3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Predictors of weight loss in HIV-infected women on antiretroviral therapy in Rwanda.(2014-03-28) Kimenyi, Jean PaulBackground: Highly Active Antiretroviral Treatment (HAART) has reduced the frequency of weight loss/wasting associated with HIV infection. However, weight loss remains a problem, even in the HAART era. Objectives: This study was carried out to assess weight change in a cohort of HIV-infected women on HAART in Rwanda, from 2005 to 2008, and to identify factors that predict weight loss in this cohort. Methods: Data from a cohort of 449 HIV-positive women on HAART enrolled in the Rwanda Women’s Inter-association Study and Assessment (RWISA), starting in May 2005, and followed at six monthly intervals until December 2008, were analysed. The outcome assessed in this study was change in weight, measured in kilograms at 6, 12 and 24 months after HAART initiation. Nutritional status was recorded and laboratory measurements (weight, height and CD4 cell count) were taken prior and after HAART initiation. All covariates were time dependent, except for the history of weight loss which was recorded at baseline only. Generalized Estimating Equation (GEE) using the linear link (Gaussian [normal]), exchangeable covariance structure and robust standard error was used to assess the factors associated with changes in weight (weight loss or weight gain) and to control for potential confounders. Results: Prior to HAART initiation, the mean weight of the study participants was 53.1 kg (SD 9.5). The mean BMI was 21.3 kg/m2 (SD 3.6) and the mean CD4 cell count was 222.9 cells/μL (SD 120.6) [47.6% had CD4 cell counts <200 cells/μL, 52.2% had CD4 cell counts ≥200 cells/μL]. Overall, the participants gained weight from baseline to 12 months after HAART initiation. The mean weight change was 1.9 kg (SD 7.8) (p<0.001) 6 months after HAART initiation, 2.9 kg (SD 5.9) (p <0.001) 12 months after HAART initiation, and 2.4 kg (SD 6.5) (p <0.001) 24 months after HAART initiation. Six months after HAART initiation, 48.3% of participants had gained weight, and 21.0% had lost weight. Twelve months after HAART initiation, 56.9% had gained weight, and 18.3% had lost weight, Twenty-four months after HAART initiation, 56.6% had gained weight, and 22.6% had lost weight. Participants with CD4 cell counts ≤ 200 cells/μL at baseline gained more weight than those with CD4 cell counts > 200 cells/μL at 6, 12 and 24 months after HAART initiation. Participants who were underweight (BMI <18.5 kg/m2) at baseline gained more weight than other participants three months after HAART initiation. Time-dependent diarrhoea for more than two weeks and a CD4 cell count of 200 - 350 cells/μL were significantly associated with weight loss (p≤ 0.05). Others factors, such as time-dependent education level (completion of secondary school), marital status (married legally and status other than married legally or widowed), and increases in CD4 cell counts, were associated with weight gain (p≤ 0.05). Conclusion: Although the majority of participants gained weight during the first 12 months of being on HAART, a significant proportion of participants lost weight while on HAART. The findings on the predictors of weight change in HIV-positive women on HAART can be used to promote weight gain in women who start HAART. Clinicians who take care of HIV-infected patients on HAART should pay attention to those who lose weight, and those who present with diarrhoea or with CD4 cell counts of <350 cells/μL at follow-up visits, since these factors are associated with weight loss in the HAART era.Item Shifting understandings of performance practice in an African context through auto-ethnography(2010-11-23) Lejowa, Jessica OreeditseAbstract By critically analysing three pieces of devised performance, Even as I Walk (2008), They Were Silent (2009) and The Wages of Sin (2009), I argue that the concept of performance is not easily defined. Rather, it is an ever-changing phenomenon, which can become a useful platform for dialoguing about deeply personal and necessarily public and political subject matter. I locate myself and the theatre makers I worked with to create the three pieces, in the work by reflecting on and writing about the processes using auto-ethnography as a lens. The context within which I write, and within which my collaborators and I work, is that of our locations in very specific African, moral, cultural, political and creative impulses which we interrogate through the creative processes. Through the writing and reflecting, I arrive at various conclusions, including what I call ‘the methodology of not knowing,’ the importance of the group in facilitating the research and creative process, the necessity of redefining or renegotiation—for the purposes of both the research and the creative goals—our understandings of what performance is.Item Is the use of hormonal contraception a risk factor for incident sexually transmitted infections in a cohort of women aged 18 to 35 in Soweto, South Africa?(2010-09-21) Moyes, Jocelyn AnstieIntroduction This secondary data analysis of a prospective cohort study set out to describe the association between the use of hormonal contraception and sexually transmitted infection (STI) acquisition in a cohort of 752 HIV negative women who were followed up for a year. Methods Outcome variables were measured by standard laboratory tests (PCR for Chlamydia trachomatis (CT) and Neiserria gonorrhoea (NG), culture for Trichomonas vaginalis (TV) and gram stain with Nugent score for Bacterial Vaginosis (BV). Exposure variable information was collected by structured interview. Basic descriptive statistics were applied to describe the characteristics of the cohort, including a comparison of women who used contraception and those who did not. A time series analysis including incidence rates for the outcomes (CT, NG, TV and BV), Kaplan Meier curves for time to event measurement and Cox regression models (univariate and multivariate), for the estimation of risk were applied. Results The analysis found no significant difference between women who use hormonal contraception and those who did not with respect to baseline demographic characteristics. Incidence rates per 100 women years to follow up with 95% confidence intervals were: CT 13 (7 to 17), NG 2 (1 to 4), TV 6 (4 to10), BV 72 (63 to 83). Kaplan Meier curves showed no significant difference in time to event between women who used contraception and those who did not. Adjusted hazard ratios for women who used contraception was 1.12 (0.69 to1.82) for CT, 0.47 (0.17 to 1.30) for NG, 1.06 (0.48 to 2.34) for TV and 0.27 (0.05 to 1.52) for BV. Conclusion This analysis did not reveal any significant associations between the use of hormonal contraception and the acquisition of STIs, however the trends in risks follow those reported in the literature.Item Cui bono?: a capabilities approach to understanding HIV prevention and treatment for pregnant women and children in South Africa(2010-06-29T06:52:34Z) Sprague, CourtenayThe global health revolution of the last 50 years has generated significant health gains in terms of increased life expectancy and reduced maternal mortality. South Africa, an upper middle income country, has performed poorly along the same development indicators. Development gains for women and children won over two decades are now being reversed, largely due to HIV/AIDS. This is in spite of the evidence that lifesaving antiretroviral medication can prolong life and enhance quality of life. Using a joint capabilities and health equity lens, this thesis seeks to understand a critical development problem in South Africa – premature mortality in pregnant women and children attributed to HIV – an infectious disease that is both preventable and treatable. The research identifies key barriers faced by pregnant and postnatal women with HIV who seek (freely available) access to PMTCT (prevention of mother to child HIV transmission) and ART (antiretroviral therapy) programmes in the public health sector. The study considers whether disparities in, and missed opportunities for, preventing and treating HIV in these population groups comprise avoidable, systematic and unfair health inequities. The implications for the capabilities of women and children with HIV in this country are also explored. Qualitative research methods are employed to investigate the research concern. Semi-structured interviews with 83 women comprise the mainstay of the field research. Interviews with 37 caregivers of children with HIV, together with patient files and interviews with key informants, supplement the data collection. Research was undertaken in two sites in two provinces: Eastern Cape and Gauteng. Each site constitutes a bounded case study. A rural-urban perspective is put forward – with attention to equity considerations in access to maternal-child HIV services. The study evinces a host of avoidable factors in the operational delivery of ART/PMTCT, along a range of intervention points in the continuum of care: including the antenatal, labour, postnatal and pediatric wards. While some of these factors are influenced by individual behaviour, the vast majority are directly linked to the health system – illuminating the ways in which the health system serves as a social determinant of health (SDH), and often restricting, constraining, and ironically, preventing people from obtaining the interventions and information they need to improve their health. iii By connecting the empirical findings related to ART/PMTCT within the health system to the capabilities and health equity literatures, an understanding of disparities in access to, and delivery of, such services – and their importance in shaping health, development and health outcomes of these population groups – becomes clearer. As a consequence, strengthening the public health system is a necessary first step to ensuring at least some of the minimum conditions that allow people to be healthy. As an entry point, there is great scope for systems’ interventions that would address the shortfall in health for black South Africans and deprivations in their health capability. At the same time, the research reveals that – owing to the contribution of social determinants of health (e.g., factors that impact on health such as living and working conditions, but lie outside the realm of healthcare) to health status: good health is not achieved solely by access to and provision of good healthcare. This reality underscores the importance of health as a central capability; and good health as a normative social goal. In the capability view, the moral concern for state and society is the reduced capability of individuals due to health inequities that are socially-constructed, and in turn, changeable. Recommendations to address modifiable factors related to effective ART/PMTCT provision in these facilities are put forward, with a set of suggestions for future research in maternal, child and women’s health in South Africa.Item Relationship between economic wellbeing and risky sexual behaviour among 14-35 year old women in Limpopo Province, South Africa(2010-04-20T08:30:40Z) Nyamboli, Mirabel AkwaObjective The study examined the relationship between socioeconomic status (SES) and risky sexual behaviour in young women living in the Limpopo Province of South Africa. Methods Quantitative data were drawn from the 2001–2005 Intervention with Microfinance and Gender Equity Study. The analyses were restricted to 705 sexually active young women aged 14–35 years. Logistic regression models were employed to assess the effect of socioeconomic status (estimated from household asset index and employment status, on risky sexual behaviours). Odds ratios (OR), adjusted odds ratios (AOR) and 95% confidence intervals (CI) are reported. Results After controlling for the potential confounding effects of wealth perception, age, level of education, marital status, birth control and HIV knowledge; there was no statistically significant association between asset index, or employment status and most of the risky sexual behaviours. However, students were significantly more likely to have experienced first sex at or before age 17 years (AOR: 3.80, 95% CI: 2.63, 6.11), and significantly less likely to have had more than three lifetime sex partners (AOR: 0.47, 95% CI: 0.29, 0.78). Discussion Given that age had emerged as a definite predictor of the sexual behaviours that were significantly associated with being a student, and that 75% of the students were aged 14-19 years, it is possible that the associations may be due to an age effect, or a cohort effect. That aside, the results suggest that women in general are equally at risk of HIV infection, hence further research is needed to determine other factors that enhance young rural women’s vulnerability to HIV/AIDS. Conclusion The study did not show any strong evidence to suggest that socio-economic status is associated with risky sexual behaviour. The findings underscore the need to re-examine the assumption that poverty drives risky sexual behaviour so that efforts to ensure that HIV prevention messages get across all strata of society. However, it is possible that SES as used in this study did not differentiate people well enough to be able to identify factors associated with risky sexual behaviour. It is recommended that more research be done to establish how other major factors besides wealth may enhance the vulnerability of women to HIV/AIDS. The current study however contributes to the growing evidence that the relationship between wealth and HIV/AIDS is either exaggerated or is very complex and should be considered when designing new policies, programs and interventions to alleviate the growing HIV incidenceItem The effect of shift work on women shift workers(2010-02-19T11:07:56Z) Van Grenen, HelenItem Does religion matter?: white women's perception of religious influence on childrearing(2009-01-21T09:25:22Z) Libhaber, ArielAbstract This study explores perceptions of religion and attitudes towards childrearing of white women. The focus on whites is motivated by the misconception that they comprise a homogeneous population group in South Africa. These perceptions of religion are measured through a focus on religiosity, in other words, religious commitment. Different levels of religiosity are then identified, through a number of indicators, including women’s own views on what religion means to them. A scale of three levels of religiosity is consequently used to observe to what extent religion influences childrearing attitudes. In terms of childrearing, the analysis identifies four major components in which religion informs, in different ways, childrearing attitudes: attitudes towards children’s education, attitudes towards the family, attitudes towards the children’s future, and the role of the partner in childrearing. This analysis is located as well within the context of the ‘secularisation debate’, where we try to find out to what extent the identified religiosity corresponds to trends in regards to secularisation.Item The stigmatization of HIV-positive women and the role of associations of people living with HIV/AIDS (APWA)(2008-03-19T12:45:46Z) Ikome, Namondo MagdalineAbstract Throughout history, many diseases have carried considerable stigma, including leprosy tuberculosis, cancer, mental illness and many STDs. Now HIV/AIDS is the topmost in the list of diseases that leads to devastating patient stigmatization. Despite international efforts to tackle HIV/AIDS, stigma and discrimination remain among the most poorly understood aspects of the epidemic. In the face of numerous intervention strategies, HIV/AIDS continues to spread and to pose a threat to the socio-economic transformation of South Africa. The broad objective of this study was to investigate how the stigmatisation of HIV-Positive women is made manifest and look at how successful the National Association of people living with HIV/AIDS (NAPWA) in South Africa has been in achieving their objectives and goals of changing the perceptions people have about HIV/AIDS and creating awareness about the debilitating effect stigmatisation has in the society, especially when it viciously targets HIV-positive women. A case study approach was used to examine the experiences of HIV/AIDS infected/affected women and NAPWA administrators. Methods used in the collection of data were self-administered questionnaires, participant observation and archival evidence in the form of documents. Through these methods, the study investigated ways in which the stigmatisation of HIV-positive women was made manifest, the role of NAPWA in fighting HIV/AIDS stigmatisation, how successful NAPWA has been in the fight against the stigmatisation of people infected and affected by HIV/AIDS in South Africa, challenges faced by NAPWA in the fight against HIV stigmatisation and discrimination, weaknesses of NAPWA and what impact all these have in the spread of HIV/AIDS. The research results show that HIV-positive women suffer stigmatisation and that; organisations of people living with HIV/AIDS (e.g. NAPWA-SA) play a major role in eradicating the stigma attached to HIV/AIDS. It also suggests that APWAs in effect help to reduce the spread of the disease and prolong the life span of those infected by it. All this not withstanding, the study also discovered that APWAs like NAPWA-SA need the support of government and stakeholders in South Africa to fully implement their strategies and programmes geared towards reducing stigma and the spread of HIV/AIDS.Item Women making headlines: influences of women editors on newsroom socialisation and the news agenda(2008-02-22T09:06:16Z) Luimes-Sindane, Wilhelmina HenriettaAbstract This study takes a qualitative look at the interplay between women’s leadership and newsroom socialisation and the news agenda as experienced and understood by women editors at the Mail & Guardian, through a process of interviews with women editors, supplemented by a brief look at the publication when referenced during the course of the interviews. This study confirms previous research that suggests that an increase of women in the newsroom is not enough to address issues of gender representation in newsrooms and news representation. Although at the Mail & Guardian, this study indicates that the appointment of a woman editor impacted the newsroom positively on gender awareness issues and the publication itself in its gender representation, there are indications that this is a result of a number of factors and not gender alone. In summary, this research found that it is the combination of positioning, power and influence, with a gender agenda, intention and purpose, in an environment that is receptive to change, that will significantly contribute to changes both within the socialisation of the newsroom and translate into a higher level of gender awareness and sensitivity in newspaper’s gender representation.Item Prevalence and patterns of tobacco use among woman in Benin city, Nigeria(2006-11-20T10:04:18Z) Okwuolise, Ogheneruemu VincentBackground: Tobacco use is one of the single biggest causes of preventable deaths and is increasingly affecting developing countries and men and women alike. Tobacco use is historically more common in men but is becoming more common among women. In the absence of population-based health information in many dev eloping countries and sub- Saharan Africa in particular, public health planning and priority setting is in disarray. Most of the prevalence studies on tobacco have concentrated on smoked tobacco and men in particular. This cross-sectional study design looked at the prevalence, patterns and determinants of tobacco use among women in Benin City, an urban area in Nigeria. Methods: 491 face-to-face interviews were conducted in 45 enumeration areas randomly sampled in Oredo LGA in Benin City, Nigeria. Twelve households were randomly sampled in each EA and eligible woman over the age of 18 years was identified in each household. Results: The prevalence of tobacco use was 8.8% comprising of smoking (3.3%) and smokeless (5.5%) initiation occur during the teenage years mostly. Smoking cigarettes was more common among the younger, more educated women and Tabba (a mixture of powdered dry tobacco leaf and sodium bicarbonate) used mostly by older less educated women (RR = 3.10, CI = 1.01 - 9.48). The participants perceived friends using tobacco as a reason for their starting to use tobacco. Determinants of tobacco use were education, exposure to tobacco advertising and / or promotions which occurs almost unrestricted despite some tobacco control legislations. Dr. OV Okwuolise; 0209663K/2005 Page 2 of 2 Conclusions: The findings suggest that tobacco use is going on unhindered and unless something is done to curtail the activities of the tobacco industry, a major public health catastrophe is looming.