PURPOSE: The main aim of this study was to systematically assess women’s maternal health care seeking behaviour and its determinants in Addis Ababa, Ethiopia. DESIGN: A quantitative and cross-sectional community based study was the selected methodology for this study. METHOD: Data was collected using structured questionnaire administered to 903 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary and multinomial logistic regression models were employed to identify predictors of adequacy of antenatal care and delivery care. RESULTS: Most of the women (97.9%) visited health care facilities at least once for antenatal care follow up. About 86.5% of them had at least four visits during their last pregnancy; and only 51.1% started their first antenatal visit early. Further, only about one out of five of the antenatal care attendees received sufficient content of antenatal care services. Consequently, only about one out of ten women received overall adequate antenatal care mainly due to inadequate use of the basic components of antenatal services. Most of the women delivered in public health care institutions (76.3%) despite the general doubts about the quality of services in these facilities. Women of better socioeconomic status preferred to give birth at private health care facilities. Caesarean section delivery rate in Addis Ababa (19.1%) is higher than the maximum WHO recommended rate (15.0%); particularly among the non-slum residents (27.2%); clients of private health care facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women who belong to the highest wealth quintile (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery and about 9.0% of the caesarean section births had no medical indication. CONCLUSION: Disparities in maternal health care utilisation between the socio-economic groups was evident, requiring urgent attention from policy makers and other stakeholders to enable Ethiopia to meet its millennium development goal 5. Improving the quality of antenatal care in public health facilities which are the main provider of health care services to the majority of the Ethiopian population is urgent. The increase in the rate of caesarean section beyond the World Health Organization recommended upper limit has to be taken seriously. / Health Studies / D. Litt.. et Phil. (Health Studies)

This comparative research explores the work experiences of dementia care workers in nursing homes. The aim of this study is to understand concepts central to care and to gain insights from the care workers‟ perspectives. A comparative framework and symbolic interactionist approach is used to analyse data collected using ethnographic methods from 59 dementia care workers in Canada, Scotland, and the United States. The fieldwork settings are institutionalised; dominated by for-profit ownership; and provide care for a resident population with high cognitive and physical needs. The comparative findings underscore the importance of work conditions that provide care workers with sufficient resources to do their job and enough time to complete their work. The absence of these critical components creates stressful work conditions for the care workers. The lack of time, staff and supplies such as towels, wash cloths, and continence products do not allow the residents‟ choices in their care and disregard their dignity and rights. The inability to deliver care for the residents according to the guaranteed government care standards often result in the violation of human rights for the care workers and residents. The care workers are unable to supply the quality of care they know the residents need and are capable of providing given better circumstances. There are frequently not enough care workers, resources, or time to meet the level of care that relevant standards mandate or the care workers know is possible. The analysis reveals that care workers struggle to provide more than basic physical care and are seldom able to meet essential social care needs for the residents. Unwritten rules are implemented in each setting that include separating people with dementia, placing these residents out of view of the public, not allowing the residents access to go outside, and not providing them with engaging and meaningful interactions. While policies are frequently developed with good intentions, many are counter-productive without dementia knowledge. This comparative research reveals care practices and routines share strong similarities across the fieldwork sites while the care worker characteristics as a workforce vary the most between countries. Some differences involve the training required, average age, pay and mode of dress or appearances. Too often researchers frame stress issues for care workers as problems with attitudes, motivation, training and incentives. Yet, the broader social structures and conditions that set the context in which these problems have their origins are commonly ignored. Good working conditions for care workers are precursors to good care for the residents. This thesis concludes with recommendations for practice, research and policy development.

Text in Afrikaans with abstracts in Afrikaans and English / In hierdie proefskrif word die agtergrond van die pre-koloniale stand van die destydse Kaapkolonie geskets en die historiese ontstaan van een gemeenskap word as tersaaklike voorbeeld behandel. Die verhouding wat met verloop van tyd tussen hierdie gemeenskap en die indringende koloniste ontwikkel het, is grotendeels gebaseer op persepsies en houdinge wat reeds sedert die 17e, 18e en veral die 19e eeu weens die ontmoeting tussen die uiteenlopende bevolkingsgroepe ontstaan het. Die verhoudinge wat inherent as gevolg van hierdie koloniale inmenging vertroebel is, was die oorsaak dat sekere inheemse bevolkingsgroepe radikale verandering ondergaan het. Die inheemse bevolking se rol het al hoe meer ondergeskik geword en die landskap het vir goed verander. Waar die inheemse bevolkingsgroepe se grondgebied van hulle ontneem is, moes hulle hul oorlewingstrategieë drasties verander. Die sogenaamde bruinmense, wat ontstaan het uit die ondertrou van die koloniale inkommers met die plaaslike bevolking en ingevoerde slawe, is gou tot die rol van arbeiders gereduseer en hul status het bly verlaag soos die tyd verbygegaan het. Aangesien min van hulle grondbesitters kon wees, wys hierdie proefskrif dat daar wel uitsonderings was. Daar is ’n gemeenskap wat die eienaars van erfgrond aan die Gouritzrivier is en dit steeds na 155 jaar besit. Hierdie gemeenskap is Buisplaas. ‘n Blanke voorvader, Frederick du Buis het aan sy twee seuns wat van gemengde bloed was, Simson en Saul ’n stuk grond langs die Gouritzrivier in die suidooste van die Wes-Kaap nagelaat. Op hierdie 94 hektaar het ’n Buis-gemeenskap ontstaan wat deur al die jare van politieke veranderinge in Suid-Afrika bly voortbestaan en gegroei het. Die onsimpatieke geografie en klimaat van Buisplaas het sy beperkings ingehou en tog het hierdie gemeenskap oorleef en die skamele voordele soos die nabyheid van die rivier en die aalwyne tot hulle voordeel gebruik. Al het die ekonomiese realiteit die meeste van die inwoners genoop om elders te gaan vir verdere opleiding en werksgeleenthede het die Buis-afstammelinge dikwels na hul aftrede uit hul beroepe teruggekeer na hul heimat. Ontwikkeling en die daaropvolgende verbetering van hul omstandighede het eers 127 jaar na die oordrag van Buisplaas aan Simson en Saul Buis begin en ’n groot verbetering in hul lewensomstandighede gemaak. Die rol van die Buisplaas Bewonersvereniging wat in 1986 gestig is en die belangrike proses van ontwikkeling wat deur hierdie vereniging begin is, vorm ’n kernaspek van die studie. Oor die jare het die twee kerke, die Lutherse en Anglikaanse kerke ’n deurslaggewende invloed op die inwoners gehad en veral omdat die Lutherse kerk ook verantwoordelik was dat daar ’n laerskool op Buisplaas opgerig is. Die navorsingsproses het die toepassing van ’n multi-dissiplinêre benadering behels, maar is daar hoofsaaklik van historiese metodologie gebruik gemaak. Die aktiewe bydrae van verskeie inwoners en oud-inwoners van Buisplaas het die gebruik van ander primêre en sekondêre bronne aangevul. Die fokus van die studie was derhalwe op die Buisplaas-gemeenskap wat vir so lank reeds bruin grondeienaars is, te midde van die problematiek van grondeienaarskap in Suid-Afrika. Alhoewel die konkrete realiteite van hierdie gemeenskap behandel word, gaan dit meer oor die ontasbare emosionele verbintenis van die mense met hulle plek, hulle eiendom. Dit gaan oor ‘n landskap wat uit kulturele tradisies en herinneringe bestaan. Dit kry die mistiek deur die krag van onthou, deur die nooit-vergeet-nie van mense se plekbewussyn. Plek word die verlenging van die self want plek is dan ook ‘n oord van tussenmenslike verbondenheid. Dit maak dit nie ‘n volmaakte plek nie maar ten minste ‘n plek waar mense van mekaar geweet het en steeds weet. Die veranderende ekonomiese en politieke streeksdinamika het ‘n invloed op die betekenis wat die inwoners aan hulle plek heg. Die fisiese en ruimtelike omgewing beïnvloed ook die interaksie en verhoudings van hierdie mense. / This thesis describes the background of the pre-colonial situation in the Cape Colony of the time. It uses the historical origin and development of one specific community as an example. The relationship which developed between this community and the intrusive colonialists is based to a large extent on perceptions and attitudes which were observed in the seventeenth and eighteenth but especially during the nineteenth century between the diverse population groups. The interference of the colonialists caused great harm to these relationships and consequently some of the indigenous population groups underwent radical changes. The indigenous population’s role in the area became more and more submersed and the landscape changed forever. As the territories of the indigenous groups were taken from them, they had to change their survival strategies drastically. The group which in former times was called ‘coloured’ because of inter marriages between the colonialists and the local population or the imported slaves, was soon reduced to labourers and their status diminished as time went by. In spite of very few being able to remain as landowners this thesis shows that there were exceptions. There is a community which inherited land next to the Gouritz River and after 155 years they are still the rightful owners. This community is known as Buisplaas. A white ancestor, Frederick du Buis left his two sons, Simson and Saul who were of mixed blood, 94 hectares of land next to the Gouritz River, in the south eastern part of the Western Cape. This is where the Buis community came into being and through the many years of political change in South Africa they continued to remain and develop there. The harsh geography and climate of Buisplaas had its limitations and yet the community survived. They used the meagre possibilities of the area like their proximity to the Gouritz River and the aloes growing there to their benefit. Although the economic realities forced many of the inhabitants to move elsewhere to further their studies or to find work opportunities, the Buisplaas descendants often returned to their community after retirement. It was only 127 years after Simson and Saul Buis inherited Buisplaas that development and consequently improvement started happening on a bigger scale. It changed their quality of life immensely. In 1986 the Residents’ Association of Buisplaas was formed and its role in the development of the community forms the major part of this study. Over the years both the Lutheran and the Anglican churches had a very strong influence on the inhabitants, especially since the Lutheran church was responsible for the establishment of a primary school at Buisplaas. The research entailed a multi-faceted approach, but mostly historical methodology was used. The active participation of different members of the Buisplaas community as well as some of the former inhabitants and neighbours in this thesis, supplemented the use of various other sources. The focus of the study was on the Buisplaas community who had been land owners as so-called ‘coloured’ people long before the issues and problems of owning land in South Africa were addressed. Although the basic realities of survival of this community will be addressed, the main focus is on the emotional bonds of the people with their place, with their property. It deals with their memories and with the cultural traditions that form the backbone of the area. This study has a charm which is revealed because of the memories of the people and the omnipresent consciousness of the ownership of their special place. Place becomes an extension of the self because place and space are also where human ties exist. It doesn’t make the place perfect but it remains a place where the people have always been aware of one another. The changing political and economic dynamics of the area have an influence on the importance and meaning of this place for its inhabitants. The physical and spatial environment and its spiritual importance also influence the interaction and relationships between these people. / History / D. Litt. et Phil. (Geskiedenis)

PURPOSE: The main aim of this study was to systematically assess women’s maternal health care seeking behaviour and its determinants in Addis Ababa, Ethiopia. DESIGN: A quantitative and cross-sectional community based study was the selected methodology for this study. METHOD: Data was collected using structured questionnaire administered to 903 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary and multinomial logistic regression models were employed to identify predictors of adequacy of antenatal care and delivery care. RESULTS: Most of the women (97.9%) visited health care facilities at least once for antenatal care follow up. About 86.5% of them had at least four visits during their last pregnancy; and only 51.1% started their first antenatal visit early. Further, only about one out of five of the antenatal care attendees received sufficient content of antenatal care services. Consequently, only about one out of ten women received overall adequate antenatal care mainly due to inadequate use of the basic components of antenatal services. Most of the women delivered in public health care institutions (76.3%) despite the general doubts about the quality of services in these facilities. Women of better socioeconomic status preferred to give birth at private health care facilities. Caesarean section delivery rate in Addis Ababa (19.1%) is higher than the maximum WHO recommended rate (15.0%); particularly among the non-slum residents (27.2%); clients of private health care facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women who belong to the highest wealth quintile (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery and about 9.0% of the caesarean section births had no medical indication. CONCLUSION: Disparities in maternal health care utilisation between the socio-economic groups was evident, requiring urgent attention from policy makers and other stakeholders to enable Ethiopia to meet its millennium development goal 5. Improving the quality of antenatal care in public health facilities which are the main provider of health care services to the majority of the Ethiopian population is urgent. The increase in the rate of caesarean section beyond the World Health Organization recommended upper limit has to be taken seriously. / Health Studies / D. Litt. et Phil. (Health Studies)

Mobilité, désir d’accéder à une meilleure qualité de vie, attraction de la campagne s’accélèrent depuis une trentaine d’années au Québec, comme ailleurs en occident. La campagne et les usages que l’on en fait se diversifient et se complexifient, à l’instar des populations qui l’habitent. Dans ce contexte, cette thèse se penche sur l’expérience géographique de la campagne, en tant qu’espace social. Elle met en lumière l’expérience géographique des ruraux, plus particulièrement les modalités de leur rencontre dans divers lieux qui marquent leur quotidien. Le matériel empirique de la thèse consiste surtout en des témoignages recueillis lors d’entrevues qualitatives menées auprès de nouveaux résidents et des ruraux de longue date dans deux municipalités régionales de comté (MRC) contrastées au Québec : Brome-Missisquoi et Arthabaska. La démarche privilégiée et les principales contributions qui en découlent se déclinent en trois temps. D’abord, une comparaison directe des deux populations rurales étudiées fait ressortir que leurs pratiques de mobilité et leurs sens des lieux se rejoignent dans une certaine mesure, mais affichent aussi des différences. Par exemple, elles partagent toutes deux un sentiment d’appartenance marqué à leur milieu de vie, mais pas nécessairement avec la même intensité et pour les mêmes raisons. En outre, leurs pratiques d’engagement local convergent, favorisées par un même désir de contribuer au bien-être de leur milieu. La thèse démontre aussi que certains lieux de sociabilité rapprochent ces deux groupes au quotidien, quoique subsistent des tensions notamment liées à leurs origines rurale ou urbaine, leur classe sociale, leurs expériences antérieures des lieux, la durée vécue dans leur milieu de vie, leur historique familial, leurs représentations et usages de la campagne... Se décèle aussi un effet de milieu entre les deux MRC à cet égard. Dans l’ensemble, leur rencontre s’avère timide et surtout réservée à l’espace public. Enfin, en se basant sur leurs représentations de l’avenir, la thèse illustre que l’espace de leur rencontre représente un espace d’opportunités pour le dialogue sur la campagne, bien que celui-ci ne se produise pas sans affrontements et heurts. Ainsi, au-delà du binarisme traditionnel et antagonique lié aux statuts de « nouveaux » et « anciens » ruraux, l’espace de rencontre, celui à l’intérieur duquel s’opèrent à la fois tensions, négociations, compromis et nouvelles alliances, participe à construire la nouvelle ruralité contemporaine.

Mobilité, désir d’accéder à une meilleure qualité de vie, attraction de la campagne s’accélèrent depuis une trentaine d’années au Québec, comme ailleurs en occident. La campagne et les usages que l’on en fait se diversifient et se complexifient, à l’instar des populations qui l’habitent. Dans ce contexte, cette thèse se penche sur l’expérience géographique de la campagne, en tant qu’espace social. Elle met en lumière l’expérience géographique des ruraux, plus particulièrement les modalités de leur rencontre dans divers lieux qui marquent leur quotidien. Le matériel empirique de la thèse consiste surtout en des témoignages recueillis lors d’entrevues qualitatives menées auprès de nouveaux résidents et des ruraux de longue date dans deux municipalités régionales de comté (MRC) contrastées au Québec : Brome-Missisquoi et Arthabaska. La démarche privilégiée et les principales contributions qui en découlent se déclinent en trois temps. D’abord, une comparaison directe des deux populations rurales étudiées fait ressortir que leurs pratiques de mobilité et leurs sens des lieux se rejoignent dans une certaine mesure, mais affichent aussi des différences. Par exemple, elles partagent toutes deux un sentiment d’appartenance marqué à leur milieu de vie, mais pas nécessairement avec la même intensité et pour les mêmes raisons. En outre, leurs pratiques d’engagement local convergent, favorisées par un même désir de contribuer au bien-être de leur milieu. La thèse démontre aussi que certains lieux de sociabilité rapprochent ces deux groupes au quotidien, quoique subsistent des tensions notamment liées à leurs origines rurale ou urbaine, leur classe sociale, leurs expériences antérieures des lieux, la durée vécue dans leur milieu de vie, leur historique familial, leurs représentations et usages de la campagne... Se décèle aussi un effet de milieu entre les deux MRC à cet égard. Dans l’ensemble, leur rencontre s’avère timide et surtout réservée à l’espace public. Enfin, en se basant sur leurs représentations de l’avenir, la thèse illustre que l’espace de leur rencontre représente un espace d’opportunités pour le dialogue sur la campagne, bien que celui-ci ne se produise pas sans affrontements et heurts. Ainsi, au-delà du binarisme traditionnel et antagonique lié aux statuts de « nouveaux » et « anciens » ruraux, l’espace de rencontre, celui à l’intérieur duquel s’opèrent à la fois tensions, négociations, compromis et nouvelles alliances, participe à construire la nouvelle ruralité contemporaine.

Mobilité, désir d’accéder à une meilleure qualité de vie, attraction de la campagne s’accélèrent depuis une trentaine d’années au Québec, comme ailleurs en occident. La campagne et les usages que l’on en fait se diversifient et se complexifient, à l’instar des populations qui l’habitent. Dans ce contexte, cette thèse se penche sur l’expérience géographique de la campagne, en tant qu’espace social. Elle met en lumière l’expérience géographique des ruraux, plus particulièrement les modalités de leur rencontre dans divers lieux qui marquent leur quotidien. Le matériel empirique de la thèse consiste surtout en des témoignages recueillis lors d’entrevues qualitatives menées auprès de nouveaux résidents et des ruraux de longue date dans deux municipalités régionales de comté (MRC) contrastées au Québec : Brome-Missisquoi et Arthabaska. La démarche privilégiée et les principales contributions qui en découlent se déclinent en trois temps. D’abord, une comparaison directe des deux populations rurales étudiées fait ressortir que leurs pratiques de mobilité et leurs sens des lieux se rejoignent dans une certaine mesure, mais affichent aussi des différences. Par exemple, elles partagent toutes deux un sentiment d’appartenance marqué à leur milieu de vie, mais pas nécessairement avec la même intensité et pour les mêmes raisons. En outre, leurs pratiques d’engagement local convergent, favorisées par un même désir de contribuer au bien-être de leur milieu. La thèse démontre aussi que certains lieux de sociabilité rapprochent ces deux groupes au quotidien, quoique subsistent des tensions notamment liées à leurs origines rurale ou urbaine, leur classe sociale, leurs expériences antérieures des lieux, la durée vécue dans leur milieu de vie, leur historique familial, leurs représentations et usages de la campagne... Se décèle aussi un effet de milieu entre les deux MRC à cet égard. Dans l’ensemble, leur rencontre s’avère timide et surtout réservée à l’espace public. Enfin, en se basant sur leurs représentations de l’avenir, la thèse illustre que l’espace de leur rencontre représente un espace d’opportunités pour le dialogue sur la campagne, bien que celui-ci ne se produise pas sans affrontements et heurts. Ainsi, au-delà du binarisme traditionnel et antagonique lié aux statuts de « nouveaux » et « anciens » ruraux, l’espace de rencontre, celui à l’intérieur duquel s’opèrent à la fois tensions, négociations, compromis et nouvelles alliances, participe à construire la nouvelle ruralité contemporaine.

This thesis argues that truth-telling in high level (nursing home) aged care is a undamentally important aspect of care that ought to reside equally alongside instrumental care. The health of the resident in a nursing home, as with individuals in other care contexts, is directly linked to care provision that allows the resident to be self determining about their care and thus allows them to make reasonable choices and decisions. This qualitative study explores the meaning of truth-telling in the care providerresident dyad in high level (nursing home) aged care. Grounded within the epistemology of social constructionism and the theoretical stance of symbolic interactionism, this study relied on oral and written text from care providers (personal care assistants and registered nurses) and residents. Thematic analysis of data relied on practices within grounded theory to determine their understanding and the conditions and consequences of their understanding about truth-telling in the nursing home. Through an understanding of the relationship-role-residency trinity, truth-telling in high level (nursing home) care comes to be understood. It has been determined that the link between truth-telling and the nature of the care provider-resident (and residents' families) relationship is that both personal carers and nurses in this study premise their understanding of truth disclosure on knowing a resident's (and resident's family's) capacity for coping with the truth and therefore catering for the resident's or family's best interests. The breadth and depth of this knowing and how the relationship is perceived and described determine what care providers will or will not tell. That is, the perceptions both personal carers and nurses have about the relationship - how they describe themselves as 'family like', 'friend' and 'stranger', has implications for the way disclosure operates and is described. Additionally, how care providers perceive and understand their role determines what care providers will or will not tell. That is, the perceptions both carers and nurses have about their own and each other's role - how they describe themselves for example as 'hands-on' carer and 'happy good nurse' has implications for the way disclosure operates and is described. Furthermore, care providers' meaning and understanding of truth-telling in aged care is not possible in the absence of an appreciation of how the care providers give meaning to and come to understand the care circumstance - residency, the aged care facility, the nursing home. That is, the perceptions both personal carers and nurses have about the aged care facility - how they describe residency as 'Home away from Home' (and what this means), as a place of little time and a plethora of situations have implications for the operation of truth-telling as a whole. Recommendations from the study include the implementation of a telling audit to better serve the truth-telling preferences of residents and the reorientation of care practices to emphasise affective care (talk rather than tasks). Furthermore, it is recommended that changes occur to the care provider roles, that care providers define themselves as facilitators rather than protectors, and education be ongoing to improve communication with and care of residents with dementia and those dying. Finally, the language of residency as 'home' needs to capture an alternate philosophy and attendant practices for improved open communication.

Water is a vital component for human survival but unsustainable patterns of water consumption are still evident internationally. In South Africa, water conservation has traditionally been limited to the responsibility of the state, with little effort being made by the consumers. However, as water scarcity increasingly becomes a problem, government and residents need to find out how urban South Africans can access water and implement water conservation methods in their homes without the support of government supervision programmes. This study explores the relationship between urban residences in two different parts of Johannesburg (Meadowlands in Soweto and Florida in Roodepoort) and their consumption, perception and usage of water and its conservation. Based on interviews with residents from different backgrounds, the results of this research show that residents have varied but generally limited concern for water issues. Findings from this study indicate that for a resident to conserve water, the type of abode in which he/she lives is irrelevant. Whether the resident lives in suburban home or small government funded housing, the attitudes of the interviewees and the perceptions which they expressed regarding solutions to the water dilemma proved to be similar: people in these urban areas are aware of the importance of water conservation, however, there is limited practice thereof. / Geography / M. Sc. (Geography)

Whilst the mining industry has stimulated the economic growth of South Africa, its activities have also impacted on the social and environmental well-being of the communities and ecosystems in which it operates. Environmental degradation often severely affects the livelihoods of people in rural areas, who are often impoverished. Hondeklip Bay, a small fishing community in the Northern Cape, has been affected by the mining activities of the adjacent Hondeklip Bay Mine. The purpose of this paper is to identify whether impoverished residents affected by the detrimental effects of mining activity have rights to enforce the protection of their environment. These environmental rights pertain to an environment that is safe and not harmful to one's health and well-being. Environmental obligations of the mines as illustrated in terms of applicable legislation, and legal recourse available to the residents affected by the infringement of their environmental rights are furthermore explored. / Jurisprudence / LL.M