Submitted in fulfilment of the requirements for the Degree of Master of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2015 / Brief background: The Expanded Programme on Immunisation (EPI) is one of the most powerful and cost-effective public health programmes to improve child survival. In South Africa the programme remained fragmented because of the system of apartheid until 1995 when the national EPI was formed through the unification of all immunisation services in the country. Since then there have been significant advances in immunisation service delivery in South Africa. Amongst the revisions that were made in 2009 was the change of the EPI schedule. Aim of the study The aim of the study was to investigate the factors that influence the uptake of the revised EPI for children between the ages of 6 to 12 years at Umlazi Township, KwaZulu-Natal in order to improve immunisation coverage. Methodology A descriptive quantitative design was used to conduct the study. A total of ten primary health care clinics were included in the study. Data was collected from child caregivers and health care workers using self-directed questionnaires. Results: It was worth noting that although the results of the study revealed that the EPI coverage for children between the ages 6 to 12 years remained low in Umlazi Township, however, the programme was well-implemented. Several factors that influenced the uptake of the immunisations were identified and these factors could be used to strengthen the EPI programme in Umlazi. Factors that had a negative influence on the uptake of immunisations were also identified and these factors could be used to develop strategies address the challenges.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Water-borne infections have been a menace in many countries around the globe, claiming millions of lives. Cholera in particular has spread to all continents and now on its seventh epidemic. Although control measures have been continually developed through sanitation, vaccination and rehydration, the infection still devastates populations whenever there is an outbreak. In this research work, mathematical models for cholera transmission dynamics with focus on the impact of sanitation and hygiene, metapopulation spread, optimal control and biological control using a bacteriophage specific for pathogenic Vibrio cholerae are constructed and analysed. Vital analyses for the models are precisely given as well as numerical results depicting long term behaviour and the evolution of populations over time. The results of our analysis indicate that; improved sanitation and hand-hygiene are vital in reducing cholera infections; the spread of disease across metapopulations characterised by exchange of individuals and no cross community infection is associated with synchronous fluctuation of populations in both adjacent communities; during control of cholera, the control measures/efforts ought to be optimal especially at the beginning of the epidemic where the outbreak is often explosive in nature; and biological control if well implemented would avert many potential infections by lowering the concentration of pathogenic vibrios in the aquatic environment to values lower than the infectious dose. / AFRIKAANSE OPSOMMING: Water-infeksies is ’n bedreiging in baie lande regoor die wêreld en eis miljoene lewens. Cholera in die besonder, het op sy sewende epidemie na alle kontinente versprei. Hoewel beheermaatreëls voortdurend ontwikkel word deur middel van higiëne, inentings en rehidrasie, vernietig die infeksie steeds bevolkings wanneer daar ’n uitbraak voorkom. In hierdie navorsingswerk, word wiskundige modelle vir cholera-oordrag dinamika met die fokus op die impak van higiëne, metabevolking verspreiding, optimale beheer en biologiese beheer met behulp van ’n bakteriofaag spesifiek vir patogene Vibrio cholerae gebou en ontleed. Noodsaaklike ontledings vir die modelle is gegee sowel as numeriese resultate wat die langtermyn gedrag uitbeeld en die ontwikkeling van die bevolking oor tyd. Die resultate van ons ontleding dui daarop dat; verbeterde higiëne is noodsaaklik in die vermindering van cholera infeksies; die verspreiding van die siekte oor metapopulaties gekenmerk deur die uitruil van individue en geen kruis gemeenskap infeksie wat verband houmet sinchrone skommeling van bevolkings in beide aangrensende gemeenskappe; tydens die beheer van cholera,behoort die beheermaatreëls/pogings optimaal te wees veral aan die begin van die epidemie waar die uitbreking dikwels plofbaar in die natuur is; en biologiese beheer, indien dit goed geïmplementeer word, kan baie potensiële infeksies voorkom deur ’n vermindering in die konsentrasie van patogene vibrio in die water tot waardes laer as die aansteeklike dosis.

Submitted in fulfillment of the requirements for the degree of Master of Technology: Emergency Medical Care, Durban University of Technology, Durban, South Africa, 2013. / Background In the Emergency Medical Services (EMS), paramedics play a vital role in the treatment of critically ill or injured patients, as they are often the first link or point of contact for the patient in the healthcare setting. They may therefore also play a vital role in the prevention and control of the transmission of communicable diseases, provided that proper infection control measures are in place. The objectives of the study There is presently no national policy on communicable diseases and infection control that is specifically designed for use in the South African prehospital environment. Given the paucity of research in the area, qualitative multiple case studies were conducted to develop an ambulance specific disinfection protocol and to evaluate its effectiveness in the public sector EMS in the eThekwini District of KwaZulu-Natal. Methodology The study comprised of three phases. In the first phase focus group discussions were conducted to identify the factors needed to develop a disinfection protocol. The study population consisted of both operational and management staff from the EMS under study. The first four focus groups consisted of eight to ten EMS operational staff each and the fifth focus group consisted of five EMS management staff. Thereafter, the information gathered was used in conjunction with internationally accepted guidelines to develop an ambulance specific disinfection protocol (Phase Two). The third phase entailed the implementation of the protocol at seven ambulance bases in the eThekwini health district and the evaluation of the protocol with the use of an open-ended questionnaire at two weeks and four weeks after implementation. A single ambulance crew and their immediate supervisor from each base were utilized in this phase. Conclusion and recommendations An ambulance specific disinfection protocol was developed and implemented in the EMS under study. During the development, implementation and evaluation of the protocol, many themes with regard to infection control in EMS were identified. These themes were used to better understand the present situation in EMS in relation to infection control and in the formulation of recommendations to assist in the improvement of the present situation. The researcher recommended that all EMS staff require training and education with regard to infection control and prevention. The development and implementation of a protocol and policy document for infection control specifically for EMS is required. There is a need for the deployment of more ambulances and the employment of more operational EMS staff together with the appointment of Infection Control Supervisors at all ambulance bases. Without adequate infrastructure needed to meet infection control and prevention requirements, there may be a serious risk to both staff and the patients they serve. / M

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-04-03T11:16:12Z No. of bitstreams: 1 Mário Henrique da Mata Martins.pdf: 5332165 bytes, checksum: 092a2beea420955fa7d651dff0349e90 (MD5) / Made available in DSpace on 2018-04-03T11:16:12Z (GMT). No. of bitstreams: 1 Mário Henrique da Mata Martins.pdf: 5332165 bytes, checksum: 092a2beea420955fa7d651dff0349e90 (MD5) Previous issue date: 2018-03-01 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The purpose of this thesis was to explore the ways in which causes to a public health problem, people responsible for its existence and specific places and periods for intervention are assigned, engendering certain government strategies to the detriment of others. Our goal was to make visible the effects of these definitions on the actions of a public policy and to problematize the bases that sustain their production. The phenomenon of our study was human leptospirosis, a potentially lethal disease which has been doubly neglected by public policy because of the invisibility of its population profile and its mimetic clinical picture. We adopted discursive practices as our theoretical and methodological framework and focused on the attribution processes presented in the definition of this public health problem and on the versions produced. An analytical tool was developed in order to enable the analysis of these elements in documents of public domain (scientific articles, models of notification and investigation forms, campaign materials) and speeches (interviews with managers, technicians and users of public health services). In our analysis of the Brazilian scientific literature on the subject, we have identified a recurrent attribution of cause to the bacteria, which could lead one to believe that the investment in vaccines and antibiotics would eliminate the problem. However, the plurality of types of bacteria and the controversy over the use of antibiotics in cases of leptospirosis show the limitation of this reasoning. The analysis of the leptospirosis models of notification and investigation forms made it possible to identify that a biomedical version of the disease was produced with the justification that only clinical-laboratory factors, in detriment of environmental and epidemiological data would be under direct responsibility of the health sector. On the other hand, when analysing posters, folders and leaflets used in the campaigns for the prevention of leptospirosis in a Brazilian municipality, we have identified that they present a preventive version of the disease. In these materials, the communicational model is unidirectional and authoritarian, and the responsibility for infection and prevention actions is attributed to the population, sometimes acknowledging and sometimes neglecting their living conditions. Finally, we have also analysed the attributions of cause and responsibility for the disease in the speeches of managers, technicians and users of health services. Through the analysis, it was possible to identify five common causes and responsibilities addressed by the participants: social conditions, basic sanitation, the rat, the preparation of the health sector and the population. However, the resolution uttered by the majority of managers and technicians was the need to inform, educate and/or punish the population, an attribution that is not presented in the users' speech and points to a lack of dialogue between these groups. Given the multiplicity of attributions and the potential effects they generate for the management of Brazilian health policy, we could defend the thesis that the definition of a health problem is a psychosocial practice in which the attributions and associations between repertoires constitute a central element of dispute, produced in the use of language / O objetivo desta tese foi explorar os modos pelos quais se atribuem causas a um problema de saúde pública, pessoas responsáveis por sua existência e lugares e períodos específicos para intervir sobre ele, engendrando determinadas estratégias de governo em detrimentos de outras. Nossa meta foi tornar visíveis os efeitos dessas definições nas ações de uma política pública e problematizar os fundamentos que sustentam sua produção. Nosso fenômeno de estudo foi a leptospirose humana, uma doença potencialmente letal que tem sido duplamente negligenciada pela política pública em virtude da invisibilidade de seu perfil populacional e seu quadro clínico mimético. O referencial teórico-metodológico adotado foi o das práticas discursivas com foco nos processos de atribuição, presentes na definição do problema e nas versões produzidas sobre o fenômeno. Uma ferramenta analítica foi desenvolvida para possibilitar a análise desses elementos em documentos de domínio público (artigos científicos, modelos de fichas de investigação e materiais de campanha) e falas (entrevistas com gestores, técnicos e usuários dos serviços de saúde). Em nossa análise da literatura científica brasileira sobre o assunto, identificamos uma recorrência à atribuição de causa à bactéria, o que poderia levar a crer que o investimento em vacinas e antibióticos eliminaria o problema. Todavia, a pluralidade de tipos da bactéria e a controvérsia sobre o uso ou não de antibióticos para casos de leptospirose evidenciam a limitação desse raciocínio. A análise que realizamos dos modelos das fichas de notificação e investigação da leptospirose, possibilitou identificar que, conforme os modelos eram alterados, uma versão biomédica da doença era produzida, com a justificativa de que apenas fatores de ordem clínico-laboratorial, em detrimento de dados ambientais e epidemiológicos, seriam de responsabilidade direta do setor saúde. Por outro lado, analisamos os cartazes, folders e panfletos utilizados nas campanhas de prevenção à leptospirose em um município brasileiro e identificamos que eles apresentam uma versão preventiva da doença. Nesses materiais, o modelo comunicacional é unidirecional e autoritário e a responsabilidade pela infecção e pelas ações de prevenção é atribuída à população, ora reconhecendo, ora negligenciando suas condições de vida. Por fim, analisamos também as atribuições de causa e responsabilidade pela doença nas falas de gestores, técnicos e usuários dos serviços de saúde. Por meio da análise, foi possível identificar cinco causas e responsáveis comuns abordados pelos participantes: as condições sociais, o saneamento básico, o rato, a preparação do setor saúde e a população. Todavia, a resolução proferida pela maioria dos gestores e técnicos foi a necessidade de informar, educar e/ou punir a população, atribuição que não se apresenta na fala dos usuários e aponta para uma falta de diálogo entre esses grupos. Tendo em vista a multiplicidade de atribuições e os efeitos potenciais que geram para o gerenciamento da política de saúde brasileira, pudemos defender a tese de que a definição de um problema de saúde é uma prática psicossocial na qual as atribuições e as associações entre repertórios que as constituem figuram um elemento central de disputa, produzidos na linguagem em uso

published_or_final_version / Politics and Public Administration / Doctoral / Doctor of Philosophy

Orientadores: Ana Maria Segall Correa, Antonieta Keiko Kakuda Shimo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-13T02:09:05Z (GMT). No. of bitstreams: 1 Feracin_JussaraCunhaFleury_D.pdf: 1330727 bytes, checksum: 070897d55253d8c3248839454c7f0a06 (MD5) Previous issue date: 2009 / Resumo: Constitui prioridade de pesquisa e intervenção no Brasil a transmissão vertical do vírus HIV, infecção que tem aumentado entre as mulheres em idade fértil, resultando em progressiva redução na relação homem/mulher. O objetivo deste trabalho é analisar as ações de prevenção da transmissão vertical do vírus da AIDS durante o pré-natal, parto e puerpério, bem como as ações de vigilância epidemiológica, entre as mulheres grávidas soropositivas ao vírus HIV, residentes em um município do interior do estado de São Paulo. Trata-se de estudo realizado em duas fases, com abordagem quantitativa na primeira e qualitativa na segunda. Na primeira, descreve-se a situação epidemiológica dos 11 municípios pertencentes àquele Departamento, no período de janeiro de 2000 a dezembro de 2005, partindo-se das notificações e das fichas epidemiológicas de 112 gestantes portadoras do vírus HIV e das crianças nascidas destas gestações. As informações referem-se à idade das mulheres, local de sua moradia, momento de identificação da infecção, local e data do parto, além daquelas relativas aos procedimentos assistenciais terapêuticos e profiláticos. Na abordagem qualitativa, ou seja, na segunda fase foram realizadas entrevistas nas quais foi utilizado um roteiro padronizado e pré-testado com enfermeiros e médicos que prestam atendimento às gestantes e parturientes nas Unidades Básicas de Saúde e Hospital do município sede do Departamento Regional. Os resultados mostram, entre outras coisas, que todas as gestantes residiam em zona urbana, a maioria era branca (67,9%), de baixa escolaridade, sendo que mais de dois terços não haviam completado o primeiro grau e 42,9% tinham idade abaixo de 25 anos. Mais da metade conhecia seu status de soro-positividade antes da gravidez (53,6%) e para 10,7%, essa era a 2ª gravidez após o diagnóstico. Foram observadas falhas na profilaxia da transmissão vertical na gestação, parto e pós-parto. Nessa última intervenção, 17 mulheres não receberam AZT intravenoso e três recém-nascidos não fizeram profilaxia com AZT oral e outros três iniciaram a profilaxia 24 horas depois do parto. A estimativa de transmissão vertical do HIV foi de 4,5%. Na etapa qualitativa, foi observado que as solicitações de exames anti-HIV eram rotina estabelecida no pré-natal, não havendo, no entanto, aconselhamento pré e pósteste. No momento que antecede o parto, é sempre solicitado teste rápido. A necessidade da profilaxia, a indicação do parto cesariano e a inibição da lactação são de conhecimento dos profissionais, porém, esses profissionais não referem à forma como manejam essas intervenções. Conforme dados epidemiológicos resultantes desta pesquisa, algumas atitudes relacionadas à assistência às gestantes HIV positivas e a seus filhos não atendem as recomendações do Ministério da Saúde para a redução da transmissão vertical e as falas dos profissionais reforçam a necessidade de programas de capacitação e treinamentos na forma de educação continuada sobre o assunto para alcançar o objetivo proposto nas diretrizes nacionais de saúde / Abstract: A priority for public health research and intervention in Brazil is the vertical transmission of the AIDS virus, which has increased among women of reproductive age, resulting in a decreasing male/female ratio. The objective of this study is to analyze actions to prevent the vertical transmission of the AIDS virus during pregnancy, childbirth, and postpartum period, as well as the actions of epidemiological monitoring, of HIV-positive pregnant women residing in a city in the interior of the state of São Paulo. The study has two phases, one quantitative and the other qualitative. The first phase consisted of a descriptive study of the epidemiological situation in 11 municipalities pertaining to the Department of Health in the period from January, 2000, to December, 2005, based on epidemiological notifications and case records of HIV-positive pregnant women and the children resulting from those pregnancies. Information collected included the women's age, residence; time the HIV infection was identified, locale and date of delivery, as well as data on therapeutic and prophylactic care procedures. In the qualitative phase of the study, semi-structured interviews were conducted with nurses and physicians working in Primary Health Care Units and hospitals in the city where the Regional Health Department is located and, who provide care to the pregnant women and newborns. All the pregnant women reside in the urban area, most are White, with low educational levels, and 42.9% were less than 25 years old. More than half were aware of their HIV-positive status before becoming pregnant, and 10.7% of these were in their second pregnancy after having been diagnosed. Errors were observed in prophylactic procedures to prevent vertical transmission during pregnancy, during childbirth, and post-partum. With reference to the latter, 17 women were not given intravenous AZT, three newborns were not given AZT orally, and an additional three initiated prophylaxis 24 hours postpartum. The estimated vertical transmission of HIV was 4.46%. In the qualitative phase, it was observed that requests for anti-HIV tests were routine in pre-natal care, but with no counseling provided before or after the test. A rapid test is routinely requested at the moment just before childbirth, but there are no institutional standardized procedures that obligate staff to follow the recommendations that come with the test. The need for prophylaxis, cesarean birth, and inhibition of lactation are known by the professionals, however they do not refer to the way they normally deal with those procedures with the women. It was also observed that pediatricians deal better than other professionals with patients diagnosed as HIV-positive. The observed failures in health care and epidemiological surveillance for HIV-positive pregnant women and for their children confirm that the Ministry of Health HIV/AIDS protocols were not always followed by the health professionals, which shows the needs for continuing education, as they themselves pointed out / Doutorado / Saude Coletiva / Doutor em Saude Coletiva

The following treatise first frames the role of CBOs in responding to the HIV/Aids crisis in relation to their position in the global health governance system through a literature survey that moves from an analysis of the global structures down to the local. The survey covers the role of international organisations, international NGOs (INGOs), national governments, local NGOs and CBOs and outlines the context in which Masizakhe is working within the global health governance structure. Secondly the research design and methodology are outlined focusing on the longitudinal, case study and participant--‐observation approaches. Hypotheses, conceptualisation, definitions, key variables are described and data collection methods and fieldwork practice extrapolated upon. Following that data capturing, editing and analysis are discussed in conjunction with shortcomings and sources of error. In the fourth chapter the research discusses the history, structure and outlines the research findings by comparing what has changed within the organisation over time, presenting and discussing the results. The outcomes of this research have shown that existing problems in this particular CBO are very difficult to overcome without committed, sustained support from donors, government, community and the organisation’s members. CBOs are often hamstrung by a series of intersecting factors which hamper their ability to problem--‐solve, even when the route to overcoming the problem is clear, particularly when the capacity and will to do so is not always present from both within the organisation and from outside support systems. These challenges then impact on the overall quality of and ability to deliver the services the organisation is structured to deliver. The major challenge for the organisation remains the inconsistent donor cycle and resultant instability thus created within an organisation already working in a highly volatile, unstable situation marked by poverty and disease. Thus the title, The Aids of Aid?, captures the essence of Masizakhe’s struggle with its own syndrome of problems. It summarises a comment made by the project secretary said that: “Sometimes it feels like we are not only fighting for the health of our people – We are fighting for the health of our organisation. We are a sick organisation trying to help sick people. All we need is donors and funding –we can’t live without them, and when they don't give, we get sick” (Stamper, Pers Comm, 2011). The other emergent challenges were a battle internally with ‘founder syndrome’, lack of management transparency and a dysfunctional board.

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.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Nurses, midwives and clinical officers referred to as Mid-level Practioners (MLPs) play an important role in the health care system especially in rural Africa. With particular reference to rural Uganda, due to the large shortage of doctors, MLPs handle most of the duties usually meant for doctors, at health centre IV(s). From 2009 to 2011, two training interventions of MLPs were performed at 36 sites in Uganda by the Integrated Infectious Disease Capacity Building Evaluation (IDCAP). The two interventions were: Integrated Management of Infectious Diseases (IMID) and On-site Support Services (OSS) which aimed at improving MLPs’ case management for four diseases: HIV, TB, pneumonia and malaria. In this thesis, we have developed three mathematical models to investigate the effect of the two training interventions on these infectious diseases. All the models are formulated using systems of ordinary differential equations which are structured in three age groups: [0, 5), [5, 14) and [14, 50). We explored the effect of the two training interventions in the context of malaria-pneumonia, HIV-TB co-infections and the four diseases together. Our analysis shows that: i) For malaria-pneumonia, both IMID and the combination of IMID and OSS reduce the number of cases, deaths and prevalence of disease but have no effect on the incident episodes of disease. ii) Results from the HIVTB model propose that HIV and TB testing are important steps in quality of health care and are capable of offsetting slightly negative effects of reduction in ART enrollment and provision of treatment. iii) The HIV-TB-malaria-pneumonia (HTMP) model concurs with the results of the first two models and its results demonstrate that high coverage levels of the training interventions increase the positive effects that the interventions have on mortality and morbidity. Overall, our results suggest that training of MLPs is much more effective for the short term duration diseases such as malaria and pneumonia, where the baseline values for most of the performance indicators are ≥ 0.6, but not so much for long term duration diseases such as HIV and TB, whose baseline values for most of the performance indicators are < 0.6. The results further highlight that problems such as case detection and drug stock-outs need to be addressed in order for training to have substantial impact, especially in instances where the performance indicator proportions are low. / AFRIKAANSE OPSOMMING: Verpleegsters, vroedvroue en kliniese beamptes wat gesamentlik na verwys word as midvlak praktisyns (MVPs) , speel n belangrike rol in die gesondheidsorg sisteem, veral in landelike dele van Afrika. Met spesifieke verwysing na gesondheid sentrums in Uganda, waar daar te min dokters is, hanteer MVPs die meeste van die pligte wat eintlik deur dokters verrig moet word. Vanaf 2009 tot 2011 is twee opleidingsprogramme vir MVPs by 36 fasiliteite in Uganda deur die Integrated Infectious Disease Capacity Building Evaluation (IDCAP) organisasie aangebied. Die twee programme staan bekend as: Integrated Management of Infectious Diseases (IMID) and On-site Support Services (OSS). Beide die programme stel ten doel om die MVPs se pasint bestuur vir die siektes MIV, tuberkulose (TB), longontsteking en malaria te verbeter. Drie wiskundige modelle word in hierdie tesis ontwikkel om die effek van die opleidingsprogramme op hierdie oordraagbare siektes te ondersoek. Al die modelle word geformuleer deur gebruik te maak van stelsels van gewone differensiaal vergelykings wat gestruktureer is in drie ouderdomsgroepe: [0, 5), [5, 14) en [14, 50). Die effek van die opleidings programme word in die konteks van longontstekingmalaria mede-infeksie, MIV- TB mede-infeksie en al vier siektes gelyk, ondersoek. Die analise wys dat: i) Vir longontsteking-malaria mede-infeksie het beide IMID en die kombinasie van IMID en OSS die aantal siekte-gevalle, sterftes en die prevalensie van die siektes verminder, maar het geen effek op die insidensie van siekte-gevalle nie. ii) Resultate van die MIV-TB model dui aan dat MIV en TB toetsing n belangrike aspek van die gehalte van sorg is en dat dit die effense negatiewe effek van die afname in ART inskrywing en voorsiening van behandeling, teenstaan. iii) Die MIV-TB-longontsteking-malaria model (HTMP) stem ooreen met die resultate van die bogenoemde twee modelle en demonstreer dat ho dekking van die opleidingsprogramme die positiewe effek van die programme op mortaliteit en morbiditeit verhoog. In geheel stel die resultate van hierdie studie voor dat die opleiding van MVPs baie meer effektief is vir die korttermyn siektes soos malaria en longontsteking waarvoor die meeste van die beginwaardes van die prestasie-aanwysers ≥ 0.6 is, maar nie soveel vir lang-termyn siektes soos MIV en TB waarvoor die meeste van die beginwaarde van die prestasie-aanwysers < 0.6 is. Die resultate dui verder aan dat opleiding nie voldoende is wanneer die prestasie-aanwysers < 0.6 is nie en dat probleme soos die opsporing van siekte-gevalle en n gebrek aan medisyne by die klinieke aangespreek moet word vir opleiding om aansienlike impak te hê.

M.Cur. / Statistics prove that the monster called HIV/AIDS invades our country. More women are said to be HIV positive in comparison to men. The midwives are the frontline health workers who have to care for these pregnant HIV positive women and therefore are at occupational risk of HIV infection because of their caring role. The experience of midwives regarding the delivery of the babies of HIV positive women was not well addressed before as limited studies have been undertaken about the experiences of midwives, therefore inspiring the researcher to undertake this study. The purpose of this study was to: • Explore and describe how midwives experienced the delivery of the babies of HIV positive women. • Describe the guidelines for health professionals to support midwives in order for them to render good midwifery care. The paradigmatic perspective of this study was guided by the Theory for Health Promotion in Nursing (Rand Afrikaans University, Department of Nursing Science, 1992:2-15), which reflects the focus on the whole person.