INTRODUCTION: Malaria is a deadly infectious disease that affects millions of people around the world. This vector-borne tropical disease is caused by parasites that belong to the Plasmodium genus and is transmitted through the bite of an infected female Anopheles mosquito. Tools such as long-lasting insecticide nets (LLINs) and attractive toxic sugar baits (ATSBs) have been shown to work well in delivering insecticides to mosquitoes, but due to the spread of insecticide resistance throughout sub-Saharan Africa and Southeast Asia, there has been much interest in finding alternative chemical compounds against Anopheles mosquitoes. Compounds, such as methoxyfenozide (MET), have been shown to have insecticidal effects against Anopheles gambiae females. MET alongside another insecticide, hydramethylnon (HYD), have been shown to have antimalarial properties against mosquito-stage Plasmodium falciparum parasites; HYD’s insecticidal effects on A. gambiae is unknown. Atovaquone (ATQ), a known antimalarial drug for humans, has been observed to have antimalarial properties against mosquito-stage P. falciparum. The primary focus of my study is to assess the potential of the three compounds when used in tarsal contact assays (MET) or sugar feeding assays (ATQ, HYD, and MET). METHODS: A. gambiae females were exposed to ATQ, HYD, or MET through sugar feeding assays, and MET through tarsal contact assays to assess the effect of these compounds on mosquito survival, P. falciparum infection, or mosquito egg development. Effects on P. falciparum infection were assessed through oocyst intensity, the prevalence of infection, the oocyst size, and the number of sporozoites present in the salivary glands. RESULTS: Through sugar feeding, ATQ induced a significant reduction in P. falciparum prevalence of infection when A. gambiae were exposed to the treated sugars before an infectious blood meal. ATQ had also significant effects on P. falciparum oocyst size and number of sporozoites when A. gambiae were continuously exposed to the treated sugars after an infectious blood meal. There was a dose-dependent survival effect caused by HYD on A. gambiae females through sugar feeding, and also a significant effect of HYD-treated sugar feeding on the prevalence of P. falciparum infections. MET had little effect through tarsal contact on infection and egg development but showed significant effects on egg development through sugar feeding. CONCLUSION: This study identified important compounds that could be used in ATSBs and LLINs. In particular, ATQ had antimalarial effects when infected mosquitoes were exposed to ATQ-treated sugar meals, and HYD-treated sugar meals had insecticidal effects against A. gambiae mosquitoes, with promising implications for the future of vector control and malaria eradication.

Background: Injury remains a leading cause of childhood morbidity and mortality in the developing world. Probability of injury occurrence is influenced by agent, host and environmental factors. Studies of repeat injuries in childhood thus provide insight into factors in the epidemiological triad predisposing children to injury. Objectives: The study objectives were to determine the proportion of children and the factors associated with repeat presentations to Red Cross War Memorial Children’s Hospital Trauma Unit (RCWMCH TU) for all non-transport related injuries in childhood. Methods: This was a retrospective cohort study using data from RCWMCH TU. We included children aged 0-10 years with first presentation from January 1997 to June 2013, and followed up until the earliest of age 13 years or June 2016. We assessed individual and population-level factors associated with repeat injury using multilevel Poisson regression. Child Dependency Ratios were derived from the 2011 national census. Results: Between 1997 and 2013, 72 490 children under 10 years of age (59% male) presented to RCWMCH TU for the first time with injuries. After the initial injury, 9 417 (13%) presented with a repeat injury by 2016 and before age 13 years. After adjusting for health Sub-District, distance from RCWMCH TU and age at first presentation, factors associated with reduced repeat presentation were: injury identified as due to abuse (adjusted incidence rate ratio [aIRR] 0.6; 95% confidence interval [CI]: 0.4 - 0.7), fluid burn (aIRR 0.6; 95% CI: 0.6 - 0.7), foreign body ingestion (aIRR 0.7; 95% CI: 0.7 - 0.9), moderate and severe (vs minor) initial injury (aIRR 0.9; 95% CI: 0.8 - 0.9) and (aIRR 0.7; 95% CI: 0.6 - 0.8 respectively), whilst boys were more likely to have repeat injury presentations (aIRR 1.4; 95% CI: 1.4 - 1.5). Conclusion: Repeat presentations constituted a substantial proportion of disease burden. Factors associated with repeat presentations were identified, strengthening the argument that injuries arise due to sustained exposure to host, agent and environmental risk factors. While it is reassuring that children with initial injuries due to abuse and severe initial injuries are less likely to present again, injury prevention education should not neglect patients with minor and unintentional injuries. The findings of this study suggest that post-injury health promotion activities should not exclude patients who present with minor injuries, and that targeted education and further research is indicated for specific injuries, including those due to non-height falls and injuries sustained whilst playing sport.

No description available.

Includes bibliographical references.

Bibliography leaves 230-248. / This study attempts to assess the equity and technical efficiency aspects of the South African health system. It empirically assesses the status qua and trends in equity as it relates to child morbidity and mortality and self-reported illness and utilization of different service providers in adulthood. Furthermore, an assessment of the technical efficiency and productivity of a sample of public sector hospitals is conducted. This is meant to explore the size of potential efficiency gains that is tantamount to the injection of additional resources, which are highly needed for addressing inequities in a scenario where mobilization of additional resources from the public purse is seriously constrained as a result of poor economic performance, stringent fiscal policies and competing priorities, among other things. Secondary data are used in the analyses. These include data from the Living Standards and Development Survey (LSDS) of 1993, conducted jointly by the World Bank and the South African Labour and Development Research Unit at the University of Cape Town, and data from the October Household Survey (OHS) series (OHS 1995 and OHS 1998) that are conducted annually by Statistics South Africa. For the analysis of hospital efficiency, data are obtained from annual statistical publications of provincial health departments. The equity analysis is done using concentration indices (and curves). In the adult population, standardized concentration indices are computed to rule out a possible confounding effect of the demographic variables, age and gender. Furthermore, utilization of services is standardized for need as measured by self-reported acute or chronic illness. Additionally, to identify some factors, which may be associated with inequities in child health, probit models are estimated. Data envelopment analysis (DEA) and DEA-based Maimquist productivity index are used to examine the state of hospital technical efficiency and productivity respectively. With the limited data available a tobit regression is also run to identify factors influencing the technical efficiency of hospitals. Overall, the findings of this study indicate that the huge income-related inequalities in health and health care that existed prior to the change of the political system in 1994 have been reduced significantly in the years after the installation of the new government. Analyses of the LSDS 1993 indicate significant pro-rich inequities in all the dimensions of equity in health and health care utilization examined in this study. Under-five mortality and child malnutrition manifest pro-rich inequalities of high magnitude. In the adult population, as is seen in many other studies, pro-poor inequities are seen in self-reported acute illness. This paradoxical pro-poor finding is, however, changed to pro-rich inequalities in the OHS 1995 and 1998 data. Inequalities in under-five mortality in the OHS 1998 data that do not show when income is used as a measure of socio-economic status (SES) are prominently seen when SES is proxied by race and residential location. This implies that the apparent bridging of inequities seen when income is used as a measure of SES may not enable us to definitively assert the absence of socio-economic inequities in health. Utilization statistics from all data sets indicate pro-poor horizontal inequities in the use of primary and other public health facilities, implying an appropriate targeting of public sector health care resources. The data clearly show that considerable health and health system inequities remain in South Africa. In order to rapidly address these inequities, additional resources are required to improve health and other health-promoting services in currently under-served areas and for specific disadvantaged groups. However, given the macro-economic context, the allocation of additional resources to the health sector is unlikely. The hospital sector, which absorbs the lion's share of the public health resources, seems to be plagued by high degrees of technical inefficiency. With the prevailing high levels of technical inefficiency and the adverse economic realities of the country, it would be difficult to mobilize additional resources needed for addressing existing inequities. Hence it is of paramount importance to address the existing technical inefficiencies in the hospital sector. Finally the study recommends that to address the inequities that besiege the country's health system, policies that transcend the health sector are needed and that there is an urgent need to rectify existing inefficiencies.

Includes bibliographical references (p. 269-299) / This thesis examines the "supply" and "demand" for health care expenditure in South Africa's public sector health care services. In this context supply refers to the availability of funding and demand to the requirement for funding. The literature review focuses on the health sector planning and its application to inform sector funding. A quantitative health sector planning model is developed and applied to inform the requirement for funding public sector health services. Uses of the model include simulation, forecasting and scenario planning.

Chemicals used in agricultural activities, could possibly be the most potent group of compounds used on a regular basis by employees representing a significant fraction of the unskilled, economically active, labour market of a country. Certainly, such a statement will hold true for South Africa and probably for most Third World and developing states. All chemical compounds contain the inherent property of being toxic and/or hazardous. However, pesticides are chemicals intentionally used to kill. They are therefore not avoidable and in contrast to other chemicals are used only because of their ability to kill. As in most other countries in the world, poisoning in the Republic of South Africa is to be expected due to the use of pesticides. In the handling of pesticides, statistics show South Africa to be vulnerable to an appreciable number of deaths and poisoning cases. There could be a number of reasons for this phenomenon, two of them probably being ignorance and negligence on the part of officers in charge of handling pesticides, and perhaps the most important, the exploitation of unskilled labour in applying and handling pesticides. It is believed that the South African agricultural industry represents both the First and Third World and should thus be ideally suited for investigating: (1) acute intoxication due to chemicals used in the agricultural industry. It was found that the annual consumption of pesticides in the Republic of South Africa results in a dose of approximately 250 mg/m² which compares very favourably with consumption rates of developed countries. An analysis of the products registered indicates a total of 1 211 products containing 359 different active ingredients. The three chemical groups responsible for 73% of the poisoning cases (organophosphates 55%, carbamates 14%, organochlorines 4%) are with the exception of pyrethroids, also the chemicals most frequently formulated. Products containing these three chemical groups constitute only 41% of all formulated products, but are responsible for 73% of all intoxications. It is concluded that the poisoning rate by pesticides is appreciably higher than officially notified, and that the fatality rate could be two orders of magnitude higher than developed countries. A compendium - the first of its kind in South Africa for use by hospitals and clinical practitioners and containing trade names, chemical classification, active ingredients, toxicology, symptomatology and proposed treatment procedures for each product, is presented as an appendix. (2) chronic exposure to residues of agricultural products in the diet of South Africans is investigated. Food intake data was calculated from 24-hour dietary recall studies. Residues of only 4 compounds were present in 33 composite, ready-to-eat foods, consisting of 5 538 foodstuffs sampled over a period of one-year country wide, and representing 142 different food items categorised into 11 food groups. The residues found were well within acceptable levels and compare very favourably with those found in the diets of developed countries. It has to be concluded that possible chronic exposure due to agricultural chemical contaminants, to the white population at least, does not exist, and emphasises a sound regulatory policy towards the use of these chemicals in South Africa. (3) a hypothesis of this study that it is not possible that neither the inherent toxicities of pesticidal compounds, nor a paucity of knowledge about the toxicological, chemical and physical properties of these compounds could be mainly responsible for the numerous intoxications recorded annually. An epidemiological 400 case study (descriptive design), investigated the contribution by occupational, environmental, cultural and socio-economic variables to poisoning. The numerous effects by these variables are described and amongst many others, it is concluded that the recommendations of the World Health Organization to classify pesticides by hazard, is confusing to illiterate and semi-educated users and should not be recommended to developing countries.

PART A is a research protocol which describes the background and proposed methodology of this systematic review and meta-analysis. This section details the quantitative and qualitative methods to be used when analysing the effect of Aloe in the treatment of patients with irritable bowel syndrome (IBS). PART B is an extended literature review which expands on some of the topics raised in the background section of the protocol. A more in-depth explanation of the epidemiology of IBS, is presented, as well as the strengths and limitations of current treatment options in order to understand the context around the proposed research. PART C presents this research in the form of a journal manuscript in a format suitable for submission to Plos ONE. This manuscript includes a background to the research followed by the results section which is then discussed. Lastly, implications for clinical practice are posited and suggestions for further research are offered.

The objectives of the study were to assess the impact of a PITC intervention on HIV test uptake rates and on access to HIV care, to evaluate the extent to which ethical principles were upheld in its implementation, and to examine the influence of implementation factors on the intervention.

National community health worker programmes are returning to favour across the globe. While such programmes expand access and deepen community engagement in health, they require considerable resources and support to sustain. This thesis seeks to enhance understanding of the system-wide changes and governance and leadership required to implement community health worker programmes at scale. Empirically, it examines the implementation of a community based delivery strategy, referred to as Primary Health Care Ward Based Outreach Teams (hereafter referred to as outreach teams), adopted in South Africa since 2011. These outreach teams are reconfiguring a community based care and support sector that evolved organically in response to HIV, towards a comprehensive approach, integrated into the primary health care system. Located within the field of health policy and systems research and using multi-method (document reviews, interviews, observations) case study research, the thesis describes the evolution of community-based services in South Africa and analyses the adoption and early implementation of the outreach team strategy in two provinces (Western Cape, North West). These case studies highlight the diverse and context specific ways in which the strategy emerged at sub-national level, as a negotiated product of local histories of community based services and new mandates from the top. Drawing on an additional case study in a third province (Gauteng), a cross case analysis inductively identified the challenges facing, and the strategies adopted, by provincial and district managers in implementing the new strategy. It shows how implementation of community health worker programmes is far from linear, and the complex and distributed nature of governance and leadership required, spanning analytic, managerial, technical and political roles. The thesis concludes by proposing a multi-level governance and leadership framework for community health worker programmes at scale. Through this lens it adds a more general understanding on health system governance and leadership. The thesis is presented as four published papers embedded in a narrative, that includes a literature review and cross-cutting discussion.