Tuberculosis (TB) remains one of the major public health problems in South Africa. The overall aim of the research project was to evaluate the completeness of TB notification data. A descriptive study design was used. The TB data from the Disease Notification System for the period 1993 to 2003 were analysed to describe 11 year trends by province, sex and population group. The levels of under-reporting of tuberculosis were estimated by comparing the annual numbers and the rates of notified cases and deaths per 100 000 population with the data of registered cases in the electronic TB register and registered TB deaths from the Statistics South Africa’s metadata on causes of deaths in South Africa. A total of 768896 cases and 39052 deaths were recorded in the Disease Notification System for the period 1993 to 2003. The annual case load declined from 42099 cases in 1993 to 36081 in 1996, then peaked to 89111 in 1998. The peak in 1998 resulted mainly from two-fold increases in notified cases in the provinces of Eastern Cape, KwaZulu-Natal and Western Cape. There was also a three-fold increase in Western Cape in 2001 and four-fold increase in Northern Cape in 2002. The lowest numbers of notified cases were for Mpumalanga in the years 1993 to 1996. In Limpopo, a total of 13 cases only were notified between the years 1999 to 2003 inclusively. Nationally and provincially, the annual numbers of notified cases and deaths and rates per 100 000 population were consistently higher among males than females. The Wilcoxon signed rank test comparing the medians between male and female cases showed a p-value of 0.003 indicating that the difference exists between the two medians. Nationally the lowest number of deaths was 1967 notified deaths in 1994 and the highest number of deaths was 6085 notified in 2002. The number of deaths notified varied between the provinces and fluctuated between the years. It was the highest for the years 1993 to 1996 in Western Cape and the highest for the years 1997 to 2003 in Eastern Cape. It was the lowest in Mpumalanga for the years 1993 to 1997 and the lowest in Limpopo for the years 1999 to 2003 and KwaZulu-Natal in the years 2002 to 2003. The Disease Notification System was found to have lesser numbers of notified cases in comparison to registered cases recorded in the TBSYS or electronic TB register. The percent difference between notified and registered cases ranged between 28% in 2001 to 69% in 1996. Comparison of notified and registered TB deaths for the period 1997-2003 showed that the annual numbers and rates of registered deaths in the Statistics South Africa’s metadata were higher for all the years than the notified deaths in the disease surveillance system. It is recommended that the disease surveillance system is evaluated periodically, facility data assessment tools are introduced and capacity for surveillance is strengthened at all levels of the national health systems. Copyright / Dissertation (MSc)--University of Pretoria, 2009. / School of Health Systems and Public Health (SHSPH) / Unrestricted

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-07-14T14:51:53Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Dissertação para BC 26 07 16 (3) (1).pdf: 978178 bytes, checksum: 4843714a900446479ccf95b7aab6edc1 (MD5) / Made available in DSpace on 2017-07-14T14:51:53Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Dissertação para BC 26 07 16 (3) (1).pdf: 978178 bytes, checksum: 4843714a900446479ccf95b7aab6edc1 (MD5) Previous issue date: 2016-03-01 / Os acidentes de trânsito no Brasil são a causa de grande morbimortalidade anualmente, gerando dor, sofrimento e perda de qualidade de vida imputada às vítimas, aos seus familiares e à sociedade como um todo, além de custos econômicos provocados ao setor saúde e previdência. Dessa maneira, o presente trabalho tem como objetivo identificar o perfil epidemiológico das vítimas de acidentes de transporte terrestre em Pernambuco, utilizando microdados da Pesquisa Nacional de Saúde (PNS) 2013. Este trabalho é um estudo descritivo, de base populacional e corte transversal com abordagem quantitativa; para o processamento de dados, foi utilizado o programa SPSS versão 20.0. Através dessa pesquisa observou-se principalmente que a concentração de acidentes se dá com motocicleta como meio de transporte. Predominante os homens são mais acometidos, na faixa etária entre os 18 e 35 anos, mas em alguns casos o intervalo de idade entre 36 e 59 anos o percentual de vítimas fica similar; a relação do número de acidentes entre homens e mulheres pode estar atrelada a alguns fatores como homens utilizarem com maior frequência carros e motos, além de os homens beberem mais frequentemente e intensamente do que as mulheres, Sendo relevante destacar a necessidade de estudar o perfil epidemiológico dos acidentados como medida coadjuvante na formulação de estratégias de enfrentamento desse problema de saúde pública, pois os acidentes de trânsito geram como consequência uma perda anual de capital humano para o país, custos hospitalares, custos para sociedade em geral, além de custos pessoais e familiares. / Traffic accidents in Brazil are the cause of high morbidity and mortality annually, causing pain, suffering and loss of quality of life attributed to the victims, their families and society as a whole, as well as economic costs caused to the health sector and welfare. Thus, this study aims to identify the epidemiological profile of victims of road accidents in Pernambuco, using micro data from the National Health Survey (PNS) 2013. This work is a descriptive, a population-based and cross-sectional study with a quantitative approach; for data processing we used the SPSS version 20.0. Through this research, it was observed mainly that the concentration of accidents happens with the motorcycle as a means of transport; Predominantly men are more affected, aged between 18 and 35 years, but in some cases the age range between 36 and 59 years, the percentage of victims is similar; the ratio of the number of accidents between men and women may be linked to factors such as men using cars and motorcycles more often, and men drinking more frequently and intensively than women, It is important to highlight the need to study the epidemiological profile of the victims as a supporting measure in the development of strategies of coping this public health problem, since traffic accidents generate results in an annual loss of human capital for the country, hospital costs, and costs for society in general, as well as personal and family costs.

Orientador: Solange L'Abbate / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T05:47:57Z (GMT). No. of bitstreams: 1 Garcia_RosanaAparecida_D.pdf: 5581875 bytes, checksum: 00e9d86de7ff28079b760ab5c21a818d (MD5) Previous issue date: 2015 / Resumo: A Vigilância em Saúde é entendida aqui, como uma instituição - conceito base para a Análise Institucional (AI). Seu processo de institucionalização nos remete à história da Saúde Pública, impactando no atual modelo de gestão e nas ferramentas de trabalho utilizadas em sua contemporaneidade. Considerando que a Vigilância em Saúde tem raízes e processos a partir deste modelo conceitual, há um impacto na prática e estratégias utilizadas pelos sujeitos que dela fazem parte, marcada, muitas vezes, por modelos verticalizados e pouco participativos. O objetivo deste estudo foi estudar a trajetória da Vigilância em Saúde de Campinas (SP) na perspectiva da Análise Institucional sócio-histórica, buscando uma compreensão de sua gênese histórica, social e teórica e seu processo de institucionalização (duração, temporalidade e historicidade). Neste sentido, a proposta da análise institucional na vertente sócio-histórica fundamenta-se na necessidade de ampliação do conhecimento acerca de fatos no passado, mas que ainda possuem repercussão no presente. Foram utilizados alguns conceitos chave da Análise Institucional, como analisador, implicação e instituição ¿ desdobrando em seus momentos instituído, instituinte e institucionalização. Esse estudo teve natureza qualitativa, teórico e empírico, com base em entrevistas semiestruturadas e pesquisa documental. As entrevistas iniciais ¿ chamados de "entrevistas disparadoras" ¿ foram realizadas com os sujeitos que participaram dos processos iniciais de municipalização, descentralização e regionalização da Vigilância em Campinas. Em seguida foram entrevistados outros gestores e trabalhadores dos serviços de saúde que vivenciaram a história mais recente da Vigilância. A maioria das entrevistas foram gravadas e posteriormente transcritas e enviadas aos entrevistados para que acrescentassem ou retirassem o que julgassem importantes. Após a análise dos das entrevistas e de alguns documentos que trouxeram alguns eventos realizados pela Vigilância de Campinas, o grupo entrevistado foi convidado para duas oficinas de restituição para debate sobre os achados e construção do texto. O trabalho demonstrou que o modelo atual de Vigilância não insere o sujeito dentro de suas ações e nem considera seu contexto social. Tendo esse pressuposto como modelo, as estratégias utilizadas pela Vigilância são predominantemente normativas e administrativas, mais ligadas à tecnologia dura e dura-leve, ou seja, pouco se trabalha com as relações intersubjetivas que estão diretamente relacionadas com a missão da Vigilância. O modelo de Vigilância de Campinas, apesar do protagonismo dos sujeitos, mantem pouca articulação com a sociedade e controle social. Os desafios percebidos são relacionados a investir nas tecnologias leves (relacionais) no sentido de incluir os diferentes sujeitos no processo de Vigilância. A possibilidade de intercessão entre suas práticas e a sociedade, deve ser motivada por um desejo de dar autonomia aos sujeitos que protagonizarão mudanças dentro da instituição / Abstract: The Health Surveillance is understood in this thesis as an institution ¿ base concept for the Institutional Analysis. Its process of institutionalization refers to the history of Public Health, presenting an impact in the present model of management and in the work settings utilized in its contemporaneity. Since Health Surveillance has its roots and processes departing from this theoretical model, there is an impact in the practices and strategies used by the subjects who are part of it; this impact is marked very often by verticalized and non-participative models. The objective of this project was to study the journey of the Health Surveillance in Campinas (SP) in the perspective of the socio-historic Institutional Analysis, aiming at a comprehension of its historic, social and theoretical genesis and its process of institutionalization (duration, temporality and historicity). Thus, the institutional analysis purpose in the social-historical field is based in the need of spreading the knowledge about past facts but which still have repercussion until the present. Some key-concepts of the Institutional Analysis were used as analyzer, implication and institution ¿ reshaping its moments as instituted, instituter and institutionalization. This study has a qualitative, theoretical and empirical nature and it is based on semi-structured interviews and document research. The early interviews ¿ so called "triggering interviews" ¿ were made with the subjects who participated in the early processes of municipalization, decentralization and regionalization of the Health Surveillance in Campinas. Following this part other managers and health workers who lived the recent history were interviewed. Most of the interviews was recorded and then transcripted and sent to the interviewees for them to add or erase any information they could judge important. After the analysis of the interviews and some documents which brought up events made by the Health Surveillance, the interviewed group was invited for two restitution workshops for a debate about the discovers and the construction of the text. The work showed that the present model of Health Surveillance is not inclusive in its actions nor considers peoples social contexts. Having this assumption model, the strategies used by the Health Surveillance are mainly based on rules and administration and are more connected to the hard and hard-soft technology, that means that very few works are done about the inter-subjetive relations that are directly related to the mission of the Health Surveillance. The model of Health Surveillance, although its subjects are protagonists, keeps few articulation with the society and its control. The challenges observed are relational to investing in soft technologies (related) in a way that it includes different subject in the process. The possibility of interception between its practices and society must be motived by a desire of giving independence to the subjects who were protagonists in the changes inside of the institution / Doutorado / Ciências Sociais em Saúde / Doutora em Saúde Coletiva

京都大学 / 0048 / 新制・課程博士 / 博士(情報学) / 甲第22575号 / 情博第712号 / 新制||情||122(附属図書館) / 京都大学大学院情報学研究科社会情報学専攻 / (主査)教授 黒田 知宏, 教授 守屋 和幸, 教授 吉川 正俊 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DFAM

The goal of this master thesis is to construct a software system, named the LIFE Spatial Data Visualization System (LIFE-SDVS), to automatically visualize the data obtained in the LIFE project spatially. LIFE stands for the Leipzig Research Centre for Civilization Diseases. It is part of the Medical Faculty of the University of Leipzig and conducts a large medical research project focusing on civilization diseases in the Leipzig population. Currently, more than 20,000 participants have joined this population-based cohort study. The analyses in LIFE have been mostly limited to non-spatial aspects. To integrate geographical facet into the findings, a spatial visualization tool is necessary. Hence, LIFE-SDVS, an automatic map visualization tool wrapped in an interactive web interface, is constructed. LIFE-SDVS is conceptualized with a three-layered architecture: data source, functionalities and spatial visualization layers. The implementation of LIFE-SDVS was achieved by two software components: an independent, self-contained R package lifemap and the LIFE Shiny Application. The package lifemap enables the automatic spatial visualization of statistics on the map of Leipzig and to the extent of the authors knowledge, is the first R package to achieve boundary labeling for maps. The package lifemap also contains two self-developed algorithms. The Label Positioning Algorithm was constructed to find good positions within each region on a map for placing labels, statistical graphics and as starting points for boundary label leaders. The Label Alignment Algorithm solves the leader intersection problem of boundary labeling. However, to use the plotting functions in lifemap, the users need to have basic knowledge of R and it is a tedious job to manually input the argument values whenever changes on the maps are necessary. An interactive Shiny web application, the LIFE Shiny Application, is therefore built to create a user friendly data exploration and map generation tool. LIFE Shiny Application is capable of obtaining experimental data directly from the LIFE database at runtime. Additionally, a data preprocessing unit can transform the raw data into the format needed for spatial visualization. On the LIFE Shiny Application user interface, users can specify the data to display, including what data to be fetched from database and which part of the data shall be visualized, by using the filter functions provided. Many map features are also available to improve the aesthetic presentation of the maps. The resulting maps can also be downloaded for further usage in scientific publications or reports. Two use cases using LIFE hand grip strength and body mass index data demonstrate the functionalities of LIFESDVS. The current LIFE-SDVS sets a foundation for the spatial visualization of LIFE data. Suggestions on adding further functionalities into the future version are also provided.

Philosophiae Doctor - PhD / This study deals with the social interpretation of childhood diarrhea among the Xhosa speaking people of the Western Cape in South Africa. It highlights how in the Western Cape political consciousness and moralist discourses strongly influence relationships between different health care systems and the production of continuing conflicts around problems of health care delivery. It is argued that if meaningful relationships could be found between socially based health-seeking strategies and biomedical classifications of enteric and other diseases of women and children, they could facilitate the provision of more equitable, effective and widely acceptable health care. Furthermore, it compares the etiological explanations of childhood illness signs and symptoms of mothers and health practitioners of two kinds, i.e., professional nurses trained in biomedicine and indigenous African health practitioners (IHPs). The comparison focuses particularly on the interpretation of stool quality and associated symptoms. For stool quality the study refers to the color and texture of children's feces that mothers and health practitioners identify and associate with distinctive conditions of affliction. The study found these descriptive categories do not exhaust the variety of interpretations known to Nguni people in the area. There is variation, even ambiguity, in the interpretation of commonly understood illness categories and with respect to diarrheal illnesses, knowledge remains contested between mothers and professional nurses. Moreover, the availability of a wide range of therapeutic options m Khayelitsha diversifies the mother's causal explanations. It was found this diversity in causality and management of illnesses is manifested in the quality of children's stools, "green" feces in particular. Here too, different hues are not separable from the media in which they appear. Their interpretations draw on senses of value, ideas, social histories, different forms of power, systematic knowledge, and a great variety of other forms of significance that are embedded in the concrete domains of everyday life. In addition to the notion of isuntu,(that is humaneness) the study more importantly reveals that among Nguni of the Western Cape a tripartite relationship of umoya,(vital force) inyongo,(gallbladder) and ithongo (ancetral dream) is the dynamic philosophical component that describes Nguni experiences of health and illness. vi https://etd.

L’utilisation des pesticides peut être à l’origine de graves nuisances pour la santé humaine,comme l’ont montré les études en milieu professionnel agricole.L’objectif de cette thèse était d’étudier les manifestations, principalement respiratoires etsurvenant à court terme, dans la population générale exposée aux pesticides utilisés enagriculture.Les résultats de deux études épidémiologiques, Phytoriv, menée en Gironde et Phytoniger, plusexploratoire, sont présentés, toutes deux menées au sein de population d’adultes et d’enfantsvivant en milieu rural.L’étude Phytoriv a mis en évidence la présence de concentrations faibles mais plus élevées depesticides dans l’air ambiant à proximité de zones viticoles traitées et a permis de recueillir surune période de une à trois semaines les symptômes ressentis par les riverains de manièrejournalière. L’absence d’effet majeur de l’exposition sur la santé respiratoire chez les riverainsobservée dans cette étude demande à être confirmée, en améliorant notamment l’estimationtemporelle et spatiale de l’exposition.L’étude Phytoniger a permis de démontrer la faisabilité d’une étude de santé environnementaledans un pays en développement. L’utilisation de pesticides non autorisés et potentiellementdangereux, pour des usages agricoles mais également domestiques, est importante au Niger etpose la question de leur impact sur la santé des populations. Certains symptômes respiratoiresétaient plus fréquemment observés en zone agricole humide, où les usages de pesticides, maiségalement les feux de démoustication, sont plus importants qu’en zone sahélienne agropastorale.Enfin, dans les deux études Phytoriv et Phytoniger, des risques plus élevés de symptômesrespiratoires étaient observés, notamment chez les enfants, en lien avec l’utilisation domestiquede pesticides.A l’avenir, une caractérisation plus précise des sources, niveaux et déterminants d’exposition dela population générale permettrait d’améliorer les connaissances sur le lien avec la survenue desymptômes et pathologies respiratoires et d’identifier les axes d’intervention les plus pertinents. / Pesticides are widely used in agriculture worldwide. However, it is now recognised thatoccupational pesticide exposure, especially in agriculture, can pose serious health concerns. Weaimed to study short term respiratory symptoms in general populations exposed to pesticidesused in agriculture.Here we present results of two epidemiological studies, Phytoriv, performed in Bordeaux area,France, and Phytoniger, performed in a Sahelian African country, both among rural adult andchildren populations.Higher pesticide levels in ambient air were observed in the surrounding of vineyards in Phytoriv.However, no major effect was observed on resident’s respiratory health. This need to beconfirmed by studies with improved temporal and spatial exposure assessment.Phytoniger allowed us to show the feasibility of environmental health studies in a developingcountry. Unauthorized and hazardous pesticides are widely used in Niger, for agricultural as wellas for residential purposes, and concerns are growing on their potential health effects. Some ofthe short term respiratory symptoms were more frequent in the agricultural wetland area,compared to the Sahelian agro-pastoral area. Pesticides are more susceptible to be used in thefirst area, but it is also more subject to mosquito control fires.Finally in both surveys, higher risks of respiratory symptoms have been observed for peopleliving in houses treated with indoor pesticides, and especially in children.All these results warrants further studies to improve assessment of sources, exposure levels anddeterminants of pesticide exposure in the general population, in order to improve knowledge onits respiratory and short term health effects. Thus, relevant public health interventions could beperformed.

This dissertation describes the epidemiological investigation and management of the first outbreak of Contagious Equine Metritis (CEM) reported in South Africa. In addition, the subsequent implementation of a nationwide quantitative polymerase chain reaction (qPCR)- based stallion screening programme and traceback of exposed animals to define the spread of CEM in South Africa is described. The first South African outbreak of CEM caused by the bacterium, Taylorella equigenitalis was reported on the 9th May 2011 to the World Health Organisation for Animal Health (OIE). The outbreak was recognized subsequent to the importation of a young Warmblood stallion from Germany. The outbreak initially appeared confined to a single index property (focus property), an equine breeding facility in Midrand, Gauteng, South Africa with a single confirmed case of transmission involving the index stallion and a Thoroughbred mare. The initial response was rapidly instituted following the suspicion of T. equigenitalis on the index property. This included an inspection of the index property and its records. A riskclassification of in-contact animals allocated them to “high,” “moderate” or “low”-risk categories. The classification was dependent on the temporal relationship of their presence on the index property relative to the period of residence of the index cases. After T. equigenitalis infection was confirmed from both index cases, the breeding facility was placed under state– administered quarantine and all exposed mares and the index cases were transferred to a quarantine facility. The animals were re-tested by genital swabbing for bacterial culture following a standard protocol according to internationally-accepted practice (OIE Terrestrial Manual on Contagious Equine Metritis). Additional duplicate swabs were obtained for real time qPCR. None of the mares were shown to be positive on either bacterial culture or qPCR. All animals were however treated according to an accepted protocol for T. equigenitalis infection (Luddy and Kutzler, 2010, UK Horseracing Betting Levy Board (HBLB) Code of Practice, 2011). All stallions that had been present on the index property and undergone semen collection on the same day as the index stallion were classified as “moderate risk” and were similarlytested. This identified two additional T. equigenitalis-positive stallions, which were confirmed on bacterial culture (World Organization for Health (OIE) Manual of Diagnostic Tests and Vaccines for Terrestrial Animals (Chapter 2.5.1, Contagious Equine Metritis version adopted 20/10/2011) and which were subsequently quarantined and successfully treated. Following recognition of this outbreak, the Department of Agriculture, Forestry and Fisheries (DAFF) in consultation with the Equine Research Centre (ERC) of the Faculty of Veterinary Science at the University of Pretoria promulgated a nationwide qPCR-based screening programme that aimed to establish the prevalence and distribution of T. equigenitalis in South Africa. This required certification of all South African stallions used for breeding either by natural cover or assisted reproductive techniques. The compliance for certification was based on submission of two sets of genital swabs that both tested negative for T. equigenitalis on qPCR-testing. The process was coordinated by a web-based platform (http://wto the prescribed World Organisation for Health (OIE) method (Terrestrial Manual on Contagious Equine Metritis). All stallions apart from one could be linked to the index property. As of 31st October 2013, two additional T. equigenitalis-positive females have been identified, following a traceback of all identified potentially-exposed mares and their offspring that was instituted in September 2012. An “exposed mare” was defined as a mare that had been bred, either by natural breeding or assisted breeding techniques to the index stallion or any other T. equigenitalis-positive stallion. These mares were distributed across five provinces of South Africa at the time the traceback was initiated. During the nationwide traceback, a subpopulation focus was identified when 24 of the 33 resident stallions at the South African Lipizzaner Centre, Midrand, Gauteng tested positive for T. equigenitalis. Six of these stallions had visited the index property for semen collection over the course of several years prior to the arrival of the index stallion. This suggested the possible albeit undetected presence of T. equigenitalis on these premises prior to the arrival of the first reported index case. We strongly suspected that there may have been undetected CEM incursions into South Africa in the past. The index case in this outbreak may either have introduced a new infection or was infected by a pre-existing source of infection subsequent to his arrival. It is hoped that future strain-typing of the isolates from the positive cases identified during this intervention will further clarify this scenario. The use of qPCR-based screening proved to be a highly specific and sensitive method for detecting T. equigenitalis and helped to define the distribution and prevalence of T. equigenitalis in breeding stallions and exposed mares in South Africa. In addition, this method had significant practical advantages with respect to the associated costs, turn-around times and in-the-field application when compared with bacterial culture. The institution of a web-based platform from which the national screening programme was launched and coordinated proved to be indispensable in managing stakeholder access and information availability. To date, 31st October 2013, a total of 39 horses (36 males and 3 females) have been identified as T. equigenitalis-positive and have all subsequently been successfully treated. © Universityww.cemsa.co.za) As of 31st October 2013, an additional 33 carrier stallions have been identified by this screening programme. Of these stallions, 23 have been confirmed on bacteriology according to the prescribed World Organisation for Health (OIE) method (Terrestrial Manual on Contagious Equine Metritis). All stallions apart from one could be linked to the index property. As of 31st October 2013, two additional T. equigenitalis-positive females have been identified, following a traceback of all identified potentially-exposed mares and their offspring that was instituted in September 2012. An “exposed mare” was defined as a mare that had been bred, either by natural breeding or assisted breeding techniques to the index stallion or any other T. equigenitalis-positive stallion. These mares were distributed across five provinces of South Africa at the time the traceback was initiated. During the nationwide traceback, a subpopulation focus was identified when 24 of the 33 resident stallions at the South African Lipizzaner Centre, Midrand, Gauteng tested positive for T. equigenitalis. Six of these stallions had visited the index property for semen collection over the course of several years prior to the arrival of the index stallion. This suggested the possible albeit undetected presence of T. equigenitalis on these premises prior to the arrival of the first reported index case. We strongly suspected that there may have been undetected CEM incursions into South Africa in the past. The index case in this outbreak may either have introduced a new infection or was infected by a pre-existing source of infection subsequent to his arrival. It is hoped that future strain-typing of the isolates from the positive cases identified during this intervention will further clarify this scenario. The use of qPCR-based screening proved to be a highly specific and sensitive method for detecting T. equigenitalis and helped to define the distribution and prevalence of T. equigenitalis in breeding stallions and exposed mares in South Africa. In addition, this method had significant practical advantages with respect to the associated costs, turn-around times and in-the-field application when compared with bacterial culture. The institution of a web-based platform from which the national screening programme was launched and coordinated proved to be indispensable in managing stakeholder access and information availability. To date, 31st October 2013, a total of 39 horses (36 males and 3 females) have been identified as T. equigenitalis-positive and have all subsequently been successfully treated. / Dissertation (MMedVet)--University of Pretoria, 2013. / gm2014 / Production Animal Studies / unrestricted

<div>Public health policies increasingly rely on complex models that need to approximate epidemics realistically and be consistent with the available data. Choosing appropriate simplifying assumptions is one of the critical challenges in disease modeling. In this thesis, we focus on some of these assumptions to show how they impact model outcomes. </div><div>In this thesis, an ODE model with a gamma-distributed infectious period is studied and compared with an exponentially distributed infectious period. We show that, for childhood diseases, isolating infected children is a possible mechanism causing oscillatory behavior in incidence. This is shown analytically by identifying a Hopf bifurcation with the isolation period as the bifurcation parameter. The threshold value for isolation to generate sustained oscillations from the model with gamma-distributed isolation period is much more realistic than the exponentially distributed model.</div><div><br></div><div>The consequences of not modeling the spectrum of clinical symptoms of the 2014 Ebola outbreak in Liberia include overestimating the basic reproduction number and effectiveness of control measures. The outcome of this model is compared with those of models with typical symptoms, excluding moderate ones. Our model captures the dynamics of the recent outbreak of Ebola in Liberia better, and the basic reproduction number is more consistent with the WHO response team's estimate. Additionally, the model with only typical symptoms overestimates the basic reproduction number and effectiveness of control measures and exaggerates changes in peak size attributable to interventions' timing.</div><div><br></div>

Notre travail a montré qu’un système de surveillance épidémiologique (SEpi), comme ceux basés sur la téléphonie mobile, doit être obligatoirement intégré au système national. Souvent les acteurs extérieurs imposent et décident de la mise en place d’un système d'information (SI), sans réelle concertation avec les utilisateurs et responsables, sans intégration au système national, sans réflexion à long terme, sur le fonctionnement, les coûts, les développements. Les utilisateurs et les responsables doivent s’approprier le dispositif, tant dans sa mise en place que dans le maintien, le développement et l’analyse. L’exemple de la variation spatio-temporelle du paludisme a montré que des facteurs non sanitaires, en l’occurrence environnementaux, impactent sur la survenue d’épidémies. Il est donc nécessaire, pour avoir une vision de la situation épidémiologique dans un contexte de décision nationale, d’intégrer ces facteurs pour optimiser l’analyse et la SEpi. Il est indispensable, pour une analyse utile d’une situation épidémiologique, d’avoir, en temps réel, des échelles spatiales et temporelles très fines. Le succès du développement d’un SI réside principalement dans l’implication des autorités à chaque niveau hiérarchique. Sans politique de SIS décidée au plus haut niveau, structurée et activement coordonnée, toute mise en œuvre d’un nouvel outil (tablette, téléphone etc.) est vouée à l’échec, quel que soit le budget alloué.Il faut sortir de la tradition de bilan/rapport annuels qui n’analyse que des informations agrégées passées, déconnectées du SI national, pour entrer dans la SEpi 2.0 en temps réel, réactive, intégrée dans un SIS structuré et coordonnée nationalement. / Our work has shown that an epidemiological surveillance system (SEpi), such as those based on mobile phones, must be integrated into the national system. Often external actors impose and decide on the implementation of an information system (IS), without real consultation with users and managers, without integration into the national system, without long-term reflection on the functioning, costs and developments. Users and managers must take ownership of the system, both in its implementation and in its maintenance, development and analysis. The example of the spatial and temporal variation of malaria has shown that non-health factors, in this case environmental factors, have an impact on the occurrence of epidemics. It is therefore necessary, in order to have a vision of the epidemiological situation in a national decision-making context, to integrate these factors to optimize the analysis and the SEpi. It is essential, for a useful analysis of an epidemiological situation, to have, in real time, very fine spatial and temporal scales. The success of IS development depends mainly on the involvement of authorities at each hierarchical level. Without an SIS policy decided at the highest level, structured and actively coordinated, any implementation of a new tool (tablet, mobile phone, etc.) is doomed to failure, regardless of the budget allocated.It is necessary to move away from the tradition of annual review/reporting, which only analyses past aggregated information, disconnected from the national IS, to enter SEpi 2.0 in real time, reactive, integrated into a structured and nationally coordinated SIS.