No description available.

No description available.

Magister Philosophiae - MPhil / According to a 2010 report by the United Nations, mortality rates among children under the age of five remain extremely high in most countries in sub-Saharan Africa in which Zimbabwe is one of them. Child mortality in Zimbabwe is found to be associated with the specific causes with differing factors. This thesis analyses main causes of child mortality in Zimbabwe with selected socioeconomic, bio-demographic, maternal fertility behaviour, sexual reproductive health and services delivery factors in the study area, and Zimbabwe’s progress towards reaching MDG 4&5, which is to improve maternal health and reduce child mortality. The study used secondary data from the Demographic and Health Survey Zimbabwe of 2010-11, which is a nationally representative sample of all deaths based on household interviews to assess the impact of socioeconomic factors, health care accessibility and HIV/AIDS on infant and child mortality. This is a theoretical and descriptive study which uses odds and hazard rates of analysis and also used bio-demographic variables to understand the problem by exploring the data to obtain the most plausible estimates of infant and child mortality in the past decades. The findings, to a great extent showed that, socioeconomic factors have a huge contribution to infant and child mortality rates in Zimbabwe. Preceding birth interval, family size, birth type, breastfeeding status, source of drinking water, mother education, mother income, area of residence, and father education have significant effect at univariate level, whereas, area of residence, mother education and father education were not significant at multivariate level. The finding from the study revealed that mother’s educational level is not a determinant factor of infant and child mortality in Zimbabwe unlike other studies. However, awareness about the influencing factors of infant and child mortality is vital in order to control them, so also is enlightenment on the need of birth control and family size and benefit of breastfeeding. Improvement on the socioeconomic status and empowerment of citizens most especially women will help to reduce infant and child mortality.

Magister Artium (Psychology) - MA(Psych) / Due to the recent findings that the majority of South African’s have been exposed to high levels of trauma, the effects of trauma on mental health and wellbeing have become an important area of research in the South African context. Although many individuals in our country experience high exposure and multiple incidences of trauma, there are a significant number of people who seem to cope well in the face of adverse circumstances and trauma and do not develop stress symptomology as a result of exposure to a traumatic event. These individuals are viewed as resilient as they are able to utilize protective factors at their disposal, aiding them in preventing the development of symptoms associated with Posttraumatic Stress Disorder (PTSD). A large body of literature exists that identifies various protective factors, which may have a positive influence on an individual’s response to a traumatic event, thus making them more resilient. However, there is a gap in the South African research on the relationship between exposure to trauma, protective factors and the development of PTSD. The aim of this study is to explain how protective factors mediate PTSD symptoms. It investigates protective factors that resilient individuals utilize in the face of trauma such as; internal characteristics or traits, various demographic factors (i.e., age, gender), supportive interpersonal relationships, religious affiliation and community and family factors that have been identified as protective factors in the literature. Resilience emerged as significant in that it mitigated the development of posttraumatic symptoms (PTS) amongst the sample of university students. This indicates that despite the high incidences of exposure to trauma, individuals have the ability to be resilient, which therefore serves as a protective factor in the event of trauma. The present study constitutes a secondary analysis of previously collected survey data. The data being analysed is from a quantitative, cross-sectional survey that adopted a non-random, convenience sampling method. Logistic regression was undertaken in order to determine the relationship between age, religious affiliation, type of exposure, resilience and posttraumatic stress exposure. Only resilience emerges as a significant predictor underlying its importance for mediating traumatic outcomes. It highlights the importance od including protective factors in future research and interventions.

ABSTRACT Teenage pregnancy is a health and social problem in Malawi as a result of physical, psychological and socio-economic consequences on the teenage mother, family and the society as a whole. Although studies have been conducted on the prevalence and risk factors that cause teenage pregnancy in Malawi before, detailed reports are scanty, especially for Zomba district. In spite of studies and interventions that have been and are being implemented, the prevalence of unplanned teenage pregnancy in Malawi is still high, suggesting that more efforts are required to achieve effective preventive measures. The aim of this study was to explore risk factors such as cultural issues, non-use of contraceptives, lack of knowledge on sexual and reproductive health, circumstances of first sex, gender power dynamics, sexual and physical violence, age difference between teenage girls and their partners and socio-economic status for unplanned teenage pregnancy in Zomba district of Malawi. A cross-sectional analytic design was used. Five antenatal clinics were selected using a stratified and simple random sampling technique. Data were obtained from 505 participants under the age of 20 years using a questionnaire administered through face-to-face interviews. Descriptive statistics were used to analyse data and comparisons between planned and unplanned teenage pregnancy were conducted using the Chi-squared (P ≤ 0.05) and logistic regression model to predict factors for unplanned pregnancy. Findings reveal that unplanned pregnancy accounted for 76.4% of teenagers attributable to early sex and marriage, low contraceptive use, educational levels and socio-economic status, lack of knowledge of reproductive and sexual health, physical and sexual violence and substance abuse, transactional sex due to poverty, early school dropout, misleading counselling causing a lack of knowledge on sexual and reproductive health and gender inequalities. Recommendations made are aimed at eliminating myths and misconceptions surrounding the use of contraceptives and condoms, empowering teenagers economically and in decision making, promoting career guidance, awareness on human rights, including sexual and reproductive rights and implications of early marriage and training of traditional counsellors. A multisectoral approach, including government, Non-Governmental Organisations (NGOs) and communities, is required to implement these recommendations.

MSc (Med), Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand / Introduction: Tuberculosis (TB) persists as a serious global public heath problem of a magnitude requiring urgent attention. The increase in new cases of TB in African countries where the prevalence of HIV is relatively low has been associated with other host and environmental factors. There is little or no comparable data on the association between host and environmental related factors and TB incidence in low HIV prevalence regions of South Africa. Objectives: This study aims to investigate host and environmental factors associated with incident TB in one region of South Africa. Methods: 3493 TB-free participants were recruited, and baseline data collected at the beginning of 2003 in the Lung Health Study in Ravensmead and Uitsig, Cape Town, South Africa. The TB register was used to identify new cases among the 3493 participants between 2003 and 2007. Results: Of the 3493 study participants, 109 developed TB; i.e. 57 males and 52 females. The incidence of TB in the Ravensmead and Uitsig study population was 632 per 100 000. Cohabiting, OR= 2.09 (95% CI= 1.05 - 4.17), smoking, OR= 2.19 (95% CI= 1.48 - 4.14), and history of imprisonment OR= 1.88 (95% CI= 1.09 - 3.23) were all statistically associated with TB incidence in multiple logistic regression models. The summary population attributable fraction for these three factors was 53.2%. Conclusions: TB incidence was high in this community. Cigarette smoking was one of the most important predictors of TB incidence, and the proportion of smokers in this population was relatively high. TB control and prevention strategies need to focus on interventions which will reduce or limit the impact of TB risk factors.

MSc (Med), Population-Based Field Epidemiology, School of Public Health, Faculty of health Sciences, University of the Witwatersrand / Introduction: The achievements of the United Nations’ millennium development goals (MDGs) are not possible in isolation. Adult health and mortality with the exception of maternal health is one of the health issues that were openly missing among the list of MDGs. But eradicating extreme poverty and hunger would not be possible if the economically active population is not supported to be healthy and to live longer. Little has been done on adult health, especially to reduce mortality as compared to child health. Adult mortality is expected to equal or exceed child mortality in sub-Saharan Africa if nothing is done. There are varying factors associated with specific-causes of adult deaths within and among different settings. Obtaining more and better data on adult deaths and understanding issues relating to adult deaths in Africa are crucial for long life and development. Objectives: The study seeks to (i) describe causes of adult mortality, (ii) estimate adult cause-specific mortality rates and trends and (iii) identify risk factors of cause-specific mortality in the Ifakara Health and Demographic Surveillance System (IHDSS) population from 2003 – 2007 among adults aged 15 – 59 years. Methodology: The data for the study was extracted from the database of the Ifakara Health and Demographic Surveillance System (IHDSS) in Tanzania from 2003-2007. It was an open cohort study. The cohort was selected based on age (15-59years) and active residency from 1st January 2003 to 31st December 2007. Survival estimates were computed using Kaplan-Meier survival technique and adult mortality rates were estimated expressed per 1000 person years observed (PYO). Verbal autopsy method was used to ascertain causes of deaths. Cox proportional hazards method was used to identify socio-demographic factors associated with specific-causes of adult deaths. v Findings: A total 65,548 adults were identified and followed up, yielding a total of 184,000 person years. A total of 1,352 deaths occurred during the follow-up. The crude adult mortality rate (AMR) estimated over the period was 7.3/1000PYO. There was an insignificant steady increase in annual AMR over the period. The AMR in 2007 increased by 11% over year 2003. Most people died from HIV/AIDS (20.4%) followed by Malaria (13.2%). The AMR for the period was 2.49 per 1000PYO for communicable disease (CD) causes, 1.21 per 1000PYO for non communicable disease (NCD) causes and 0.53 per 1000PYO for causes related to accidents/injuries. Over the study period, deaths resulting from NCDs increased significantly by 50%. The proportion of deaths due to NCDs in 2003 was 16% increasing to 24% in year 2007. Adult deaths from Accidents/Injuries were significantly higher among men (hazard ratio (HR) = 2.2) after adjusting for socioeconomic status (SES), level of education and household size. For communicable and NCDs, most people died at home while for Accidents/Injuries most people died elsewhere (neither home nor health facility). The risk factors that were found to be associated with adult deaths due to NCDs were age and level of education. An improvement in level of education saw a reduction in the risk of dying from NCDs ((HR(Primary)=0.67, 95%CI:0.49, 0.92) and (HR(beyond Primary)=0.11, 95%CI:0.02, 0.40) after adjusting for age and sex. Age, SES and “entry type” were the factors found to be associated with dying from communicable diseases among the adults. In-migrants were 1.7 times more likely to die from communicable disease causes than residents having adjusted for age, household size, educational level, employment status of the head of household and SES. Conclusion: HIV/AIDS is the leading cause of adult deaths in IHDSS area followed by malaria. Most adult deaths occurred outside health facility in rural areas. This could probably be explained by the health seeking behavior and or health care accessibility in vi the rural area of sub-Saharan Africa. NCDs are increasing as a result of demographic and epidemiological transitions taking place in most African countries including Tanzania. Without preventions the rural community in Tanzania will soon face increased triple disease burden; (CD), NCD and Accident/Injuries. Policies on accident/injury preventions in developing countries will be effective if based on local evidence and research.

MMed, Community Health, Faculty of Health Sciences,University of the Witwatersrand / Introduction: The complications associated with diabetes usually occur over a long period of time and are mainly influenced by poor glycaemic control. Diabetic complications impact on the individual, the healthcare delivery system, and also have high cost implications. A number of studies have shown the management of diabetes to be sub-optimal in primary health care settings. Barriers that impair a patients’ ability to achieve good glycaemic control can be looked at from a patient, health facility and health professional perspectives. Good glycaemic control will not only benefit the individual patient but will also have a positive financial impact on South Africa’s already overstretched healthcare budget. Methods: In this cross sectional analytical study set in three Community Health Centres (CHCs) in the Johannesburg Metropolitan Health District, 418 diabetic patients were selected. An HbA1c test was conducted for every patient and was used to classify patients into a well controlled glycaemic group (HbA1c < 7%) or a poorly controlled group (HbA1c ≥ 7%). Differences between the two groups in terms of their risk factors for poor glycaemic control were investigated. Patient related risk factors studied included, basic demographic, treatment related, clinical, behavioural and lifestyle characteristics. Healthcare professionals and facility managers were interviewed and patient records were reviewed to describe health system challenges to providing optimal care. Univariate and multivariate logistic regression models were used to determine patient related factors influencing glycaemic control. Results: Of 394 patients with a measurable outcome (HbA1c), only 62 (15.7%) had well controlled diabetes. The mean HbA1c was similar across the three CHCs studied (p=0.464). Good glycaemic control was significantly associated with unemployment, shorter duration since diabetes diagnosis, treatment with oral medication alone and normal LDL-cholesterol levels (p<0.05). On multivariate analysis significant predictors of good glycaemic control were found to be a shorter duration since diabetes diagnosis, treatment with oral medication alone, being male, and those who were unemployed. Numerous challenges to providing optimal diabetes care were reported by health professionals including high patient to staff ratios, lack of working equipment as well as a need to improve diabetes management skills. Record review revealed that only a limited number of patients (16%) had ever had HbA1c testing. Conclusions: The majority (84.2%) of patients attending the selected facilities for diabetes care had poor glycaemic control. Management of diabetes in these CHCs is suboptimal. Patients with a shorter duration of diabetes, those who were male, Black African, unemployed and treated with oral medication alone were more likely to have good glycaemic control. Although the study concludes that patient related factors are at the forefront in terms of factors influencing glycaemic control, improved strategies in all spheres can only improve diabetes management at the CHCs.

INTRODUCTION Cardiovascular diseases (CVD) are more common in kidney transplant recipients (KTRs) than in the general population. The high incidence of CVD in the KTRs can be attributed to traditional risk factors, additional risk factors associated with graft dysfunction and those specifically related to transplantation. Carotid intima-media thickness (cIMT) is a proven surrogate of atherosclerosis; it correlates with vessel pathology and is precisely imaged using ultrasound technology. This study was aimed at determining the prevalence and predictors of cardiovascular risk among KTRs at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and to examine the relationship between cardiovascular risk factors and carotid intima media thickness. METHODS Patients aged 18 years and above who received a kidney transplant at the CMJAH between January 2005 and December 2009 were recruited. A questionnaire that captured cardiovascular risk factors was administered. Patients records were assessed for information on their post transplant follow up. All patients had echocardiography and carotid doppler done for measurement of intima-media thickness. The Framingham Risk Score was used to categorize patients into low, moderate, high risk and very high risk groups. Results were analyzed using statistical package for social sciences (SPSS) version 17, p value of 0.05 was considered significant. RESULTS One hundred (KTRs) 63 male (63%) and 37 female (37%) were recruited ranging in age from 19 to 70 years, with a mean age of 42.2 ± 12.42. Thirty six patients (36%) were found to have high cardiovascular risk. Multiple regression showed proteinuria (p = 0.022), higher cumulative steroid dosage (p = 0.028), elevated serum triglycerides (p = 0.04) and the presence of plaques in the carotid artery (p = 0.012) as predictors of higher cardiovascular risk.Carotid intima-media thickness correlates with higher CVD risk. Fourteen patients (14%) had a carotid artery plaque. Twenty five patients (25%) had cIMT of >0.7 mm. CONCLUSION Kidney transplant recipients in CMJAH were found to have high cardiovascular risk (36%) and carotid intima-media thickness correlates with this high CVD risk. Routine follow up of KTRs should include measurement of cIMT as it provides a simple non-invasive assessment of subclinical atherosclerosis.

ABSTRACT Odontogenic abscesses and Ludwig’s angina are infections commonly seen by maxillofacial surgeons. Both infections have periapical or periodontal origin and caused by oral bacteria. Ludwig’s angina is an aggressive and fast spreading infection compared to odontogenic abscess. The origin and the responsible bacteria of these infections are similar but the development and response is different in patients. There is no comprehensive study that has investigated the bacterial and host factors involved in the development of there infections. The aim of this study was to compare the presence of bacteria and enzymes in to the pus samples collected from patients with odontogenic abscess and Ludwig’s angina. Furthermore, various haematological and immunological tests were also compared between the two study groups. Forty two patients presenting with localized odontogenic abscesses and 15 with Ludwig’s angina were selected. Patient was examined according to standard protocol and history was recorded. Bloods were collected for haematology and immunology tests and pus was collected for microbiology and enzymatic tests. The results showed that highly virulent bacteria such as Staphylococcus aureus and black pigmented bacteroides were prevalent, increase in c-reactive protein, white blood cell count, IL6 and decrease in urea, circulating immune complexes and IgE in patients with Ludwig’s angina. Development of Ludwig’s angina could be due to the aggressive bacteria, their byproducts and low immune response compared to the odontogenic abscesses.