis. The research adhered to ethical principles and trustworthiness was ensured. Constructivism and Bronfenbrenner’s bio-ecological systems theory were used to frame the study and to make meaning of the findings. In response to the primary research question, What views do Coloured youth attending a secondary school in a rural town have of HIV and AIDS?, five themes emerged, namely: individuals spread HIV, impoverished family life increases youth vulnerability to HIV, youth under pressure from peers knowingly engage in risky behaviour, misconceptions fuel the epidemic, and HIV and AIDS “captures the community in its net”. Drawing on the findings and in response to the secondary research question, What guidelines can be developed to assist educators to facilitate learners taking action against the spread of HIV and AIDS?, several guidelines were developed. They suggest that teachers should use participatory pedagogies to engage secondary school learners when teaching HIV and AIDS, build self-esteem in their learners, assist learners in dealing with peer pressure, engage learners in erasing misconceptions, and enable learners to break free from being “caught in the net” of HIV and AIDS. Collectively these guidelines could enable learners to take action in protecting themselves and their community against the spread of the HI virus. The study concludes that the views that Coloured secondary school learners from a rural town have about HIV and AIDS show their awareness of the realities of the epidemic affecting the individual, the family, the school and their community. They have constructed their views of HIV and AIDS in a way which shows their understanding of the complexities of the epidemic.

The HIV and AIDS pandemic have become not only a health concern but educational and social concern as well. According to Beyers and Hay (2011, p. 99) many school-going children are not only affected by HIV but a large number of adolescents are also either HIV positive or have AIDS. Other researchers argue that education should act as a vaccine against new HIV infections (Kendall and O’Gara, 2007, p. 6). This argument comes with the expectation that all teachers are willing and ready to work with learners made vulnerable by HIV and AIDS; without considering the lived realities of the teachers in relation to HIV and AIDS. While many teachers make a difference in the lives of affected and infected learners through the way in which they deal with the learners concerned, some may not take up the challenge to assist the learners, while others might unknowingly and unintentionally do harm. This study, therefore, aimed at exploring high school teachers’ experiences of working with learners made vulnerable by HIV and AIDS in order to generate guidelines to assist teachers to effectively deal with vulnerable learners in their classrooms.

Epidemiologists engage in the study of the distribution and determinants of health-related states or events in human populations. Eventually, they will apply that study to prevent and control problems and contingencies associated with the health of the population. Due to the spread of new pathogens and the emergence of new bio-terrorism threats, it has become imperative to develop new and expand existing techniques to equip public health providers with robust tools to predict and control health-related crises. In this dissertation, I explore the effects caused in the disease dynamics by the differences in individuals’ physiology and social/behavioral characteristics. Multiple computational and mathematical models were developed to quantify the effect of those factors on spatial and temporal variations of the disease epidemics. I developed statistical methods to measure the effects caused in the outbreak dynamics by the incorporation of heterogeneous demographics and social interactions to the individuals of the population. Specifically, I studied the relationship between demographics and the physiological characteristics of an individual when preparing for an infectious disease epidemic.

Bakgrund: Smittsamma sjukdomar kan spridas på många sätt, och vissa sjukdomar har egenskapen att de sprids snabbt och orsakar sjukdomsutbrott. Vid utbrott av smittsamma sjukdomar behövs sjuksköterskor för att vårda patienter, ofta under ansträngande förhållanden. En miljö där sjuksköterskan själv riskerar att smittas medför nya utmaningar för henne. Syfte: Studien hade till syfte att undersöka sjuksköterskors erfarenheter av att arbeta patientnära under epidemier och utbrott av mycket smittsamma sjukdomar. Metod: En deskriptiv litteraturstudie utfördes där dataanalysen är en beskrivande syntes av kvalitativa data. Kombinationer av sökord relaterade till sjuksköterskeyrket, smittsamma sjukdomar och kvalitativa studier användes i databasen PubMed för att finna relevant forskning. Slutliga artiklar valdes ut när de bedömts svara mot syftet och vara av kvalitativ karaktär, samtidigt som de svarade mot urvalskriterier som ramar in rätt undersökningsgrupp (sjuksköterskor) och bedömdes vara inriktade mot sjuksköterskornas personliga upplevelser Huvudresultat: Fyra teman och tolv underteman visade sig. De fyra temana som framträdde var 1) Ett närvarande hot, 2) En uttröttad yrkesgrupp, 3) En ständig ovisshet och 4) Ett meningsfullt arbete. Inom ramen för dessa kunde det bland annat ses att rädslan för att sjuksköterskan och hennes familj skulle smittas upplevdes som påtaglig. Samtidigt upplevde de även att arbetet var djupt meningsfullt. Slutsats: Sjuksköterskors negativa erfarenheter av att vårda patienter med smittsamma sjukdomar kretsade kring hotet att smittas, omgivningens syn, en utmattande arbetssituation och omfattande och opålitlig information. Men där fanns också positiva erfarenheter som personlig utvecklig, en stärkt identitet som sjuksköterska och meningsfulla relationer med patienter. / Background: Contagious diseases can be transmitted in many ways. Some spread rapidly and causes disease outbreaks. When disease outbreaks occur in a large scale, nurses is needed for the care of patients, often under strained circumstances. An environment where the nurse risk to get infected herself, brings new challenges to the role.  Aim: The scope of the study was to investigate nurses' experiences of working close to patients during disease outbreaks. Method: A descriptive literature review was performed where data analysis is a descriptive synthesis of qualitative data. Combinations of search terms related to nursing, contagious diseases and qualitative studies where used in database PubMed to find relevant research articles. Finally, articles where chosen when they were assessed to answer the aim of the study and be of qualitative character, while simultaneously targeting nurses and their personal experiences. Main results: Four major themes arose from the study: 1) A present threat, 2) An exhausted workforce, 3) A permanent uncertainty and 4) A meaningful task. Within these themes, it could be seen that the nurses experienced fear of themselves or their family getting the disease, but also that they found their work deeply meaningful. Conclusion: Nurses negative experiences of giving care to patients carrying contagious diseases had many aspects such as the threat to get sick, the view of others, an exhausting work situation and extensive unreliable information. But there were also positive experiences such as personal development, a strengthened identity as a nurse and meaningful relations with patients.

Infectious diseases are the major cause of human death worldwide and the need for new generations of anti-infective agents to overcome the drug resistant urgently needs to be tackled. Plant natural products are potential sources of novel antimicrobial compounds. In this study, an investigation into the antimicrobial lead compounds from Michelia figo, Macleaya cordata and Ardisia gigantifolia in Lingnan region is presented. The prevention of dental diseases is targeted at the control of dental biofilm. Streptococcus mutans and S. sobrinus are the leading bacterial strains in the formation of dental biofilm. Extracts of Michellia figo and Macleaya cordata displayed antimicrobial potential in our screening assays. Bioassay-guided isolation of M. figo revealed the presence of artabotryside B and acteoside which were isolated for the first time from this plant. Moreover, chelerythrine and sanguinarine, the two alkaloids isolated from Macleaya cordata displayed the ability to prevent the formation of biofilms of S. mutans and S. sobrinus with the MIC50 values in the range of 18.5-34.0 μM. Anti-TB bioassay-guided isolation of the extract of Ardisia gigantifolia led to isolation of two 5-alkylresorcinols, 5-(8Z-heptadecenyl) resorcinol (1) and 5-(8Z-pentadecenyl) resorcinol (2). We further synthesized 15 derivatives based on these two compounds. Resorcinols 1 and 2 exhibited anti-TB activity with MIC values at 34.4 μM and 79.2 μM in MABA assay, respectively, and 91.7 μM and 168.3 μM in LORA assay, respectively. Among these derivatives, compound 8 was found to show improved anti-TB activity than its synthetic precursor (2) with MIC values at 42.0 μM in MABA assay and 100.2 μM in LORA assay. Chelerythrine and sanguinarine are the representative and the major active constituents of M. cordata. Both compounds showed significant fungicidal effects in vitro and significant therapeutic effects on guinea pigs of dermatophytosis. Mechanism study for the antifungal efficacy showed that chelerythrine and sanguinarine were potent inhibitors of ergosterol bio-synthesis by reducing the amount of ergosterol without affecting the synthesis of 1,3-β-glucan. In summary, these results highlight the promising antimicrobial activity of chelerythrine, sanguinarine and alkylresorcinols from the medicinal plants in Lingnan region. The active compounds may be regarded as new hits for further study as novel classes of antimicrobial agents for the treatment of infectious diseases.

Immigrants of Sweden are suffering from various non-communicable diseases more than Swedish natives which becomes a major public health concern nowadays. The objective of this systematic review is to investigate the physical activity level of Swedish immigrants compare to Swedish-born, their physical and mental health outcomes, and barriers and facilitators of being physically active. Electronic database CINAHL PLUS, PUBMED, EBSCOhost, SWEPUB was searched and 17 articles were included which was peer-reviewed, English language, based on physical activity of immigrants living in Sweden. Findings of these articles revealed that immigrants had a higher prevalence of non-communicable, anxiety, depression more than Swedish natives. Lack of motivation, weather, cultural and language barriers, environmental, infrastructure, and economic barriers are identified as barriers. Self-motivation, family and social support, culturally appropriate strategies, government-induced programs, community support are identified as facilitators of being physically active. The quality of evidence of outcomes scored by using GRADE. In conclusion, the available evidence support that immigrants are less physically active than Swedish-born and lack physical activity associated with their physical and mental health outcomes and there are several barriers and facilitators for being physically active.