O presente estudo teve por objetivo descrever a cobertura do DOT e os resultados de tratamento (cura, abandono e óbito), no Município de Sorocaba, para o período de 1998 a 2004. Trata-se de um estudo descritivo de abordagem quantitativa que utilizou fontes secundárias de informações (EPI-TB da Secretaria Estadual de Saúde, Índice Paulista de Responsabilidade Social e Índice Paulista de Vulnerabilidade Social da Fundação Seade). Os dados foram dispostos em uma planilha do Excel e analisados por estatística descritiva. O município apresentou, para o período proposto, taxas de cobertura do DOT crescentes embora oscilantes, evidenciando taxas de 1998 a 2004 respectivamente de: 14%, 19%, 23%, 22%, 39%, 28% e 42%. A implantação do DOT atuou de forma positiva em relação às taxas de cura e abandono, que apresentaram respectivamente aumento e declínio. Com índices, para 2004, respectivamente de 80% e 8,33%. Quanto ao número de óbitos, houve elevação. Em 1998 os índices de óbito perfaziam 5,23% sendo 6,67% para 2004. Fatores socioeconômicos e demográficos compuseram o cenário da TB no município interferindo no seu controle. Concluiu-se que a presença de fatores de vulnerabilidade conferiu a Sorocaba peculiaridades que devem ser consideradas frente à implementação de ações para o controle da TB no município, e na elaboração de políticas públicas de saúde. / This study had the objective to describe the DOT coverage and the treatment results (cure, abandonment and death), in the Sorocaba county, for the period to 1998 to 2004. It is a descriptive study with quantitative approach that used secondary sources of information (EPITB of the State Secretary of Health, Paulista Index of Social Responsibility and Paulista Index of Social Vulnerability of Seade Foundation). The data were disposed in a spread sheet of Excel and analyzed with decriptive statistic. The county presented, for the proposed period, rates of DOT coverage increasing while oscillating, demonstrating rates to 1998 to 2004 respectively of: 14%, 19%, 23%, 22%, 39%, 28% e 42%. The DOT implementation operated in a positive mean for the cure and abandonment rates that presentes, respectively, increase and decline, with indices, for 2004, respectively, of 80% and 8,33%. In regard to the death numbers, it had rise. In 1998 the death indices counted 5,23%, being of 6,67% for 2004. Socioeconomical and demographic factors composed the TB scene in the county, intervening with its control. We concluded that the presence of vulnerability factors conferred to Sorocaba peculiarities that must to be considered in front of the implementation of the TB control actions in the county, and the elaboration of public health politics.

Este estudo teve como objetivo analisar a transferência da política do Tratamento Diretamente Observado (TDO) da tuberculose, em sua fase de manutenção e expansão, nas unidades de Atenção Primária à Saúde em municípios prioritários para o controle da tuberculose no estado do Amazonas. Trata-se de um estudo de métodos mistos, do tipo convergente, com a combinação das vertentes quantitativa e qualitativa, realizado em cinco municípios: Itacoatiara, Manacapuru, Parintins, Tabatinga e Tefé. Na etapa quantitativa participaram 138 profissionais de saúde e na etapa qualitativa sete enfermeiros e quatro Agentes Comunitários de Saúde. O estudo quantitativo foi caracterizado como um estudo tipo inquérito epidemiológico, sendo aplicado o instrumento \"Avaliação da Transferência de Políticas - Inovação, Informação e Conhecimento em Tuberculose - ATP-IINFOC-TB\" agrupado em sete domínios de análise. Para a etapa qualitativa foi utilizado um roteiro para entrevista, previamente testado, composto por questões semiestruturadas relacionados às informações gerais do TDO. A coleta dos dados foi realizada no período de janeiro a abril de 2016. A análise dos dados quantitativos foi realizada por meio de técnicas de estatística descritiva e multivariada, utilizando o software Statistica 12, da Statsoft.Inc e programa R versão 3.2.3. Para a organização dos dados qualitativos utilizou-se o software Atlas.ti 7.0., e a análise dos dados foi realizada por meio do referencial teórico metodológico da Análise de Discurso, em três etapas: Passagem da superfície linguística para o objeto discursivo; Passagem do objeto discursivo para o processo discursivo; Delineamento da formação discursiva e sua relação com a ideologia. Os resultados apontaram que, dos sete domínios avaliados, cinco (ações da gestão, ações da equipe de saúde, recursos para o desenvolvimento do TDO, prática do TDO e percepção sobre estratégias para melhorar o TDO) apresentaram diferença estatística significante para média, apresentando os menores valores na avaliação dos profissionais de saúde. Na análise exploratória dos domínios com menores valores e mediante as sequências discursivas analisadas identificou-se uma infraestrutura deficitária; escassez de recursos humanos; necessidade e dificuldade de adaptação do TDO à realidade local; necessidade de potencializar o processo de discussão entre a equipe; dificuldades que permeiam o processo de tratamento da pessoa com TB; a falta de treinamentos e a necessidade do uso de estratégias de sensibilização para melhorar a prática do TDO. Conclui-se que, para avançar na transferência da política do TDO, os municípios necessitam investir em infraestrutura adequada; disponibilização de materiais educativos; recursos humanos suficientes e qualificados e estratégias que atendam aos indivíduos na sua singularidade, como orientações individuais, acolhimento, uso de figuras, roda de conversa e projetos terapêuticos singulares, considerando as características de cada população e os determinantes sociais de saúde / This study aimed to analyze the transfer of the policy of Directly Observed Treatment (DOT) for tuberculosis, in its phase of maintenance and expansion in the Primary Healthcare Units in priority municipalities for tuberculosis control in the state of Amazonas. This was a mixed methods, convergent study, with a combination of quantitative and qualitative aspects, carried out in five municipalities: Itacoatiara, Manacapuru, Parintins, Tabatinga and Tefé. A total of 138 health professionals participated in the quantitative stage and seven nurses and four community health agents in the qualitative stage. The quantitative study was characterized as a epidemiological, inquiry study, with the application of the instrument \"Policy Transfer Evaluation - Innovation, Information and Knowledge in Tuberculosis - ATP-IINFOC-TB\" covering seven analysis domains. For the qualitative step, a pre-tested script, consisting of semi-structured questions related to general information about DOT, was used for the interviews. Data collection was carried out from January to April 2016. The analysis of the quantitative data was performed through descriptive and multivariate statistical techniques, using the Statistica 12 software, Statsoft. Inc, and R version 3.2.3 program. For the organization of the qualitative data the Atlas.ti 7.0 software was used, and data analysis was performed using the methodological theoretical framework of Discourse Analysis in three stages: Passage from the linguistic surface to the discursive object; Passage from the discursive object to the discursive process; Design of the discursive formation and its relation with the ideology. The results showed that, of the seven domains assessed, five (management actions, health team actions, resources for the development of DOT, practice of DOT and perception of strategies to improve DOT) presented statistically significant differences for the mean, presenting the lowest values in the assessment of the health professionals. In the exploratory analysis of the domains with lower values and through the discursive sequences analyzed, the following factors were identified: a deficient infrastructure; shortage of human resources; need and difficulty to adapt DOT to the local reality; need to enhance the process of discussion among the team; difficulties that permeate the treatment process of the person with TB; lack of training; and need to use awareness strategies to improve the practice of DOT. It was conclude that, to advance in the transfer of the DOT policy, the municipalities need to invest in adequate infrastructure; provision of educational materials; sufficient and qualified human resources; and strategies that contemplate individuals in their uniqueness. such as individual guidance, acceptance, use of figures, wheel of conversation and individual therapeutic projects, considering the characteristics of each population and the social determinants of health

Magister Public Health - MPH / Background: The incidence of tuberculosis in South Africa last measured at 834 in 2015 as reported by the World Bank. Out of these cases, only 54% cured and 13% of patients stop taking treatment. In Pretoria, Gauteng, comprehensive TB services are available in 87% of clinics and all these clinics offer the Directly Observed Treatment Short-course (DOTS) programme and help to diagnose TB and trace contacts. However, the average Pretoria district DOTS coverage has decreased from 88.8% to 84.7% in the last few years. The health district's cure rate as at 2012 is 61%, and its average rate of successful treatment of all new smear positive cases is 66% since 2005. Certain factors that determine patients' adherence towards TB treatment have been identified to include demographic, psychosocial and health system related factors. However, the WHO identified factors responsible for or predisposing patients to discontinue the DOTS programme have not been investigated in the study setting. Aim: The aim of this study was to assess the determinants of adherence to DOTS therapy amongst TB patients who commenced TB treatment at the TB clinic of a district hospital during April – June 2014. Methodology: A quantitative study was conducted using a descriptive cross-sectional design. An inclusive sample was drawn from adults in the DOTS programme receiving first line treatment during the 6-month period prior to commencement of the research. The calculated sample size was 234 individuals. The data collection tools included a questionnaire, 2-day recall and 30-day recall instruments and pill counts. Data were analysed using EPI info version 7 which included descriptive statistics to measure level of adherence. Associations between identified factors and adherence to TB treatment were also determined. Results: The final sample size was 80 participants of which 76% were male. The mean composite adherence rate was found to be 94% while the proportion of the patients who achieved adherence of 95% and above was 75%. Identified barriers to adherence include forgetfulness, lack of transport fare on clinic appointment days, patients not feeling well and so were not strong enough to attend clinic appointments. On the other hand, the role of treatment supporters and counseling were found to have a positive impact on adherence to DOT in this setting. The use of reminders such as cell phones and alarm-radios were also identified as facilitators to adherence. Patients' knowledge of consequences for not taking medications as prescribed, which is closely linked with counseling, was found to be significantly associated with adherence in this study. Education status of participants was found to be significantly associated with adherence to DOTS (p = 0.01), when considering the pharmacy refill pill count as the adherence measure. Significant association was found between DOTS treatment regimens and 30-day recall adherence measures (p = 0.002). Significant association was also found for medication side effects and the adherence measures of 2-day recall, 30-day recall and pill count with p = 0.04; p = 0.03; p = 0.05 respectively There were significant associations between age and adherence with two of the adherence measures (30-day recall and pill count) at p = 0.002 and p = 0.003 level of significance respectively. Significant association was observed between duration of DOTS treatment when dichotomised using the mean treatment period (17 weeks) as the cut-off point and any of the adherence measures. Conclusion: The factors identified in this study can be classified into patient related factors, economic factors, social factors and health care workers and health system related factors. Furthermore, the factors at these different levels impact on one another and their improvements need to be made at all these levels to address the challenges facing TB patients to achieve optimal treatment adherence. This study is the first study of its kind in the study location and the findings have provided useful baseline data on the adherence rates and some insights into the major factors that affect adherence among patients on DOTS at a Pretoria West District Hospital. However further qualitative and quantitative studies are required to explore the factors influencing adherence further.

PURPOSE: The purpose of this study was to assess factors associated with the development of drug resistant tuberculosis in Ethiopia. DESIGN: A quantitative case-control study was conducted to determine if there were any significant differences in prevalence of pre-defined factors between cases and controls. METHODS: Cases were patients with drug resistant tuberculosis who had a confirmed diagnosis by culture drug-susceptibility or gene expert tests. Successfully treated, tuberculosis symptom free patients who had been on first-line tuberculosis treatment and who were registered as cured or treatment completed were taken as controls. An equal number of cases (N=181) and controls (N=181) was selected using a systematic random sampling method and was used in the study. A structured questionnaire developed by the researcher was used to collect data. Odds ratio and multiple logistic regression were used to quantify the strength of association between dependent and independent variables. RESULTS: The development of drug resistant tuberculosis was significantly associated with two or more previous episodes of tuberculosis illness (adjusted odds ratio (AOR): 14.84; 95% CI 8.90 –24.75), previous first-line tuberculosis treatment not directly observed by a health worker for 7 to 8 weeks (AOR: 13.41; 95% CI 8.06 – 22.29) and previous first-line tuberculosis treatment outcome of failure (AOR: 39.19; 95% CI 12.05 -127.46). Interruption of first-line tuberculosis treatment for one day or more (AOR = 4.28; 95% CI 2.76 – 6.64) and history of treatment in the first-line tuberculosis treatment category for previously treated patients (AOR: 3.70; 95% CI 2.40 – 5.72) were also significantly associated with the development of drug resistant tuberculosis in the current study. CONCLUSION: Patients with a history of previous first-line tuberculosis treatment, patients who interrupted previous first-line tuberculosis treatment and patients with previous first-line tuberculosis treatment outcome of failure were at high risk of developing drug resistant tuberculosis. Therefore, the full course of first-line tuberculosis treatment should be given, following the Directly Observed Treatment (DOT) guide. Patients with recurrent tuberculosis and unfavourable first-line tuberculosis treatment outcome should be tested for drug susceptibility. / Health Studies / D. Litt. et Phil. (Health Studies)

In this thesis, we hope to dispel some confusion regarding the so-called post hoc power, i.e. power computed making the assumption that the estimated sample effect is equal to the population effect size. In previous research, it has been shown that post hoc power is a function of the p-value, making it redundant as a tool of analysis. We go further, arguing for it to never be reported, since it is a source of confusion and potentially harmful incentives. We also conduct a Monte Carlo simulation to illustrate our points of view. Previous research is confirmed by the results of this study.

The purpose of the study was to investigate the factors associated with the interruption of tuberculosis treatment in the Swakopmund district of Namibia. A descriptive cross-sectional survey was conducted. Data was collected using a structured questionnaire administered by interviewers. The population consisted of both treatment interrupters and non-interrupters. The total sample was 143 respondents. The findings revealed that three factors were significantly associated with TB treatment interruption, namely a lack of formal education (p = 0.032), lack of access to media (p = 0.017), and clinic opening times (p = 0.000). Recommendations made include improving the support given to TB patients, increasing their understanding of TB and adopting new research and technology. / Health Studies / M.A. (Public Health)

No description available.

This research focuses on the measurement of the non-observed economic activities by sector of South Africa for the 2011 and 2016 calendar years. The purpose of the research is to determine whether the current GDP as estimated by Statistics South Africa is under- or overestimated when considering the non-observed economy. The research is based on the 2008 System of National Accounts as it determines the guidelines, definitions and characteristics of the “Non-observed economy (NOE)” sector and it allows national accountants to use/supplement the research in the estimates of the GDP. This research follows a quantitative methodology where several surveys of Statistics South Africa are used. Where lack of data exists, some administrative data is used regarding the illegal activities. The findings of the research is that the total economy of South Africa is underestimated when taking into account the NOE activities. / Economics / M. Com. (Economics)

We propose a new method to perform functional principal component analysis (FPCA) for discretely observed functional data by solving successive optimization problems. The new framework can be applied to both regularly and irregularly observed data, and to both dense and sparse data. Our method does not require estimates of the individual sample functions or the covariance functions. Hence, it can be used to analyze functional data with multidimensional arguments (e.g. random surfaces). Furthermore, it can be applied to many processes and models with complicated or nonsmooth covariance functions. In our method, smoothness of eigenfunctions is controlled by directly imposing roughness penalties on eigenfunctions, which makes it more efficient and flexible to tune the smoothness. Efficient algorithms for solving the successive optimization problems are proposed. We provide the existence and characterization of the solutions to the successive optimization problems. The consistency of our method is also proved. Through simulations, we demonstrate that our method performs well in the cases with smooth samples curves, with discontinuous sample curves and nonsmooth covariance and with sample functions having two dimensional arguments (random surfaces), repectively. We apply our method to classification problems of retinal pigment epithelial cells in eyes of mice and to longitudinal CD4 counts data. In the second part of this dissertation, we propose a sparse Fisher’s discriminant analysis method with thresholded linear constraints. Various regularized linear discriminant analysis (LDA) methods have been proposed to address the problems of the LDA in high-dimensional settings. Asymptotic optimality has been established for some of these methods when there are only two classes. A difficulty in the asymptotic study for the multiclass classification is that for the two-class classification, the classification boundary is a hyperplane and an explicit formula for the classification error exists, however, in the case of multiclass, the boundary is usually complicated and no explicit formula for the error generally exists. Another difficulty in proving the asymptotic consistency and optimality for sparse Fisher’s discriminant analysis is that the covariance matrix is involved in the constraints of the optimization problems for high order components. It is not easy to estimate a general high-dimensional covariance matrix. Thus, we propose a sparse Fisher’s discriminant analysis method which avoids the estimation of the covariance matrix, provide asymptotic consistency results and the corresponding convergence rates for all components. To prove the asymptotic optimality, we provide an asymptotic upper bound for a general linear classification rule in the case of muticlass which is applied to our method to obtain the asymptotic optimality and the corresponding convergence rate. In the special case of two classes, our method achieves the same as or better convergence rates compared to the existing method. The proposed method is applied to multivariate functional data with wavelet transformations.

Cette thèse porte sur le problème d'estimation à travers les échelles pour un processus stochastique. Nous étudions comment le choix du pas d'échantillonnage impacte les procédures statistiques. Nous nous intéressons à l'estimation de processus à sauts à partir de l'observation d'une trajectoire discrétisée sur [0, T]. Lorsque la longueur de l'intervalle d'observation T va à l'infini, le pas d'échantillonnage tend soit vers 0 (échelle microscopique), vers une constante positive (échelle intermédiaire) ou encore vers l'infini (échelle macroscopique). Dans chacun de ces régimes nous supposons que le nombre d'observations tend vers l'infini. Dans un premier temps le cas particulier d'un processus de Poisson composé d'intensité inconnue avec des sauts symétriques {-1,1} est étudié. Le Chapitre 2 illustre la notion d'estimation statistique dans les trois échelles définies ci-dessus. Dans ce modèle, on s'intéresse aux propriétés des expériences statistiques. On montre la propriété de Normalité Asymptotique Locale dans les trois échelles microscopiques, intermédiaires et macroscopiques. L'information de Fisher est alors connue pour chacun de ces régimes. Ensuite nous analysons comment se comporte une procédure d'estimation de l'intensité qui est efficace (de variance minimale) à une échelle donnée lorsqu'on l'applique à des observations venant d'une échelle différente. On regarde l'estimateur de la variation quadratique empirique, qui est efficace dans le régime macroscopique, et on l'utilise sur des données provenant des régimes intermédiaire ou microscopique. Cet estimateur reste efficace dans les échelles microscopiques, mais montre une perte substantielle d'information aux échelles intermédiaires. Une procédure unifiée d'estimation est proposée, elle est efficace dans tous les régimes. Les Chapitres 3 et 4 étudient l'estimation non paramétrique de la densité de saut d'un processus renouvellement composé dans les régimes microscopiques, lorsque le pas d'échantillonnage tend vers 0. Un estimateur de cette densité utilisant des méthodes d'ondelettes est construit. Il est adaptatif et minimax pour des pas d'échantillonnage qui décroissent en T^{-alpha}, pour alpha>0. La procédure d'estimation repose sur l'inversion de l'opérateur de composition donnant la loi des incréments comme une transformation non linéaire de la loi des sauts que l'on cherche à estimer. L'opérateur inverse est explicite dans le cas du processus de Poisson composé (Chapitre 3), mais n'a pas d'expression analytique pour les processus de renouvellement composés (Chapitre 4). Dans ce dernier cas, il est approché via une technique de point fixe. Le Chapitre 5 étudie le problème de perte d'identifiabilité dans les régimes macroscopiques. Si un processus à sauts est observé avec un pas d'échantillonnage grand, certaines approximations limites, telles que l'approximation gaussienne, deviennent valides. Ceci peut entraîner une perte d'identifiabilité de la loi ayant généré le processus, dès lors que sa structure est plus complexe que celle étudiée dans le Chapitre 2. Dans un premier temps un modèle jouet à deux paramètres est considéré. Deux régimes différents émergent de l'étude : un régime où le paramètre n'est plus identifiable et un où il reste identifiable mais où les estimateurs optimaux convergent avec des vitesses plus lentes que les vitesses paramétriques habituelles. De l'étude de cas particulier, nous dérivons des bornes inférieures montrant qu'il n'existe pas d'estimateur convergent pour les processus de Lévy de saut pur ou pour les processus de renouvellement composés dans les régimes macroscopiques tels que le pas d'échantillonnage croît plus vite que racine de T. Enfin nous identifions des régimes macroscopiques où les incréments d'un processus de Poisson composé ne sont pas distinguables de variables aléatoires gaussiennes, et des régimes où il n'existe pas d'estimateur convergent pour les processus de Poisson composés dépendant de trop de paramètres / This thesis studies the problem of statistical inference across time scales for a stochastic process. More particularly we study how the choice of the sampling parameter affects statistical procedures. We narrow down to the inference of jump processes from the discrete observation of one trajectory over [0,T]. As the length of the observation interval T tends to infinity, the sampling rate either goes to 0 (microscopic scale) or to some positive constant (intermediate scale) or grows to infinity (macroscopic scale). We set in a case where there are infinitely many observations. First we specialise in a toy model: a compound Poisson process of unknown intensity with symmetric Bernoulli jumps. Chapter 2 highlights the concept of statistical estimation in the three regimes defined above and the phenomena at stake. We study the properties of the statistical experiments in each regime, we show that the Local Asymptotic Normality property holds in every regimes (microscopic, intermediate and macroscopic). We also provide the formula of the associated Fisher information in each regime. Then we study how a statistical procedure which is optimal (of minimal variance) at a given scale is affected when we use it on data coming from another scale. We focus on the empirical quadratic variation estimator, it is an optimal procedure at macroscopic scales. We apply it on data coming from intermediate and microscopic regimes. Although the estimator remains efficient at microscopic scales, it shows a substantial loss of information when used on data coming from an intermediate regime. That loss can be explicitly related to the sampling rate. We provide an unified procedure, efficient in all regimes. Chapters 3 and 4 focus on microscopic regimes, when the sampling rate decreases to 0. The nonparametric estimation of the jump density of a renewal reward process is studied. We propose an adaptive wavelet threshold density estimator. It achieves minimax rates of convergence for sampling rates that vanish polynomially with T, namely in T^{-alpha} for alpha>0. The estimation procedure is based on the inversion of the compounding operator in the same spirit as Buchmann and Grübel (2003), which specialiase in the study of discrete compound laws. The inverse operator is explicit in the case of a compound Poisson process (see Chapter 3), but has no closed form expression for renewal reward processes (see Chapter 4). In that latter case the inverse operator is approached with a fixed point technique. Finally Chapter 5 studies at which rate identifiability is lost in macroscopic regimes. Indeed when a jump process is observed at an arbitrarily large sampling rate, limit approximations, like Gaussian approximations, become valid and the specificities of the jumps may be lost, as long as the structure of the process is more complex than the one introduced in Chapter 2. First we study a toy model depending on a 2-dimensional parameter. We distinguish two different regimes: fast (macroscopic) regimes where all information on the parameter is lost and slow regimes where the parameter remains identifiable but where optimal estimators converge with slower rates than the expected usual parametric ones. From this toy model lower bounds are derived, they ensure that consistent estimation of Lévy processes or renewal reward processes is not possible when the sampling rate grows faster than the square root of T. Finally we identify regimes where an experiment consisting in increments of a compound Poisson process is asymptotically equivalent to an experiment consisting in Gaussian random variables. We also give regimes where there is no consistent estimator for compound Poisson processes depending on too many parameters