Includes bibliographical references (leaves 72-73). / Christel House South Africa (CHSA) is an independent primary and secondary school that offers a comprehensive educational programme that includes two meals and snacks to children from disadvantaged areas known as the Cape Flats. Anthropometric measurements such as weight and height are widely recognised as a reliable way to assess growth and nutritional status of children. Underweight and wasting are indicators of recent and severe malnutrition while stunting is associated with poor socio-economic conditions. Academic performance is associated with many factors including genetics, socio-economic circumstances, parental education and ill-health. However, there is no convincing evidence supporting a direct link between improved academic performance and improvement in nutritional status. This study aims to evaluate the comprehensive programme that CHSA provides by assessing anthropometric measurements and academic performance as well as absenteeism among the learners over a two year period. In particular, to assess whether those learners who showed improved anthropometry also demonstrated improved academic performance and reduced absenteeism between 2002 and 2004. The study is a cross-sectional survey with a retrospective cohort analysis. Existing data, part of the school's routine data collection, were used. The data consisted of weight and height measurements, end-of-year grades for English and Mathematics, and absenteeism records, all for 2002 and 2004. After obtaining informed consent from parents and guardians, a sample of 175 learners was established and used for cross-sectional analyses. This represented 65% of all eligible learners in the sample population. The median age was 8.5 years. Sex and age specific anthropometric measurements, expressed as weight-for-age, height-for-age and weight-for-height Z-scores, were created using the Epi Nut software in EPilnf06. Due to age and height limits in data that can be entered in this software, a cohort sub-sample of 81 learners, median age 7.2 years, was created and used for cohort analyses. As a result of measurement error with regard to height measurements in 2002, height-for-age and weight-for-height outcomes for 2002 were rendered invalid and excluded from statistical analyses of height-for-age and weight-for-height Z-score change between 2002 and 2004. However, by creating a 'gain' variable that took account of the measurement error, selected comparisons could still be done. The study found a prevalence of underweight of 8% in 2002 and 1.7% in 2004 (n=175). The reduction in underweight was statistically significant (P<0.05). There was a significant improvement in weight-for-age, English performance and Mathematics performance between 2002 and 2004, both in the complete sample (n=175) and the cohort (n=81). These improvements were statistically significant for both sexes, except for weight-for-age among girls in the cohort. There was no significant reduction in absenteeism during this period, either in the complete sample or the cohort. For 2004, bi-variate analyses showed a modest but significant positive correlation between weight-for-age Z-score and English (r=0.21, P<0.05) and Math (r=0.25, P<0.05) performance respectively, and a significant modest negative correlation with absenteeism (r=-0.18, P<0.05) (n=175). These correlations were not apparent in 2002. Multivariate analyses using logistic regression showed no associations between weight-for-age Z-score gain or height-for-age Z-score gain and improvement in English, Math and absenteeism, respectively (n=81). A negative association (OR=0.3, 95% CI 0.11-0.76) was found between weight-for-height Z- score gain and improvement in absenteeism. All analyses were adjusted for sex, age and having failed a year in school between 2002 and 2004. No significant associations were found when assessing improvement in English, Math and absenteeism in relation to quartiles of change in weight-for-age Z-score. A modest positive correlation was found between reduction in absenteeism and improvement in English (r=0.3, P<0.05) (n=81). Limitations of the study include measurement error in height in 2002, leading to the exclusion of height-for-age and weight-for-height in most of the analyses, and eliminating stunting and wasting as indicators of malnutrition from the overall assessment. Secondly, as a result of the limitations for age and height in the EpiNut software, a cohort was created. Analysis indicated that those included in the cohort were significantly different 'from those not included in the cohort in terms of age and sex. In particular, selection bias caused the exclusion of older and taller girls from the cohort. As such, findings for the cohort may not be representative of the study population. In spite of its limitations, this study identified a number of significant findings in respect of academic performance and anthropometric outcomes, suggesting that the programmes as provided by Christel House South Africa benefit their learners. In view of future monitoring and evaluation it is recommended that a protocol for weight and height measurement taking is agreed on, that the same instruments are used consistently, and that these instruments are regularly calibrated. It is also recommended that any future research related to child growth and academic performance at CHSA include data on socio-economic circumstances and parental education. Lastly, it is recommended that CHSA makes an assessment of the quality and nutritional value of the food provided, to ensure that the meals and snacks are healthy, varied and nutritionally balanced.

Includes bibliographical references. / The question of treatment adherence remains a concern that affects the health outcomes of patients attending public health clinics in South Africa. Patients with chronic illnesses who reside in impoverished communities face particular challenges in terms of managing the often complex aspects of their treatment. The sample for the study was selected from patients diagnosed with diabetes or hypertension attending public health clinics in the Boland area of the Western Cape. A total of 23 patients between the ages of 32 and 80 participated in the study. All participants were Afrikaans-speaking had been classified as Black or "Coloured" under the apartheid system and as such were all historically disadvantaged. Participants were selected by means of convenience sampling and were asked to participate in qualitative interviews under confidential conditions. The interviews addressed various aspects of the participants' experience of their illness and treatment and were conducted by two trained interviewers. Interviews were recorded, transcribed, and entered into Atlas.ti, a computer programme that assists in the analysis of textual data. The analysis of the data focused on the content of participants' concerns and difficulties associated with adhering to treatment recommendations. The themes that emerged from the study included participants' attribution of the origin of their illness, their experience of their illness and of the health care system, their own concerns about the consequences of poor adherence, financial and problems, psychosocial support, spirituality, alternative medicine, and patients' own understanding of the symptoms of poor adherence. The results of the study are discussed in terms of the often hierarchical relationship between health care workers and patients. Public health care workers often hold sceptical and suspicious views about their patients regarding their illness, symptoms, and level of adherence. As such, patients may be regarded in a paternalistic manner and in some cases even be admonished by health care workers for poor adherence. Yet, competing social realities often inhibit patient adherence. These include financial constraints, being labelled a patient, side effects of medication and family opposition to treatment. Adherence may also be related to the notion of responsibility for the causes of and solutions to medical problems. The results of the study were considered in terms of four models of attribution of responsibility for the origin of and solution to the medical problem as identified by Brickman, Rabinovits, Karuza, Coates, Cohn, and Kidder (1982). These models are the moral model, the compensatory model, the medical model, and the enlightenment model. The medical model is the most dominant in the South African public health system. Yet, in many instances, participants appeared to adopt other models of engaging with the causes and solutions to their illness conditions. The question of participants' understanding of the consequences of adherence is discussed in terms of the theoretical work by Pepper's (1942), who proposed four possible perspectives with which people may view the world. These world-views are formism, mechanism, contextualism, and organicism. In many instances adherence as a means of controlling somatic symptoms occurs as part of a logical and mechanistic understanding of health. However, in terms of an organismic worldview, adherence may represent an effort to restore equilibrium to the patient's constitution that has spiralled into disequilibrium as a result of disease.

No description available.

Includes bibliographical references. / Epidemiological research has long since observed that the prevalence of hypertension varies across populations' socioeconomic strata. Higher socioeconomic status (SES) has been consistently associated with lower levels of blood pressure in most studies from Europe and North America, while research in low- and middle-income countries at an earlier stage of the epidemiological transition revealed mixed patterns. The causal mechanisms underlying these varying relationships are largely unknown. Only in recent years the pathways through which SES impacts the cardiovascular system have been explored in large-scale studies, with results suggesting that body mass index, heart rate, and to a lesser extent physical exercise, alcohol use and smoking, may play a role in mediating these associations. However, these results refer to high-income countries, while similar research in low- and middle-income countries, and sub-Saharan Africa in particular, is lacking. In 2008, the National Income Dynamics Study (NIDS) collected a broad range of information on a representative sample of the population of South Africa, a medium-income country undergoing rapid epidemiological transition. Among other topics, information was gathered on blood pressure, biologic and behavioural risk factors, education, income and other indicators of socioeconomic position.

No description available.

Includes bibliographical references (leaves 103-109). / The prevalence of current wheeze and asthma in school children in Cape Town has been reported to be increasing. The multi centre International Study of Asthma and Allergies in Childhood Phase 3 (ISAAC 3) offered an opportunity to investigate the relationship between environmental or dietary risk factors and asthma symptoms or diagnosis.

Includes bibliographical references. / BACKGROUND AND OBJECTIVES Malnutrition, which is widespread in many parts of South Africa, is a problem that affects child growth and predisposes children to early death. Another driver of child mortality in South Africa is the HIV/AIDS epidemic. An understanding of the interactions between malnutrition and HIV is therefore important, especially for vulnerable groups such as infants. This study is aimed to report on growth, in the first 36 weeks of life, of infants in three cohorts of motherinfant pairs: those infected by their HIV-positive mothers (infected), HIV-negative infants born to HIV-positive mothers (uninfected), and HIV-negative infants born to HIV-negative mothers (unexposed). Infant growth was also compared between the three different settings in South Africa. METHODS A prospective cohort study, called the Good Start Study, was conducted in three different settings in South Africa. Mothers were recruited at 28-36 weeks of pregnancy and followed up until the 36 weeks post delivery. Infant growth measurements were taken at 3, 24 and 36 weeks during scheduled home visits. The work presented in this document was a secondary analysis of data collected during the Good Start Study. Mean z-scores were calculated for length-for-age (LAZ), weight-for-age (WAZ) and weight-for-length (WLZ), and if they were below minus two, the infant was considered as moderately stunted, underweight and wasted, respectively. Mean z-scores, stratified by infant HIV exposure and infection status at three weeks, were plotted against infant age to assess growth over time. RESULTS The final sample included 98 infected, 386 uninfected and 193 unexposed infants. Although these infants differed significantly with regard to some demographic characteristics, these differences were minor. Infected infants had significantly lower mean WAZ (-1.11) compared to uninfected (-0.55) and unexposed (-0.55) infants at the three week (P<0.01) and subsequent iv visit times (P<0.01). Infected infants had significantly (P<0.01) lower mean WLZ (0.02) than uninfected (0.72) and unexposed (0.52) infants at 24 weeks. Infected infants had a significantly lower mean LAZ (-1.09) compared to uninfected (-0.29) and unexposed (-0.44) infants at 24 week visit (P<0.01), as well as at the 36 week (P<0.01), but not the three week visit (P=0.50). No significant difference (P>0.05) in all mean z-scores was observed between uninfected infants and unexposed infants. Results from the multivariate analysis showed a significant (P=0.01) effect of time on the difference in mean WAZ between uninfected infants and unexposed infants between the 3 and 24 week visit times. Uninfected infants had a steeper growth trajectory compared to unexposed infants. Infants living in Rietvlei were significantly (P<0.01) more stunted compared to infants in the wealthier sites of Umlazi and Paarl. CONCLUSION HIV-infected infants in this study were significantly more malnourished compared to uninfected or unexposed infants. The growth of uninfected infants did not differ significantly from that of unexposed infants. Early HIV infection and not exposure placed infants at increased risk of growth failure. Prevention of mother-to-child transmission of HIV and prompt diagnosis of infant infection at around 6 weeks, with appropriate care including assessment for eligibility for ARV's, is critical to prevent malnutrition in HIV-infected children.

Includes bibliographical references. / [Objective] The objective was to assess the uptake and coverage of SD-NVP to prevent mother-to-child transmission of HIV in women of unknown HIV status presenting in labour a sample of delivery sites in the Western Cape. This monitoring activity also accurately measures the prevalence of HIV among pregnant women and ascertains the proportion of HIV exposed infants delivered to these mothers, who received NVP prophylaxis to prevent MTCT. [ Design ] Anonymous, unlinked specimens of cord blood from discarded placentas were tested for HIV antibodies to determine population-level information on HIV infection and NVP coverage among all women delivering in the facilities. Uptake was measured by counting the number of women who were recorded to have accepted NVP when offered while coverage was measured by using the cord blood NVP assay. [ Results ] A total of 2198 (96.5%) cord blood specimens were collected from women at delivery. From these, 1876 (85.4%) women received pre-test counselling. Of those who were counselled, 1851 (84.2%) were tested for HIV and 365 (19.3%) tested positive. Amongst those who were infected, 229 (62.7%) received SD-NVP and but only 57.8% adhered to SD-NVP according to the cord blood. Of the infants born to HIV-infected mothers, 311 (85.2%) were recorded as 9 having received SD-NVP. There was no significant difference in SD-NVP uptake between the two facilities. The overall NVP coverage (mother and infant doses) was 55.3%. [ Conclusions ] The NVP coverage of 55.3% is poor. In order for PMTCT services to be successful, each mother-infant pair should go through a rigorous cascade of events that include HIV testing, receipt of results, diagnosis and drug adherence. The attrition cascade in this study was described using a new cord blood surveillance methodology. Coverage fails for a number of reasons and interventions are likely to differ from one facility to another. Appropriate interventions should be introduced to reduce the transmission to infants.

Includes abstract. / Includes bibliographical references. / Breast cancer is the leading cancer among women in South Africa (SA). Studies conducted in developing countries have shown that the majority of women present with advanced stage breast cancer at diagnosis. There is a gap in terms of recent data on the profile of breast cancer patients in SA. The purpose of the study was to obtain recent data with regards to the sociodemographic, clinical and risk factor profile of breast cancer in patients who presented at a Breast Clinic linked to a tertiary public hospital in the Western Cape in order to underpin the development of strategies for earlier detection and diagnosis of breast cancer. A cross-sectional descriptive medical record review was conducted. The studypopulation included all newly diagnosed patients with histological or cytological confirmedbreast cancer who presented at the Breast Clinic during the period 01 January 2009 to 31December 2010. All patients with a previous diagnosis of breast cancer were excluded. Data onthe socio-demographic, clinical and risk factor profile of breast cancer patients were collectedusing a standardised data capture sheet. Data was entered using Epidata version 3.1 and analysedusing Stata Statistical package version 12.After calculation of initial descriptive analysis for the whole sample, male subjects wereexcluded and further analysis was restricted to 585 female subjects. Stage at presentation wascategorised as “early stage” (stage 0, I, IIA, IIB) and “late stage” (stage IIIA, IIIB, IIIC, IV). Crude associations of potential predictors with stage at presentation were tested using Wilcoxon rank-sum tests for medians and Chi-square tests and Fischer Exact tests for proportions. Logistic regression was used to create a model with stage at presentation as dependent variable. Age and racial group were introduced in the model as possible confounders. Based on literature findings other variables present in the dataset were considered as potential predictors of stage at presentation (namely place of residence, employment status, medical aid status, family history of breast cancer, menopausal status, parity, having ever smoked or used alcohol, clinical signs of breast cancer as well as duration of symptoms) and introduced in the model if their bivariate association with the outcome (adjusted for age and race) was statistically significant. A significance level of p <; 0.15 was used. The only variable showing a significant association according to this criterion was the ordinal variable duration of symptoms. The final logistic regression model, therefore, included stage at presentation as the dependent variable and age, racial group and symptom duration as predictors.

Background and Rationale: Paediatric antiretroviral (ART) care in the Western Cape Province (WCP) has evolved following South Africa's (SA) massive roll-out of antiretroviral therapy in 2004 in response to the country's human immunodeficiency virus (HIV) epidemic. Decentralization of paediatric ART services was adopted in scaling up access to ART services for children living with HIV. Although children now mainly initiate ART at lower level facilities, sick or very young infants continue to initiate ART at tertiary health facilities and become eligible for transfer to lower level facilities after stabilization at tertiary health facilities. There has been limited assessment of the effectiveness of this model of ART care since its implementation. Aims and Objectives: The primary objective of this study is to determine the proportion of children that successfully transferred from Red Cross War Memorial Children's Hospital (RCWMCH) to referral facilities for continued ART within 18 or 48 months of their last appointment at RCWMCH. Successful transfer was defined in two ways: a laboratory test performed by a lower level facility (i) ≤18 months or (ii) ≤48 months after transfer date. The first interval corresponds to guideline recommendations for annual CD4/viral load monitoring; the second captures all children retained in care. Our secondary objectives are as follows: 1. To identify the determinants of successful transfer from RCWMCH. 2. To describe the CD4 and viral load outcomes of children that successfully transferred to referral lower health facilities within WCP. 3. To determine the feasibility of using the SA National Health Laboratory Service (NHLS) data for routine monitoring of children transferring between paediatric ART sites. Methods: A retrospective analysis of prospectively collected data was performed. The study population was children below the age of 16 years who were initiated onto ART at RCWMCH and transferred out to lower level facilities within the WCP from December 31, 2007 - January 1, 2012. We described children's characteristics before transfer out and post-transfer date. In those who successfully transferred, we compared their immunological and virological status at transfer out and at the first visit within 48 months after the transfer out date, using median change for continuous variables and difference in proportions for categorical variables. Results: Data from 1127 children with median age of 5.6 months (interquartile range [IQR] 3.1-19.9) was included; at ART initiation 85% had WHO stage III/IV disease and 57% were severely immunosuppressed. A total of 725 (64%) children were transferred; 69% (496) and 76% (541) successfully transferred within 18 and 48 months respectively. Since there is about 90% compliance with annual CD4/viral load monitoring guidelines, we estimate that up to 85% of children may have actually successfully transferred. Median time to successful transfer was 5.4 months (IQR 3.7-7.8). Among the 184 children (25%) who did not transfer successfully, 11% returned to RCWMCH. In patients who successfully transferred, median (IQR) CD4% increased between transfer out and first visit post-transfer [25.1% (17.3-33.8%) vs 30.2% (22.9-36.6%), p-value = 0.0000]. Children who had their transfer sites recorded in the database and those transferred before 2010 were identified to be associated with successful transfer (adjusted odds ratio (aOR 7.99, 95% Confidence Interval (CI) (2.3-28.5 and aOR 5.21, 95% CI 1.5-18.4 respectively). Conclusion: The proportion of children remaining in HIV care by 48 months after transfer out was at least 76% and 92% of those that transferred successfully reached the referral facility and undergoing a laboratory test within 18 months of transfer out. In children who successfully transferred, CD4% and viral load suppression improved after transfer. This suggests that paediatric ART decentralization is feasible with good outcomes. However, outcomes in those who were lost after transfer out need further investigation.