MSc, Paediatrics and Child Health, Faculty of Health Sciences,University of the Witwatersrand / Background To investigate whether in-utero exposure to highly active antiretroviral treatment (HAART) is associated with low birth weight and/or preterm birth in a population of South African women with advanced HIV infection. Methods A retrospective observational study was performed on women with CD4 cell counts ≤250 cells/mm3 attending antenatal antiretroviral clinics at two clinics in Johannesburg between October 2004 and March 2007. Low birth weight (<2.5kg) and preterm birth rates (<37 weeks) were compared in those exposed versus unexposed to HAART during pregnancy. Effects of different HAART regimen and duration (<28 weeks or ≥ 28 weeks) were assessed. Results Among HAART-unexposed infants 27% (60/224) were low birth weight (LBW) compared to 23% (90/388) of early HAART-exposed and 19% (76/407) of late HAART-exposed infants (P=0.05). In the early HAART group, older maternal age was associated with LBW and higher CD4 cell count protective against LBW (AOR 1.06, 95% CI 1.00- 1.12 and AOR 0.58, 95% CI 0.46-0.73, P<0.001, respectively). HAART-exposed infants had an increased risk of preterm birth vii (<37 weeks) (15% [138/946] versus 5% [7/147], p=0.001), with early (<28 weeks) nevirapine and efavirenz having the strongest associations with preterm birth (AOR 5.4, 95%CI 2.1-13.7, P<0.001 and AOR 5.6, 95%CI 2.1-15.2, P=0.001, respectively). Conclusion Among infants born to women with CD4 cell counts <250 cells/mm3, HAART exposure was associated with preterm birth, but not with low birth weight. More advanced immunosuppression was a significant risk factor for both LBW and preterm birth, highlighting the importance of earlier HAART initiation in pregnant women, both to optimize maternal health and to improve infant outcomes

Student number:0312412A Faculty of Health Sciences School of Public Health / Management of multidrug-resistant tuberculosis (MDR-TB) is more expensive, lengthy and is associated with less favourable outcomes and more adverse reactions than management of susceptible tuberculosis. The aim of this study was to review the management and treatment outcomes of registered MDR-TB patients hospitalized at Sizwe hospital during a five-year period. A cross-sectional study with both descriptive and analytic features was done on 237 MDR-TB patients hospitalized from the beginning of June 1998 to the end of May 2003. Data were analysed using SPSS version 12 Software. Main outcome measures were interim treatment outcomes at the end of hospitalization period. These outcomes comprised culture conversion rates, time to culture conversion, transfer out, interruption, and death rates. Multiple logistic regression analysis was performed to determine risk factors for poor treatment outcomes. These poor outcomes were defined as treatment interruption, failure and mortality rates. The burden of institutional care for MDR-TB patients in this setting was found to involve high numbers of MDR-TB patients for whom the allocated hospital beds were insufficient. Patients with primary MDR-TB, who had no history of nonadherence to treatment, were paradoxically more likely to be hospitalized shortly after diagnosis. Acquired MDR-TB patients were mostly managed as outpatients immediately after diagnosis only to be hospitalized later due to persistent nonadherence or disease severity. Overall, acquired MDR-TB patients were hospitalized in larger numbers than those with primary disease. This reflects the higher prevalence of acquired MDR-TB compared to primary MDR-TB. Page v Abstract Culture turnaround time was on average 19 days. The overall culture conversion rate of the hospitalized patients was low at 41.9 percent. This low culture conversion rate resulted in protracted hospitalization periods and high interim mortality rates. The mean duration of hospitalization, 3.52 months, correlated favourably with the time interval to the first culture conversion of 2.96 months. Hospitalization did not guarantee the expected adherence to treatment. Surgical interventions were done belatedly with resultant high mortality outcomes. The main reasons given by patients for refusing hospital treatment were visiting traditional healers, solving socioeconomic problems and attending to family matters. A large percentage of hospitalized patients were co-infected with HIV. HIV care and support was incomplete as antiretroviral drugs were not available at the hospital. Among the main findings of the study was the powerful influence HIV status had on poor hospitalization outcomes. Recommendations arising from the study include the need to provide ARVs at the Sizwe hospital. Admission and discharge guidelines aimed at ensuring adequate beds are reserved for deserving patients should be formulated. Continuing education for service providers must be encouraged and rewarded. Infection control procedures at both community and health institution level ought to be vigorously promoted. Patients known to be hopelessly non-adherent should at least be partially hospitalized in the interest of public health.

Submitted in partial fulfilment for the degree of Masters in Education at the University of the Witwatersrand, Johannesburg, South Africa 30 June 2015 / This study explores the role of the principal as an instructional leader in two successful township primary schools in challenging circumstances. It examines instructional strategies used by principals of the two schools that may account for high levels of learner achievement and explores how these successful leaders deploy leadership styles and management approaches to deal with prevailing challenging circumstances that affect their schools academically and other spheres of governance and management. Sixteen participants were involved including 2 principals, 4 Heads of department (HODs), 4 educators, 4 parents from the two schools and 2 district officials under who both schools account. Using qualitative approaches, triangulation of data was achieved through semi-structured interviews, observation and document analysis. The study found that the key instructional leadership approaches used by these principals were promoting teamwork, active participation, collective decision making, sharing of responsibilities, collaboration/collegiality and distribution of tasks amongst multiple leaders or people. The claims made by the principals were corroborated by educators, parents, members of the School Management Team (SMT) and district management teams. Data also indicated that the principals relied on a combination of different leadership styles and efficient and effective management approaches with their subordinates to garner the enthusiastic implementation of instructional approaches which are claimed to yield good learner outcomes in Annual National Assessment (ANA) tests. The study suggests that there might be a strong link between leadership styles and management approaches on one hand and learner performance on the other. Further, the data suggests that the application of appropriate management systems and relevant leadership styles can contribute to institutional resilience against the prevailing challenges which tend to depress performance in many schools in similar circumstances. The findings of the study have several important implications including:  Schools as organisations require the collective effort of all stakeholders in order to achieve their objectives or goals.  That ‘one size fits all’ form of leadership has no place in different environments but that more often than not, a combination of different leadership styles and management approaches should be explored in an attempt to realize a common vision of an organisation. The study makes specific recommendations for a more broad based research agenda to examine factors which contribute to resilience and success in schools operating in challenging circumstances. It also calls for more contextualised studies in specific schools to explore the leadership forms that have greatest potential for delivering better learning outcomes in schools facing challenging circumstances.

Warfarin is the most widely prescribed oral anticoagulant used for the long-term treatment and prevention of thromboembolic events. Its administration is challenging as it may result in bleeding-related deaths, inadequate anticoagulation and fetal teratogenesis, including fetal warfarin syndrome. A number of environmental and genetic factors contribute to interindividual warfarin dosage variability. The CYP2C9 and VKORC1 genes explain 40- 50% of this variability. The aim of this study was to determine the frequency of known and any new variants in these genes in the SA black population, and correlate these variants and a small subset of environmental factors to dosage variability and pregnancy outcomes. I sequenced the exons and intron/exon boundaries of the CYP2C9 and VKORC1 genes in 100 random black control and 113 patient samples that had at least one pregnancy on warfarin. I observed six previously described CYP2C9 variants, 27 novel CYP2C9 variants, and three previously described VKORC1 variants. 14 of these variants were observed at an allele frequency of 0.02. Of these 14, six appear to decrease (all of which are CYP2C9 variants) and four increase (2 CYP2C9 variants and two VKORC1 variants) warfarin dosage requirement. These 14 CYP2C9 and VKORC1 variants along with a small subset of environmental factors account for 45.3% of warfarin dosage variability in the SA population. I observed an increase in the number of poor pregnancy outcomes in patients on high doses of warfarin. These results allow us to predict the maintenance dose of warfarin in SA black patients better, thereby reducing the risk of adverse effects, and identify those at risk of having a poor pregnancy outcome.

Faculty of Health Sciences School of Patholgy 8601804k erine.gregersen@nhls.ac.za / The oral anticoagulant, warfarin, when administered in pregnancy, can cause warfarin embryopathy, fetal central nervous system abnormalities, spontaneous abortion and fetal intrauterine death. Women with prosthetic heart valves usually require warfarin in pregnancy because of their high risk for thromboembolic complications. Anticoagulation regimens in pregnancy in these women aim to balance the fetal effects of warfarin with maternal risks of thromboembolism. This study was conducted by structured interview of 124 black urban South African women of childbearing age, who had at least one warfarin-exposed pregnancy. The study aimed to determine the pregnancy outcomes in this cohort, their awareness of the effects of warfarin in pregnancy, and what management practices, as reported by them, had occurred with regard to their anticoagulation in pregnancy and what genetic counselling they had received. There was a significant difference in outcome between warfarin-exposed and non-exposed pregnancies; 55.2% (123/223) of warfarin-exposed pregnancies ended in the birth of an abnormal baby, spontaneous abortion or intrauterine death. The warfarin embryopathy rate was estimated at 4.5 – 5.4%. Most women reported having been given information about warfarin in pregnancy, though their awareness about the personal and fetal effects of warfarin was often inaccurate. Of warfarin-exposed pregnancies, 95% were reportedly exposed during critical weeks six to ten of pregnancy, and >50% after 36 weeks. Only 5/124 (4%) interviewees had genetic counselling. Poor pregnancy outcomes, lack of awareness about the effects of warfarin in pregnancy, and management practices at odds with international regimens are all areas highlighted by this study that require urgent attention in this high-risk group of women.

Post 1994 the South African education system has focused on creating education for all under a single core syllabus. It also stressed the need for a shift from the traditional teacher-centred approach to a learner-centred approach. As a result, the shift was made from an aims-and-objectives education to Outcomes Based Education (OBE). OBE has placed a different set of demands on teachers and the way in which they assess. Specifically teachers are required to use peer collaboration to bring about learning and simultaneously assess that learning has transpired. However, many teachers are left feeling uncertain about the efficacy of OBE. This report reviews the relevant literature as well as theories needed to understand the process learning. The objective of this research report is to establish teacher’s current perceptions are of OBE. More so, the research aimed to ascertain how useful peer collaboration is in facilitating learning. The results from this study show that teachers are uncertain about the efficacy of OBE. Although a significant number of teachers strongly agree with the underlying principles of OBE they feel that implementation as intended by policy makers is idealistic. Furthermore, they are conflicted about the notion that peer collaboration can sufficiently facilitate learning. Lastly, the findings of this study suggest that in implementing peer collaboration successfully, tenets from social psychology such as group dynamics need to be considered.

Thesis advisor: Mary E. Walsh / School readiness at kindergarten is an important predictor of children's future academic success (Duncan et al., 2007). While early pre-academic and behavioral skills are important for all students, there is considerable inequality in students' levels of readiness at the start of school (Coley, 2002; Lee & Burkam, 2002; Razza, Martin & Brooks-Gunn, 2010; Ryan, Fauth, & Brooks-Gunn, 2006; Welsh, Nix, Blair, Bierman & Nelson, 2010), and research has pointed to a range of out-of-school and poverty-related factors that contribute to these inequalities (Coley, 2002; Dearing, 2008; Foster, 2002; Hill, 2001; Razza et al., 2010; Ryan et al., 2006). This study utilizes relational developmental systems theory (Lerner, 2006; 2011) to examine the individual and contextual factors that co-act dynamically to shape and predict student outcomes. Specifically, this study extends the body of research on early child development by examining the factors that predict school readiness skills within a sample of 521 young children preparing to enter the first grade from urban early education programs. Multilevel regression models indicate that student characteristics, classroom characteristics, and peer contexts each predict students' school readiness scores, and that the interactions among these variables make unique contributions to the prediction of school readiness scores as well. Implications for theory, policy, and practice are discussed along with recommendations for future research. / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

Tuberculosis remains a communicable disease of major public health importance in South Africa. The purpose of this study is to search for trends in management of tuberculosis at Hillbrow Health Centre from 2000 to 2002. Furthermore, to assess completeness of routine records, compare performance of tuberculosis control in this clinic with others in region 8 during 2002 and identify residential areas with high volumes of tuberculosis patients. Data was obtained from tuberculosis documents at the facility. Information provided by the district office was compared with research findings and used to evaluate performance of Hillbrow Health Centre against the other four clinics in the region. The main findings from the study conducted at Hillbrow Health Centre were the large number of patients diagnosed with tuberculosis annually and cure rates below 40% during the study period. In 2002, the clinic reported the highest proportion of TB patients and the lowest cure rate compared to the other four clinics reporting tuberculosis in region 8. “Hot spots” for the disease were identified in Hillbrow and Joubert Park suburbs and this is where Esselen, Hillbrow and Urban Health Clinics are situated. There is room for improvement of tuberculosis control. More research needs to be done to determine factors contributing to the high incidence of TB in Hillbrow and Joubert Park Suburbs.

Organisation socialisation is the process by which an individual acquires the attitudes, behaviour, and knowledge she or he needs to participate as an organisation member (Van Maanen & Schein, 1979). During socialisation, organisations seek to mould new employees to fit its needs and employees attempt to define acceptable work roles for themselves within the organisation (Fisher, 1986). Several scholars believe that an important way in which socialisation occurs is through social interactions between newcomers and „insiders‟ or more experienced members of their organisation (Feldman, 1981; Louis, 1990; Reichers, 1987). Relationships might be important, but little is known about the types of relationship patterns that are most conducive to effective socialisation (Morrison, 2002). This research will view the socialisation process from the perspective of social network structure and examine the effect of the relationships on socialisation outcomes.

South Africa has engaged in an outcomes-based curriculum innovation that includes Arts and Culture as a new learning area. Few empirical studies have examined what the curriculum innovation looks like in practice in this high inequity and low capacity school system. This study examines what teachers' curriculum looked like, what influenced their design decisions, and what the growth of their curriculum knowledge looked like. A small sample of new grade 7 Arts and Culture teachers from a disadvantaged township setting participated in an adaptation of empowerment evaluation to gather curriculum data over a 1.5 year period. The findings of this evaluation-research study showed teachers using a more dialogic process to design curriculum with varied influences from policy, learning support materials, and handson arts practice, rather than a linear design process starting with learning outcomes. Gaps in curriculum knowledge about outcomes and assessment were also identified. As part of the empowerment curriculum evaluation (ECE), learning outcomes seemed to play a more powerful role as heuristics in growing their meaning(s) in practice, and generating valid assessment critiera. Evidence was found to argue that the ECE was associated with curriculum knowledge growth and increased self-determination for the teachers who had some initial experience in the learning area before participating in the study. iv