3. Electronic Theses and Dissertations (ETDs) - All submissions
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/45
Browse
12 results
Search Results
Item Socioeconomic determinants of early health care utilisation and association with malaria hospitalisation among under five years children in Manhiça, Mozambique(2024) Chauque, Alberto AnicetoIntroduction Malaria is one of the significant health problems in the world, and the greatest burden of the disease is concentrated in Africa, which accounts for about 95% of cases. The WHO (World Health Organization) indicates that early seeking for treatment is crucial to avoid worsening the disease and, consequently, death. This work, was evaluated the factors that influence early health care seeking in children under five years old and the effect of early health care seeking on hospitalisations. Methods It was conducted a health facility-based observational longitudinal study where malaria cases were identified in an ongoing surveillance database. Using the first visit for all children that visited a Health Facility with fever and malaria and defined early health care seeking as a visit to a health centre within 48h after the onset of fever. Multilevel logistic regression was used to identify the factors related to early health care seeking and the association between early health care seeking and hospitalisation. Results A total of 66 620 children aged 0 to 15 years were screened. Excluding all children who did not meet the study criteria, ending up with 2 299 children with malaria and fever, but only 1 603 children had demographic information. A kilometre increase in the distance to a health facility reduces the odds of early health care seeking (aOR = 0.89; CI: [0.83-0.95]; p=0.001). Early health care seeking reduces the odds of hospitalization (aOR = 0.56; 95% CI: [0.34 -0.93]; 0.024) and year increase in the year of the visit also increases the odds of hospitalization (aOR = 1.66; 95% CI: [1.41-1.93]; p<0.001). Conclusions Increasing the distance to health facilities reduces the likelihood of early health seeking, whereas early health care reduces the risk of hospitalisation. Maluane and calanga lead the hospitalisation cases in the study area in children with malaria and cases of delay in health-seekingItem Retrospective review of children with osteogenic sarcoma from 1990 to 2010 at a tertiary hospital in Johannesburg(2018) Ngcana, Thandeka Vuyiswa ZamansunduBACKGROUND Survival rates of South African children with osteosarcoma (OS) are known to be poor but prognostic factors have not been elucidated in an African setting. AIM AND SETTING To determine the overall survival rate and prognostic factors in children with OS at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). METHODS A retrospective review was conducted of children with OS from 1990 to 2010. Descriptive statistics, Kaplan-Meier survival analysis and Cox logistic regression were performed. RESULTS 55 files were available for analysis. The median symptom duration was 90 days. The median age was 12.1years. The majority had poor prognostic features: 47 (85%) had masses larger than 8cm diameter, all patients had high alkaline phosphatase and 46 (83.6%) had elevated lactate dehydrogenase (LDH). Histology included osteoblastic (37/55) and chondroblastic OS (9/55). Forty-three (78.2%) patients had low BMI at presentation. Forty-one patients were treated with ifosfamide, doxorubicin, methotrexate and cisplatinum and one patient was on a hybrid protocol. Thirteen (25%) did not receive chemotherapy and four patients declined surgery. The five-year survival rate of those treated with curative intent was 42%. Causes of death included progression of disease (22/42) and treatment complications (5/42). On univariate analysis site of primary tumour (p = 0.044), LDH (p = 0.011) and stage (p = 0.0001) impacted on survival, while on multivariate analysis confirmed only stage (p=0.0001) and unknown LDH level (p= 0.011) as significant. CONCLUSION Advanced disease at presentation, which is a modifiable factor, was common and impacted negatively on overall survival.Item Knowledge, attitude and practices of caregivers (KAP) on management of childhood diarrhoes amond children aged between 0-5 years attending child welfare clinic (CWC) in Mogoditshane Village, Botswana(2018) Mosweu, Gofaone JessicaBackground: Diarrheoa continues to plague on Botswana children, resulting in high mortality of children below five years. In 2015 childhood diarrheoa accounted for 6 percent of deaths of children in Botswana. Good knowledge, attitude and practices of caregivers is pivotal to protection, prevention and treatment of childhood diarrhoea, hence reduce mortality thereof. Study aim: The aim of the study was to determine the level of Knowledge, Attitudes and Practices (KAP) of caregivers on management of childhood diarrhoea among children between 0 to 5 years attending childwelfare clinics in Mogoditshane village, Botswana. Methodiology: A cross-sectional survey with a convenience sampling was used to select participants. A structured questionaire was used to collect data from 84 respondants regarding demography, knowledge, attitudes and practices on management of dirrhoea in children. Data was analyzed using Epi Info software. Descriptive statistis included measures and frequency tabulations and and inferential statistics included cross-tabulations to investigate statistical associations with KAP were used for analysis. Multiple logistic regression models were used to determine factors associated with KAP. Results: The study found inadequate KAP among caregivers that was significantly associated with gender and level of education. Gender was significantly associatedwith level of knowledge (p<0.001) and level of practice (p= 0.04) while level of caregivers education was significant with level of attitude. (p= 0.015). There was no statistical significant relationship found between KAP variables. Practice and knowledge (p-value close to 1), practice and attitude (p=0.70), attitude and knowledge (p=0.66). Mean age was 30 years (SD=8.38). 26 (32%) had good knowledge and 58 (68%) had moderate knowledge. The mean score of respondents’ attitudes was 14.33 (SD= 3,178) with 36 (43%) having good attitudes towards the prevention and treatment of diarrhoea while 48 (57%) had poor attitudes. 28(57%) of caregivers had good practices and (71%) had poor practices. Conclusion: Existing public health programs targeting prevention of diarrhoea and dehydration should consider gender, level of education, perceptions and beliefs of caregivers when planning for interventions.Item Pilot study: Home, school and community participation of children attending a special needs school in South Africa: Barriers and supports(2017) Behrens, Theresa JuanitaBackground: The International Classification of Functioning, Disability and Health (ICF) is an important framework when describing disability. Participation is seen as the “ultimate goal in rehabilitation” and is a multidimensional construct. The environment has a significant influence on the participation of children and is an important aspect of intervention. Therefore measuring the participation of children in various environments is crucial. The Participation and Environment Measure for Children and Youth (PEM-CY) is a fairly new tool that was developed to determine participation in relation to certain environmental aspects. The aim of this pilot study was to describe the patterns of participation in the home, school and community of children attending a learner with special educational needs school (LSEN) in Gauteng province, South Africa. Objectives: To examine patterns of home, school and community participation and environmental factors that affect home, school and community participation of children attending a special needs school using the PEM-CY. To determine if there is a difference in participation based on whether the child attends Academic phase, Special phase or Vocational phase schooling and based on the child's primary diagnosis using the PEM-CY. Methods: The PEM-CY was piloted in this sample of 378 parents of children attending the LSEN school between the ages of five and 17. One hundred questionnaires were analysed. Findings: There were no significant differences found between the groups. The results showed that participation in the home and school was good, children participated with regular frequency and involvement. Participation in the community was fairly regular, with good involvement, however with low frequency. The results showed that the participation was lower compared to children without disabilities in some instances, similar to previous research with regards to the participation of children with disabilities. However, in some activities the children in this study participated at a level similar to children without disabilities. Parents desired changes in extra-mural type activities and special roles at schools. Barriers to participation were mainly financial, lack of programmes and services, information, social demands and cognitive demands. Parents felt supported when they received sufficient information and additional supplies for assistive devices or school supplies. Conclusion: The PEM-CY has been proven useful in this group of children and it is recommended that future studies validate it for use in the South African population.Item Assessing fear of hypoglycaemia among parents of children with Type 1 Diabetes Mellitus(2017) Madumetse, Kitsiso OneIntroduction: Hypoglycaemia is the most widespread acute side effect of insulin therapy in individuals with type 1 diabetes mellitus. Severe hypoglycaemia can cause loss of consciousness, seizures, accidents or physical injuries, and even death. Given these severe consequences, it is almost inevitable for patients or their caregivers not to develop fear of hypoglycaemia. Fear of hypoglycaemia in children and their parents has not, thus far, been measured at diabetic clinics in South Africa. Fear of hypoglycaemia among paediatric type 1 diabetes mellitus patients and their parents affects quality of life and adherence to diabetes management strategies. However, behavioural workshops can address and decrease such fears and therefore increase compliance with T1DM management programmes. An improved understanding of fear of hypoglycaemia should assist nurses running clinics to develop appropriate programmes to offer support. Aim of the study: To assess fear of hypoglycaemia among parents whose children have type 1 diabetes mellitus. Study objectives: The objectives of the study were: 1. To identify aspects suggestive of worry about hypoglycaemia among parents whose children have type 1 diabetes mellitus, and 2. To determine the behaviours adopted by parents to prevent hypoglycaemia among children with type 1 diabetes mellitus. Method: A descriptive and cross-sectional survey design was used to identify factors suggesting fear of hypoglycaemia among parents and the actions parents take to prevent hypoglycaemia. In this study the population comprises parents of type 1 diabetes mellitus children attending a specific diabetic outpatient’s clinic (N=140). The total population was used as a sample over a period of three months due to the limited population size. Fifteen (15) patients are pre-booked for clinic services every Monday from 08h00–13h00. vi Only parents or guardians of children aged 3 to 18 years, diagnosed with type 1 diabetes mellitus and on insulin therapy, were considered eligible for the study. Data collection: A self-administered Hypoglycaemia Fear Survey – Parent version (HFS-P) was used to collect data. Besides demographic data, the HFS-P’s data collection tool focuses on worry and avoidant behaviours, with a total of 25 questions scored using Likert Scales ranging from 0 (“never”) to 4 (“always”). The Worry subscale HFS-P (W) measures different anxiety-provoking aspects of hypoglycaemia. The Behaviour subscale HFS-P (B) measures behaviours used to avoid hypoglycaemia and its consequences. The demographic data collected concerned parents’ ages, genders, marital status, employment status and levels of education. Data analysis: Data was analysed using STATA version 13.1. Data analysis was divided into descriptive and inferential statistics. Results: Parents of type 1 diabetes mellitus children are more likely to experience fear of hypoglycaemia and to practise negative behaviours to avoid hypoglycaemia, which eventually impact negatively on glycaemic control. Nurses should be able to intervene and teach such parents how to manage type 1 diabetes mellitus correctly.Item Health risk assessment of lead exposure to children in Blantyre, Malawi(2016) Utembe, Wells RobertAlthough lead (Pb) is highly toxic, exposure to Pb has not been studied in Malawi. The aims of this study were therefore to: 1. Determine the levels of Pb from different sources of exposure such as food, water, and soil/house dust to predict the levels of Pb in blood (BPb) using the Integrated Exposure Uptake Biokinetic (IEUBK) model. 2. Measure the levels of BPb and compare to those predicted from the IEUBK model as an indication for its applicability in Malawi. 3. To relate the measured and predicted BPb levels as well as the prevalence of high BPb to potential health effects using the WHO and CDC guidelines. 4. Assess burden of disease using WHO spreadsheets. 5. Identify additional sources and risk factors for exposure to Pb in children in Malawi to assist the policy makers to reduce exposure to lead. In this cross-sectional study 152 children, aged 1-6 years, were recruited. To determine sources of exposure, children’s toys, domestic paints, foods, house dust, playground soil and water were collected and analyzed for Pb. A Pb exposure risk assessment questionnaire was also administered to identify potential risk factors and a 7-day food frequency questionnaire was used to collect information on food consumption. For measured BPb levels, venous blood was collected and analysed. Logistic regression was performed in STATA to evaluate the relationship between risk factors and high BPb (BPb ≥ 5 μg/dl). The comparisons between predicted and measured blood lead showed that the IEUBK model may be used provided that the bioavailability values for lead from different sources are available as well as the food consumption rates are provided for Malawi.. There was also a high prevalence (71.7%) of high BPb that is expected to result in 8.38 cases of mild mental retardation per 1000 children aged less than five years. From the identified risk factors, only areas of residence has correlated to prevalence of high BPb in statistically significant manner (p = 0.013). It can therefore be concluded that IEUBK model may be used for Malawi, that a significant proportion of children in Blantyre are exposed to levels of lead that are detrimental to their health and that exposure to lead in Blantyre require urgent intervention measures.Item The Imagined Child(2016) Richards, Jo-AnneThis PhD comprises a work of fiction and a dissertation, both of which explore childhood, children and parenthood. The Imagined Child, the novel, closely examines the nature of parenthood, the expectations inherent in the parent-child relationship, and the responsibilities that society imposes on parents. It explores the strains of guilt and blame that surround all primary relationships: every child is damaged in some way – through nature and nurture. How they deal with that damage determines the kinds of adults – and ultimately the kinds of parents – they become. The dissertation approaches childhood as a literary device. It explores the ways in which four novelists from different historical periods have characterised and thematised childhood. It presents ‘childhood’ as a social construct and considers the ways in which childhood and parenting have changed in recent, Western history. It then focuses on the research into and literary representations of children in Africa to explore the versions of childhood inherited by African, and particularly South African, children and how this differs from American or European models. Textual analysis was employed to examine the representation of childhood in four texts: Charles Dickens’s David Copperfield (1850), L.P. Hartley’s The Go-Between (1953), Harper Lee’s To Kill a Mockingbird (1960), and Michiel Heyns’s The Children’s Day (2002). An examination of research and literature shows a very different trajectory for childhood in Africa than in Europe, and reveals that childhood on the continent has never been consistent, in life or literature. There is, in other words, no universal “African childhood”. The literary children of South Africa are examined not only to show how differently childhood is experienced in diverse segments of society, but also to measure the temperature of the times. The differing versions of literary childhood, and their varying treatments, provide a gauge for the zeitgeist in South African society from the 1990s. The dissertation argues that an examination of literary children provides insight into the development of a new democracy. The dissertation and the novel, taken together, suggest that through the real and imagined children of literature can be gained a sense of ourselves.Item Monitoring and evaluation for crime prevention: the 16 days of no violence against women and children campaign(2014-01-02) Bosilong, Kgomotso Pearl.South Africa has the highest levels of violent crime in the world and is home to high levels of violence against women and children. In response to the challenge imposed by the high level of crime and violence, the South African Government initiated the development of the National Crime Prevention Strategy(NCPS). One of the goals of the NCPS is to identify and implement programmes to prevent crime and to support, protect and empower victims of crime and violence, with special focus on women and children. Responding to the international call to prevent and act against women and child abuse and within the ambit of the NCPS, the 16 Days of No Violence against Women and Children Campaign (referred to as the 16 Days Campaign in this research) was established in1999. The main aim of the 16 Days Campaign is to generate an increased awareness of the negative impact of crime and violence on women and children thus contributing to the prevention of crime and violence against women and children. The first impact assessment of the 16 Days Campaign was undertaken by the Council for Scientific and Industrial Research (CSIR) in 2009. The CSIR report states that the 16 Days Campaign has not yet showed a positive impact due to the lack of proper planning, implementation and monitoring and evaluation (M&E) system tofacilitate the assessment of its impact. The majority of Government departments and Non-Governmental Organisations (NGOs) that participated in this research (99%) do not know the tools used to monitor and evaluate the 16 Days Campaign. Each department or participating NGO works in silos and does not share good practice on M&E of the 16 Days Campaign, rendering planning, implementation inadequate and subsequently M&E inconsistent. This research demonstrates that the GCIS Tracker Survey and Exit Reports are not effective M&E Tools for the 16 Days Campaign. It proposes a iii comprehensive M&E Framework based on the insight from the literature review, good practice and inputs from participants. The M&E Framework facilitates the planning, implementation, monitoring and evaluation and impact assessment of the 16 Days Campaign.Item The utilisation of child support grant by caregivers : the case of Ba-Phalaborwa sub-district in the Limpopo Province of South Africa.(2013-07-24) Khosa, PriscaliaChildren are part of the vulnerable population and mostly affected by poverty. The main policy response to children living in poverty in South Africa is the Child Support Grant (CSG). It is payable to a needy primary caregiver of a child for the benefit of that child. The aim of the CSG is to alleviate poverty among children. Although the grant is meant to benefit children, some of the caregivers misuse the grant resulting in children living in poverty. The study explored how caregivers in Ba-Phalaborwa sub-district in Limpopo Province utilise the CSG in the best interest of children. The researcher was motivated to conduct the study due to the reported cases of misuse of the CSG. It came to the researcher s attention that many caregivers do not utilise CSG in the best interest of children. Instead, caregivers use the grant for their own needs, leaving children s needs unmet. The study adopted a qualitative approach and it was exploratory in nature. The sample of the study was drawn from a population of 27 945 recipients of the CSG in the sub-district. A non-purposive sampling technique was used to select a sample of 20 caregivers aged between 21 and 50 who were also the beneficiaries of poor relief. A semi-structured interview schedule was used to collect data. The researcher conducted face-to-face individual interviews with 20 CSG recipients in Ba-Phalaborwa. The researcher also observed the participants home circumstances which further assisted her in data analysis. Thematic content analysis was used in analysing the data. The findings revealed that the CSG is mostly utilised to buy food, clothes and school necessities for children. This is a reflection that the grant does benefit children directly. Indirectly, the children benefit through contribution to burial societies with the grant. However, the findings further revealed that, there were perceptions that some recipients did not utilise the grant in the best interest of children. The misuse was through gambling and purchasing alcohol with grant. This disadvantages children. Suggestions were proposed on how those who misuse the grant can be dealt with. The suggestions included; initiating food vouchers, changing the recipient, monitoring, and punishing those who misuse the grant. In addition to the money being utilised to purchase food, clothes and school necessities for children, the findings also revealed that the participants were of the view that a slight amount of the grant need to be saved on a monthly basis so that it will help the children in future, especially when they go to tertiary institutions. However, participants complained about the inadequacy of the grant. VI Based on the research findings, it was recommended that if it is found that the recipients misuse the grant, someone should be appointed to receive the grant on behalf of the child and to use it for the benefit of that child. This should be done in collaboration with social workers and SASSA officials. Social workers should monitor the utilisation of CSG in order to ensure that the grant benefits children. Given the fact that the caseload for social workers is high, hiring other personnel (e.g. Auxiliary Social Workers) to deal specifically with the monitoring of the grant was recommended. The Auxiliary Social Workers can also assist families who are unable to manage their finances in drawing budgets with the CSG. It was further recommended that there is a need for South Africa to develop a comprehensive system of social protection which will enable caregivers to receive support in their own right. This would serve to ensure that the CSG is used specifically to meet the needs of children.Item Exploring the psychological needs of cross-border unaccompanied minors in Johannesburg: how cross-border unaccompanied minors are challenging psychosocial programmes(2012-08-24) Johnston, LibbyBackground: This research investigates the psychosocial needs of cross-border unaccompanied minors (UAMs) within urban Johannesburg, a city that attracts nearly half of all the cross-border migrant population in South Africa (Landau and Gindrey, 2008). The focus of the research is dual; firstly, it explores what the prime psychosocial needs of UAMs are by eliciting them from the UAMs themselves via participatory research workshops. South Africa, by law, has an obligation to all UAMs to provide for them. By ascertaining these needs, this study reveals discrepancies between existing psychosocial programmes designed and provided by the government or service providers and the needs of the UAM. Secondly, the research examines how UAMs are trying to satisfy their psychosocial needs. Identifying the psychosocial needs of UAMs and their coping mechanisms gives us a better understanding of the nature of the issues UAMs face, as well as their subjective perception of and priority they place on those issues. This can consequently contribute (a) to providing constructive suggestions on designing psychosocial programmes by governmental, nongovernmental organisations (NGOs), and non-profit organisations (NPOs) and (b) valuable input to further research on livelihood-seeking UAMs, a group that is currently under-represented in cross-border UAM studies, unlike asylum seeking or refugee UAMs. Aims: The aim of this study is to understand the psychosocial needs of UAMs and how they are meeting those needs in Johannesburg. This will provide insights on the nature of the psychosocial needs of UAMs that will ultimately be helpful both to government agencies as well as NGOs and NPOs responsible for programme planning, legislation, and execution of policies regarding cross-border UAMs. Finally, the study aims to draw attention to livelihood-seeking UAMs and to encourage further research on this particular group of UAMs. Therefore my research question is: what are the psychosocial needs of cross-border UAMs in Johannesburg? Methods: In this study, a qualitative research approach is used with the aim of uncovering the psychosocial needs of cross-border UAMs. This was done by using participatory action research and a visual methodology. The data was elicited via two participatory workshops, the first with 36 cross-border minors participants and the second with 12 cross-border UAM participants. This was followed by a series of group discussions after the workshops. Afterwards, a comparison between the participants’ visual inputs with their narratives and responses allowed me to extrapolate their psychosocial needs and ways in which they meet those needs. Adding to the study, 11 semi-structured interviews were conducted with service providers from various organisations, both non-governmental and governmental. Finally, the data was compiled from both the cross-border UAM s and service providers to answer the research question and objectives. Conclusion: This research identifies and discusses the following psychosocial needs of crossborder UAMs: family, a care-giver, documentation, fitting-in with their South African peers, security, schooling, better life quality (economic and social advancement), counselling, and playing. The four themes in bold text represent psychosocial needs, which continue to be unmet or unfulfilled by service providers current responses. Although the basic (ontological) needs of cross-border UAMs seem to be met (i.e., food, housing, clothing), psychosocial needs - those needed for emotional well-being - are undermined because service providers do not see them as fundamental as basic needs. One conclusion from my study is that NGOs can better cater to UAMs’ psychosocial needs due to their flexible infrastructure that can accommodate personalisation and prompt redesigning of programmes offered, in contradistinction to the recalcitrant governmental infrastructure. Currently service providers, such as governmental departments, NGOs and NPOs use the law (such as the Children’s Act (2008)), regulations or psychosocial programmes to aid cross-border UAMs, but these laws and programmes are manufactured for either homogenous groups or very specific groups such as refugees and asylum seekers. However, there are persisting gaps in the services available. These gaps are due to the varied nature of psychosocial needs that each ‘child’ has to meet, which is also contingent on their own background and personality. Under the Children’s Act (2008), minors are categorised as a homogeneous group and therefore individual needs are overlooked. Organisations both governmental and non-governmental have tried to incorporate child friendly practices, although in most of the interviews it was mentioned that policy, such as the Children’s Act (2008), is not necessarily ‘child’ or ‘family’ friendly. Overall this research indicates that NGOs and NPOs are well-equipped to cater to the psychosocial needs of UAMs, such as school, family reunification and basic needs. Certain psychosocial needs, however, such as ‘fitting-in’, are still unmet. In these cases, UAMs resort to catering to their own needs (lke living on the street in selfappointed families), relying on service providers for emotional support and/or basic needs.