In Plasmodium falciparum-infected children, the relationships between blood cell histopathology, blood plasma components, development of immunocompetence, and disease severity remain poorly understood. This investigation relates levels of the pro-inflammatory cytokines IFN-g, IL-2, TNF-a, CRP, and IL-6, and select anti-inflammatory cytokines TGF-b and IL-10 to the formation of neutrophil extracellular nets (NETs), IgG antinuclear antibodies (ANA), and IgG antineutrophil cytoplasmic antibodies (ANCA) in blood collected before and seven days after initiation of Sulfadoxine-Pyrimethamine treatment from 21 Nigerian children under six years old presenting with uncomplicated malaria. The children exhibited a Th2 dominated cytokine profile and left-shifted leukocyte differential. Elevated TNF-a levels correlated with significant NET formation evident in the peripheral blood smears. ANA levels (inclusive of all subsets of ANA) were significant in 86% of the children pretreatment and in 100% of the children seven days after SP treatment but in only 33% of age-matched control samples collected during the season of low parasite transmission. IgG ANA subset levels to dsDNA were significant in 81% of both the pre- and post treatment samples, whereas ANCA levels were positive in only 14% of both the pre-and post-treatment samples. Our results suggest that an inverse relationship between TGF-b and CRP levels may contribute to homeostasis and that TNF-a-associated NET formation and ANA may induce pathology in falciparum-infected children or activate a protective mechanism against falciparum malaria in adults. The significance of in vivo circulating chromatin in NETs and ANA to dsDNA as a causative factor in the hyporesponsiveness of CpG olignucleotide-based malaria vaccines is discussed. / A Dissertation submitted to the Department of Biological Science in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Degree Awarded: Spring Semester, 2007. / Date of Defense: April 5, 2007. / Anti-Neutrophil Cytoplasmic Antibodies, Innate Immune Protection, ANA, ANCA, Neutrophil Extracellular Traps, Falciparum Malaria, Vaccine Hyporesponsiveness, Nets, Anti-Nuclear Antibodies, Autoimmunity, Cytokines / Includes bibliographical references. / Thomas Keller, III, Professor Directing Dissertation; Qing-Xiang Sang, Outside Committee Member; Robert H. Reeves, Committee Member; Kenneth H. Roux, Committee Member; Wu-Min Deng, Committee Member.

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There is currently no effective tool available to quickly and economically measure a change in landmass in the setting of biomedical professionals and environmental specialists. The purpose of this study is to structure and demonstrate a statistical change-detection method using remotely sensed data that can detect the presence of an infectious land borne disease. Data sources included the Texas Department of Health database, which provided the types of infectious land borne diseases and indicated the geographical area to study. Methods of data collection included the gathering of images produced by digital orthophoto quadrangle and aerial videography and Landsat. Also, a method was developed to identify statistically the severity of changes of the landmass over a three-year period. Data analysis included using a unique statistical detection procedure to measure the severity of change in landmass when a disease was not present and when the disease was present. The statistical detection method was applied to two different remotely sensed platform types and again to two like remotely sensed platform types. The results indicated that when the statistical change detection method was used for two different types of remote sensing mediums (i.e.-digital orthophoto quadrangle and aerial videography), the results were negative due to skewed and unreliable data. However, when two like remote sensing mediums were used (i.e.- videography to videography and Landsat to Landsat) the results were positive and the data were reliable.

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Magister Public Health - MPH / Background: A growing concern about possible age-related inequities in health care access has emerged in the increasing debate on the challenges of population ageing and health in sub-Saharan Africa. Older persons may experience systematic exclusion from health services. Viewed as one of the poorest, most marginalized groups in SSA societies, older people are deemed to lack access to even basic, adequate health care. There is an assumption, furthermore, that older persons have less access to required health services than do younger age-groups. This suggests an element of age-related inequity. One possible indicator of age-related inequity may be found through measuring the relative availability of essential medicines for chronic non-communicable diseases (NCD), relative to the availability of medicines for communicable diseases (CD). Aim and objectives: The aim of the study was to compare the availability of essential medicines for NCD and CD in Kenya, as an indicator of age-related inequities in access to health care in Kenya. The three study objectives were as follows, in public and mission facilities in Kenya: 1. To assess the availability of medicines for the following CD: diarrhoea, HIV, malaria, pneumonia and other infections 2. To assess the availability of medicines for the following NCD common in older populations: arthritis, diabetes, glaucoma, gout, heart disease, hypertension and Parkinson’s disease 3. To compare the availability of medicines for CD and NCD and draw conclusions on possible age-related inequities in access. Study design: Using an adapted version of the HAI / WHO methodology, a cross sectional descriptive survey of medicines availability was conducted. HAI and WHO collaboratively developed a standardized and validated methodology for comprehensively measuring medicines availability, as well as prices, affordability and price components. The survey manual, launched in 2003 and revised in 2008, is available to the public. The methodology involves collecting data on the availability and price of medicines found in a sample of health facilities across sectors of interest within national health systems. If the specific medicine, dose and form being surveyed is available on the day of the survey, then the medicine is documented as being available. Methods: Random sampling was carried out in six of Kenya’s eight provinces, targetting ten facilities per province. Data on availability of the targeted medicines was collected by trained data collectors on pilot-tested data collection forms adapted from the standardized WHO / HAI methodology. The list of medicines included sixteen for communicable diseases to treat infections such as diarrhoea, HIV, malaria, and pneumonia and twelve medicines used to treat non-communicable diseases such as diabetes, arthritis, hypertension, gout, glaucoma, stroke and Parkinson’s disease. Availability of medicines was noted by physical observation by a data collector, and calculated as the percentage of facilities where a medicine was found on the day of data collection. The availability of brands and generics was not distinguished and were combined to establish availability of each medicine. Overall availability of all CD and NCD medicines was compared, and within each category between rural and urban areas and between mission and public facilities. The Ministry of Health was informed of the survey and provided the data collectors with an MOH endorsement letter. The names of facilities participating in the study were recorded on the data collection forms, but not reported. No data on individual patients was collected, and no patients were interviewed for this survey. Data were entered into an Excel file and exported to and analyzed with SPSS. Results: A total of 56 facilities were surveyed: 49 in the public sector and 7 in the mission sector, giving a facility response rate of 93%. Thirty facilities were located in rural settings and 26 were in urban settings. More CD medicines were available than medicines for NCD. Of a total of 896 individual observations of CD medicines, 632 (70.5%) were recorded as available on the day of visit, compared to 306 (45.5%) of 672 possible individual observations of NCD medicines. These differences were highly significant statistically (chi-square=98.8, p<0.001). Furthermore, comparison of availability between urban and rural areas showed statistically significant differences for NCD medicines (40.6% vs. 51.3%, p=0.007), but not CD medicines (72.5% vs. 68.3%, p=0.190). There were no significant differences in availability of medicines in mission compared to public facilities. Conclusions: This study reveals the low relative availability of medicines for NCDs in Kenya’s public and mission sector. Medicines for NCDs were less available in rural vs. urban facilities, but there was no rural vs. urban difference in medicines for CDs. While more research should be carried out to understand the reasons behind these findings, immediate attention to the supply and financing of medicines for NCDs is urgently needed. The relatively lower availability of medicines for NCDs than for CDs may be an indicator of age-related inequities in access to health care in Kenya and calls for more investigations on equity and access to health for older people in Kenya.

Call number: LD2668 .T4 1978 Q47 / Master of Science

Non-communicable diseases (NCDs), also known as chronic diseases of lifestyle, cause the greatest burden of disease globally. The major risk factors for NCDs are hypertension, hyperglycaemia, high cholesterol, tobacco smoking, alcohol abuse, overweight/obesity and physical inactivity. NCDs in South Africa are increasing in black South Africans with the transition from rural to urban areas. The transitions have resulted in a change in lifestyle. Regular moderate intensity physical activity (PA) has many health benefits and decreases the risk for NCDs. PA is often determined by means of questionnaires, motion sensors (pedometers and accelerometers), heart rate and accelerometry combined. Within the South African context PA has traditionally been determined with internationally composed questionnaires adapted for South Africa. In South Africa the relationship between PA and risk factors for NCDs has not been investigated in populations in transition, and limited information on the relationship between change in PA and the change in risk factors in a South African population is available. The objectives of this study was to determine the correlation between the adapted Baecke physical activity questionnaire and the International Physical Activity Questionnaire (short version) (IPAQ-S), the changes in PA and how the changes relate to changes in BMI, and finally the relationship between the changes in PA and the changes in the risk factors for NCDs of black South Africans. The study forms part of the baseline and five year follow-up of the South African leg of the Prospective Urban and Rural Epidemiological (PURE) study. This study is a longitudinal study of which the baseline data was allocated in 2005 and the five year follow-up allocated in 2010. 2 000 participants aged 30 years and older were recruited for the initial study – 1 000 urbanised (from Ikageng), and 1 000 rural black adults (from Ganyesa, Moswana and Tlakgameng). Data, including the PA questionnaires (Baecke & IPAQ-S) were collected by a specialised multidisciplinary team. After signing an informed consent form, questionnaires were completed during individual interviews and conducted by extensively trained fieldworkers in the language of the participants’ choice. The variables used in this study were anthropometric measurements, blood pressure, serum lipids and fasting blood glucose. BMI was calculated from the body weight divided by the height squared. Statistical analysis was performed using SPSS for windows (Version 21.0). Descriptive statistics were performed to determine the characteristics of the participants. The relationship between Baecke and IPAQ-S was determined by means of a partial correlation adjusting for age and BMI. Linear regression analyses were used to determine the relationship between the changes in PA (dependent variable) and BMI (predictor variable) and then adjusted for gender and age. Where a significant relationship was observed (in the case of setting, urban versus rural) separate analyses were performed for the rural and urban participants; likewise the relationship between the changes in PAI (dependant variable) and the change in the risk factors for NCDs (predictor variable) was determined by means of linear regression analysis, and also adjusted for gender, change in age and setting (urban/rural). The results from this study indicated that a weak but significant relationship was found between the Baecke and IPAQ-S (Spearman r = 0.243; p = 0.00) when adjusted for age and BMI. Significant differences were found between rural and urban participants for age and BMI in 2005, where the urban participants where older and reported a higher BMI compared to the rural participants. Rural women gained significantly more weight than the urban women. The PAI in the urban participants increased from 2005 (6.40 ± 1.84) to 2010 (7.50 ± 1.40), but decreased in rural participants from 2005 (8.21 ± 1.48) to 2010 (5.10 ± 1.54). Change in BMI was significantly inverse associated with change in PA for the urban population after adjusting for gender, setting (rural/urban) and change in age (β = -0.10; p = 0.004). Significant differences were found for resting systolic blood pressure (SBP) for the rural (129.72 ± 23.30) and urban (137.33 ± 25.14) participants as well as the diastolic blood pressure (DBP) of rural (86.16 ± 14.48) and urban (89.28 ± 14.46), fasting glucose of rural (4.88 ± 1.23) and urban (5.10 ± 1.86), triglycerides of rural (1.21 ± 0.64) and urban (1.38 ± 0.92) and physical activity index (PAI) of rural (8.21 ± 1.48) and urban (6.40 ± 1.84) in 2005. There were significant changes in the high density lipoprotein cholesterol (HDL-C) and in the low density lipoprotein cholesterol (LDL-C). Although the overall PAI decreased from 2005 (7.30 ± 1.90) to 2010 (6.46 ± 1.85), it increased in urban participants (6.40 ± 1.84 – 7.50 ± 1.40) and decreased in rural participants (8.21 ± 1.48 – 5.10 ± 1.54). A significant negative relationship between changes in PAI and changes in blood pressure (systolic and diastolic), total cholesterol and LDL-cholesterol was found when adjusted for gender. When changes in PA and changes in risk factors were separated according to gender, a significant negative relationship was found between PA and diastolic blood pressure (β -0.63; p 0.02) in the male population, and a significant negative relationship for females between PA and systolic blood pressure (β -1.05; p 0.002), diastolic blood pressure (β -0.59; p 0.003), total cholesterol (β -0.05; p 0.01) and LDL-cholesterol (β -0.07; p 0.00). In conclusion, the study found that the low but significant correlation between PAI assessed with the Baeck questionnaire and IPAQ-S makes both questionnaires applicable for the South African context, however the Baecke questionnaire is based on various domains for PA, while the IPAQ-S report on time spent in physical activity. Over the 5-year period PA decreased in this black South African population with a concomitant increase in BMI. Biological risk factors for NCDs increased from 2005 to 2010. The change in PA was inversely related to changes in total blood pressure. Future in PA interventions would be beneficial in the management of hypertension in the at risk South African black population. / PhD (Human Movement Science), North-West University, Potchefstroom Campus, 2014