Thesis (Ph.D.)--University of Melbourne, Dept. of Opthalmology, 2007. / Typescript. SAFE Strategy refers to Surgery for trichiasis, Antibiotics for active infection, Facial cleanliness and Environmental improvements. Includes bibliographical references (leaves 233-253). Also available electronically: http://eprints.unimelb.edu.au/archive/00003844.

225 leaves printed on single pages, preliminary pages i- xxiii and numbered pages 1-203. Includes bibliography, list of abbreviations, list of definitions, list of tables and figures and list of appendices. / Digitized at 330 dpi color PDF format (OCR), using KODAK i 1220 PLUS scanner. / Thesis (MNutr (Interdisciplinary Health Sciences))--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: "A comprehensive package of care for the Prevention of Mother- To-Child Transmission (PMTCT) of HIV" states that all mothers participating in the PMTCT Programme should receive education that will enable them to make informed decisions about infant feeding options. Rapid, same-day HIV testing and results that are available immediately, enable health care workers to be responsible for providing pre- and post-test counselling (which includes infant feeding options) on the same day. This could place a tremendous workload and time pressure on the health care workers. The aim of this study was to determine how "informed" is the literate mother's decision regarding infant feeding options, who participated in the PMTCT Programme, in the Gert Sibande District, Mpumalanga, South Africa. Method: Data was collected from health care workers and mothers on the PMTCT Programme at 23 PMTCT sites in the Gert Sibande District, with the help of 6 field workers and the PMTCT site manager at each PMTCT site, by means of once-off, self-administered questionnaires, which had been previously tested and validated. Results: Health care workers' attitude towards the PMTCT Programme was positive, although some (14%) indicated that what was expected of them was not achievable in their working environment. The most prominent change relating to the personal preferences of health care workers regarding infant feeding options for HIV-infected mothers, after attending the 5-day PMTCT course, was from formula-feeding to breast-feeding. Most (65%) indicated it was possible to stay neutral in a counselling session regardless of personal preference for infant feeding and 60% of those who could not stay neutral, still thought it was in the mother's best interest to be counselled by them. Most (98%) agreed mothers had the right to make informed decisions and 80% agreed mothers were able to make such a decision. Most (67%) health care workers indicated that not enough staff was stationed at PMTCT sites, only 53% used the feeding option cards when counselling mothers and indicated that more educational material was needed. Sixty one percent of the health care workers demonstrated the preparation of the formula to the mothers and allowed the mothers to demonstrate back to them. Between 49-82% and 37-56% of the health care workers knew the correct answers to knowledge questions relating to breastfeeding and formula-feeding, respectively. Not one health care worker, nor mother, knew all the steps in preparing a formula feed. Most (80%) mothers made decisions based on information provided to them by health care workers and only a small (13%) percentage were influenced by the community to practise a different feeding option than what they had chosen. Conclusions: The attitude, personal preferences, knowledge of and resources available to health care workers, influenced the decision made by mothers regarding infant feeding options and seeing that most mothers made their decision, based on information provided by health care workers, it is concluded that mothers can only make an informed decision about infant feeding options if they are advised appropriately by well trained, equipped and informed health care workers. / AFRIKAANSE OPSOMMING: "A comprehensive package of care for the Prevention of Mother-To-Child Transmission of HIV", vermeld dat moeders, wat deelneem aan die Voorkoming van Moeder-Tot-Kind Oordrag (VMTKO) progam, voorligting behoort te ontvang ten opsigte van voedingsopsies vir hul babas, sodat hulle in staat sal wees om 'n ingeligte keuse te maak. Gesondheidswerkers is verantwoordelik om voorligting voor en na die HIV toets te gee, wat die voedingsopsies vir babas insluit, op dieselfde dag. Dit kan 'n ontsaglike werkslading op die gesondheidswerkers plaas. Die doel van die studie was om te bepaal hoe "ingelig" is die geletterde moeder se keuse ten opsigte van voedingsopsies, wat deelneem aan die VMTKO program, in die Gert Sibande distrik, Mpumalanga, Suid-Afrika. Metode: Die data is ingesamel by 23 VMTKO-klinieke en -hospitale in die Gert Sibande distrik onder gesondheidswerkers en moeders op die VMTKO-program, met behulp van 6 veldwerkers en VMTKO-bestuurders, deur middel van eenmalige, selfvoltooide vraelyste, wat van tevore getoets en gevalideer was. Resultate: Die gesondheidswerkers se houding teenoor die VMTKO-program was positief, alhoewel 14% aangedui het dat wat van hulle verwag word nie prakties of moontlik is in hul werksomgewing nie. Die prominentste verandering rakende die persoonlike voorkeure van die gesonheidswerkers teenoor voedingsopsies vir HIV -geinfekteerde moeders, na die 5-dag VMTKO kursus, was van formulevoeding na borsvoeding. Meeste (65%) het aangedui dit is moontlik om neutraal te bly gedurende 'n voorligtingssessie, ten spyte van persoonlike voorkeure vir voedingsopsies en 60% van die wat nie neutraal kon bly nie, het steeds gedink dit is in die beste belang van die moeder om deur hulle voorgelig te word. Meeste (98%) het saamgestem dat dit die moeder se reg is om 'n ingeligte keuse te maak en 80% het saamgestem dat die moeder wel in staat is om so 'n besluit te neem. Meeste (67%) gesondheidswerkers het aangedui dat personeel tekorte bestaan by die VMTKO klinieke en hospitale. Slegs 53% gebruik die voedingsopsie kaarte gedurende 'n voorligtingsessie met die moeder en het aangedui dat meer voorligtingsmateriaal benodig word. Een en sestig persent van die gesondheidswerkers het die voorbereiding van die formulevoeding aan die moeders gedemonstreer en het moeders toegelaat om ook die demonstrasie te doen. Nege en veertig tot twee en tagtig persent en 37-56% van die gesondheidswerkers kon die korrekte antwoorde verskaf vir vrae oor borsvoeding en formulevoeding, afsonderlik. Nie een gesondheidswerker of moeder kon al die stappe vir die voorbereiding van die formulevoeding noem nie. Meeste (80%) moeders maak keuses gebaseer op inligting wat aan hulle verskaf word deur die gesondheidswerkers en slegs 'n klein persentasie (13%) word beinvloed deur familielede om die teenoorgestelde voedingsopsie te praktiseer as wat hulle gekies het. Gevolgtrekking: Die houding, persoonlike voorkeure, kennis van en hulpbronne beskikbaar aan die gesongheidswerkers, beinvloed die besluit wat moeders neem ten op sigte van voedingsopsies en aangesien die moeders hulle besluit baseer op inligting wat deur die gesondheidswerkers aan hulle gegee word, word die gevolgtrekking gemaak dat moeders slegs 'n ingeligte keuse aangaande voedingsopsies kan maak indien hulle voorligting ontvang deur goed opgeleide en ingeligte gesondheidswerkers.

Vulnerabilidade e empoderamento apresentam-se como elementos presentes na vida profissional e pessoal dos enfermeiros. Delimitou-se como objeto de estudo as representações sociais elaboradas por enfermeiros que cuidam de pacientes com HIV/Aids acerca de sua vulnerabilidade no contexto do cuidar em enfermagem. O objetivo geral foi analisar as representações sociais construídas por enfermeiros acerca de sua vulnerabilidade no contexto do cuidado que exercem. Trata-se de pesquisa qualitativa, descritiva e exploratória, orientada pelo referencial teórico-metodológico das Representações Sociais em sua abordagem processual. Participaram do estudo trinta enfermeiros de um hospital público municipal do Rio de Janeiro. Como técnicas de coleta de dados foram utilizados o questionário sociodemográfico e a entrevista semiestruturada em profundidade. Como técnica de análise de dados adotou-se a análise de conteúdo temático-categorial proposta por Bardin, sistematizada por Oliveira e operacionalizada pelo software QSR NVivo 9.0. Entre os sujeitos, há predomínio do gênero feminino, da faixa etária de 41 a 45 anos, da realização de pós-graduação lato sensu e de tempo de atuação mínimo de 16 anos em HIV/Aids. Sete categorias emergiram na segmentação do material discursivo: 1) O acesso a informações, a formação profissional e o desenvolvimento da naturalização da aids através da experiência: elementos de vulnerabilidade e de empoderamento; 2) A instituição hospitalar e sua infraestrutura como polo de vulnerabilidade e de empoderamento nas construções simbólicas de enfermeiros que cuidam de pacientes com HIV/Aids; 3) Entre o risco e a prevenção: a vulnerabilidade e o empoderamento no contexto dos acidentes ocupacionais biológicos e as práticas preventivas adotadas por enfermeiros frente ao HIV/Aids no cotidiano hospitalar; 4) Relações interpessoais entre enfermeiro e paciente soropositivo para o HIV enquanto mediadoras da vulnerabilidade e do empoderamento de ambos; 5) As limitações psíquicas enfrentadas por enfermeiros no vivenciar do trabalho junto a portadores do HIV/Aids; 6) A busca pela espiritualidade e pela religiosidade como bases de apoio para a vida profissional contextualizada na aids; e 7) O HIV e a aids no contexto de diferentes modalidades de relacionamento: a presença do risco como elemento organizador da discursividade. Na vida profissional, as representações sociais da vulnerabilidade são compostas pela fragilidade, pelo risco e pela dificuldade. O empoderamento, por sua vez, emerge sustentado por um tripéformado pela proteção, suporte e satisfação como elementosdo bem-estar. Na vida pessoal, o risco possui centralidade nas representações. Já o empoderamento se mostra oriundo do bem-estar e da proteção. Conclui-se que a reconstrução sociocognitiva da vulnerabilidade e do empoderamento permitiu o acesso ao arsenal simbólico do qual o grupo dispõe para a superação do que o ameaça. Vulnerabilidade e empoderamento são, portanto, diversificados e mutáveis em suas bases e produtos e, em movimentos de balanço e contrabalanço, corporificam a díade vulnerabilidade-empoderamento. / Vulnerability and empowerment present themselves as elements of the professional life of nurses. It was established as study object the social representations developed by nurses who care for patients with HIV/Aids on their vulnerability in the nursing context concerned. This is a qualitative, descriptive, and exploratory research based on the theoretical and methodological reference from the Social Representations in its processual approach. Participated in the study thirty nurses from a municipal public hospital of Rio de Janeiro, Brazil. The data collection techniques were the sociodemographic questionnaire and the detailed semi-structured interview. With regard to the data analysis, the thematic and categorical content analysis proposed by Bardin, systematized by Oliveira, and performed through the software QSR NVivo 9.0, was adopted. Among the subjects, it is highlighted the predominance of the female gender, the age group from 41 to 45 years, the catholic individuals, the stable relations, the lato sensu graduate course, and the minimum experience of 16 years in HIV/aids scenario. As qualitative results, seven categories emerged in the segmentation of the discursive material: 1) The access to information, professional training, and development of aids naturalization through experience: elements of vulnerability and empowerment; 2) The hospital institution and its infrastructure as a pole of vulnerability and empowerment in the symbolic constructions of nurses who care for patients with HIV/Aids; 3) Between risk and prevention: the vulnerability and empowerment in the context of biological labor accidents and the preventive practices adopted by nurses facing HIV/Aids in the hospital daily activities; 4) Interpersonal relations between nurse and HIV-seropositive patient as mediators of their vulnerability and empowerment; 5) The psychic limitations faced by nurses experiencing the work with patients with HIV/Aids; 6) The search for spirituality and religiosity as supporting bases for the professional life contextualized within aids; and 7) The HIV and aids in the context of different modalities of relationship: the presence of risk as an organizing element of discursivity. In professional life, the social representations of vulnerability are formed through frailty, risk, and difficulty. Empowerment, in its turn, emerges on a tripod formed by protection, support, and satisfaction as elements of well-being. In personal life, risk plays a central role in the representations of vulnerability. And empowerment shows to come from the intersections between well-being and protection. It was concluded that the social and cognitive reconstruction of vulnerability and empowerment allowed access to the symbolic arsenal which the group has to overcome its threatening danger. Vulnerability and empowerment are, thus, diversified and changeable with regard to their bases and products, in balance and counterbalance movements which embody the dyad vulnerability-empowerment.

The prevalence of Brucella canis in South Africa is unknown and suspected to be under-detected. The majority of dogs in South Africa are not tested for Brucella canis, not only because of the level of awareness of Brucella canis in South Africa, but also because of the lack of clinical suspicion. It is not known how the infection entered South Africa. Brucella canis, a zoonotic organism that causes canine brucellosis in dogs, is a significant cause of reproductive failure in dogs worldwide. Canine brucellosis is a chronic infectious zoonotic disease whose main etiological agent, the Brucella canis bacterium, are rough, intracellular proteobacteria in the Brucellaceae family. Clinical signs in bitches are mainly infertility and abortion, while in males, epididymitis and orchitis occur. However, discospondylitis may develop in both sexes. A serological survey was conducted to determine the prevalence of Brucella canis infection in dogs from the Nelson Mandela Bay Metropolitan (NMBM) Port Elizabeth (PE) area. A total of 400 samples were collected, 350 of which were collected in seven different townships and 50 were collected in the three different welfare organisations in the study area. Of the 400 serum samples collected, 39 (9.75%) tested serologically positive by using the Tube Agglutination Test (TAT), the 2-Mercaptoethanol-TAT (2ME-TAT) or the Compliment Fixation Test (CFT). The results of the CFT showed that nine of the 39 positive samples had a maximum antibody titre of 784 IU/ml. The prevalence rate varied tremendously between the samples from the townships and those from the welfare organisations. The prevalence rate of seropositive animals in PE ranged between 5% and 16% in the study area. No positive cases were found in KwaMagxaki and the Animal Welfare Society of PE, but both were surrounded by areas that had positive cases of Brucella canis infection. The female dogs in the study area had a higher sero-prevalence of only 0.0169 (95% CI, 0.0631 to 0.1489) differences in proportion, and were thus not significant (p > 0.05). However, the female spayed dogs had a much higher significant difference of 0.1898 (95% iv CI, 0.1058 to 0.2738) in proportion to the male neutered dogs and were thus statistically significant (p < 0.05). Despite those results, out of all the dogs positive for Brucella canis only two were neutered males and five were spayed females, and the rest were all intact. In conclusion, according to the results, Brucella canis antibodies were detected in sera of dogs mostly from the townships surveyed. Preventive measures against this contagion should be taken into consideration to eliminate Brucella canis infection from the entire dog population. Reservoir dogs and actively infected dogs either should be kept in quarantine or should be euthanized, because not only can they spread the disease and end the reproductive life of any breeding animal, but they are also a risk to human health. Even though this is the first survey conducted in the Eastern Cape, the results are still high dogs in the study area had a higher sero-prevalence of only 0.0169 (95% CI, 0.0631 to 0.1489) differences in proportion, and were thus not significant (p > 0.05). However, the female spayed dogs had a much higher significant difference of 0.1898 (95% iv CI, 0.1058 to 0.2738) in proportion to the male neutered dogs and were thus statistically significant (p < 0.05). Despite those results, out of all the dogs positive for Brucella canis only two were neutered males and five were spayed females, and the rest were all intact. In conclusion, according to the results, Brucella canis antibodies were detected in sera of dogs mostly from the townships surveyed. Preventive measures against this contagion should be taken into consideration to eliminate Brucella canis infection from the entire dog population. Reservoir dogs and actively infected dogs either should be kept in quarantine or should be euthanized, because not only can they spread the disease and end the reproductive life of any breeding animal, but they are also a risk to human health. Even though this is the first survey conducted in the Eastern Cape, the results are still high / College of Agriculture and Environmental Sciences / M. Sc. (Agriculture)

Vulnerabilidade e empoderamento apresentam-se como elementos presentes na vida profissional e pessoal dos enfermeiros. Delimitou-se como objeto de estudo as representações sociais elaboradas por enfermeiros que cuidam de pacientes com HIV/Aids acerca de sua vulnerabilidade no contexto do cuidar em enfermagem. O objetivo geral foi analisar as representações sociais construídas por enfermeiros acerca de sua vulnerabilidade no contexto do cuidado que exercem. Trata-se de pesquisa qualitativa, descritiva e exploratória, orientada pelo referencial teórico-metodológico das Representações Sociais em sua abordagem processual. Participaram do estudo trinta enfermeiros de um hospital público municipal do Rio de Janeiro. Como técnicas de coleta de dados foram utilizados o questionário sociodemográfico e a entrevista semiestruturada em profundidade. Como técnica de análise de dados adotou-se a análise de conteúdo temático-categorial proposta por Bardin, sistematizada por Oliveira e operacionalizada pelo software QSR NVivo 9.0. Entre os sujeitos, há predomínio do gênero feminino, da faixa etária de 41 a 45 anos, da realização de pós-graduação lato sensu e de tempo de atuação mínimo de 16 anos em HIV/Aids. Sete categorias emergiram na segmentação do material discursivo: 1) O acesso a informações, a formação profissional e o desenvolvimento da naturalização da aids através da experiência: elementos de vulnerabilidade e de empoderamento; 2) A instituição hospitalar e sua infraestrutura como polo de vulnerabilidade e de empoderamento nas construções simbólicas de enfermeiros que cuidam de pacientes com HIV/Aids; 3) Entre o risco e a prevenção: a vulnerabilidade e o empoderamento no contexto dos acidentes ocupacionais biológicos e as práticas preventivas adotadas por enfermeiros frente ao HIV/Aids no cotidiano hospitalar; 4) Relações interpessoais entre enfermeiro e paciente soropositivo para o HIV enquanto mediadoras da vulnerabilidade e do empoderamento de ambos; 5) As limitações psíquicas enfrentadas por enfermeiros no vivenciar do trabalho junto a portadores do HIV/Aids; 6) A busca pela espiritualidade e pela religiosidade como bases de apoio para a vida profissional contextualizada na aids; e 7) O HIV e a aids no contexto de diferentes modalidades de relacionamento: a presença do risco como elemento organizador da discursividade. Na vida profissional, as representações sociais da vulnerabilidade são compostas pela fragilidade, pelo risco e pela dificuldade. O empoderamento, por sua vez, emerge sustentado por um tripéformado pela proteção, suporte e satisfação como elementosdo bem-estar. Na vida pessoal, o risco possui centralidade nas representações. Já o empoderamento se mostra oriundo do bem-estar e da proteção. Conclui-se que a reconstrução sociocognitiva da vulnerabilidade e do empoderamento permitiu o acesso ao arsenal simbólico do qual o grupo dispõe para a superação do que o ameaça. Vulnerabilidade e empoderamento são, portanto, diversificados e mutáveis em suas bases e produtos e, em movimentos de balanço e contrabalanço, corporificam a díade vulnerabilidade-empoderamento. / Vulnerability and empowerment present themselves as elements of the professional life of nurses. It was established as study object the social representations developed by nurses who care for patients with HIV/Aids on their vulnerability in the nursing context concerned. This is a qualitative, descriptive, and exploratory research based on the theoretical and methodological reference from the Social Representations in its processual approach. Participated in the study thirty nurses from a municipal public hospital of Rio de Janeiro, Brazil. The data collection techniques were the sociodemographic questionnaire and the detailed semi-structured interview. With regard to the data analysis, the thematic and categorical content analysis proposed by Bardin, systematized by Oliveira, and performed through the software QSR NVivo 9.0, was adopted. Among the subjects, it is highlighted the predominance of the female gender, the age group from 41 to 45 years, the catholic individuals, the stable relations, the lato sensu graduate course, and the minimum experience of 16 years in HIV/aids scenario. As qualitative results, seven categories emerged in the segmentation of the discursive material: 1) The access to information, professional training, and development of aids naturalization through experience: elements of vulnerability and empowerment; 2) The hospital institution and its infrastructure as a pole of vulnerability and empowerment in the symbolic constructions of nurses who care for patients with HIV/Aids; 3) Between risk and prevention: the vulnerability and empowerment in the context of biological labor accidents and the preventive practices adopted by nurses facing HIV/Aids in the hospital daily activities; 4) Interpersonal relations between nurse and HIV-seropositive patient as mediators of their vulnerability and empowerment; 5) The psychic limitations faced by nurses experiencing the work with patients with HIV/Aids; 6) The search for spirituality and religiosity as supporting bases for the professional life contextualized within aids; and 7) The HIV and aids in the context of different modalities of relationship: the presence of risk as an organizing element of discursivity. In professional life, the social representations of vulnerability are formed through frailty, risk, and difficulty. Empowerment, in its turn, emerges on a tripod formed by protection, support, and satisfaction as elements of well-being. In personal life, risk plays a central role in the representations of vulnerability. And empowerment shows to come from the intersections between well-being and protection. It was concluded that the social and cognitive reconstruction of vulnerability and empowerment allowed access to the symbolic arsenal which the group has to overcome its threatening danger. Vulnerability and empowerment are, thus, diversified and changeable with regard to their bases and products, in balance and counterbalance movements which embody the dyad vulnerability-empowerment.

Traditional Public Health decision-support can benefit from the Web and social media revolution. This dissertation presents approaches to mining social media benefiting public health epidemiology. Through discovery and analysis of trends in Influenza related blogs, a correlation to Centers for Disease Control and Prevention (CDC) influenza-like-illness patient reporting at sentinel health-care providers is verified. A second approach considers personal beliefs of vaccination in social media. A vaccine for human papillomavirus (HPV) was approved by the Food and Drug Administration in May 2006. The virus is present in nearly all cervical cancers and implicated in many throat and oral cancers. Results from automatic sentiment classification of HPV vaccination beliefs are presented which will enable more accurate prediction of the vaccine's population-level impact. Two epidemic models are introduced that embody the intimate social networks related to HPV transmission. Ultimately, aggregating these methodologies with epidemic and social network modeling facilitate effective development of strategies for targeted interventions.

Background Bikesharing is a versatile intervention, that enables cheap and convenient cycling for urban populations, and according to recent literature, has a positive impact on health, safety and the economy. Many of these impacts are based on the assumption of a modal shift induced by bikesharing, i.e. implementing a Bicycle Sharing System (BSS) will increase population cycling. However, the evidence is inconclusive. The aim of this study was to evaluate if the intervention of implementing a BSS increases cycling. The study was conducted using bicycle count data from Helsinki between 2014 to 2018. Methods A controlled interrupted time series design was used in combination with segmented regression as the method. An intervention series and a control series were analysed separately. The slopes (trend) and intercepts (level) of pre-intervention (2014&amp;2015) segments were compared with post-intervention segments (2016-2018). The same analysis was performed in both intervention series and control series.  ResultsThe results from the intervention series showed an increase of 105% in the level of the outcome after the implementation of the intervention. Simultaneously, the control series showed that the underlying trend of cycling remained largely unchanged during the whole study period (level increased by 3%). Stratified analysis supported these results in both intervention and control series.   Conclusion The analysis of the intervention series revealed, that the level of the outcome increased sharply after the intervention, implying that the intervention had an immediate effect. However, the lack of statistical significance in the analysis of the slopes made it impossible to determine if the effect was sustained.

MPH / Department of Public Health

MPH / Department of Public Health / See the attached abstract below

MPH / Department of Public Health / Background: Malaria is a public health issue killing more than 435 000 people in Sub Saharan Africa. In South Africa, malaria is endemic in 3 provinces namely: Limpopo, Mpumalanga and Kwazulu Natal. Limpopo Province contributes more cases than the other provinces in the country. Purpose: The purpose of the study was to assess community knowledge and prevention practices of malaria at Masisi village, in Mutale Municipality, Vhembe District. The study was conducted at Mutale municipality, Vhembe District. Methodology: A quantitative cross-sectional descriptive approach was used. Data was collected using a questionnaire with open and close ended questions. The targeted population was made up of males and females between the ages of 18 to 75. Validity and reliability have been ensured in the study and the results for reliability were 0.85. Pretesting was done in 5 household at Sanari village which is near Masisi village as they share the same characteristics. A sample of 152 participants was selected from the target population by means of systematic sampling and then select them randomly. Questionnaires were used to collect data. There after Data were analyzed using SPSS version 24.0. The analyzed data were presented in tables, graphs, and in percentages. Results: The findings revealed that majority of the participants 103(67.8%) have secondary education, and most of them, 103(67.8%) are unemployed. The study revealed that about 77% have knowledge regarding malaria transmission. About 130(85.5%) indicated that malaria is caused by a mosquito bite. About 57(38.51%) indicated that they use mosquito coils and nets in their household. Conclusion: Malaria still poses a threat to the lives of people living in malaria endemic areas. Community members at Masisi village have better insight regarding malaria transmission, causes and signs and symptoms. Although the community shows a better understanding of the prevention method they still has to put this into practice in order to eliminate malaria in the area. Health workers are doing a great job in educating the community regarding malaria related issues. / NRF