Introdução - Considerada um grave problema de saúde pública mundial em regiões de clima tropical e subtropical, a dengue foi a única dentre as doenças tropicais negligenciadas a apresentar tendência de aumento na mortalidade nos últimos anos. Fatores relacionados ao ciclo de vida do principal vetor, fêmeas do mosquito Aedes aegypti, influenciam a distribuição espacial e o caráter sazonal da doença. A incidência de casos de dengue é dependente de uma complexa rede de relações entre vetor, vírus e hospedeiro, assim como a ocorrência de casos graves e de óbito. Desde a introdução do vírus, o estado de São Paulo vem apresentado epidemias envolvendo número cada vez maior de municípios, de incidência de casos e de óbitos por dengue. Objetivo - Avaliar a distribuição espacial, temporal e espaço-temporal dos óbitos por dengue no estado de São Paulo. Métodos - Trata-se de estudo ecológico, com componentes espacial e temporal, a partir da notificação de óbitos por dengue no SINAN, tendo como unidades de análise os municípios e as microrregiões do estado de São Paulo, no período de 1998 a 2017. Os óbitos por dengue no estado de São Paulo foram descritos segundo sexo e idade. As taxas de mortalidade bruta, padronizada por sexo e idade e suavizada pelo método bayesiano empírico local foram estimadas e mapeadas segundo município de residência. Os sorotipos detectados pelo Instituto Adolfo Lutz foram mapeados segundo microrregião. Estimou-se as tendências temporais da mortalidade. Aglomerados de alto risco espacial e espaço-temporal e de variação espacial na tendência temporal foram detectados e mapeados. O risco relativo espacial da mortalidade por dengue ajustado pelo tempo e covariáveis consideradas foi estimado por modelos Bayesianos Gaussianos Latentes com abordagem INLA (2007 - 2016). Foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Saúde Pública da Universidade de São Paulo sob parecer de número 1.687.650. Resultados - Foram identificados 1.121 óbitos por dengue com confirmação laboratorial e residentes no estado de São Paulo entre 1998 e 2017. A mediana de idade foi de 57 anos. A média anual da mortalidade bruta por dengue no estado de São Paulo na série histórica foi de 0,14 óbitos por 100.000 habitantes. Houve tendência de elevação da mortalidade para todos os sexos e idades no período, sendo o crescimento mais proeminente nos adultos com >= 50 anos, e de aumento do percentual de municípios com casos e óbitos ao longo dos anos estudados. Houve associação positiva entre as regiões com maior quantidade de sorotipos e taxas de mortalidade mais elevadas. Aglomerados de alto risco foram identificados nas áreas com alta taxa de mortalidade. O grau de urbanização, número de anos com casos e a introdução de novo sorotipo associaram-se a um maior risco relativo para a mortalidade por dengue. Tanto as taxas de mortalidade mais elevadas, quanto os maiores riscos relativos para o óbito foram observados nas regiões norte, noroeste, oeste, sudeste e litoral do estado de São Paulo. Conclusão - a mortalidade por dengue no estado de São Paulo apresentou padrão cíclico e sazonal, com tendência de elevação principalmente nas faixas etárias mais avançadas. Houve identificação de agregados de área de alto risco, com associação do grau de urbanização, do número de anos com casos e da introdução de novo sorotipo a maior risco de mortalidade por dengue. / Introduction - Considered a major global public health problem in tropical and subtropical regions, dengue was the only one among neglected tropical diseases to show an increase in mortality in recent years. Factors related to the life cycle of the main vector, females of Aedes aegypti mosquito, influence the spatial distribution and the seasonal nature of the disease. The incidence of dengue cases is dependent on a complex network of relationships between vector, virus and host, as well as the occurrence of severe cases and death. Since the introduction of the virus, the state of São Paulo has been presenting epidemics involving an increasing number of municipalities, incidence of cases and deaths due to dengue. Objective - To evaluate the spatial, temporal and spatial-temporal distribution of dengue deaths in the state of São Paulo. Methods - This is an ecological study, with spatial and temporal components, based on the notification of dengue deaths at SINAN, with the municipalities and microregions of the state of São Paulo as analysis units from 1998 to 2017. Deaths from dengue in the State of São Paulo were described according to sex and age. The crude mortality rates standardized by sex and age and smoothed by the local empirical Bayesian method were estimated and mapped according to the municipality of residence. The serotypes detected by the Adolfo Lutz Institute were mapped according to microregion. The temporal trends of mortality were estimated. High-risk space and space-time clusters and spatial variation in time trend were detected and mapped. The spatial relative risk of dengue mortality adjusted by time and covariables considered was estimated by Latent Gaussian Bayesian models with INLA approach (2007 - 2016). It was approved by the Research Ethics Committee of the School of Public Health of the University of São Paulo under opinion number 1,687,650. Results - A total of 1,121 dengue deaths with laboratory confirmation were identified and residents of the State of São Paulo between 1998 and 2017. The median age was 57 years. The annual average of the gross mortality from dengue in State of São Paulo in the historical series was 0.14 deaths per 100,000 inhabitants. There was a trend of increased mortality for all sexes and ages in the period, with the most prominent growth in adults aged >= 50 years, and an increase in the percentage of municipalities with cases and deaths over the years studied. There was positive association between the regions with the highest number of serotypes and the highest mortality rates. High-risk clusters were identified in areas with high mortality rates. The degree of urbanization, number of years with cases and the introduction of a new serotype were associated with a higher relative risk for dengue mortality. Both the highest mortality rates and the highest relative risks for death were observed in the north, northwest, west, southeast and coastal regions of the State of São Paulo. Conclusion - dengue mortality in the state of São Paulo presented a cyclical and seasonal pattern, with a tendency to increase mainly in the more advanced age groups. There was identification of high risk area clusters, with association of the degree of urbanization, number of years with cases and the introduction of a new serotype at greater risk of dengue mortality.

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

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

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

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

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

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

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

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

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