Tuberculosis (TB) is an ancient infectious disease that has been infecting different populations around the globe and it has also been considered as one of the most successful human and animal disease. TB found in animals such as cattle and other known bovids is known as bovine tuberculosis. Bovine tuberculosis (BTB) is an infectious disease found in cattle mainly caused by Mycobacterium bovis. M. bovis is a member of the Mycobacterium tuberculosis complex (MTC) together with M. tuberculosis, M. africanum, and M. canetti where the natural host is humans; whereas M. caprae, M. microti and M. pinnipedii usually have animals as their natural host. In this study the molecular characterization of the MTC from cow milk in the Eastern Cape was investigated. One hundred and twenty samples (40 ml each) were collected from three dairy farms in the Eastern Cape, South Africa. These samples were processed using a modified Petroff decontamination method. Sample processing was followed by DNA isolation using a Zymo Bacterial/Fungal DNA Kit and the amplification and detection of the MTC was done using the Seeplex MTB Nested ACE assay. The drug susceptibility tests were done using GenoTypeMTBDRplus assay which detects mutations and resistance to INH (isoniazid) and RMP (rifampicin). The milk isolates were further analyzed using a spoligotyping method which is based on the PCR amplification of a highly polymorphic direct repeat locus in the M. tuberculosis genome which detects and types the MTC. A percentage of 20.8 % samples were found to be positive for MTC using the Seeplex MTB Nested ACE assay. There were 42.1 % samples that were resistant to both INH and RMP with the rest sensitive to either INH or RMP. The spoligotyping method showed that 78.3 % samples resembled Family 33 strains and the rest (21.7 %) resembled a spoligotyping signature known to be that of M.africanum. Both these strains belong to the Ancestral lineage with Indo-Oceanic and West Africa 2 lineage. The outcomes of our study showed that molecular methods for detection of MTC can be applied directly on milk samples without the need for culturing.

PhD / Department of Public Health / See the attached abstract

Submitted in fulfilment of the requirements for the Master of Health Sciences in Nursing, Durban University of Technology, 2017. / Tuberculosis (TB) is South Africa’s greatest community health problem. Nurses have a critical role in supporting patients in the TB treatment process. An estimated 480 000 new cases of Multidrug-Resistant Tuberculosis (MDR-TB) and 190 000 people died in 2014. An estimated 43 million lives were saved between 2000 and 2014 with effective diagnosis and treatment of TB. Despite these measures TB remains one of the world’s biggest threats. In an attempt to improve the practice of nurses in the prevention of MDR-TB, the knowledge of nurses with regards to the prevention of MDR-TB is essential. Aim of the Study The aim of the study was to describe the practice of the nurses in the prevention of MDR-TB and to determine whether the practice was effective in the prevention of MDR-TB. Methodology Quantitative, descriptive survey was used to conduct the study. Purposive sampling method was employed to select six primary health care clinics at uThungulu District. The target population consisted of professional nurses and enrolled nurses working in these clinics. The sample size was 122. The questionnaire was used to collect data. Descriptive statistics was used to describe the data graphically. In order to test for significant trends in the data, inferential statistics were applied. Results The findings of the study revealed that nurses were implementing measures of preventing MDR-TB like tracing of patients who interrupted TB treatment although there were inconsistencies with implementation of other measures. There were gaps related to attendance of TB courses by TB staff. Nurses were working in an overcrowded environment where it was difficult to implement measures for preventing MDR-TB. There was an increase in the workload due to the high number of patients having TB. Conclusion In this study, the majority of nurses working in primary health care clinics scored well in infection control measures with regard to practicing cough hygiene, placing patients in a well-ventilated area, collection of sputum from patients suspected of having TB and giving of health education to patients with TB and relatives but there areas that need improvement. The findings indicate knowledge gap with regard to TB. There is a need for attendance of short courses in TB, increase of staff attending to TB patients so as to cope with the workload and efficient allocation of resources. / M

This thesis is an investigation into the socio-economic constraints that influence the decisions of tuberculosis sufferers in the health seeking process and therapeutic management of tuberculosis in Grahamstown, the Eastern Cape. It is shown that structural violence influences experiences and perceptions of tuberculosis at all levels. Management of tuberculosis in the formal health sector is explored at local levels and related to national and global strategies of health care. The role of health workers, and particularly voluntary health workers, is explored and it is shown that they work within a context of growing burden of sickness and co-infections and a lack of government commitment to deal with increasing TB and HIV incidences. Kleinman’s notion of explanatory models is explored and it is evident that although knowledge of the aetiology of tuberculosis is well-known to patients and general members of the communities, they are nevertheless victims of increased stigmatisation and marginalisation as a result of illness. The importance of social support in curing tuberculosis is explored using Janzen’s concept of therapy managing groups. Social capital is a fundamental component in adhering to biomedical therapy, but is commonly weak among the structurally poor. The availability of temporary social grants for people living with TB influences health seeking behaviour. In a context of structural poverty the sick are faced with what Nattrass terms “perverse incentives”, having to choose between the right to health and the right to social security, both guaranteed in the South African Constitution, for him/herself and dependants. Although adherence to biomedical therapy is essential in curing tuberculosis, it is shown throughout this thesis that ignoring wider structural causes of disease limits the patient’s ability to get well. The ethnography shows that the right to health is a social and economic right which is not the reality for most South Africans.

PhD (Health Sciences) / Department of Advanced Nursing Science

MCur / Department of Advanced Nursing Science

MPH / Department of Public Health / See the attached abstract below

M. Tech. (Department of Biotechnology, Faculty of Applied and Computer Sciences), Vaal University of Technology. / Background: There are critical unmet needs for improved strategies in the detection and diagnosis of M.tuberculosis infection in children, and for prevention of tuberculosis disease in children. Bacillus Calmette-Guérin (BCG) vaccination has limited the utility of tuberculin skin testing (TST) in areas with high vaccine coverage. Objectives: The aim of this study was to estimate the prevalence of M.tuberculosis infection in children with household tuberculosis contacts, using QFT-GIT testing in comparison with TST. Methods: This study was a cross-sectional design to assess the performance of a new T-cell based blood test, namely QuantiFERON-TB Gold In Tube (QFT-GIT), for diagnosis of tuberculosis infection in the children (n=182) of adults (n=124) with pulmonary tuberculosis, additionally to determine the prevalence of M.tuberculosis infection in children with household tuberculosis contacts, using QFT-GIT testing in comparison with TST. The study was carried out at Chris Hani Hospital. For children involved in the study, tuberculosis exposure information was obtained, together with TST, QFT-GIT, and HIV testing. Data obtained from both experiments was statistically analysed using SPSS version 24 to determine whether there was a significant agreement between QFT-GIT and TST on the detection of M.tuberculosis prevalence in children with house hold contacts with confirmed M.tuberculosis infection. Results: This study examined the sensitivity and specificity of the QFT-GIT tests compared with the standard TST for diagnosing latent tuberculosis disease in paediatric contacts. Because of the lack of a latent tuberculosis “gold standard”, the specificity and sensitivity of QFT-GIT was calculated with a two-by-two table method. The specificity of the QFT-GIT was 84% and the sensitivity was 85%. There was a good correlation between QFT-GIT and TST (Cohen’s kappa of 0.705). Seventeen percent (17%) of the 182 children tested by QFT-GIT yielded indeterminate results. Age was associated with indeterminate QFT-GIT results in paediatric tuberculosis contacts. Point prevalence for QFT-GIT was recorded as 31% at baseline and 39.5% after six months indicating variability between QFT-GIT results at baseline and after six months. Conclusion: It was concluded that the prevalence of tuberculosis infection was common among South African children who live with an adult with active tuberculosis. The agreement between QFT-GIT assay and TST for the diagnosis of latent tuberculosis in children was high. Although TST and QFT-GIT assays appeared comparable, QFT-GIT showed higher positivity rate amongst those contacts with reported household tuberculosis exposure compared to TST. The QFTGIT assay was a better indicator of the risk of M.tuberculosis infection than TST in a BCG-vaccinated population.

BACKGROUND: The prevalence of tuberculosis (TB) has been rapidly on the ascendency in the recent years globally due to its co-infection with HIV/AIDS. TB case finding is one of the technical pillars of the Directly Observed Treatment Short course (DOTS) TB strategy and there has been advocacy for early TB case detection to be the new focus of TB control efforts. PURPOSE: The purpose of this non-experimental study was to assess the determinants of TB case finding among pulmonary TB patients registered for treatment in Makana Municipality METHOD: A quantitative, non-experimental, cross sectional descriptive study among PTB patients registered for treatment at the primary health care clinics in Makana Municipality was done. Data collection was by self-administered questionnaires while sampling was by systematic sampling of PTB patients at five systematically selected clinics. RESULTS: Patient–related delay contributed more to total delay, in this study sample, than health system-related delay. Health system delay was found to be significantly associated with poorer finances, passive smoking history, seeking care from multiple health providers, initially visiting a non- NTCP health provider, TB stigma , overcrowding in the household and having difficulty with breathing as an initial symptom (p<0.05). CONCLUSION: There was a significant delay in TB case finding among PTB patients in this local municipality and patient related determinants contributed more than health system related determinants to this delay. There is need for the municipal TB programme to embark on an aggressive health education programme to furnish the populace with accurate information about TB, improve their health seeking behaviour and help address the issue of stigma associated with TB. / Health Studies

Text in English with Abstracts in English and Afrikaans / Health promotion is an educational tool that can be used to educate and create awareness of health issues through various media forms. The purpose of this study was to explore the use of TB Proof South Africa‘s Facebook page in creating TB awareness. The literature on TB, social media, health promotional campaigns and health promotional models was reviewed to contextualise this study. A qualitative case study approach was used to collect data from TB Proof South Africa‘s Facebook page. Data was collected using three data collection methods; namely, online ethnographic observation, textual analysis and visual analysis. The findings indicate that TB Proof South Africa‘s Facebook page creates awareness of TB. Results from this study also suggested collaboration between South African healthcare professionals and traditional health practitioners in the fight against tuberculosis. The study advocates the need for comparative studies to explore the use of other health-related Facebook pages. / Gesondheidsbevordering is ʼn opvoedkundige werktuig wat gebruik kan word om op te voed en bewustheid van gesondheidskwessies deur middel van verskeie mediavorme te skep. Die doel van hierdie studie was om die gebruik van TB Proof South Africa se Facebook-blad in die skepping van TB-bewustheid te verken. Leesstof oor TB, sosiale media, gesondheidsbevorderingsveldtogte en gesondheidsbevorderingsmodelle is beoordeel om hierdie studie te kontekstualiseer. ‘n Kwalitatiewe gevallestudiebenadering is gebruik om data van TB Proof South Africa se Facebook-blad in te samel. Data is ingesamel deur gebruikmaking van drie data-insamelingsmetodes, naamlik aanlyn etnografiese waarneming, teksontleding en visuele ontleding. Die bevindings dui daarop dat TB Proof South Africa se Facebook-blad bewustheid van TB skep. Resultate van hierdie studie beveel ook samewerking tussen Suid-Afrikaanse gesondheidsorgberoepslui en tradisionele gesondheidspraktisyns in die stryd teen tuberkulose aan. Die studie bepleit die behoefte aan vergelykende studies om die gebruik van ander gesondheidsverwante Facebook-blaaie te verken. / Communication Science / M.A. (Communication)