Thesis (MPH.) -- University of Limpopo, 2022 / Background: Termination of pregnancy among young women is a public health issue, particularly in South Africa where high prevalence of pregnany terminations has lately been reported. It is estimated that 260000 terminations of pregnancy take place in South Africa every year. Studies in South Africa have reported that risk factors associated with termination of pregnancy such as financial problems, being poorly educated, being young, unemployed, dependent on parents, widowed or single and other relationship problems were most common. Approximately 1200 pregnancies were terminated in the District Hospital of Limpopo Province between 2017 and 2018. There is also an increased rate of unintended pregnancy among HIV positive women which suggest that women with HIV may be more likely to terminate pregnancy but chooses not to terminate due to fear of being judged. Therefore, the primary objective of this study was to investigate the risk factors associated with termination of pregnancy at a District Hospital in Limpopo Province. Methodology: A cross-sectional descriptive retrospective review study in which convenience sampling of the records of women who terminated pregnancies was used in this study. A self-constructed data extraction tool was used to extract the data from patients records. The tool covered variables such as the age of the women, educational status, marital status, year and month of termination of pregnancy, gestational age, parity, and gravidity, HIV status and circumstances leading to termination of pregnancy. Data analysis was done using the STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). The independent t-test was used for variables having two categories as it assesses whether the difference between means of two groups are statistically significant. This test was performed at the 95% confidence level. The p-value of less than 0.05 in the study results was used for statistical significant difference in means between the categories which were investigated. vi Results: The mean age was 27.9 years (standard error [Std. Err.] =0.37) and majority of women who terminated pregnancies were in the age group 20 – 24 years, single and had a secondary educational level. There was a statistical significance difference between age groups and the gestational age, parity and gravidity at p=0.004 and p<0.001 respectively. The proportion of women who were at gestational age of 1 to 8 weeks decreased with increasing maternal age from 22.4% in age ≤20 years to 13% in age group 30 – 34 years. There was again a statistical significance difference (p<0.001) in relation to number of pregnancies that have each resulted in the birth of an infant capable of survival (parity) and similarly to gravida. The prevalence of HIV amongst women who terminated pregnancy in the current study was found to be 21.3% and the risk of women who terminated pregnancies being HIV positive increased significantly with age as older women (age 20 years and above) were 6.5 times more likely to be HIV positive as compared to younger ones (p<001). Low educational level, gestational age of more than 13 weeks and parity of 1 – 2 were significantly associated with termination of pregnancy. The association of gravida of women who terminated pregnancies and HIV revealed that women who were in their second or third pregnancies (gravida) while HIV positive were 3.9 times more likely to terminate pregnancies as compared to those who were first pregnancy (p<0.001). Marital status was not significantly associated with termination of pregnancy. Conclusion: Termination of pregnancies among adolescents and youth is a major public health issue and the findings of this study highlight the need to address the structural socio-economic drivers of family planning which results in high number of termination of pregnancy amongst the youth. Structural interventions, such as increasing contraceptive use which may be useful for reducing the burden of unplanned pregnancies. These findings suggest the need for targeted interventions for women of child-bearing age to access reproductive health interventions to prevent unintended pregnancies and the associated risk of termination.

There is a noticeable improvement in the quality of the lives of women engaged in economic activities beyond the home. In a democratic South Africa, women – including those in rural areas – are being freed from their fixed gender roles. Today women are regarded as co-participants in any undertaking, whether as organisers, natural environmentalists or economists, in order to achieve sustainable development. It is for this reason that a number of laws and statutory bodies are in place to speed up the empowerment of women. Consequently, women as individuals or groups are doing their best to respond to the call of democracy in order to balance the equation which has for long remained skewed. In the study area of the Makhuduthamaga Local Municipality, women have initiated projects through mobilisation of their capabilities and available resources to sustain their personal needs, and those of their households. Hence, their well-being with regard to health, nutrition, mobility and social connectivity has improved. There is no doubt that these women are primary breadwinners for their families on a daily basis, as the majority have no other source of income or their husbands’ jobs are taken by migrant labour. The research reveals that, unless women stand up and take action to disprove what is known as ‘feminisation of poverty’, nothing good can happen. Through Participatory Rural Appraisal and Community Asset Mapping techniques, an observation of ethical considerations, participants responded willingly and exposed the realities of their lives. One remaining challenge that needs to be constantly monitored is that there should be a balance between policies and practices with men needing to be empowered to understand, accept and assist in the empowerment of women with a view to achieving sustainability in almost every undertaking. / Geography / D.Litt. et Phil. (Geography)

There is a noticeable improvement in the quality of the lives of women engaged in economic activities beyond the home. In a democratic South Africa, women – including those in rural areas – are being freed from their fixed gender roles. Today women are regarded as co-participants in any undertaking, whether as organisers, natural environmentalists or economists, in order to achieve sustainable development. It is for this reason that a number of laws and statutory bodies are in place to speed up the empowerment of women. Consequently, women as individuals or groups are doing their best to respond to the call of democracy in order to balance the equation which has for long remained skewed. In the study area of the Makhuduthamaga Local Municipality, women have initiated projects through mobilisation of their capabilities and available resources to sustain their personal needs, and those of their households. Hence, their well-being with regard to health, nutrition, mobility and social connectivity has improved. There is no doubt that these women are primary breadwinners for their families on a daily basis, as the majority have no other source of income or their husbands’ jobs are taken by migrant labour. The research reveals that, unless women stand up and take action to disprove what is known as ‘feminisation of poverty’, nothing good can happen. Through Participatory Rural Appraisal and Community Asset Mapping techniques, an observation of ethical considerations, participants responded willingly and exposed the realities of their lives. One remaining challenge that needs to be constantly monitored is that there should be a balance between policies and practices with men needing to be empowered to understand, accept and assist in the empowerment of women with a view to achieving sustainability in almost every undertaking. / Geography / D.Litt. et Phil. (Geography)

PHD (African Studies) / Center for African Studies / The challenges facing divorcees when it comes to pastoral care and counselling are among the toughest to face members of the Reformed Churches South Africa (RCSA) in the Vhembe District today. There are many people in South Africa who are experiencing the pain of being divorced. The RCSA in the Vhembe District are also faced with this challenge and it affects their doctrines and their practical ministries. These challenges also affect the pastors of the RCSA. The aim of this research is to investigate the challenges that divorcees face regarding pastoral care and counselling in the RCSA in the Vhembe District, Limpopo, South Africa in order to develop an approach to pastoral care and counselling to support divorcees so that they may learn to cope with their challenges. Caring and counselling for the divorcees is the primary mission of the church. The study utilised a qualitative, exploratory, descriptive, and contextual design to obtain data from the participants within the RCSA in the Vhembe District. A sample of 30 participants (divorcees) from the RCSA in the Vhembe District was used. Data were collected on an individual basis by means of unstructured interviews. The qualitative data were collected and analysed using the six steps of open coding proposed by Tesch in an effort to understand personal experiences of divorcees. The research used Graham Redding’s approach to establish trustworthiness. The study adhered to four criteria to assess the value of the findings of qualitative research, namely credibility, applicability, consistency, and conformability. The ethical considerations were taken into account. The findings of this study show that divorcees experience many challenges, and that Reformed pastors are not equipped and not doing enough to address those challenges. This research helps to enhance the quality of pastoral care and counselling to the divorcees within the RCSA in the Vhembe District. The findings and recommendations of the study are useful in guiding all Reformed pastors in providing pastoral care and counselling to divorcees.

MSc (Microbiology) / Department of Microbiology / BACKGROUND: Human papillomavirus (HPV) is a common sexually transmitted virus known to be a causative agent of cervical cancer (CC), one of the most frequent cancers in women worldwide. HPV is a double stranded DNA virus of approximately 7,900 bp; belonging to Papillomaviridae family. To date, about 202 low risk (LR) and high risk (HR) HPV genotypes have been identified. However, available vaccines against HPV infection are designed based on the most common known genotypes. Therefore, it is critical to understand the scope and diversity of HPV genotypes in all geographical locations which can help to inform the design and development of future vaccines. OBJECTIVE: The objective of this study was to describe the burden and diversity of HPV genotypes in a cohort of women in routine care in northern South Africa. METHODS: Eighty seven women consented to participate in the study and each provided a specimen for analysis. With the help of qualified health care practitioners, Aptima Cervical Specimen Collection and Transport Kit (Hologic, San Diego, CA) was used to collect cervical specimens from each study participant following the manufacturer’s procedure. Total DNA was purified from the cervical pellet using QIAamp DNA mini kit (Qiagen, Hilden, Germany) according to the manufacturer’s instructions. The purified DNA was then subjected to a single round conventional PCR in a reaction volume of 100 μl to amplify HPV L1 gene comprising of approximately 450 bp. A portion of each PCR amplicon from each participant was denatured, hybridized and genotyped using the Linear Array HPV genotyping Test Kit (Roche Molecular Systems, Inc. Branchburg, NJ USA). The kit is designed to detect 37 HPV genotypes (genotypes 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 45, 51, 52, 53, 54, 55, 56, 58, 59, 61, 62, 64, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84, IS39 and CP6108). To detect the HPV genotypes, the Linear Array (LA) reference guide was used for results interpretation following the manufacturer’s instructions. The other portion of each of the amplicons was subjected to next generation sequencing (NGS) using the Illumina MiniSeq platform. Using the Nextera XT DNA Library preparation kit, an initial input of 1ng genomic DNA was tagmented, cleaned up, normalized and pooled. The pooled library was then denatured with 0.1 N NaOH and diluted into a final volume of 500 μl at 1.8 pM then sequenced using the Local Run Manager option following the manufacturer’s instructions. The generated sequence data was downloaded into fastaQ format and analysed using Genious 11.0.5 software. RESULTS: Of the 87 participants, the overall proportion of women harbouring HPV DNA by linear array (LA) PCR was 23% (n=20). Of the 20, 16 (80%) were living with HIV. However, this difference was not significant (p=0.077). Genotyping data generated by Roche LA method was successful for all the 20 positive amplicons. In this study, 27 (73%) of the 37 HPV genotypes incorporated in the Roche Linear Array method were detected. The detected genotypes include: types 84, 83, 81, 73, 72, 71, 70, 69, 68, 66, 62, 61, 59, 54, 53, 52, 51, 45, 42, 39, 35, 26, 18, 16, 6, IS39 and CP6108. Most women (15/20;75%) harboured multiple infections compared to single infection. In terms of genotypes distribution, the most frequent genotypes detected LR HPV types in increasing order of frequency included HPV type 61 and 83 (12%), 62 (36%) and 81 (43%). On the other hand, HPV type 66, 53, 52, 51, 18 and 16 were the most common genotypes detected HR HPV types. In contrast, although genotyping data was successfully generated from 15 of 20 women (75%), NGS technology was seen to be more sensitive compared to Roche LA method. Nearly all the detected genotypes identified by the commercial kit were detected by NGS. In addition, NGS detected 10 namely: HPV types 11, 31, 33, 40, 55, 56, 58, 64, 67, and 82 that were not detected by the LA yet incorporated in the kit. Moreover, it was observed that NGS identified additional 6 HPV types including HPV types 2, 27, 30, 35, 85 and 102 not incorporated in the Roche LA kit. A similar distribution of HPV multiple infections was observed in the study population, however, high frequency of 93% (14 of 15) was detected by NGS. The proportion of women harbouring one or more of the 22 LR HPV types was 100% (n=15).The most frequent LR genotypes in increasing order of frequency was HPV type 62 and 70 (27%), 6 (40%) and 11 (47%). HPV types 40, 42, 54, 72, 64, and 81 were the least detected genotypes with n=1 (7%) each. Furthermore, the common combination observed among the participants was type 6 and 11. In contrast, the most frequent detected genotypes in the study population by NGS under the HR HPV types in increasing order of frequency include type 35 (21%), 39, 56 and 82 (29%), 68 (36%) and 51 (50%). In addition, HPV types 26, 31, 45, 53, 56, 58 and 66 were the least detected genotypes n=1 (7%) in the study population. HPV 39 and 68 were observed as the common combination detected under HR HPV types. Following genotyping by LA and NGS, the demographic and clinical data of all the 20 positive subjects by PCR were subjected to statistical analysis to determine the association between HPV positive DNA status and associated risk factors. Smoking status (p=0.000), age at first sexual intercourse (p=0.011), vaccination status (p=0.000), gender of sexual partner (p=0.000), highest level of education (p=0.004), marital status (p=0.008) and number of sexual partners (p=0.000) were found to be having a positive statistical association. CONCLUSION: Amplification of targeted HPV DNA from cervical specimens demonstrated the presence of HPV infection in the study cohort, with a proportion of 23%. The findings illustrate that there is a diversity of HPV genotypes prevalent in the study population as shown by Roche LA and NGS methods. However, the NGS method was observed to be more sensitive than Roche LA in detecting HPV genotypes. Furthermore, NGS identified 6 additional HPV types not incorporated in the Roche LA. Thus, there are genotypes that may be present in the study population that the Roche commercial kit may fail to detect. Therefore, is it imperative to use both genotyping methods to confirm HPV genotypes. / NRF

PHDRDV / Institute for Rural Development

MSc (Microbiology) / Department of Microbiology

MSCPNT / Department of Nutrition

MPM / Oliver Tambo Institute of Governance and Policy Studies

MA (Sociology) / Department of Sociology / The study aimed to explore on the oral narratives of selected female migrants in South Africa. It was a case study of Thohoyandou in the Limpopo Province. Female migrants are faced with integration challenges such as political and socio-economic challenges. The study focused on reflecting on stories of selected female migrants who reside in Thohoyandou. The study was qualitative in nature and utilised a qualitative exploratory research design because it was aimed at exploring perceptions on oral narratives of selected female migrants. The researcher made use of non-probability sampling in the form of purposive sampling method and snowball. Data was collected through semi-structured interviews. Data was then sorted, coded, organised and indexed in a manner that made it easier for the researcher to interpret, analyse and present in content analysis. Text was summarised by checking key themes, phrases or passages that were used in a more detailed analysis. The process was guided by the original aim of the study. Findings of the study postulated that most female migrants came for economic reasons and discrimination is perceived to be an important barrier to integration. Other significant integration barriers include linguistic, educational, and institutional factors. Internal factors (social, cultural, and religious norms, immigrants' own opinions about themselves, lack of motivation and intergenerational mobility) are also serious barriers to integration.