Theses and Dissertations (Public Health)

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    Is there an association between bacterial vaginosis infection and HIV-1 infection acquisition among women aged 18-35 years in Soweto
    (2010-01-29T06:57:47Z) Chimbatata, Nathaniel Weluzani Banda
    BACKGROUND Studies suggest an association between Bacterial Vaginosis (BV) and HIV infection; however, its temporal effect has not been greatly investigated. METHODS This is a secondary data analysis of a cohort study: set out to describe the association between BV infection and HIV acquisition. There were 750 participants enrolled in the primary cohort study. The main exposure, BV, was measured from a gram stain slide prepared from a vaginal swab. The slide was read in a laboratory qualitatively and scored by Nugents scoring. A score of 7 or above was considered positive for BV. The outcome variable (HIV) was determined by dual rapid tests and confirmed in the laboratory by a third generation ELISA. Descriptive statistics was done to describe demographic characteristics and the prevalence of BV and STIs. HIV incidence rate was calculated. Kaplan Meier survival time analysis and log rank test for significance were performed. Cox regression (univariate and multivariate) was done to determine association of BV with HIV infection. RESULTS The baseline prevalence of BV was 52 %, 95 % CI; 45 – 59. There were 21 HIV seroconversions experienced of which 7 had BV results missing and were excluded in the analysis. The remaining 14 seroconversions were followed for a mean time of 0.40 of a year and accumulated follow up time at risk of 286 person years, this represented an HIV incidence rate of 4.9 per 100 person years of follow up, 95 % CI: 2.9 – 8.27. Kaplan Meier curves revealed a higher risk of HIV-1 acquisition among women who were BV positive than the women who were BV negative. A log rank test showed that the v probability of seroconversion was different among the women depending on BV status, chi-square value 3.8, p 0.05. Controlling for confounding variables, seroconversion was high, but not significant, among BV positive women, adjusted hazard ratio 3.21; 95 % CI; 0.85-12.12, p value 0.08. CONCLUSION This study suggests that BV increases HIV seroconversion risk though statistical significance was not achieved. Vaginal cleansing education, screening and treating women with BV could maintain normal vaginal flora and reduce their susceptibility to HIV.
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    Providers' responses to the patients' rights charter in South Africa: a case study in policy implementation
    (2010-01-28T11:52:57Z) Raphaely, Nika Thandiwe
    Abstract The Patient Rights’ Charter is one of several progressive health policies in South Africa with disappointing implementation in practice. Barriers to implementation have already been described. Policy analysis theory and empirical studies suggest that power and resistance may contribute to implementors’ responses to policies. This secondary analysis of existing semistructured interviews with health providers in Limpopo explicitly examined the influence of power and resistance on their implementation of the Patients’ Rights Charter. Open coding yielded themes of implementation experience, to which a deductive analysis applied a heuristic framework, derived from the literature, to examine power and resistance. The critical importance of implementors in translating policy into practice, and of discursive manifestations of power, were reiterated. Resonances in the data of the functionalist ‘sick role’ brought together surveillance, expert knowledge and the loss of health workers’ influential voice, in a way not previously discussed. Implications for future management strategies are considered.
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    Occupational health and safety activities of Port Elizabeth's integrated Department of Labour Inspectorate in 2005
    (2010-01-28T07:06:42Z) Huna, Bulelwa Daniswa Denise
    This study was aimed at describing the nature of Occupational Health and Safety (OHS) inspections and blitzes conducted in the Port Elizabeth Integrated Department of Labour (DoL) in 2005, the nature and number of prohibitions, contraventions, as well as improvement notices issued. The objectives were to determine the number of OHS inspections conducted in the Port Elizabeth Labour Centre (PELC) in 2005; to describe the nature of the inspections and the type of industries inspected in the PELC in 2005; and to determine the frequency and nature of prohibitions, contraventions and improvement notices issued. The data was obtained from the PELC. The results of the study revealed that the inspectorate conducted a total of 1258 and this exceeded the target of 800 OHS inspections for the PELC. However, it is questionable how this target was developed. The target is not representative and does not give an overall picture of conditions in the workplace. The results indicated that inspectors were not competent in conducting boiler inspections as well on Major Hazardous Installation (MHI) since none of these inspections were conducted. On the inception of the OHS task team, there was a sudden increase in inspections conducted in the construction industry in October 2005 as well as the rate of finalisation of incidents in November 2005 and this was attributed to the fact that they were not conducting inspections on other labour laws and were only focusing on OHS. An assessment of the inspectors’ inspection checklists revealed that the inspections were being reduced to just a yes or no tick exercise, with no recommendation on appropriate action to be taken by the employer. It became evident that the inception of a special team in September 2005 contributed to an increased number of OHS inspections, since they were only focusing on OHS issues. This team ensured that in November 2005 there were 43 incidents finalised as compared to the 101 finalised over 11 months. They also ensured that a total of 258 OHS inspections were conducted from September 2005 to December 2005. Although these inspectors were not fully competent in addressing health and s afety issues their momentary focus on OHS activities ensured that they made a difference in the rate of finalisation of incidents. However, when some of the cases were taken to court no successful prosecution could be obtained because there are no OHS focused prosecutors, which have a clear understanding of Act. Discussions with the inspectors revealed that there was a lack of morale and loss of interest in their work, thus causing them not to put in much effort. These discussions revealed that this lack of morale was caused by the frustrations they often experienced in the execution of their duties due to lack of training as well as lack of cooperation from the employers. Furthermore, the inspectors revealed that the great number of resignations from inspectors who were leaving for greener pastures left them with a lot of work with no financial incentive. It also became apparent that there was no objective strategy underlying the number of inspections required relative to the purpose of the inspections, taking into account the nature and complexity of the industry that is to be inspected. The failure of the Service Delivery Unit to give a direction on how qualitative inspections should be measured demoralised them because the focus was only on the quantity (240 inspections per annum) of inspections that are to be conducted by each inspector. It is recommended that training, which should include a proper career path be conducted for inspectors to improve the inspectors’ capability and to motivate them. Strong relations with the South African Police Services and the Department of Justice should be promoted to ensure effectiveness of service delivery. These relations will ensure that inspectors are readily assisted by the police when they deal with uncooperative employers. Training of prosecutors will ensure that they understand the OHSA and its implementation and therefore effectively defend cases that are taken to court. The targets set for inspections should be scientifically supported and take into account the nature and complexity of the production processes. Lastly, revision of salary packages should be looked into to ensure retention of competent staff. The above recommendations will only be effective if the Business Unit Manager and the Regional Manager address them through the National Department of Labour since their implementation will affect all inspectors.
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    Children left behind: the effects of temporary labour migration on child care and residence patterns in rural South Africa
    (2010-01-22T11:43:34Z) Kautzky, Keegan Joseph Michael
    Background: The rural South African population is characterised by high and stable levels of male temporary migration and rapidly rising levels of female temporary migration, with approximately 60% of men and 20% of women between the ages of 20 and 60 years absent from the home for more than 6 months of the year. Despite the magnitude of this social phenomenon, limited research exists analysing its effect on child care and children’s residence patterns. Objectives: The purpose of this study is to examine temporary labour migration patterns as a household coping strategy in rural northeast South Africa in 2002 and 2007, describe characteristics of the children left behind, and to assess the effect of temporary migration on child care patterns, specifically analysing household variation in child care and residence by sex and refugee status of the migrant. Methods: An analytic cross-sectional study was conducted on approximately 83,000 individuals in 14,000 households in 25 villages of the Agincourt sub-district of the Bushbuckridge region of Limpopo Province. Data was collected in a special module on temporary migration incorporated into the annual Agincourt Health and Demographic Surveillance System census update in 2002 and 2007. Secondary analysis of the data utilised descriptive statistics and Pearson Chi2 tests of association. Results: The proportion of temporary migrants in the population rose between 2002 and 2007 and now constitutes nearly one-fifth of the population. Nearly three-quarters – 13% of the total population – are labour migrants. A slight increase in the proportion of female and Mozambican descent migrants is observed. Today, three-quarters of temporary labour migrants are male and one-quarter female, three-quarters are South African descent and more than one-quarter are Mozambican descent. Temporary labour migrants with children constitute nearly 6% of the total population. Temporary labour migrants overwhelmingly rely on a single care strategy. Complex care arrangements are far less common, constituting the response of only 5% of migrants. Highly complex care arrangements are rare, but do exist. Child care strategies are becoming increasingly complex over time for all migrants. Female migrants and migrants of South African descent are more likely than male and Mozambican descent migrants to rely on complex care arrangements. The overwhelming majority of migrants keep all children in the same household, maintaining relative stability in care and residence, 10% move children with them, 2% move children elsewhere for care and less than 1% move a childcarer into the household while they are away for work. Less stable child care arrangements are increasingly utilised over time. If the migrant is male, children are more likely to remain in the same household; if the migrant is female, children are more likely to move with the migrant. Approximately one-fifth of children in the population are effectively left behind by temporary labour migrants today, a decline from nearly one-third in 2002. There is significant variation in child care, residence and decision-making authority among relatives: mothers and stepmothers provide the majority of care in the absence of a migrant, with grandmothers a secondary and female siblings and aunts a tertiary source of child care.