Thesis (M.Admin. (Development)) --University of Limpopo, 2010 / Feminist studies show that gender inequality is an impediment for livelihoods diversification among rural households. Whereas women are understood to be the designers, planners and managers of livelihoods for household survival, their roles in diversification of the means of earning a living are generally undermined through a myriad of social and cultural laws, values, norms and beliefs. Despite the publicity, attempts and efforts in redressing gender inequality in a demographic South Africa, the dissertation argues that gender inequality in rural areas has remained persistent, posing an obstacle to the capacity of households to diversify their livelihoods. The study uses survey results from Sebayeng Village in order to demonstrate that the community’s perceptions of women’s roles perpetuate the status quo wherein women’s capacity to diversify livelihoods are undermined. The survey involved 200 households that were sampled through the simple random design. The respondents consisted of 56.5% females and 43.5% males. The survey results demonstrate that gender inequality remains deep in Sebayeng Village and that such inequality negatively affects the ability of households to diversify their livelihoods. Therefore, this study tends to confirm the general principle that gender inequality renders women as unexplored resources in rural development. To that extent, the study concludes that one of the tests for the success in gender transformation in South Africa is in releasing the energies of women in the sphere of livelihoods diversification.

Attention-deficit hyperactivity disorder (ADHD), once considered a childhood-limited neuropsychiatric condition, is now recognized as often persisting into adolescence and beyond. Recent studies of ADHD and its symptom domains--hyperactivity and inattention--indicate that symptoms can wax and wane over time and follow discrete trajectories characterized by different symptom levels and shapes. However, little is known about symptom trajectories in high-risk groups, such as boys from low socioeconomic backgrounds. Childhood ADHD is associated with cigarette smoking in adolescence, but whether the risk is specific to hyperactivity or inattention or their respective symptom trajectories is not clear. The aims of my dissertation research were to identify trajectories of hyperactivity and inattention symptom scores in a sample of boys from low socioeconomic backgrounds and to assess the associations of those trajectories with cigarette smoking outcomes in late adolescence and young adulthood. In pursuit of those aims, I first conducted a narrative literature review to assess current evidence regarding the persistence of childhood ADHD, hyperactivity and inattention into adolescence, and the associations of persistent ADHD and its symptom domains with the risks of cigarette smoking and nicotine abuse and dependence in adolescence and early adulthood. Data on boys of low socioeconomic status, where available, were summarized. Evidence suggests that nearly 50% of individuals with childhood ADHD or its symptom domains continue to have symptoms in adulthood. Hyperactivity symptom trajectories are likely to decline over time, whereas inattention symptom trajectories are more stable. The sparse literature on the association between ADHD, hyperactivity, and inattention symptom persistence and high symptom score trajectories and smoking outcomes suggests that high inattention symptom score trajectories are associated with earlier onset and higher risk of nicotine abuse or dependence in early adulthood than lower trajectories. Evidence on hyperactivity symptom score trajectories and similar smoking outcomes is inconclusive. Literature on symptom trajectories in low socioeconomic boys is sorely lacking; no study has evaluated the association of symptom score trajectories with smoking outcomes. Second, in a sample of 1,037 boys from low socioeconomic neighborhoods, I derived trajectories of hyperactivity and inattention symptom scores between childhood and mid-adolescence (ages 6-15 years), using teachers’ and mothers’ ratings, separately. I also evaluated risk factors for high symptom score trajectories. Three trajectories were identified for both hyperactivity and inattention symptom scores. Hyperactivity symptom scores generally declined over time (high declining, moderate declining, and low declining), whereas inattention symptom scores remained stable (high stable, moderate stable, and low stable). Most boys had low symptom scores over time (i.e., low declining for hyperactivity or low stable for inattention), but approximately one-fifth to one-third followed high symptom score trajectories (high declining for hyperactivity or high stable for inattention). Mothers were more likely than teachers to rate boys as having higher symptom scores. Boys’ behavioral symptom scores (hyperactivity, inattention, opposition, and anxiety) at age 6 years and lack of family intactness were risk factors for high hyperactivity and inattention symptom score trajectories. Third, in the same sample of boys from low socioeconomic neighborhoods, I assessed the associations of the hyperactivity and inattention symptom score trajectories with frequency of cigarette smoking at ages 16-17 years (late adolescence) and daily and heavy (≥1 pack/day) smoking at ages 23 and 28 years (young adulthood). I further conducted mediational analyses to assess the potential impact of cigarette smoking frequency and use of alcohol, marijuana, and other drugs in late adolescence on smoking outcomes in young adulthood. High vs. low symptom score trajectories of hyperactivity (i.e., high declining vs. low declining) and inattention (i.e., high stable vs. low stable) were associated with nearly doubled odds of high cigarette smoking frequency (≥40 times in the past year) in late adolescence (hyperactivity: OR=1.97 [95% CI=1.30-2.98]; inattention: OR=1.87 [1.27-2.76]). High (vs. low) symptom score trajectory of inattention, but not hyperactivity, was further associated with elevated risk for daily cigarette smoking (OR=2.67 [1.53-4.64]) and heavy cigarette smoking (OR=1.95 [1.10-3.45]) in young adulthood. Part of the associations (about 11-23%) was mediated by high cigarette smoking frequency in late adolescence. The mediation roles of other substances were not statistically significant. Although the socioeconomically disadvantaged boys whose data I analyzed were similar in number of symptom score trajectories and trends (declining for hyperactivity and stable for inattention) to boys in general populations, they were at elevated risk for high scores for both of the symptom domains over time. Childhood behavioral problems as well as lack of family intactness were associated with high symptom score trajectories of both hyperactivity and inattention. High trajectories of both hyperactivity and inattention scores were associated with high risk of cigarette smoking frequency in late adolescence, but inattention appeared to have a longer-term impact on smoking behaviors. Altogether, my research findings suggest that children with high symptom levels of hyperactivity and/or inattention at an early age, especially those with symptoms that persist over time, might benefit from early interventions to manage and reduce their symptoms and their risk of becoming cigarette smokers.

No description available.

This study used a multi-method approach to explore factors associated with high and low depression in a sample of rural mothers living in poverty. From a sample of 117 women with very high or very low CES-D depression scores, 40 cases were randomly selected for in-depth qualitative analysis. Qualitative comments about a variety of issues were explored including health, mental health, childcare, transportation, community, social support, and family of origin experiences. Quantitative data were then used in response to themes that emerged from the literature and the qualitative findings. All 117 eligible participants were used for quantitative analysis to increase power. Analysis of the qualitative data revealed several critical differences between the two groups. Low risk participants mentioned fewer health issues and less severe health problems as compared to their high risk counterparts. Mental health issues were reported more in the high risk group, with this group being more likely to have multiple family members experiencing symptoms. All participants reported receiving social support, however, the low risk group reported positive social support experiences, while the high risk group reported ambivalent relationships with the people who provided them with social support. Reported family of origin experiences were quite different between the two groups, with the low risk group reporting more positive past and current relationships. Quantitatively, several interesting results were revealed, many confirming the qualitative findings. Mothers showing higher levels of depression reported significantly more health problems for themselves, their partners, and their children. Additionally, participant's work status, income, perceived adequacy of income, childhood welfare use, and presence of partner were significantly related to depression. Low risk respondents were more likely to be working, perceive their income as adequate, and have a partner. They were also less likely to have received welfare as a child and had higher incomes. The findings offer important implications for future research and policy. Risk for depression seems to be related to a variety of factors, indicating that something should be done to minimize an individual's likelihood toward experiencing depression. This study ultimately provided a clearer picture of the existence of depressive symptoms among women with children living in rural poverty. / Graduation date: 2003

<p>The current study aimed to describe the extent and reasons for substituting and switching HAART at the Katutura Intermediate Hospital in Windhoek, Namibia</p>

<p>This thesis interrogates the claim that resource-poor, rural land seekers can acquire land through the land market which constitutes the central mechanism of land redistribution in South Africa&rsquo / s market-based land reform programme. The study explores two key aspects in relation to this claim. Firstly, it provides a critique of the underlying assumptions prevalent in much of the current market-based land reform policy, as advocated by its national and international proponents, and the manner in which the market as a mechanism for land redistribution has been conceptualized and its outcomes envisaged. Secondly, it considers the extent to which this conceptualization - which it is argued, draws on idealized and abstracted notions of land market functioning - is realized and examines the extent to which the espoused outcomes of market-based land reform policy are aligned with or contradicted by the functioning of real markets and the experiences of resource-poor land seeking people in their attempts to engage in the land market with limited state support. The details of the market&rsquo / s operation are analysed, with a distinction made between the operational practice of real markets &ndash / based on direct evidence-based observation <br /> and degrees of policy abstraction and theoretical assumptions regarding how markets should or might operate. The study&rsquo / s methodological framework draws on an agrarian political economy perspective, as used by theorists such as Akram-Lodhi (2007) and Courville (2005), amongst others. This perspective enables a consideration of the various contexts and socially embedded processes involved in land transactions and the extent to which these are shaped and framed by the politics of policy-making. In line with this perspective, the study focuses on the social relations brought to bear on the acquisition of land and the way in which land markets operate. It is suggested that land is not solely viewed as an economic commodity by land-seekers. Furthermore, it was found that markets cannot be understood as neutral institutions in which participants are equal players.</p>

Despite the currently recommended dual antiplatelet treatment (DAT) with aspirin and P2Y12 inhibition in patients with coronary artery disease (CAD) there is a risk of adverse clinical outcome. Pharmacodynamic (PD) poor response to clopidogrel occurs in ~ 30% of clopidogrel-treated patients and is associated with an increased risk of recurrent thrombotic events. The aims of this thesis were to compare the PD and pharmacokinetic effects of clopidogrel 600 mg loading dose (LD)/ 75 mg standard maintenance dose (MD) with the novel P2Y12 inhibitor prasugrel 60 mg LD/10 mg MD, in 110 patients with CAD. The mechanisms behind clopidogrel poor response were investigated by assessing the pharmacodynamics after adding clopidogrel active metabolite (AM) and genotyping for variation in CYP-genes involved in thienopyridine metabolism. In another study, we compared the on-clopidogrel platelet reactivity of patients with stent thrombosis (ST) (n=48) or myocardial infarction (MI) (n=30) while on DAT and their matched controls (n=50 + 28). Prasugrel achieved a faster and greater P2Y12-mediated platelet inhibition than clopidogrel measured with light transmission aggregometry, VASP and VerifyNow® P2Y12. Prasugrel’s greater platelet inhibition was associated with higher exposure of AM. The addition of clopidogrel AM led to maximal platelet inhibition in all subjects, suggesting that prasugrel’s greater antiplatelet effect was related to more efficient AM generation compared to that of clopidogrel. Lower levels of AM as well as less platelet inhibition were seen in clopidogrel-treated patients with reduced-metabolizer genotype CYP2C19 compared to those with normal genotype. Patients with ST while on DAT showed higher on-clopidogrel platelet reactivity compared to matched stented controls. Patients with spontaneous MI after stenting did not. In conclusion, these results showed a high rate PD poor response to a high bolus dose of clopidogrel because of a partly genetically caused lower generation of AM which could be overcome by prasugrel treatment. In patients after coronary stenting, clopidogrel poor response was related to ST but not to spontaneous MI, illustrating difficulties in optimizing treatment with clopidogrel based on platelet function or genetic testing in individual patients.

In 1655 and again in 1686-1689, the Waldensians of Piedmont were massacred by the Duke of Savoy after he issued edicts forbidding the practice of their religion. The Waldensians were later followers of the medieval religious movement of the Poor of Lyons, declared heretical in 1215. The Waldensians associated with the Reformation in 1532, and thus formed a link with diverse groups of Protestants across Europe. In the periods immediately surrounding both massacres, an outpouring of publications dedicated to their plight, their history, and their religious identity appeared, a large number of which emerged in London. On both occasions, the propaganda gave rise to international sympathy and encouraged international intervention, eventually provoking the Duke to rescind the edicts that had instigated the massacres. While most contemporary scholars consider the Waldensians to have been fully absorbed into Protestantism after 1532, it is clear from the writings of both the Waldensians and their sympathizers that they considered themselves a separate entity: the inheritors of a long tradition of dissent from the Catholic Church based on their own belief in the purity of the Gospel. The Waldensian identity was based on a history of exclusion and persecution, and also on a belief that they had transmitted the true embodiment of Christianity through the centuries. The documents that were published surrounding the massacres address the legitimacy of the Waldensian identity based on centuries of practice. English and continental Protestants identified with the Waldensians, who provided ancient ties and legitimacy to their ‘new’ religion, and the Waldensians adopted that identity proudly, all the while claiming continuity. Protestants also used the Waldensians in propagandist documents, most often to justify political or religious actions and ideologies. The continuity of Waldensianism through the Reformation became crucially important for the wider umbrella of Protestantism as a legitimizing factor for the movement. This thesis investigates the claims of continuity and finds that while the Waldensians underwent a dramatic change in religious doctrine to conform to the Reformation, their belief in the continuity of their religious identity can be validated by examining religion from a socio-cultural perspective that takes aspects other than theology into consideration.

The present study treats liberal poor relief policy in Sweden between 1903 and 1918. In using institutionalist theory and Yvonne Hirdman's gender theory, along with qualitative analysis, the author interprets the motives of the actors, distilling from them both the values, attitudes and norms they themselves represented, and those they wished to communicate to the poverty-stricken through poor relief. This study shows that the liberal reformers, with the liberal, "help-to-self-help" idea as their basic ideological foundation, wanted to shape poor relief institutions so that those who came into contact with poor relief authorities would be taught to assume responsibility for their own lives. Poor relief was intended to develop the individual's will and ability to support him/herself and his/her family. Maintenance obligation was a central element here; those who neglected this obligation were therefore apprehended as criminals, and toughened regulations for neglecting the maintenance obligation were introduced into the poor relief law of 1918. Poor relief was also to be formed so that it would have a deterrent effect. Unchecked charity would be counteracted and the individual prevented from becoming dependent upon receiving welfare. This would be effected through preventive measures for the conscienious recipients, and moral education for the unruly ones. In order that the right measures be taken in each individual case, the liberal reformers advocated an individualized system of poor relief whereby poor people were judged to be either "worthy" or "unworthy", according to a moral yardstick. However, in the legislation it is apparent that the male is considered to be the norm, since it was the inability to secure gainful employment that gave one the right to receive poor relief. This employment criterion disregarded the fact that it was most often the husband who was the family provider, while the wife most often worked in the household. The poor housewife was made invisible and thus found herself relegated to a no-man's land somewhere in between the "worthy" and "unworthy" poor. The female reformers, warders and the poor women themselves lived within the confines of a gender system where the man represented the norm. However, there existed sub-systems side-by-side and on different levels of society, with class differences acting as the watershed. The progressive middle- and upper-class women and the female warders lived in a system of separation of the male and female spheres which allowed them to take the step out into the public arena — within certain boundaries — while the poor women lived in a system constructed with men foremost in mind. In conclusion, one may say that moral education was a type of social engineering intended to realize a liberal social Utopia, where all individuals would have the will and the ability to support themselves. / digitalisering@umu

<p>Background: Tuberculosis (TB) is a resurgent disease in many parts of the world, fuelled by HIV/AIDS and poverty. According to WHO, over two billion people were estimated to be infected by TB globally, 9.4 million new cases of TB were reported, while about 1.7 million people were estimated to have lost their lives to TB in 2009 (WHO, 2010). The&nbsp / global defaulter rate for TB was estimated at about 9% in 2007 (WHO, 2007). With Africa remaining the global epicentre of the TB epidemic, the epidemic in Sub-Saharan Africa,&nbsp / one of the worst affected areas in the world, shows no evidence of decline (WHO, 2008). According to the 2009 MOHSS annual report, 1300 people lost their lives to TB in&nbsp / Namibia (MOHSS, 2010). The introduction of TB treatment saves many lives globally. However, despite this effort, TB patients have been reported to default treatment in many&nbsp / parts of the world including Namibia. Namibia reported a defaulter rate of 10% above the national target of less than 5% (Maletsky, 2008). Aim: This study aimed to investigate&nbsp / the factors that contribute to treatment defaulting amongst TB patients at a major health centre in Windhoek district, Namibia. Methodology: A descriptive qualitative study using&nbsp / in-depth interviews was conducted among ten TB defaulters. Key informant interviews were also conducted with the two TB nurses based at the health centre. Eligible&nbsp / participants were purposively selected. A thematic content analysis of transcribed data was conducted where themes related to patient&rsquo / s experiences of the illness / socio- economic / community, family, cultural and religious as well as health system factors were drawn out. Results: The study results indicate that defaulting TB treatment is a big challenge to TB management. The reasons for defaulting given by respondents were complex and included patient factors such as medication related factors, lack of knowledge and information as well as alcohol abuse. The findings also revealed unemployment as a major socio-economic factor that contributes to defaulting. In addition, the study shows that community, family, religious and cultural factors such as poor family support, work-related factors and religious and cultural beliefs have an influence on defaulting. Accessibility to health care services, sharing of the TB department with ART patients and attitudes of health workers were identified as health service&nbsp / factors that influence treatment defaulting. This study also highlights the relationship between some of these factors. Conclusion: The study concludes that no single factor contributed to treatment defaulting amongst TB patients in the selected health centre in&nbsp / Windhoek district and this concurred with the literature. There are many different factors at different levels that have an influence on TB treatment defaulting. An interrelationship between personal, socio- economic, community, family, religious and cultural as well as health services- related factors was evident What makes it more complex is that these&nbsp / factors also impact on each other and therefore a holistic approach in the management of TB is required to address these factors. Recommendations based on the findings of the&nbsp / study are made. </p>