Magister Public Health - MPH / Background: Childhood obesity is on the rise in South Africa (SA) and child-directed marketing (CDM) is one of the contributing factors to children’s unhealthy food choices and consumption. This study assessed CDM on pre-packaged breakfast cereals available in South African supermarkets and describe the nutrient composition of these pre-packaged products. Methods: A descriptive observational study of CDM on pre-packaged breakfast cereals was undertaken with quantitative analysis of the nutrient composition of these products. Secondary data from the “Researching obesogenic food environments in South Africa and Ghana” study in 2019 was examined. An independently reviewed codebook of definitions of CDM was developed and breakfast cereals were assessed to identify CDM. The CDM questionnaire was developed in REDCap, an online research database and data captured therein. Statistical Package for Social Sciences (SPSS) was used for cross tabulations and one-way ANOVAs. All analysis with p value < 0.05 was taken as significant.

Thesis (M.A. Pharm. (Pharmacy Practice) -- University of Limpopo, 2020 / Background: Non-communicable chronic disease contributes to premature mortality in SA, threatening the socio-economic development of the country. The efficient management of essential medicines supply at the clinic level is vital as stock-outs of the medicines increase morbidity and mortality. Objectives: The study aimed to identify and determine the challenges in the inventory management of medicine for the treatment of non-communicable chronic diseases at public health clinics in the Dikgale community of Limpopo province. Methods: The study used a cross-sectional quantitative research design; the purposive sampling technique was used, as it requires people with specific skills, knowledge, and expertise. A Pre-validated questionnaire was used to collect data from pharmacists, professional nurses, and transport personnel. Stock card utilization review and checklist were used to verify the answers obtained from the participants. Descriptive and inferential statistics were used to analyse the data collected. All these processes ensure that stock is always available and at optimal levels. The availability of stock at optimal levels is dependent on the personnel following SOPs. Results: In total, 40% of pharmacists indicated to have never trained nursing personnel on stock management, and 66.7% which, is the majority of nursing personnel, reported they have never been trained on stock management. Only 26.67% of medicines used for NCDs did not have stock cards. The study further found that the stock-card was not used every time a transaction was made. Thirty-nine (39%) percent of the respondents did not know how to quantify order quantities; this factor contributes to stock-outs experienced at clinics. All the clinics did not have a secure dedicated area. Deliveries are offloaded outside the medicine room. Conclusions: There is a training gap that needs to be closed to meet the minimum requirements as per GPP guidelines and also help to reduce medicine stock-outs as personnel will be well equipped to handle stock. In terms of inventory management and stock control systems, all primary healthcare sectors used a manual/paper-based inventory management system. Stock control systems are in place but were not always utilised and, processes are not consistent among staff members across clinics. With distribution, it would work better if nursing personnel dedicated a person to place and receive orders as discrepancies will be picked up sooner, and quantities will be sufficient to last until the next ordering date. None of the clinics complied with “Ideal Clinic” standards for infrastructure, storage, and inventory management. / VLIR

Bakgrund: Patienter med smittsamma sjukdomar kan ibland behövas vårdas inom isolering, detta för att bryta en smittkedja och det är sjuksköterskan som har omvårdnadsansvaret. Smittsamma sjukdomar kan spridas på olika sätt exempelvis genom kontakt-, dropp- eller luftburen smitta. Syfte: Syftet med studien var att beskriva sjuksköterskors upplevelse av att vårda patienter med smittsamma sjukdomar inom isolering. Metod: En beskrivande litteraturstudie med 11 vetenskapliga artiklar, inhämtade från databaserna PubMed och Cinahl, varav nio kvalitativa, en kvantitativ och en mixed analys. Huvudresultat: Sjuksköterskorna var rädda för nya virusutbrott, de var rädda att bli smittade eller att bidra till smittspridning. Det fanns oro i om sjuksköterskorna gjorde rätt etiska val när det kom till patientens psykosociala behov. En oro och okunskap över hur bra skyddsutrustningen som användes egentligen var. Detta i sin tur ledde till ångest, utmattning och utbrändhet. Trots detta upplevde sjuksköterskorna sin profession som viktig och nödvändig i samhället. Slutsats: Denna studie har tydligt visat sjuksköterskans negativa upplevelser så som oro, osäkerhet, ovisshet och rädsla att vårda patienter med smittsamma sjukdomar. Sjuksköterskorna upplevde bristande information vid nya virusutbrott samt en rädsla kring skyddsutrustningen. De upplevde även en stigmatisering från samhället och familj. Samtidigt sågs det ett litet samband av positiva upplevelser vilket var att sjuksköterskorna utvecklades, stärktes och såg sitt arbete som värdefullt. Mer forskning skulle kunna ge sjuksköterskan bättre förståelse och hantering av patienter med smittsamma sjukdomar. / Background: Patients with contagious diseases sometimes need isolation care, this to break the chain of infection and it is the nurse who has the responsibility for nursing. Infectious diseases can be spread in different ways, for example through contact, drip or airborne infection. Aim: The aim of the study was to examine nurses' experiences caring for patients with infectious diseases in isolation. Method: A descriptive literature study of 11 articles, from the databases PubMed and Cinahl, 9 qualitative, 1 quantitative and 1 mixed analysis. Main results: Nurses were worried about new virus outbreaks, becoming infected and spreading the disease, as well as whether or not they were making ethical decisions regarding the patients' psychosocial needs. Furthermore, the nurses were concerned about how good the protective equipment used was. This, in turn, contributed to anxiety, fatigue, and burnout. Despite these issues, the nurses considered their profession as important and necessary in society. Conclusion: This study has clearly shown the nurse's negative experiences such as anxiety, uncertainty, mistrust and fear of caring for patients with contagious diseases. The nurses experienced a lack of information in the event of new virus outbreaks and worried about the protective equipment. They also experienced a stigma from society and their families. However, there was a small connection of positive experiences, which was that the nurses were developing, strengthening, and appreciating their work. More research could give the nurses a better understanding and could lead to better management of patients with infectious diseases.

Philosophiae Doctor - PhD / Background Overweight/obesity is a risk factor for non-communicable diseases such as cardiovascular diseases, diabetes, and some cancers. Obesity in childhood is known to predict later obesity in adolescence and adulthood. Understanding the factors associated with overweight/obesity among children may present an opportunity for timely and appropriate interventions in the African setting. Aims 1. To describe the prevalence of overweight and obesity and associated factors among school children aged 8 - 11 years in primary schools in Adentan Municipality, Ghana. 2. To review the available literature on childhood obesity in the African context to provide evidence to support the design and improvement of appropriate school-based interventions for the prevention and control of overweight/obesity among African learners. Methodology This was a cross-sectional study design which was conducted in two phases. In Phase I, the available literature on the prevalence of overweight and obesity among learners, school-based interventions to promote healthy nutrition and physical activity (PA), and weight status, and key policy interventions at the national levels to provide supportive environments in the African context was reviewed and synthesised. In Phase II, interviews were conducted to collect individual and family data from 543 learners in 14 schools to assess family socio-demographics characteristics, dietary, PA, and sedentary behaviours, and sleep duration. Body weight, height, and waist circumference were measured. Data on perceived school neighbourhood/ community, school food, and PA environments were collected from school heads/administrators. A sub-sample of 183 children participated in the assessment of body fat using the deuterium dilution method. Multivariable and logistic regressions, multilevel logistic regressions, and multilevel linear regression models were used to examine the associations among child, family, and school level explanatory variables, and overweight/obesity, abdominal obesity and body mass index (BMI). Results The reviews revealed the following: (i) The pooled overweight and obesity estimates across Africa were: (10.5% 95% CI: 7.1-14.3) and 6.1% (3.4-9.7) by World Health Organization; 9.5% (6.5-13.0) and 4.0% (2.5-5.9) by International Obesity Task Force; and 11.5% (9.6-13.4) and 6.9% (5.0-9.0) by Centers for Disease Control and Prevention, respectively and differed for overweight (p=0.0027) and obesity (p<0.0001) by the criteria. The estimates were mostly higher in urban, and private schools, but generally similar by gender, major geographic regions, publication year, and sample size; (ii) Although inconsistent, school-based interventions broadly improved weight status and some energy-balance related health behaviours of African learners; (iii) On applying the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, key interventions on unhealthy diets and physical inactivity targeted the school, family and community settings, and macro environments, and broadly aligned with global recommendations. In the school-based study, 16.4% of Ghanaian learners were overweight (9.2%) or obese (7.2%), with the prevalence being significantly higher in children from middle- to high socio-economic status (SES) households, and private schools. In multivariable regression models, attending private school (AOR = 2.44, 1.39–4.29) and excessive television viewing (AOR = 1.72, 1.05–2.82) significantly increased the likelihood of overweight/obesity, whereas adequate sleep (AOR = 0.53, 0.31–0.88), and active transport to and from school (AOR = 0.51, 0.31 – 0.82) decreased the odds. Using deuterium-derived percent body fat as criterion method, the published BMI criteria was found to be highly specific but with moderate sensitivity for diagnosing obesity among Ghanaian children. Moreover, the BMI-for-age z-scores that optimise sensitivity, specificity, and predictive values for obesity were lower than the published cut-off points. Multilevel logistic and linear regression analyses revealed that the school contextual level contributed 30.0%, 20.6% and 19.7% of the total variance observed in overweight (including obesity), abdominal obesity, and BMI respectively. Availability of school cafeteria (β = 1.83, p = 0.017) and shops (β = 2.34, p = 0.001), healthy foods (β = 0.77, p = 0.046), less healthy foods (β = 0.38, p = 0.048), child age (β = 0.40, p = 0.008), school-level SES (β = 1.02, p < 0.0001), private school attendance (β = -1.80, p = 0.006), and after-school recreational facilities (β = 0.89, p < 0.0001) were all associated with BMI. In the mutually adjusted models for all significant predictors, school-level SES, healthy foods, after-school recreational facilities, and PA facility index remained significant predictors of overweight and or abdominal obesity. Conclusions The prevalence of overweight/obesity is significantly higher in urban children attending private or high SES schools, regardless of criteria used to define obesity. A number of individual, family, and school-level factors significantly predicted weight status of school children in Ghana. Given that many African governments have initiated policy interventions aiming to provide supportive environments for healthy choices, it is recommended that resources are made readily available for the implementation of these interventions across the home, school and community.

Master of Public Health - MPH / Non-communicable diseases (NCDs) are the leading cause of death globally, affecting a significant proportion of the economically active population, the majority of these occurring in low- and middle-income countries (LMICs). In South Africa, over 40% of deaths are attributable to NCDs. The use of healthcare services by individuals who have NCDs is putatively high but has yet, not been adequately quantified. Furthermore, there is a paucity of research data on factors that influence healthcare services use among those experiencing NCDs in South Africa.

Orientador: Taís Maria Bauab / Coorientadora: Margarete Teresa Gottardo de Almeida / Banca: Carlos Henrique Gomes Martins / Banca: Flávia Aparecida Resende Nogueira / Banca: Elfriede Marianne Bacchi / Banca: Mara Correa Lelles Nogueira / Resumo: A elevada incidência de casos infecciosos causada por C. albicans, tal como a candidíase vulvovaginal (CVV) expõe o ser humano a terapias agressivas, bem como implica no desenvolvimento da resistência aos antifúngicos disponíveis na terapêutica clínica. Neste sentido, diversos pesquisadores encontram na natureza, bem como em plataformas nanotecnológicas de liberação de fármacos, um novo horizonte para disponibilizar novos recursos que possibilitem compor o arsenal terapêutico das doenças fúngicas. Em vista disso, este trabalho visou avaliar o potencial antifúngico in vitro e in vivo de frações do extrato metanólico de escapos de Syngonanthus nitens, o qual vem se mostrando promissor no tratamento da CVV, não incorporado e incorporado em um sistema nanoestruturado de liberação de fármacos (nanoemulsão lipídica - NE) buscando aprimorar os parâmetros referentes à biodisponibilidade das mesmas. Os ensaios investigativos foram iniciados com o fracionamento do extrato bruto (extração em fase sólida) e caracterização química das frações (ensaios cromatográficos por CCD e CLAE-DAD), seguido para o desenvolvimento da NE, a qual foi composta por colesterol (fase oleosa), Brij 58 (tensoativo) e tampão fosfato pH 7,4 + 0,25% de dispersão de quitosana (fase aquosa). 12 frações foram obtidas e apresentaram perfis químicos e antimicrobianos distintos, dentre elas, a fração Fr3 foi a mais promissora e constatou-se que o flavonóide luteolina é o composto majoritário e o responsável pela ativi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The incidence incidence of infectious caused by C. albicans, such as vulvovaginal candidiasis (CVV) exposes humans to aggressive therapies, and to the development of resistance to antifungal agents available in clinical therapy, as well. In this sense, several researchers find in the nature, and in the nanotechnology platforms for drug delivery, a new horizon to make available new resources that allow to compose the therapeutic arsenal of fungal diseases. The aim of this study was to evaluate the in vitro and in vivo antifungal potential of fractions from the methanolic extract of Syngonanthus nitens, which has been shown to be promising in the treatment of CVV, not incorporated and incorporated in a nanostructured drug delivery system (lipid nanoemulsion - NE) aiming to improve the parameters related to the bioavailability. The investigations were initiated with the fractionation of the crude extract (solid phase extraction) and chemical characterization of the fractions (TLC and HPLC-DAD chromatographic analyzes), followed for the development of the NE, which was composed by cholesterol (oil phase), Brij 58 (surfactant) and phosphate buffer pH 7.4 + 0.25% chitosan dispersion (aqueous phase). 12 fractions were obtained and presented distinct chemical and antimicrobial profiles, among them, the Fr3 fraction was the most promising and it was verified that the flavonoid luteolin is the majoritarian compound and responsible for the antimicrobial activity. Pharmacotechnical experiments (phase diagram design, polarized light microscopy, dynamic light scattering, zeta potential, stability evaluations, continuous and oscillatory rheological... (Complete abstract click electronic access below) / Doutor

Magister Scientiae (Nutrition Management) - MSc(NM) / In South Africa, healthcare professionals (HCPs) are at an increased risk of developing non-communicable diseases due to their unhealthy lifestyle behaviours, which mainly consist of excessive alcohol drinking and smoking, physical inactivity, and unhealthy diets. Attitudes towards healthy eating, a healthy lifestyle, and physical activity (PA) of individuals contribute towards individuals engaging in these health behaviours.

Background: Non-communicable diseases (NCDs) account for over two-thirds of deaths worldwide, and global efforts to address NCDs have accelerated. Current prevention and control efforts rely primarily on individual behavior/lifestyle approaches that place the onus of responsibility for health on the individual. These approaches, however, have not stopped the increasing trend of NCDs worldwide. Thus, there is urgent need for exploring alternative approaches in order to attain the aim of reducing global premature NCDs mortality by 25% by 2025, and meeting the NCD reduction objective in the Sustainable Development Goals. Discussion: We suggest the need for a structural approach to addressing the NCDs epidemic that integrates social science and public health theories. We evaluate two overarching principles (empowerment and human rights) and three social determinants of health (labor and employment, trade and industry, and macroeconomics) addressed in the 2013 Global Action Plan for the Prevention and Control of NCDs to demonstrate how a structural approach to NCDs can be incorporated into existing NCD interventions. For each area considered, theoretical considerations for structural thinking are provided and conclude with recommended actions. Conclusion: Achieving the global health agenda goals of reducing NCDs mortality will require a shift to a paradigm that embraces concerted efforts to address both behavioral/lifestyle factors and structural dimensions of NCDs.

Bakgrund: Isolering kan leda till psykosociala biverkningar och negativa känsloupplevelser, vilket tidigare forskning har uppmärksammat. Utifrån de identifierade omvårdnadsproblemen designades en litteraturstudie för ytterligare undersökande av patienters upplevelser vid isoleringsvård.    Syfte: Syftet var att undersöka patienters upplevelser av isolering i samband med allmänfarlig sjukdom på sjukhus.    Metod: Allmän litteraturöversikt med deskriptiv design.    Resultat: I patienternas upplevelser identifierades fem olika teman: stigmatisering, känslor, miljö, socialt liv och vård. I resultatet framkom det att patienter i isolering har många negativa upplevelser relaterat till vården och miljön i isoleringen. Även det sociala livet och känslolivet påverkas och många upplever stigmatisering. Förutom de negativa upplevelserna framkom även vissa positiva upplevelser, främst relaterat till relationen med vårdpersonal samt fördelarna med det utökade privatlivet ett eget rum innebar.    Slutsats: Syftet med studien var att undersöka patienters upplevelser av isoleringsvård. I resultatet framkom det flera negativa och positiva upplevelser som till stor del stämde överens med tidigare forskning inom området. Studien gav en fördjupad förståelse för patienters situation under isoleringsvård. Denna ökade medvetenhet och kunskap behövs för att vårdpersonal genom riktade omvårdnadsåtgärder ska kunna förbättra omvårdnaden av isolerade patienter i framtiden. / Background: Isolation can lead to a variety of psychosocial problems and negative emotional experiences, which previous studies have shown. Based on the identified nursing problems, a literature study was designed to further explore patients experiences in source isolation.    Aim: The aim was to investigate patients experiences of being isolated with a disease dangerous to public health in a hospital setting.    Method: A general literature review with descriptive design.    Result: The patients experiences were identified and categorized into 5 themes: stigma, feelings, enviornment, social life and care. The results showed that patients in isolation have a lot of negative experiences related to care and the environment in the isolation ward. The social life and feelings of the patients were also affected, and many reported that they experienced stigmatization. Aside from the negative experiences there were also some positive ones, mainly related to the relationship between the patients and the hospital staff and the extended privacy of having your own room in the ward.    Conclusion: The aim was to investigate patients experiences of source isolation. This study shows both negative and positive experiences among patients in source isolation, which mainly aligned with already existing studies. The result of this study gave a better understanding of patients experiences in source isolation. This knowledge and awereness is needed by healthcare workers to be able to improve the care of patients in isolation with targeted nursing care measures.

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