Thesis in English, Annexure E: Consent form (leaf 81) as well as KABP Survey Questionnaire (leaves 87-91) in English and SiSwati. / The purpose of the study was to assess knowledge, explore attitudes and determine practices of breastfeeding mothers living with HIV regarding post-natal PMTCT interventions and services. The study was quantitative and descriptive in nature, utilising a retrospective cohort design. The study sample included breastfeeding mothers living with HIV, who attended the King Sobhuza II public health unit in the Manzini region of Swaziland. A written questionnaire was administered to a non-random sample of 90 consecutively selected mothers living with HIV attending the above-cited public health unit for post-natal health purposes. The overall study results revealed that the majority of breastfeeding mothers living with HIV in the afore-mentioned region (77.8%) presented high levels of knowledge on PMTCT, and 90% demonstrated a positive attitude; while a further 90% also demonstrated positive behaviour towards PMTCT. However, stigma and discrimination among family members, non-disclosure of HIV status to sexual partners; as well as poverty and fear of future drug-resistance are the cause of non-adherence to ARV prophylaxis. Furthermore, inconsistent condom use, mixed-feeding methods and wet-nursing also emerged as other contributing factors to the increase of post-natal mother-to-child transmission of HIV among breastfeeding mothers living with HIV. / Health Studies / M.A. (Nursing Science)

In its efforts to reduce maternal mortality and prevent Mother-to-Child Transmission of HIV, the government of Swaziland developed and implemented several programmes including a special antenatal care package for HIV-positive pregnant women in line with the WHO (2009) guidelines. Since the implementation of this latest special ANC package for HIV-positive women, little is known about how these services are experienced by the intended recipients. The purpose of this study was to explore and describe the actual experiences of HIV-positive women with the antenatal care services provided at a regional referral hospital in Swaziland, with the view of providing more insight into the quality of ANC services from the users' perspectives. A qualitative descriptive, exploratory design was used to address the above purpose. The researcher used purposive sampling to select the participants who met the inclusion criteria for the study. Semi-structured individual interviews were used and saturation was reached after 18 individual face-to-face interviews. Thematic content analysis was used to analyse the collected data. Forteen themes related to the participants experiences with the ANC services and seven related to measures for improvement emerged from data. In general HIV positive pregnant women expressed positive views towards ANC services they received at the target institution. The results give an indication on the quality of the focussed ANC package provided at the hospital and specific recommendations for improvement are outlined. / Health Studies / M. A. (Nursing Science)

The purpose of this study was to assess the epidemiology of preventable risk factors for NCDs among the adult population in Tigray, Northern Ethiopia. A quantitative descriptive cross-sectional design was employed to describe the distribution of behavioural and biological risk factors for NCDs, assess the status of knowledge, perceptions, attitude and behaviour of the study participants for NCDs and their risk factors, and a matched case-control study to identify the determinants of hypertension. The data was collected using a structured questionnaire for the interview, physical measurements including weight and height scales, non-elastic measuring tape for waist and hip circumferences, Omron digital BP apparatus for blood pressure and heart rate; Accutrend Plus for measuring fasting blood glucose, cholesterol and triglycerides. For the descriptive cross-sectional study a total of 2347 participants were included, and for the matched case control study a total of 117 cases and 235 controls participated. Behavioural and biological risk factors were assessed. Only 0.8% of the study participants used optimal fruit serving per day. The prevalence of low level physical activity (<600 MET-minutes/week) was 44.8%. The magnitude of ever alcohol consumption was 66.8%. However, the magnitude of khat chewing and tobacco smoking among the study participants was not as high as the other risk factors i.e. 3.3% and 2.3% respectively. The magnitude of hypertension, central obesity, hyperglycaemia, hypercholesterolemia and hypertriglyceridemia was 9.9%, 22.2%, 3.5%, 30.3% and 32.2% respectively. Factors associated with the risks aforementioned were gender, age, place of residence, education, knowledge status on NCDs, mental stress and others. The status of knowledge on CVDs, breast and cervical cancers, diabetes and their potential risk factors was low and not comprehensive. Misconceptions on NCDs and body size and shape were pervasive. Risky behaviours underlying NCDs were rampant in the study population. Factors related to poor knowledge on NCDs were gender, age, place of residence, education and misconceptions on NCDs. The determinants of hypertension were physical inactivity, duration of alcohol intake, central obesity and mental stress. Awareness raising interventions on NCDs and their risk factors; improving socio-economic status and accessibility to health care settings have to be in place to curb these formidable problems. / Health Studies / D. Litt. et Phil. (Health Studies)

Thesis (MMed (Occupational Medicine))--Stellenbosch University, 2013. / Introduction Exposure incidents involving blood and body fluids represent a major hazard for medical undergraduates. Every medical teaching university experiences the problem of undergraduate medical students sustaining such incidents. Although Post Exposure Prophylaxis (PEP) is readily available and accessible to medical undergraduates following an incident, continuity and quality of care extends beyond the provision of PEP. This includes follow up consultations after receiving PEP according to protocol. Study Design This study was performed at the Tygerberg Campus of Stellenbosch University in Cape Town, South Africa to assess compliance with follow up consultations following an exposure incident. The study base consisted of all the medical undergraduates who reported an exposure incident at the Campus Health clinic. Cases were defined as medical undergraduate students of Stellenbosch University who had reported an exposure incident between January 2007 and December 2011. They were identified using the clinic database and records. Influential factors associated with the exposure incident, including compliance regarding follow up consultations were obtained from standardised reporting forms and medical records. The data was analysed in 2 sections, a cross sectional component (descriptive and analytical) and a retrospective cohort component. Two student cohorts were retrospectively followed from the beginning of their 3rd year to the end of their medical curriculum (6th year). Results There were 280 exposure incidents reported in the study period, of which 174 were low risk and were 106 high risk incidents for which PEP was prescribed (37.86% used PEP). For those who had high risk exposures, 90.57% (n=96) attended the 6-week follow up consultation, 48.11% (n=51) attended the 3 month visit and 34.91% (n=37) attended the 6 month follow up visit. There was an increase in the number of exposure incidents from 2010 (n=43) to 2011 (n=76). Internal medicine accounted for the most number of incidents (n=68), followed by Surgery (n=51), Obstetrics and Gynaecology (n=44), and Paediatrics (n=42). Drawing blood was the most common reported activity associated with exposures. Of notable importance was recapping, disposing of needles and insertion of blood into sample tubes. These activities accounted for 63 of the 280 exposure incidents. The 4th year students were the least at risk for exposure incidents compared to 3rd, 5th, 6th years. The annual average cumulative risk of having an exposure incident was found to be 5.7% (95%CI=4%-8%) and 6.8% (95%CI=5%-9%) amongst the 2 student cohorts over the duration of 4 years (clinical exposure time). Recommendations There is an urgent need for the number of exposure incidents to be reduced, e.g. needle recapping and disposal, and insertion of blood in sample tubes cause numerous preventable incidents. Various other strategies can be implemented in order to reduce the number of incidents across all undergraduate years of study. It is envisaged that by reducing the number of exposure incidents, there will be a subsequent decrease in the number of individuals requiring PEP. The importance of ensuring compliance with regard to follow up consultations needs to be emphasized. Factors that lead to noncompliance need to be investigated in a separate study.

【研究緣起與問題】2003年春季，SARS在全球造成一陣轟動，同時也重創全球的經濟，如今SARS會不會再來？政府如何因應？政府如何監測疫情？如何防治疫情？如果SARS等新興及再浮現感染症 （Emerging and Re-emerging Infectious Diseases）出現時，負責全國傳染病防治任務的行政院衛生署疾病管制局是如何作好全國傳染病防治工作呢？中央及地方主管機關之溝通，如何共同消除指責與誤會，發揮團隊精神，如何共同作好全國傳染病防疫任務，爭取公眾對政府之瞭解並加以支持，同時防止任何可能之攻擊，才是全民之福祉。故以「全國傳染病通報系統」的績效，其所仰賴之溝通通路之問題研究，是本研究的動機。了解「傳染病通報管理系統(WEB版)」最大的問題及新興傳染病（如SARS）防治通報的問題及「傳染病通報管理系統」最需要改進之的地方，是本研究的目的。 【研究方法與資料】本研究採取量化與質化並重的方法，以網路問卷方式的進行問卷調查，問卷對象為全國使用傳染病通報管理系統之相關人員，問卷問題內容的設計主要的型式含有開放式問卷（Open –Ended Question）、封閉式問卷（Close-Ended Question）及混合型問卷（Mixed Question）三種。同時以九十二年針對新興傳染病SARS期間為例，深度訪談當時任職於中央與地方負責傳染病防治權責具代表性者五位主管進行訪談，瞭解受訪者對新興傳染病如SARS防治的問題及「傳染病通報管理系統」最需要改進之的地方，以彌補問卷調查法無法深入瞭解到問題之缺點。 【研究結論與建議】 一、根據筆者初步研究經問卷的實證調查之後，從問卷分析資料顯示，使用者使用電腦的時間愈久，對以新版為溝通工具滿意度愈低；而愈瞭解通報系統的使用者，其以新版為溝通工具滿意度愈高，愈滿意新版改進之電腦網路溝通效果。顯示新版的通報系統在設計的操作介面與程序上，沒有人性化，作業內容繁多、需輸入的項目、資料太繁瑣、版面太繁瑣等，反而徒增使用者的困擾；而愈瞭解通報系統的使用者，其對新版的滿意度越高，表示對於使用者在操作上的教育訓練仍須加強，才能發揮新版通報系統的成效。 二、從敘述統計分析中發現： 受訪者對「訊息異動通知作業流程滿意」的使用滿意度的平均數最高，平均數為2.8095表示：較為滿意。「通報作業流程滿意嗎」的使用滿意度的平均數最低，平均數為2.3934，受訪者表示：較為滿意。以新版為溝通工具整體溝通滿意情形，平均數為2.558滿意。 三、開放式問卷分析資料顯示，花太多時間、速度太慢、網路的頻寬過窄又不穩定或無法登錄、作業內容繁多、作業流程問題、資訊管理問題及功能增添與建議等部分。 四、根據筆者初步研究深度訪談之後，彙整中央主管機關及地方主管機關的訪談核心二部分的問題與建議。 五、研究建議： 綜合問卷調查及深度訪談結果，提出政策層面、組織溝通層面、管理層面、實務操作層面等之建議。 【關鍵字】傳染病通報系統、嚴重急性呼吸道症候群(severe acute respiratory syndrome, SARS)、組織溝通、溝通通路、行政院衛生署疾病管制局 / 【Background and Issues】 In the spring of 2003, SARS outbreaks devastated the whole world; they also heavily damaged the world economy. Will SARS come back? How can governments manage it? How can government monitor the epidemics? How can we control the infection? When emerging and re-emerging infectious diseases such as SARS appear, how can the Center for Disease Control of the Department of Health, an organization in charge of national disease control, plan and execute measures for the control of communicable diseases? Effective communication between the central and the local competent authorities to remove together blames and misunderstanding, to develop team spirit, to attain jointly the goal of disease control, to solicit understanding and support of the public to the government, and to prevent any likely attack are some of the considerations in improving the welfare of the public. The reason of the present study was to understand, through the achievements thus far of the National Communicable Disease Reporting System, issues involved in the communication channels. The purposes of the study were to understand the major problems of the Communicable Disease Reporting and Management System (the Web version), issues involved in the reporting of emerging infectious diseases, and areas of the Communicable Disease Reporting and Management System where improvement was most urgently needed. 【Method and Materials】 Both the quantitative and qualitative methods were used. Questionnaire interview was conducted through the web to persons using the Communicable Disease Reporting and Management System throughout the country. The questionnaire contained open-end questions, closed-end questions and questions of mixed types. At the same time, to understand in depth areas not properly covered by the questionnaire interview, five key persons responsible for disease control at the time of the SARS outbreaks in 2003 at the central and the local levels were interviewed to understand their attitudes toward the control of emerging infectious diseases such as SARS, and the improvement most urgently needed for the Communicable Disease Reporting and Management System. 【Results and Recommendations】 1. Preliminary findings from analysis of the questionnaire interview showed that users became less satisfied with the new version communication means the longer they were in use of computers. Users who knew more about the use of the reporting system were more satisfied with the new communication means, were at the same time, more satisfied with the communication effects of the improved version. These facts suggested that the new reporting system was less user-friendly in the designing of interface and procedures. The system required more work, more detailed inputs, and thus added additional burdens on the part of the users. The more the users understood the reporting system, their satisfaction was higher, indicating that, for the new version reporting system to function in full, training of the users in the use of the system should be strengthened. 2. From the descriptive analysis, it was found that the average score of user satisfaction on the “information change reporting procedures” was as high as 2.8095, suggesting that the users were fairly satisfied. The satisfaction score on “reporting procedures” was the lowest at 2.3934. The overall satisfaction score on the use of the new version as a communication means was 2.558. 3. Findings from the open-end questions gave the following recommendations: taking too much time, too slow, frequency of the web too narrow, unstable, and unable to load, too detailed, issues related to operational procedures, issues related to information management and additional functions, etc. 4. By analysis of the in-depth interview, some issues were raised and recommendations made to the central and the local competent authorities. 5. Through questionnaire survey and in-depth interview, some recommendations concerning policies, organizational communication, management and practical operation were made. 【Key Words】 Communicable Disease Reporting System, SARS (Severe Acute Respiratory Syndrome), organizational communication, communication channels, Center for Disease Control, the Department of Health

A medicina de viagem (MV) surgiu em resposta ao crescente deslocamento populacional, com o objetivo de prevenir os agravos à saúde relacionados às viagens. No Brasil teve inicio no final da década de 90, momento em que reformas socioeconômicas levaram a melhorias das condições de vida dos brasileiros. O Núcleo de Medicina do Viajante (NMV), do Instituto de Infectologia Emilio Ribas (IIER), foi o primeiro serviço de atenção à saúde do viajante criado na cidade de São Paulo, em maio de 2000. O presente estudo visa: descrever a população de viajantes que procuraram orientação pré-viagem no Núcleo de Medicina do Viajante (NMV) do Instituto de Infectologia Emilio Ribas (IIER) no período de janeiro de 2006 a dezembro de 2010; descrever as medidas de prevenção recomendadas em relação às doenças infecciosas; descrever as atividades de ensino realizadas e a participação do serviço na discussão de diretrizes em políticas públicas em medicina de viagem. No período estudado, 2744 viajantes procuraram orientação pré-viagem no NMV do IIER. Foram realizados 2836 atendimentos de orientação pré-viagem, 92 viajantes procuraram o serviço mais de uma vez. A faixa etária entre 18 e 34 anos (54,2%), o sexo feminino (51,1%) e grau de educação superior (75,5%) foram as principais características demográficas desses viajantes. Os destinos mais procurados foram: África (24,5%), Europa (21,2%), Ásia (16,6%) e Brasil (19,2%). O turismo (35,7%) e o trabalho (35,7%) foram os motivos de viagem mais referidos. O tempo de permanência menor ou igual a 30 dias foi referido pelos viajantes em que o objetivo de viagem foi o turismo, enquanto os viajantes que referiram o trabalho ou estudo apresentaram maior tempo de permanência (p < 0,001). O meio de transporte mais referido foi o aéreo (62,8%). Os viajantes relataram durante a consulta pré-viagem dificuldade de acesso ao serviço. As fontes de informação mais referidas foram: informação a partir de amigos, indicação por profissional da saúde e mídia eletrônica. As medidas de prevenção recomendadas variaram conforme o destino. O tratamento autoadministrado para diarreia foi mais recomendado aos viajantes com destino à Ásia. As vacinas de febre amarela, poliomielite e antimeningocócica A e C foram mais recomendadas aos viajantes com destino à África, assim como a quimioprofilaxia para malária, que foi recomendada para 26,4% dos viajantes para esse destino. A quimioprofilaxia (QPX) para malária foi recomendada em 10,3% de todas as orientações. Houve diferença com significância estatística na recomendação segundo a finalidade (p < 0,30), o destino (p < 0,001) e a duração da viagem (p < 0,001). Das 422 orientações realizadas aos viajantes com destino ao Brasil, a QPX foi recomendada somente para 30 (7,1%). Dos 2744 viajantes atendidos, 664 (24,2%) relataram pelo menos uma morbidade prévia; 66 (2,4%) eram menores de 10 anos de idade; e 157 (5,7%) tinham 60 anos ou mais. Em relação às atividades de ensino, no período do estudo, 83 médicos residentes estagiaram no NMV e foram orientadas onze monografias de conclusão de residência médica. O NMV participou de 12 reuniões para discussão de diretrizes sobre a saúde do viajante e de iniciativas como a Carta de São Paulo (documento em defesa da saúde do viajante elaborado por acadêmicos e profissionais de saúde participantes do SUS). Da criação da Sociedade Brasileira de Medicina de Viagem e da criação do Comitê Estadual de Saúde do Viajante, pela Secretaria de Estado da Saúde de São Paulo. Essas atividades foram passos decisivos para corroborar a implementação de políticas públicas em saúde do viajante no Brasil / Travel medicine (TM) arose in response to the growing population displacement and its objective is the prevention of health problems related to travel. Began in Brazil in the in the late 1990s, at which socioeconomic reforms have led to improvements in of life of Brazilians. Travel Medicine Center (TMC) at \"Instituto de Infectologia Emilio Ribas\" (IIER) was the first health of traveler service created in São Paulo city in May 2000. The present study aims: to describe the traveler population who sought pre-travel guidance in TMC at IIER from January 2006 to December 2010; to describe the recommended preventive measures to travelers concerned with infectious diseases; to describe the teaching activities performed and the service involvement in debating guidelines about public policies in travel medicine. In the time period studied, a total of 2744 travelers sought pre-travel guidance in TMC of IIER, but 2836 assistances were provided for pre-trip orientation since 92 travelers sought the service more than once. The age group between 18-34 years (54.2%), female (51.1%), and university level degree (75.5%) were the main demographic characteristics. The more popular destinations were: Africa (24.5%), Europe (21.2%), Asia (16.6%) and Brazil (19.2%). Tourism (35.7%) and work (35.7%) were the main purposes of trip for travelers. For tourism purpose travelers would stay 30 or less days, while for work or study they stayed for a longer time (p <0,001). Commercial air travel was the preferred alternative (62.8%). The main sources of information were friends, health professionals, and electronic media. The recommended preventive measures varied according to the destination. The self-treatment for diarrhea was more recommended for travelers to Asia. Vaccination against yellow fever, polio, and anti-meningococcal (A and C) was more recommended for travelers to Africa, as well as chemoprophylaxis (CP) of malaria was recommended for 26.4% of travelers to the same country. The CP of malaria was indicated for 10.3% of all assistances. There was statistically significant difference in the recommendation according to purpose (p < 030), destination (p < 0.001) and trip duration (p < 0.001). From 422 assistances to travelers to Brazil, CP was only recommended for 30 (7.1%) travelers. From the 2744 travelers assisted, 664 (24.2%) reported at least one previous morbidity; 66 (2.4%) were under age 10; and 157 (5.7%) were 60 years or older. During the research period and relating to study activities, 83 residents were interns in TMC, and eleven monographs for completion of the Medical Residency were supervised. TMC participated in 12 meetings to discuss guidelines in travel medicine, and participated in initiatives such as \"Carta de São Paulo\" (a document in defense of traveler health prepared by academics and health professionals participating in the Unified Health System); in the institution of the Brazilian Society of Travel Medicine, and of the São Paulo State Travel Medicine Committee by the Secretariat for Health of São Paulo State. These were decisive steps to support implementation of public policies in traveler health in Brazil

The lack of a contextualised, relevant communication strategy focusing specifically on HAST diseases in the Limpopo Province was the impetus for this research. The purpose of this study was, therefore, to explore the knowledge, perceptions and utilisation of health facilities for HAST in order to develop an acceptable and effective communication strategy for the Province to address the high rate of HAST diseases. The study followed a qualitative approach guided by the major tenets of the Health Belief Model, namely, to determine modifying factors, individual beliefs and cues for action. An in-depth literature review was followed by focus group interviews with the community members and personal interviews with District and Provincial Deputy Directors. Based on these findings, a communication strategy was drafted and piloted for three months in one of the districts in Limpopo. Further refinement of the communication strategy followed after member-checking and further interviews with directors HAST. The final strategy specifically focused on risk groups with each of the diseases in terms of their beliefs and perceptions. It further resulted in guidelines for health providers in terms of the content and implementation of effective communication strategies within the context of educational, cultural, social and economic factors relevant to Limpopo / Health Studies / D. Litt. et Phil. (Health Studies)

Thesis in English, Annexure E: Consent form (leaf 81) as well as KABP Survey Questionnaire (leaves 87-91) in English and SiSwati. / The purpose of the study was to assess knowledge, explore attitudes and determine practices of breastfeeding mothers living with HIV regarding post-natal PMTCT interventions and services. The study was quantitative and descriptive in nature, utilising a retrospective cohort design. The study sample included breastfeeding mothers living with HIV, who attended the King Sobhuza II public health unit in the Manzini region of Swaziland. A written questionnaire was administered to a non-random sample of 90 consecutively selected mothers living with HIV attending the above-cited public health unit for post-natal health purposes. The overall study results revealed that the majority of breastfeeding mothers living with HIV in the afore-mentioned region (77.8%) presented high levels of knowledge on PMTCT, and 90% demonstrated a positive attitude; while a further 90% also demonstrated positive behaviour towards PMTCT. However, stigma and discrimination among family members, non-disclosure of HIV status to sexual partners; as well as poverty and fear of future drug-resistance are the cause of non-adherence to ARV prophylaxis. Furthermore, inconsistent condom use, mixed-feeding methods and wet-nursing also emerged as other contributing factors to the increase of post-natal mother-to-child transmission of HIV among breastfeeding mothers living with HIV. / Health Studies / M.A. (Nursing Science)

In its efforts to reduce maternal mortality and prevent Mother-to-Child Transmission of HIV, the government of Swaziland developed and implemented several programmes including a special antenatal care package for HIV-positive pregnant women in line with the WHO (2009) guidelines. Since the implementation of this latest special ANC package for HIV-positive women, little is known about how these services are experienced by the intended recipients. The purpose of this study was to explore and describe the actual experiences of HIV-positive women with the antenatal care services provided at a regional referral hospital in Swaziland, with the view of providing more insight into the quality of ANC services from the users' perspectives. A qualitative descriptive, exploratory design was used to address the above purpose. The researcher used purposive sampling to select the participants who met the inclusion criteria for the study. Semi-structured individual interviews were used and saturation was reached after 18 individual face-to-face interviews. Thematic content analysis was used to analyse the collected data. Forteen themes related to the participants experiences with the ANC services and seven related to measures for improvement emerged from data. In general HIV positive pregnant women expressed positive views towards ANC services they received at the target institution. The results give an indication on the quality of the focussed ANC package provided at the hospital and specific recommendations for improvement are outlined. / Health Studies / M. A. (Nursing Science)

The purpose of this study was to assess the epidemiology of preventable risk factors for NCDs among the adult population in Tigray, Northern Ethiopia. A quantitative descriptive cross-sectional design was employed to describe the distribution of behavioural and biological risk factors for NCDs, assess the status of knowledge, perceptions, attitude and behaviour of the study participants for NCDs and their risk factors, and a matched case-control study to identify the determinants of hypertension. The data was collected using a structured questionnaire for the interview, physical measurements including weight and height scales, non-elastic measuring tape for waist and hip circumferences, Omron digital BP apparatus for blood pressure and heart rate; Accutrend Plus for measuring fasting blood glucose, cholesterol and triglycerides. For the descriptive cross-sectional study a total of 2347 participants were included, and for the matched case control study a total of 117 cases and 235 controls participated. Behavioural and biological risk factors were assessed. Only 0.8% of the study participants used optimal fruit serving per day. The prevalence of low level physical activity (<600 MET-minutes/week) was 44.8%. The magnitude of ever alcohol consumption was 66.8%. However, the magnitude of khat chewing and tobacco smoking among the study participants was not as high as the other risk factors i.e. 3.3% and 2.3% respectively. The magnitude of hypertension, central obesity, hyperglycaemia, hypercholesterolemia and hypertriglyceridemia was 9.9%, 22.2%, 3.5%, 30.3% and 32.2% respectively. Factors associated with the risks aforementioned were gender, age, place of residence, education, knowledge status on NCDs, mental stress and others. The status of knowledge on CVDs, breast and cervical cancers, diabetes and their potential risk factors was low and not comprehensive. Misconceptions on NCDs and body size and shape were pervasive. Risky behaviours underlying NCDs were rampant in the study population. Factors related to poor knowledge on NCDs were gender, age, place of residence, education and misconceptions on NCDs. The determinants of hypertension were physical inactivity, duration of alcohol intake, central obesity and mental stress. Awareness raising interventions on NCDs and their risk factors; improving socio-economic status and accessibility to health care settings have to be in place to curb these formidable problems. / Health Studies / D. Litt. et Phil. (Health Studies)