Thesis (M.A.(Clinical Psychology))-University of Pretoria, 2005. / Includes bibliographical references. Available on the Internet via the World Wide Web.

Magister Public Health - MPH / Introduction: In-house contamination of drinking water stored in wide-mouthed buckets (even with lids) has been widely reported in epidemiologic investigations as vehicles for diarrhoea disease transmission. The long handled mukombe cup (LHM cup), recently developed by the National Institute of Health Research (NIHR), a department of the Ministry of Health and Child Care (MoHCC) in Zimbabwe, is a promising low cost dipping devise for extraction of water from wide-mouthed containers. Aim: The study aim was to assess the effectiveness and household acceptability of the long handled mukombe cup in reducing bacteriological contamination of drinking water stored in wide-mouthed vessels in the home in a peri urban settlement in Harare, Zimbabwe. Methodology: A randomised controlled trial of a long handled mukombe cup was conducted in Hatcliffe, Harare. After collecting baseline data on demographics, household water quality, and other sanitation and water handling practices, households were given basic health education before the two selected communities were randomly assigned to one of the two groups of 119 households each. The intervention group received the LHM cup while the control group received no intervention. Households were followed up after two months and assessed effectiveness and user acceptability of the intervention. Data Analysis: Data analysis was conducted using STATA 11. Descriptive statistics were calculated and reported as percentages, proportions, frequencies and measures of central tendency. Bivariate statistics were carried out to test independent associations between use of the LHM cup and E. coli. All analyses were conducted in an intention-to-intervene analysis. Results: A total of 230 households were analysed during follow-up. Samples of stored drinking water from intervention households were significantly lower in E. coli levels than those of control households (geometric mean E. coli of 0.8/100 ml vs 13.0/100 ml, p <0.0001). Overall, 78.4% (987/111) of samples from the intervention households met World Health Organization (WHO) guideline value of 0 cfu/100ml sample, while 52.1% of the 119 samples from control households met such a benchmark (p < 0.0001). In addition, 94.6% of intervention household samples were in compliance with this intervention or presented low risk, 27.7% of samples from control group households presented intermediate or high risk. There was a statistically significant association between LHM cup use and reduced E. coli bacterial contamination in stored drinking water (p < 0.05). There was no statistically significant difference in turbidity in both intervention and control groups, both for turbidity <5 and >5 (p = 0.071). Acceptability of the LHM cup was very high (100%). Conclusion: To our knowledge, this is the first study on the evaluation and acceptability of the LHM cup in the Sub-Saharan Africa. Positive results were recorded that showed that the LHM cup was effective in minimising E. coli contamination in the intervention group as compared to the control group. It is postulated that this is because the LHM cup reduces hand contact with stored water during scooping, thus maintaining improved water quality in communities in Zimbabwe that collect and store drinking water in wide-mouthed containers with lids where extraction is by scooping. However, more research is required to document the LHM cup's continued and effective use, durability and overall sustainability in the absence of any serious sampling or monitoring.

There is extensive research on the prevalence of college student engagement in risky sexual behaviors and its potentiating factors in college/university settings. However, there remains limited data and study on the use of campus health centers, as well as the patterns of how students seek sexual health care, its relationship to student gender identity, and student engagement in sexual risk behaviors. Despite literature surrounding student health centers and how students seek out medical care, the minimal data in the field regarding campus health center use, if and how students specifically seek out sexual health services, and how this collectively might vary across students with different gender identities, clearly indicate a need for further research on the experiences of students on college campuses in this regard. This dissertation is a secondary data analysis of the American College Health Association-National College Health Assessment III. This study’s specific aims were to: 1) describe key characteristics of students utilizing student health centers 2) describe if and how frequently college students are regularly seeking sexual health services; and 3) evaluate the relationship between a student’s gender identity and engagement in risky sexual behaviors. Drawing on a nationally representative sample of undergraduate students, analyses illustrated that students utilizing health services were primarily heterosexual female undergraduate students, with differing rates of utilization health services and sexual health services depending on race/ethnicity, year in school, and primary source of health insurance.The results confirmed that there are barriers to college student utilization of sexual health services, specifically for students who are non-heterosexual and transgender. Fewer students are seeking out their student health center and are seeking out care from services from other medical locations or may not be seeking out care at all. These findings highlight the need to ensure that student health centers on college campuses are inclusive of all students, regardless of gender identity. Given the important role that campus health center services play in promoting positive health outcomes and reducing sexual risk among its students, universities should consider efforts to increase student health center utilization, as it is a primary source of college student healthcare.

Background: Restrictions on induced abortion varies widely across the globe and so does the rate of induced abortion and maternal mortality (MM). Safe abortions – done by trained providers in hygienic settings and early medical abortions carry fewer health risks and reduce maternal mortality rates (MMR). However, nearly 7 million women in developing countries are treated for complications from unsafe abortions annually, and at least 22,000 die from abortion-related complications every year. Aim: The aim was to explore national and regional patterns of abortion laws, the abortions percentages and the maternal mortality rates (MMR), to see if patterns could be distinguished and how they differentiate to each other. Method: With a shape-file containing polygons representing the world’s countries, and the computer program ArcMap, was used to gather and join data. Result: The result showed that many African countries has a restrictive abortion law, and they also have a high MMR. In the Nordic countries they have a liberalized abortion law and they have low MMR. Another finding is that a restricted abortion law does not correspond to a low percentage of abortions. This is clearly demonstrated in South America, where they have a high abortion percentage, and extremely restricted abortion laws. Conclusion: This result revealed patterns showing that countries with restricted abortion laws, does not contribute to a low MMR, and restricted abortion law does not decrease the percentage of abortions.

The use of various forms of contraception in Ghana gained prominence after the government resorted to investing more in family planning programs when maternal mortality was declared an emergency in the country. In Ghana, the intention to use and actual usage of contraceptives is influenced by many factors, which may lead to non-usage or discontinuation. This quantitative study was conducted to determine risk and protective factors impacting on the intention and usage of contraceptives. Survey data from the Ghana 2014 Demographic and Health Survey (DHS) (n = 9396) was used. A sub-sample of 7661 women in their reproductive age were included in this study, who reported being sexually active within the last year. Logistic regression analyses were conducted to test the association between a broad range of risk and protective factors including religion, early sexual intercourse, frequency of sex, number of lifetime sexual partners with intention to use contraception. We controlled for income, educational attainment, and age. Overall (n = 3661; 47.8%) reported no intention of contraception use. Logistic regression analysis revealed that no formal education (OR = 1.49; 95% CI, 1.29–1.72; p < 0.001), and primary school as highest educational level (OR = 1.19; 95% CI, 1.04–1.25; p < 0.001), Islamic religion (OR = 0.73; 95% CI, 0.59–0.90; p < 0.001), not currently employed (OR = 1.50; 95% CI, 1.34–1.69; p < 0.001), husband opposing contraception use (OR = 2.19; 95% CI, 1.42–3.46; p < 0.001), and currently pregnant (OR = 1.30; 95% CI, 1.09–1.54; p < 0.001) were also positively associated with no intention of use. Engaging religious leaders for advocacy in the community was identified as an approach to address barriers and increase awareness on contraceptive use. Targeted family planning programs should intensify public education on safe sex behaviors.

Our aim with this study was to examine older people's experiences of loneliness. Specifically, we investigated how loneliness affects the elderly, how it is expressed, and what its sources are. The study was conducted using a qualitative method, by interviewing four caregivers at two nursing homes, and three social workers who work as care administrators for nursing homes. We found that the experience of loneliness is prevalent among the elderly who live in nursing homes. Furthermore, we identified two outstanding themes in their experiences, which we categorised as experiences of loneliness and feelings of being safe. Feelings of being safe had two subthemes; moving to a nursing home and the living situation. Feelings of being unsafe were closely related to loneliness, and this was partially a reason why the elderly wanted to move to a nursing home, as a way to get closer to other people and overcome loneliness. Experiences of loneliness varied in the following subthemes; suffering of existential loneliness, extent of social relationships, social networks, and social life, expressions of loneliness, and the meaning of loneliness. We found different forms of loneliness, including loneliness based on loss of relationships, mostly due to the passing away of one’s social group, which was expressed partially as an experience of existential loneliness. The elderly people’s network of friends and family varied; some of them had a close network with many visitors every day, and others had almost none that visited them.

Philosophiae Doctor - PhD / In the decade since first identified, the Acquired Immunodeficiency syndrome (AIDS) has become a serious global disease. The nature of the Human Immunodeficiency Virus (HIV) that causes AIDS, whereby a carrier may be asymptomatic yet remain infectious, has enabled its dramatic spread. The number of AIDS cases is increasing exponentially, averaging a doubling time of between 8-15 months indifferent countries. Of the millions of HIV carriers, it is now estimated that all will eventually go on to develop full-blown AIDS and probably die within 15 years. Unlike other infectious diseases, there is currently no known vaccine or cure. Further, HIV is now virtually completely dependent on volitional sexual behaviours for transmission to occur. It is therefore an entirely preventable disease. However, since the behaviours that contribute to HIV-transmission are influenced by biological, psychological, and social factors, their alteration in line with safer sexual practices has been shown to be considerably complex and difficult. Intervention strategies that have relied on imparting knowledge about the disease have achieved limited success in influencing behaviour change. Unsafe sexual practices, and the risk of HIV-infection, often continue even when knowledge regarding prevention is adequate. It has therefore become apparent that other variables intrude which may mediate between knowledge acquisition, attitude formation, and consequent sexual behaviours. There appear to be no models which adequately explain the complexities in this area, and which enable adequate intervention strategies to be developed. The present study was undertaken to redress this problem, and to explore those variables that mediate in the area. Various psychological and social factors appear to be implicated in influencing sexual attitudes and behaviours. In order to adequately test the impact of psychosocial variables that were found to have significant associations in an exploratory study, a measuring instrument was developed. The AIDS Psychosocial Scale was statistically validated using content, frequency, factor, and reliability analyses and included psychological factors of self concept, defenses of denial, repression, and rationalisation, perceived empowerment in the form of locus of control and self efficacy, and the social factor of peer pressure susceptibility. The impact of these psychosocial variables on indices of knowledge, condom attitude, and sexual practices, and on other epidemiological variables was tested using a sample of students at the University of the Western Cape (n=308). Results indicated a number of correlational and causal links between variables, confirming the mediational role psychosocial factors have in influencing knowledge acquisition, attitude formation, and behaviour outcome. A profile of lower self concept, higher defenses, lower self-efficacy, more external locus of control, and higher peer pressure susceptibility emerged which was associated with poorer knowledge, more negative attitudes, and higher unsafe sex. Based on this study, a model of psychosocial mediation is developed and its implications for intervention strategies discussed.

No description available.

Thesis (Ph. D.)--Oregon State University, 2010. / Printout. Includes bibliographical references (leaves 115-131). Also available on the World Wide Web.

The primary objectives in this study were to gain a deep level of understanding of Kenyan women’s experiences of seeking abortion, both safe and unsafe, and to explore how social and legal issues impact their choices and the routes they take to obtain abortion. I explored the contexts and interpreted 49 in-depth narratives of women’s emic experiences of abortion in Mombasa city and the Kilifi district, Kenya, using a qualitative form of inquiry conducted between April and July 2005. Ethical Review Committees granted ethical clearance to this study. This emic work revealed gender inequity consistent with developing feminist theory and thus how women conceive gendered relationships is introduced in this analysis of women's narratives. The findings provide new insights as well as useful confirmatory knowledge, gleaned from detailed empirical evidence within Kenyan women’s social contexts. The women have revealed the evidence through their narratives; such an approach is largely missing in existing abortion literature. The prominent finding is that women do not abort motherhood, but they do abort particular pregnancies to protect motherhood; to avoid a difficult motherhood likely to compromise the quality of care they envisage for their potential and existing children. This includes ensuring the best nurturing environment, paternal and religious identity, social legitimacy. The abortion decision is difficult to make and thoroughly considered. The married women make a consultative decision with their ‘breadwinners’ having the upper hand. Legal barriers cannot bar abortion but entrench inequities in abortion care access, heighten secrecy, stigma, and hamper prompt comprehensive post abortion care seeking. Thus, financial resources, peers, geographical remoteness, and knowledge significantly influence the type of abortion accessed. Consequently, unsafe abortion threatens motherhood of the most vulnerable groups of women. The foremost recommendation is that public health law must ensure healthy, enjoyable, dignified motherhood for the women; hence safe early abortion (first trimester) must become accessible to alleviate existing health care inequities. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2013.