This qualitative study focuses on the experiences of adults with Charcot-Marie-Tooth disease (CMT), a neuromuscular condition, and explores what living with this disease encompasses. The study is structured around two fundamental research questions that amount to people's experiences regarding how (in which areas) the disease affects them, and how they continuously deal with it. In order to address the research questions, data gathered from participants was qualitatively analysed, using grounded theory methodology. The study culminated in the formulation of a substantive grounded theory as to how affected people manage the disease's manifestations in order to optimise their continuous adaptation and well-being. A tripartite of concerns comprised the core concern, whereas the basic social psychological process of engaging with CMT emerged as the core strategy used by affected people to deal with the concerns. The core's three sub processes constituted three mostly sequential stages that CMT-affected people pass through in their adaptation to the disease. The identified theory and existing stage models of adaptation to chronic illnesses and disabilities were juxtaposed and discussed. The three stages were compared to and integrated with the relevant literature. These actions revealed that there are a number of new formulations and processes contained in all three stages, and that the first and last stages (orientating and optimising) are themselves unique. It emerged that there is no theoretical end-point to the adaptation process, but that a relative saturation point amounted to a variant of an outcome, called qualified wellness. For most, the core strategy was successful in resolving the main concern. A few, however, still experienced fear and agony about inheritance and dependency issues. This study contributes, via the route of knowledge and insight empowerment, to the well-being of people with CMT, including those who are struggling but do not know that they have this disease. Broadening of insight may also benefit medical help professionals and streamline service delivery. / Psychology / D. Litt. et Phil. (Psychology)

The objectives of this study were to establish the effectiveness of chlorpyrifos in suppressing H. armigera population in oranges and to determine the effect chlorpyrifos had on the health of farm pesticide operators. Experiments showed that by applying chlorpyrifos on orange trees, H. armigera larvae population was suppressed significantly. High fruit yields were realized from trees that were sprayed with chlorpyrifos. Visual observation of personnel involved in pesticide related duties, revealed that judicious use of pesticides was not practiced by farm workers in all three farms. Data analysis from questionnaires, health records and interviews proved that farm workers suffered from illnesses that were pesticide related. It was mainly those farm workers in the age group of 31 to 35 years who suffered the most from pesticide related illnesses. / Agriculture and Life Sciences / M. Sc. (Agriculture)

The aim of this study was to determine how nurses manage the nutritional care of children under the age of five years at the primary healthcare level. A quantitative approach with an explorative descriptive design was used. A self-administered questionnaire and was used to collect data. The population was 34 professional nurses working in the child health sections of 16 clinics, all of whom were accessible, but one did not respond. Ten out of the target population were also observed using an observational checklist. Findings show lack of proper implementation of Integrated Management of Childhood Illnesses (IMCI) guidelines and incorrect use of the Road-to-Health booklet. Secondly, the nurses at the child healthcare section had a high workload or had little experience in child care. The need for more emphasis on nutrition during IMCI training and the re-orientation of nurses on the optimal use of the Road-to-Health booklet were identified. / Master of Public Health (MPH) / Health Studies

In Swedish dialects we find the terms ris, skäver and skärva referring to illnesses in children. The words are also parts of various compounds which refer to variants of the illnesses. The terms are linguistic expressions denoting two folk categories of illnesses, RIS and SKÄVER/SKÄRVA. These categories are investigated from a cognitive semantic perspective. The cognitive perspective argues that we organize our understanding of reality by using Idealized Cognitive Models (ICM) based on our physical, mental and emotional experiences of the world. The aim is twofold: to demonstrate the bases on which an experienced illness is placed in a certain category, and to show how a folk conception of illness is reflected in the word formation strategies. The word formation strategies emanate from notions of characteristic symptoms, and from notions of causes of illnesses. Both categories, RIS and SKÄVER/SKÄRVA, are based on a number of ICM's. The category RIS is a radial structure, which means that the category is held together although its members have no structural criteria in common. The category SKÄVER/SKÄRVA is a concentrating structure, meaning that all members share all structural criteria. There is a strong connection between word formation strategies and the structures of the categories. Terms related to symptoms refer to members of a category which are part of a radial structure, while terms related to causes refer to members of a category which are part of a concentrating structure. This can be explained by two of the basic assumptions of cognitive semantics: semantic content is structred and symbolized overtly on the surface form of a language and categories are conventional, based on cultural assumptions about the world. / digitalisering@umu

PhD (Advanced Nursing Sicence) / Department of Advanced Nursing Science

The past two decades have witnessed transition from in-patient hospital settings to Community and Home Based Care in Zimbabwe. This is because of an increase in the number of people developing chronic health conditions such as diabetes, hypertension and cancers, and thus needing longer treatment durations. The increase in chronic conditions has mainly been attributed to the increase in incidence and prevalence of Human Immunodeficiency Virus and Acquired Immune-deficiency Syndrome in Sub-Saharan Africa. Many Governments, including that of Zimbabwe, endorsed and promoted community and home based care to provide a continuum of care to the chronically ill. Despite the implementation of Community and Home Based Care programmes, no studies known to the researcher have been done to investigate the congruency of service users’ needs and the programme goals. Purpose: The purpose of the study is twofold; firstly to explore whether Community and Home Based Care interventions provide services that effectively meet users’ goals in a dynamic social environment and secondly, to develop guidelines for enhancing care provision as well as congruency of service users’ needs and programme goals. Methods: A mixed-method approach combining qualitative and quantitative data collection and analysis was used. Concurrent collection of data with equal status was placed on both qualitative and quantitative data. For qualitative data interviews and focus groups were used with home based care service users, family care givers, and health providers. Structured questionnaires were used for the quantitative data. Framework: Imogene King’s Interacting Systems Framework and Theory of Goal Attainment were adopted to guide the study. These were utilised because of the assumption that mutual agreement on goals for effective care can be achieved through nurse-client interactions and communication Research findings: Community and Home Based Care programme in Zimbabwe does not comprehensively meet the needs of its service users. Service users have diverse needs and goals depending on the specific condition and symptoms they experience. They perceive access to medication for symptom management and pain control, food and financial stability, as priority needs. The study found that nursing services provided in Community and Home Based Care generally align with the physical needs of service users and was deficient in addressing the socio-economic and psycho-social needs of service users. Conclusion: No single sector can achieve the users’ and the programme`s goals of quality health on its own. The goals may only be realised when other stakeholders and relevant sectors contribute to the Community and Home Based Care programme, which requires diverse resources. Guidelines to enhance integration of Community and Home Based Care with social services were developed. / Health Studies / D.Litt. et Phil. (Health Studies)

This non-experimental, descriptive, quantitative survey attempted to evaluate IMCI implementation in the eThekwini district of KwaZulu -Natal. The study focused on IMCI implementation by IMCI trained registered nurses, health facility support and follow-up and supervision. The research population comprised of all IMCI trained registered nurses working in health facilities in the eThekwini district. The convenient sample consisted of 40 research subjects. Data was collected by means of an interview schedule and a checklist, and analysed using Microsoft Excel 2007. Findings of the study revealed that many of the IMCI trained registered nurses were unable to assess, classify and treat the sick child comprehensively and consistently. The recommended follow-up visit at six weeks after completion of IMCI training, and lack of on-going supervision remains an area of concern. Recommendations were that district or clinic supervisors can enhance the skills of IMCI trained registered nurses through recommended follow-up visits and on-going supervision and the provision of updated IMCI chart booklets. / Health Studies / M.A. (Public Health)

Background Under five years of age child mortality rates and the violence against women are prevalent in Rwanda. The violence is known to negatively affect the women’s and their children’s health. This study aimed to examine the association between maternal experience of lifetime intimate partner violence and symptoms of common illnesses (fever, diarrhea, cough, breathing problems) among the children under five years of age in Rwanda. Methods The study was a cross-sectional, based on the data of 2019 –20 Rwanda’s Demographic Health Survey, including 1,290 women and their children. To examine the association between physical, sexual and psychological intimate partner violence and the symptoms of common illnesses, bivariate analysis was performed, followed by logistic regression, where models were adjusted for potential confounders. Results Among the mothers, 36% had experienced physical, 14.7% sexual, and 33.7% psychological intimate partner violence. Around 43% of their children had had symptoms of common illnesses within two weeks before the data collection. In adjusted regression analysis, the experience of physical (OR 1.79, CI 1.41 – 2.27), sexual (OR 1.68, CI 1.22 – 2.30) and psychological intimate partner violence (OR 2.08, CI 1.63 – 2.65) were significantly associated with symptoms of common illnesses among children under five years of age. Conclusion This study showed that maternal experience of lifetime intimate partner violence increases the likelihood of their young children having symptoms of common illnesses in Rwanda. The finding suggests the importance of investing in strategies against intimate partner violence to lower the mortality rates of children within the country.

Sickness and healing expenence is universal, but the context in which both are perceived and dealt with is particular. Culture and the individual constitute the universal context. The social structures, values, beliefs, the symbol system of a culture and the tendency of the individual to act upon his existence within cultural parameters, inform the particular context. The relationship that exists between culture and the individual is best described as dialectic. The concept of dialect is the theoretical tool to analytically show how this relationship works out in real life. At the base of this relationship operates conflict. Sickness, or permanent ill health since early childhood as shown in an in-depth case study, triggers conflict on at least two levels: the personal-psychological and the socio­ cultural level. To effectively deal with sickness and the inner conflicts caused by it, is to channel the motivation to resolve them by way of employing a symbolic idiom, a cultural symbol that attains personal meaning. G. Chewe P. of Bemba ethnicity, the main actor of this thesis, demonstrates how his life experience of sickness made various symbols become operational, how he filled them with personal meaning, and that there was no hiatus between the public and private domain. Healing requires more than medical aid. Cultural symbols that become personal symbols are often tied into religious experience of some kind. Individuals who successfully employ personal symbols eventually achieve healing because the symbolic idiom helps them to resolve intrapsychic conflict. Missiology cannot escape from two realities: culture and the individual. If anything, missiology must be interested in culture and the individual. Missiology, in the role of aide-de-camps of the Christian Mission, shows the history of how individuals connect to God, and how God transforms them in their cultural environment. To be able to achieve both goals, the issues of context and conflict must be addressed. This thesis seeks to account for the dialectic between culture and the individual, how context and conflict shaped the person and the Christian G. Chewe P. of Bemba ethnicity, and how he acted upon this context to resolve his travail. / Christian Spirituality, Church History and Missiology / D. Th (Missiology)

Health related absenteeism was identified as a problem in the schools in the Molopo region, needing a multi-disciplinary approach which included the parents. A conceptual framework on absenteeism was used as a guideline for the descriptive research design. Using a convenience sampling technique 426 absentees, 22 teachers and 2 school nurses filled in three separate questionnaires in ten schools selected to determine the extent of absenteeism due to health related and other problems, the control measures taken and the awareness of school personnel. Health problems were identified as the main reasons for absenteeism. Inadequate communication between the schools and parents as well as lack of guidelines on the control of absenteeism, were other problems identified. Recommendations made related to the provision of school health services that promote the health status of the pupils based on Primary Health Care principles, parental involvement in school health matters and the formulation of policies aimed at controlling absenteeism in schools. / Health Sciences / M.A. (Nursing Science)