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Magister Scientiae (Physiotherapy) - MSc(Physio) / The purpose of this study was to identify the physical needs of the elderly with regard to physiotherapy services in the Livingstone district in Zambia. The objectives were to determine the knowledge of the elderly on the role of physiotherapy in the care of the elderly; the barriers to utilization of the services; the prevalence of physical problems and it also examined associations between education, knowledge and utilization of physiotherapy services in the district. / South Africa

Magister Scientiae (Physiotherapy) - MSc(Physio) / The prevalence of low back pain has assumed an upsurge trend in the last five decades despite the many interventional strategies. One interventional strategy that has been unsuccessful has been patient education. Lack of positive results from many of the existing patient education programmes is probably due to the type of health information that has been presented and the method that has been used. Many of the health education programmes have been planned according to what the medical professionals assumed the individuals needed to know, assumptions that could have ignored some crucial aspects. This study explored the perceived health education needs of individuals with low back pain at the Nairobi Hospital Rehabilitation Unit in Kenya, the method used to educate the individuals, the appropriateness of the method according to the individuals in addition to identifying the source of the health education that the individuals had. / South Africa

Master of Public Health - MPH / Background: Malaria was a major cause of mortality and morbidity in Namibia from 1999 to 2001. Malaria epidemics were recorded in 1990, 1996, 2000 and in 2001. In 2001 alone 733, 509 malaria morbidity cases and 1,728 mortality cases were documented. In recent years, however, malaria morbidity and mortality in the country have drastically declined by over 90%. This has influenced the Ministry of Health and Social Services (MoHSS) in Namibia to adopt a malaria elimination approach as opposed to the malaria case management approach. A malaria programme, known as the National Vector Disease Control Program (NVDCP) was instituted and mandated to coordinate malaria case management (diagnosis and treatment) as well as the current malaria elimination focus (elimination of transmission foci). This is all aimed at effectively addressing the current malaria epidemiology and sustain the decline observed over the last decade. Aim and Methodology: The study’s purpose was to analyse how the Namibia Malaria Strategic Plan (MSP) for 2010-2016 was developed and its relationship to health promotion. It employed an exploratory design which included stakeholders involved in malaria programmes and activities in the country. Data collection methods were of a qualitative nature through in-depth interviews and documentary review. Seven people were interviewed representing stakeholders from the public and private sectors. Those interviewed from the public sector were the Ministry of Environment and Tourism (MET), MoHSS’s division for Malaria, Policy Planning and Information Education and Communication (IEC). Others interviewed included national and international non-governmental organizations’ representatives from the World Health Organisation (WHO) and Society for Family Health (SFH). Documents reviewed include MSP 2010-2016, MSP 2003-2007, Malaria Policy of 2005, National Health Promotion policy 2012 and the Namibian Constitution. Data was analysed using content and thematic processes. Respondents were assured of confidentiality and anonymity. Key findings: The study found that information with regard to the formulation process of the MSP 2010-2016 was limited to a few superficially described events. These events involved, amongst others, a review of the previous (2003-2007) MSP, a pre-assessment questionnaire and two to three workshops. The events were not explicitly described or documented. The researcher concluded that the evidence to better understand the development processes of the MSP 2010-2016 was deficient. Consequently, the study concluded that the policy formulation aspects of the MSP were inadequate. The literature indicates that policy formulation and analysis is a complex undertaking and the MSP process did not meet these criteria. Amongst the limitations were limited stakeholder engagement and incomplete descriptions of the processes undertaken. In relation to the MSP’s focus on health promotion, the study found varied understanding of health promotion among the stakeholders. Some respondents were not aware of their organisation’s health promotion interventions while others believed that health promotion was limited to the health sector only. However, while national documents, such as the Namibian Constitution, advocate for ‘health investment as a just cause’ the MSPs limited inclusion of relevant stakeholders, such as the Ministry of Environment (MET) and the Information, Education and Communication (IEC) unit, restricted the ability of the MSP to offer malaria expansive programmes – that is, those beyond the health realm. Moreover, the implementation of malaria activities through the involvement of a limited range of actors in the malaria programmes will continue to perpetuate the existing narrow focus of health promotion by these stakeholders, as opposed to a more broad-base understanding. As a result malaria prevention will continue to be delivered as silo events or programmes. This poses serious implications in working towards the MSP goal of malaria elimination. Recommendations: The Ottawa Charter advocates for ‘Building healthy public policies’. This specifically refers to multi-disciplinary programmes. This study therefore recommends that the NVDCP follow existing international and national guidelines which systematically guide the development of MSPs and official health documents. Doing so would enable a more streamlined policy development process which would describe and contextualize the dimension of policy formulation, namely context, content, process and actors. It also recommends that the MSP is developed through a broad-based collaborative stakeholder engagement process which would facilitate an appropriately integrated inter-sectoral approach to malaria in the country.

Magister Scientiae Dentium - MSc(Dent) / Introduction: South Africa has an estimated HIV prevalence rate of 29.5%, in Gauteng province, the prevalence rate in women attending ante-natal clinic is 28.7% and in the Johannesburg Metro District, the prevalence rate is 41%. The early identification of HIV in the HIV positive well patient or HIV positive unwell patient can lead to the commencement of early intervention and treatment, thus resulting in a higher quality of life for the patient and lower treatment costs for the State. Aim: To determine the oral health knowledge, practices and treatment patterns of nurses at ARV clinics in Johannesburg Metro District. Materials and Methods: The study design was a convenient cross-sectional survey conducted between May 2014 and January 2015 in the Johannesburg Metro District. The study population comprised of nursing staff at ARV clinics in the Johannesburg Metro District. 147 questionnaires were distributed among the nurses that were in contact with the patients. Only 100 (n=147) questionnaires came back completed. The data collected was entered into Microsoft Excel and imported to STATA 13.1 to determine statistical significance using chi-squared test. A p-value was regarded significant if <0.05. Results: The results of the study depicted poor knowledge on oral manifestations of HIV/AIDS from the nursing staff at the ARV clinics in the district. Although 85% could describe the oral lesions found in the oral cavity and 66% perceived that they could identify Oral Candidiasis (OC), only 47% could correctly identify the lesion. 57% perceived knowing the condition associated with OC and only 46% correctly named the condition (p- value=0.001). Only two thirds of 43% of nurses could manage OC using drugs from the protocol accessible at the clinics, 25% referred and 32% did not know how to manage the OC (p-value=0.001). Only 40% (n=100) of the nurses referred patients for oral health promotion. Almost all the nurses (81%) indicated repeatedly that they need more training on oral health and oral health promotion. Conclusions: There is a need to include the oral manifestations of HIV in the nursing curriculum. Continued professional development should include Oral Health Promotion. Further research is needed to explore means of incorporating an oral health and disease module in the nursing curriculum.

Please read the abstract in the section 00front of this document. / Dissertation (MMed)--University of Pretoria, 2006. / School of Health Systems and Public Health (SHSPH) / Unrestricted

This case study is a qualitative examination of a health promotion project conducted in collaboration with members of the mental health peer community. More specifically, it explores the community based participatory research (CBPR) implementation process used to conduct this health promotion project to gain a deeper understanding of the mechanisms at work in the implementation process. While there has been considerable attention to the principles that guide CBPR (Braun et al., 2012; Israel et al., 2008; LaVeaux & Christopher, 2009), there remains important work to be done in bridging these principles to implementation; what processes or mechanisms translate these principles to action. Four mechanisms were initially proposed by this writer, derived from extant literature in this area (Wallerstein & Duran, 2003). These provided the initial framework for analyzing the data gathered throughout the case study. The case report discusses the findings of how these initially proposed mechanisms have been transformed and redefined in the context of this case. The resultant mechanisms, knowledge sharing, power sharing, task sharing, resource sharing, and shared purpose (there are five, as one additional new mechanism emerged in the analysis), are described with examples of how they were reflected in this case. Implications for these findings for CBPR research, collaborative health promotion with the mental health peer community, and the social work profession are shared.

This research focuses on the work of the Urban Aboriginal Community Kitchen Garden Project (the Garden Project). The Garden Project aims to be a culturally appropriate health promotion project with urban Aboriginal people, drawing on traditional Indigenous approaches to health and healing, and rooted in community food work. The project is situated within the context of colonialism, the destruction of traditional foodways, and subsequent increased need for Indigenous people to rely on a dominant food system that is seen as destructive to human and ecological health. The purpose of my research is to describe the Garden Project’s main goals and achievements from the perspective of project leaders, project participants as well as through my own observations and experiences. The research methodology was guided by participatory and community based approaches to research and qualitative methods were employed, focusing primarily on semi-structured interviews with project participants and project leaders. I also participated in and observed the project for two years, from September 2006-September 2008. Data collection and analysis happened through an iterative process of action and reflection. Based on my time with the Garden Project, I suggest that it can be seen simultaneously as a community food security, health promotion, and Indigenous health project. It connects participants with food as a natural product, builds skills around cooking and growing food, and increases knowledge about food system issues. Drawing on the health promotion discourse, it can be seen building community and social support networks, treating the whole person, and empowering participants to take actions around their own health needs. It is rooted in Indigenous approaches to health and healing in the way it promotes individuals’ physical, mental/emotional and spiritual health, the health of the community through cultural revitalization, and the health of the Universe through the opportunity it provides for awareness about ecosystem health. This research project was very site specific. Nevertheless, the findings suggest that food work with urban Indigenous people, carried out in a culturally sensitive manner, may be a powerful leverage point for promoting health with this population. These types of projects can also be vehicles for social change. / Land and Food Systems, Faculty of / Graduate

The purpose of this study was to develop an intervention health promotion programme to prevent circumcision related health problem such as sepsis, botched circumcision, dehydration, penile amputation and reduce the number of deaths. The intervention programme was aimed at promoting a safe male circumcision practice affecting boys aged 12-18 years at Libode rural communities in Eastern Cape Province of South Africa. This was achieved through a mixed method design using both quantitative and qualitative approaches utilizing sequential transformative strategy to allow for the convergence of multiple perspectives of the traditional male circumcision in Libode. The study was conducted in 22 schools of the rural communities of Libode because most of the participants are still attending school. Frequencies and percentages were used to analyse the quantitative data, utilizing the Statistical Package for Social Sciences (SPSS). A total of 1036 participants, AmaXhosa circumcised young men (abafana) and uncircumcised boys (amakhwenkwe) participated in the cross-sectional survey, quantitative phase of the study. Qualitative phase of this study was composed of 7 focus group discussions with a total of 84 circumcised and uncircumcised male participants and 10 key informants’ interviews were conducted. In analysis qualitative data, the researcher found the most descriptive words for each topic and turned them into categories or sub-themes. Topics that related to each other were then grouped in order to reduce the number of categories and to create themes. The similar categories of data were grouped and analysed using Tesch’s method. Findings indicated that traditional circumcision is performed during winter and summer holidays in order to cater for the boys who are attending schools. The circumcision age at Libode ranges from 12 and 18 years of age which is against the Health Standards in Traditional Circumcision Act (Act No. 6 of 2001). Although the participants were aware of the complications of male circumcision in Libode, there was a high preference for traditional circumcision (92.3% of participants) to hospital circumcision. The participants were of the view that the benefits of traditional circumcision outweigh the complications or challenges related to traditional circumcision. They wanted to be socially accepted and wanted to learn about manhood values in the traditional circumcision which are values that cannot be achieved through the hospital based circumcision. As male circumcision initiation is seasonal and the intervention programme needed to be approved by different stakeholders, the testing of intervention programme could not happen before the programme was approved by all the stakeholders.