Department of Public Health

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    An assessment on the knowledge, facilitators, and barriers to the uptake of cervical cancer screening among allied health science female students at the University of Namibia, Hage Geingob campus
    (University of Namibia, 2024) Kamunima, Petronela
    Cervical cancer is the leading cause of cancer-related deaths in the world. In Namibia, cervical cancer ranks as the second most frequent cancer following cancer. The purpose of this study was to assess and describe knowledge, facilitators, and barriers to the uptake of cervical cancer screening among female allied health science students at the University of Namibia (Hage Geingob Campus). A quantitative, cross-sectional, and analytical study was conducted with the use of a self-administered questionnaire. A sample size of 97 female allied health science was obtained using a systematic random sampling method. Binary logistic regression analysis was used to establish the relationship between the independent and dependent variables of the study. The findings of the analysis depicted an abnormal pap smear test (OR=84.056, 95% CI: 4.316-1636.911, p=0.003), age (OR=0.625, 95% CI: 0.441-0.886, p=0.008) to be statistically significant with female students having a Pap smear test. Results from the study further revealed that 12(13%) female students have had a Pap smear test in their lifetime. The most common barriers to cervical cancer screening included no signs and symptoms of cervical cancer (33%), fear of outcome (15%) and difficulty accessing screening services (15%). Facilitators to cervical cancer screening were reported as own decision to undergo screening (39%) and upon doctors’ requests (6%).The findings of the study showed that there is a poor level of cervical cancer screening uptake among allied health science female students at the University of Namibia. It is recommended that the University of Namibia in consultation with the Ministry of Health and Social Services tailor cervical cancer screening programs to assist in educating female students about the risk factors of cervical cancer as well as the importance of cervical cancer screening uptake
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    An investigation of challenges that impede the elimination of malaria in Andara district, Kavango east region, Namibia
    (University of Namibia, 2025) Kauejao, Shereen; Lukolo, Linda
    This study was conducted to identify challenges that impede the elimination of malaria in Andara District, Kavango East Region, Namibia, so that efforts may be put to address such. Interventions which have been put in place include universal large-scale deployment of indoor residual spraying, distributing insecticide-treated bed nets and treating with artemisinin-based combination therapy and many others. However, cases of malaria morbidity and mortality in Andara District persisted. So, this research explored deeper the major challenges faced by the communities in trying to control this endemic disease in Andara District, Kavango region. This study used a mixed research design, meaning that both quantitative and qualitative research methods were used in this study to sufficiently capture the trends and details of the malaria situation in Andara District. Stratified random sampling method was used to collect 360 respondents from the population. A self-administered questionnaire and in-depth interviews were used to collect data. The study found that factors that impede malaria elimination in Andara District include limited research on traditional malaria prevention methods, uncontrolled cross border migration, favorable environmental conditions, good climatic conditions, resistance of mosquitos to insecticides and poor surveillance of malaria transmission hotspots. The study also found that some barriers to mosquito control and prevention in Andara District include the resistance of mosquitos to insecticides, shortage of nets and sprays and shortage of healthcare workers. In light of these findings, it was recommended that the Ministry of Health and Social Services should conduct surveillance to collect, analyze, and interpret data related to malaria. The information gathered should be used to inform the planning, implementation monitoring and evaluation of malaria cases and fatalities. Surveillance may also help the country to track evolving trends in malaria-related illnesses. It has also been recommended that the government of Namibia should implement different interventions such as mass drug administration, mass testing and treatment and mass relapse prevention in order to reduce malaria transmission. The government should also implement targeted testing and treatment, routine testing and treatment at points of entry and testing and treatment of people coming to or returning from Andara District. Moreover, since this study was limited to the Andara District, it has been recommended that further studies should be carried out in all fourteen regions of Namibia in order to obtain findings that may be applied to the entire country
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    Analysis of factors contributing to non-adherence to highly active antiretroviral therapy in selected facilities in Namibia: A development of adherence improvement Programme for health professionals
    (University of Namibia, 2023) Katjiuanjo, Maazuu Zauana
    Health professionals are faced with challenges of ART non-adherence in patient enrolled on HAART. This study was aimed at developing a programme to assist health professionals to improve ART adherence at the facilities in Oshikoto and Kavango West regions. The study was carried out in four phases i) phase 1: situational analysis ii) phase 2: conceptual framework development iii) adherence programme development and iv) programme evaluation. Phase 1 involved carrying out a situational analysis using a mixed-method design to understand magnitude of adherence problem in the study area. In the quantitative part of the study a descriptive and analytic cross sectional study was conducted to collect data using structured interview, with HIV infected persons (n=296) under antiretroviral treatment in Oshikoto and Kavango West regions. Medication adherence was measured with the Adult AIDS Clinical Trial Group (AACTG) method and the Morisky Medication adherence Scale (MMAS-8) In depth Interviews (IDIs) of health professionals (n=43) and four Focus Group Discussions (FGDs) with (n=32) individuals who received ART at a primary health care clinics were conducted at four facilities in the selected regions. Overall adherence levels was 76 % with AACTG and 36 % with MMAS-8. Factors contributing to non-adherence were Type of House, Region and Health Facility, the relationship was a negative one with beta < 0. Other factors were forgetfulness and regimens missed during the weekends as reported by the MMAS-8. Determinants of non-adherence using the AACTG adherence were found to be Confident of regularly taking medicine, Intention to regularly take medicine over the next year, Treatment support in taking medicine available and Cues to Action with beta >0.5). ART potency, that is Doses per day, ART Regimen and Dose each time per day ii with beta >0.5). The factors contributing to non-adherence with Morisky scale that showed strong positive relations with beta <0.5 were the medicinal barriers, perceived barriers, more likely to get ill than others, concerned about becoming seriously ill and barriers based on Infection severity. Determinants of non-adherence using the MMAS 8 were benefits of efficacy (r = 0.143, p <0.05), perceived barriers (r = -0.194, p <0.05) and social support in taking medicine (r = -0.127, p < 0.05). Four themes emerged of factors influencing non-adherence to antiretroviral therapy, these were: patient-related factors, health system, therapy-related factors, and condition related factors. In the qualitative data analysis, health professionals reported reasons for ART non-adherence. The subthemes included Unemployment and being poor; forgetfulness; lack of knowledge due to negative beliefs; side-effects, health system challenges; workload, inadequate training, lack of skills, and poor adherence reporting systems; stigma. The HAART participants reported several barriers that negatively influenced their medication experience and adherence. These barriers included the following subthemes: financial burden; side-effects, psychological factors, such alcohol use and stigma. The facilitators included social support, treatment support and positive patient-provide relationship. In Phase 2, the development of the conceptual framework was based on the theory of Dickoff et al. (1968) using the findings of the mixed method. Phase 3 addressed the development of the Adherence Improvement Programme (AIP) for the health professionals (1). The programme was developed within the concepts of Intervention mapping framework suggested by Bartholomew et al. (2006), which outlines the processes of developing a theory-based health promotion programme. Finally, the programme was evaluated in Phase 4 using the Centre for Disease Control (CDC) iii ‘Framework for programme evaluation in public health’ (2). A pool of public health experts was utilised for this purpose. The AIP has four programme components consisting of four objectives. Key performance areas based on the intervention strategies to improve adherence were elaborated under each objective. Tasks to be performed under each key performance areas were stipulated accompanied by indicators to measure programme performance
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    Assessing the perceptions of clients and nurses regarding integration of the primary health care services, okuryangava and Wanahenda clinics Windhoek, Namibia
    (University of Namibia, 2022) Paulus, Bertha
    The successful implementation of the Integrated of Primary Health Care (PHC) services is major challenge for health systems internationally. This research study aimed to explore the perception of clients and nurses regarding integration of primary health care services between the two clinics (Okuryagava and Wanaheda clinics). The study objectives were to assess the perceptions of clients regarding integration of PHC services; To assess the perceptions of nurses regarding integration of PHC Services; and suggest possible recommendations that can be adopted to improve integration of PHC Services based on the perceptions of Clients and Nurses. The research was conducted using qualitative research methodology. The study used an interview guide to collect data through in-depth interviews. A total of 20 participants who include both nurses and clients were purposively sampled. Data is presented using the thematic approach while content analysis was used to analyse data. Research results show that integration of PHC services has improved relationship between nurses and clients, integration of PHC services is convenient, integration of PHC services enhances competence and PHC makes nurses assessment of clients made easier. On the other hand, integration of PHC services has led to the mixing of services that do not go along, it prolongs time a client is served, integration of PHC services does not resonate with the structure as well as the resources of the clinics and stigmatises clients. On the basis of the findings, it is recommended that there is need for resources, consultation rooms and instruments to be addressed so as improve the integration of PHC services at the clinics. If more infrastructure could be provided it would ease the problems that the nurses are currently facing. The study recommends that there is need to restructure the processes of the PHC provision at the clinics as the current ones seem to be out of sync with the available resources. The study suggests that immediate actions towards patient-centred care are necessary in order to operationally integrate all provided services and existing functions of the PHC system at the clinics. Participants were also of the view that health policymakers should adopt an evidence-based action plan that ensures and safeguards patient-centeredness, comprehensiveness, sound coordination, and continuity of services at the clinics.
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    Assessment of awareness, attitudes, and practices of environmental health practitioners regarding ambient air pollution and its associated health effects in Namibia
    (University of Namibia, 2025) Itumba, Laudika; Alfeius, A.
    Air pollution remains a significant global health threat, disproportionately affecting vulnerable populations, including women, children, and the elderly, across all continents. HPs are often responsible for monitoring air quality and implementing guidelines to safeguard public health. This study assessed the environmental health practitioners' awareness, attitudes, and practices regarding ambient air pollution and its associated health effects in Namibia. Using a quantitative cross-sectional analytical design, data were collected from 66 out of 76 environmental health practitioners across all 14 Regions of Namibia, yielding an 86.8% response rate. A validated online questionnaire was used. Data were analysed using SPSS version 27. The results showed that about 6.7% of participants were aware of AAP and its associated health effects. Regarding attitudes, 59% of the respondents had a negative attitude towards AAP. 9 % always participated in preventative activities regarding AAP, while 66.7% indicated that they never got involved in awareness campaigns. There was a strong negative correlation (-0.71) between the awareness and attitudes towards AAP, and a weak negative correlation (-0.20) between the awareness and practices indicating that higher awareness of AAP does not lead to greater engagement. A weak positive correlation (0.30) between attitudes and practices implies that positive attitudes may encourage greater involvement with AAP prevention strategies. Demographic factors such as age, gender, education, and experience did not significantly influence EHPs’ attitudes toward ambient air pollution (AAP), highlighting the greater impact of systemic barriers like limited resources and unclear policies. Majority of EHPs did not prioritise AAP prevention strategies due to insufficient training and infrastructure. The study recommends continuous professional development and clear guidelines to better equip EHPs in addressing air pollution effectively
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    Assessment of knowledge, attitudes and practices on infertility among adults visiting the gynaecology and urology clinics at Intermediate Katutura Hospital and Windhoek Central Hospital, Namibia
    (University of Namibia, 2024) Namene, Maria; Uushona, S. I.
    Infertility is one of the global burdens, an under-observed but significant health problem affecting one in four couples in developing countries. A total number of 48 million couples are affected by infertility globally and a total number of 186 million individuals globally. In Namibia, about 15% of couples struggle with infertility. Although causes of infertility are equally shared among male and female factors each accounting for 30%, infertility is highly stigmatised, and women are usually blamed for it. The study aims to assess knowledge, attitudes, and practices on infertility among adults visiting the Gynaecology and Urology clinics at Intermediate Hospital Katutura and Windhoek Central Hospital in Windhoek, Namibia. A convergent parallel mixed method approach was used in this study. A total number of 118 respondents were recruited to fill in the questionnaire and 18 interviews held. The study was conducted on respondents aged 21 to 79 years, including both males and females. Participants had varying levels of education, ranging from no formal education to tertiary education, and different employment statuses, including employed, self-employed, and unemployed. Additionally, respondents came from diverse tribal backgrounds. The study discovered that the knowledge on infertility is limited, 37.1% do not identify infertility as a disease and 75.2% believe contraceptives causes infertility. Participants believe witchcraft and curses causes infertility. Seeking medical services is listed as the initial option when struggling with infertility. Adoption and in vitro fertilisation (IVF) are acceptable options when struggling with infertility. Knowledge on infertility is limited among respondents, the misconception about contraceptives is widespread. An average practice on infertility is noted and the act of assigning blame for infertility is widespread in various communities. Raising awareness on infertility is recommended to increase infertility knowledge, reduce stigma, and create awareness. Dedicated fertility clinics in state hospitals are required to offer specialised services to individuals struggling with infertility. Research recruiting individuals dealing with infertility is encouraged, in order to understand their experiences better. The misconceptions of contraceptive usage leading to infertility need to be tackled through the health campaigns
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    Demographic and socio-economic factors influencing medical care-seeking behaviour among people who experienced mental health issues in Namibia
    (University of Namibia, 2023) Tjimuine, Kuara
    The current study originated from the effort to establish if the demographic and socio-economic factors influence the medical-care seeking behaviours of people who experienced mental health issues in Namibia. The study identifies geographically diverse populations in Namibia through the secondary data collected from the 2013 Namibia Demographic and Health Survey (NDHS) to gain information regarding overall influences on medical-care seeking behaviours. The study employed a quantitative approach, and cross-sectional, analytical design. Thereafter, descriptive and inferential statistics, lineal regression and Chi-square were used to determine the demographic factors and socio-econmic factors influences on medical-care seeking behaviours of respondents with mental health problems. The study established an association between the medical care-seeking behaviour of respondents with mental illnesses and demographic factors such as age, gender, place of residence, and their regions. This association includes the socio-economic factors such as wealth and education. Women were found to develop mental challenges than their men counterparts, yet are likely to seek medical care than their men equivalents. Other results showed that mental-health illness were more common among women than their men counterparts and they are more likely to seek medical care compared with men. Although the age group from 15-44 is more susceptible to encounter mental health challenges, they are more likely to seek medical care than those in the age group from 45 and above. Rural resopndents are more likely to seek medical care compared to urban dwellers. It is important to study whether these influences are changing over time, and ii whether help seeking for mild and common disorders versus severe mental illness is becoming easier or harder as a result of the overall combination of influences.
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    The determinants and effects of alcohol use among women in Oshikoto region, Namibia
    (University of Namibia, 2022) Netope, Rebekka Nangula
    Alcohol use is one of the major public health concerns in the world. The aim of this study was to investigate the determinants and effects of alcohol use among women in Oshikoto Region. The study objectives were: to assess the determinants of alcohol use among women in Oshikoto region; to describe the effects of alcohol use among women in Oshikoto region and to assess the relationship between sociodemographic characteristics and determinants of alcohol use among women in Oshikoto region. The study adopted a quantitative research approach with analytical, cross-sectional design. Ethical clearance was obtained from the relevant authorities prior to the study. The study population were all women aged 18-49 years residing in the selected constituencies who were receiving their daily medical consultations at Onandjokwe Intermediate Hospital and Omuthiya State Hospital during the study. Informed consent was obtained from all participants prior to data collection. The data was collected from one hundred and twenty-one (121) participants who were selected through the purposive sampling. An interviewer-led questionnaire with close-ended questions was used on the voluntary participants to collect the data. The data was analysed by means of Statistical Package for the Social Sciences (SPSS) version 26. A chi square statistical test was used to determine the association between variables with the alternative of Fisher exact test. Log-binomial regression reporting risk ratio was applied to assess the association between determinants of alcohol use and risky use of alcohol. The median age of the participants was 33 years. The majority 84 (69.4) of participants lived in rural areas, while 49 (40.5) were single and 75 (62%) had children. The findings indicated that 64 (52.89%) of the respondents use alcohol sometimes in order to cope with their problems. About 56 (46.28%) of the respondents use alcohol when they feel anxious, making them relaxed and forget their challenges. In the univariable log-binomial regression analysis, family history of alcohol use (p value 0.019), peer pressure (p value 0.004), and spending most time iii at cuca shops (p value 0.000) were all significantly associated with an increased risk of harmful use of alcohol. In contrast age (p value 0.329), residence (p value 0. 437), being employed (p value 0.565), education (p value 0.199), and being unemployed (p value 0.777) were not significantly associated with harmful use of alcohol. The study recommends that the Ministry of Health and Social Services (MoHSS), needs to develop guidelines on preventative measures and awareness programs on alcohol use.
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    Determinants of home child birth practices among pregnant women in Oshikuku district, Omusati region, Namibia
    (University of Namibia, 2024) Faustinus, Petronella
    Home child birth is one of the leading causes of maternal and infant mortality and morbidity worldwide but more especially in Africa. In Namibia, despite the Ministry of Health and Social Services (MoHSS) effort to enhance Maternal and newborn health by encouraging women to deliver at health facilities, there are still women who give birth at home. The main objectives of this study were to determine if there is a statistically significant association between women's socio-demographic data and gynecological history (independent variable) and home child birth practice (dependent variable). A quantitative, analytic cross-sectional study was conducted in the Oshikuku District, particularly in the Oshikuku district hospital. The study was done in Oshikuku district hospital because is the only hospital that has a maternity ward in the district. Maternal records of 146 women seeking post-natal care at above mentioned health facility after home child birth practice were reviewed using a structured Microsoft excel spreadsheet. The study reveals that the most women who deliver give birth at home are 25 years and younger. Women from rural areas give birth more at home 97% (n=141) compared to those living in urban areas 3% (n=3), 87% (n=127) were Namibian and 13% (n=19) were non-Namibian. Apart from that women with no formal education tend to deliver more at home 59% (n=86) and also single women give birth more at home 85% (n=124). 77% (n=113) of unemployed women give birth at home. Women with less gravidity and parity 1-3 tend to practice home child birth more than those with high gravidity and parity. Women with no ante-natal visits at all or less than 3 ante-natal visits give birth at home more 59% (n=86). The study also reveal that 64% (n=93) of babies born at home were healthy (no complications recorded) however 23% (n=34) had minor ii complications, 7% (n=10) had major complications and 6% (n=9) died. 72% (n=105) of women who give birth at home were healthy (no complication recorded after home child birth), 20% (n=29) had minor complications, 4% (n=6) had moderate complications, and another 4% (n=6) had major complications respectively.The study identified factors associated with home child birth among women in Oshikuku district, Omusati region in Namibia. The study result shows that younger women, unmarried with no formal employment living in rural areas with low levels of education give birth at home.The recommendations that arise from the study are to give more health education to women on the importance of giving birth in the health facilities for safe delivery. Expanding waiting areas next to health facilities in Omusati region so that more women will be accommodated. This will help women to stay close to health facilities prior to labour. Health extension workers to give health education on maternal health in the communities. Further research is needed to understand the partner’s role they play in choosing the place of child birth
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    An educational programme to support primary health care providers regarding the management of emergency contraceptives for adolescents in Ohangwena region, Namibia
    (University of Namibia, 2023) Nghifikwa, Loide Ambuga
    Family planning (FP) could be called one of the most crucial decisions in a woman, young adult, and lately in an adolescent’s life. Emergency contraceptive refers to the strategies of birth control (FP) to prevent unwanted pregnancies after unprotected sexual intercourse (WHO, 2021). On a daily basis, healthcare facilities offer free services for emergency contraceptives (ECs) to women of childbearing age including adolescents and young people to prevent unwanted pregnancies. However, the impact of such services is minimal, and adolescent pregnancies remain a public health concern in Namibia. The Ohangwena region in Namibia is among the regions with the highest adolescent pregnancies. Therefore, the aim of this study was to assess the knowledge, attitudes and practices of Primary Health Care (PHC) providers regarding the management of ECs among adolescents in order to develop an educational programme for PHC providers. The objectives of the study were: to assess the knowledge, attitudes and practices of PHC providers regarding the management of emergency contraceptives for adolescents; determine the factors related PHC providers’ knowledge, attitudes and practices of ECs by PHC providers for adolescents; to develop a conceptual framework as the foundation for an educational programme; to develop an educational programme to support PHC providers regarding the management of ECs for adolescents; to implement the educational programme; and to evaluate the educational programme. The study adopted a quantitative approach. In this study, a descriptive cross-sectional study design was used in this study. The study was conducted in four phases. The first step was to conduct a situational analysis that assessed the knowledge, attitudes and practices of PHC providers regarding the management of ECs among adolescents as well as determine the factors related to PHC providers’ knowledge, attitudes and practices of ECs by PHC for adolescents. To collect data, a self-administered questionnaire was used, and a multi-stage stratified sampling method was used to select PHC providers from various health care facilities. A total of ninety-three PHC providers completed the self- ii administered questionnaire with a response rate of 100%. The collected data were entered into the statistical package SPSS version 26. Descriptive and inferential data analysis methods were used to analyse the data. In total, 79% of PHC providers had heard of emergency contraceptives (ECs). However, only 66% of the PHC providers know that combined pills are types of ECs methods, while only 14% correctly identified copper IUD as a method of ECs. In identifying those that are eligible for ECs use, a majority of respondents (76%) named women who had unprotected sex and only 12% identified adolescents as appropriate candidates for using ECs. Rape situations (79%) were the most frequently cited reason for EC prescriptions, followed by condom breakage (61%) and (16%) in case of missed contraceptive pills. Almost 64% of the respondents knew about the effective time to use ECs. The majority (78.3%) of the respondents knew that ECs are used in preventing unwanted pregnancies. The analytical findings revealed that the standardised direct (unmediated) effect of Negative Attitudes on Positive Attitudes was -0.452 (p < 0.01, which implies that a nurse with a negative attitude is likely to have a high misconception attitude and a low positive attitude towards EC. The study found that only 15.2% of the participants were trained in both FP and ECs, and this lack of training in FP and ECs can have a negative impact on ECs practices. As evidenced by less than 50% of participants reportedly providing ECs to clients, the practice of ECs was found to be poor. There is a significant relationship between demographic variables such as age (p=0.00), professional qualification (p=0.00), and work experience (p=0.02) and PHC providers' knowledge, attitudes, and practices. The study revealed a deficit in the knowledge, misconceptions, negative attitude and poor practice of ECs by the PHC providers, which may be barriers to accessing ECs by adolescents. These findings have negative consequences for adolescents’ usage of ECs. As a result, educational interventions should be provided to PHC providers on ECs the knowledge, demystification of misconceptions and for correction of negative attitudes towards EC services. iii Based on Dickoff, James, and Wiedenbach's survey list, the second phase addressed the conceptual framework to guide the development of an educational programme to support PHC providers in the management of ECs for adolescents. The third phase focused on developing an educational programme to assist PHC providers, guided by the Nicholls Cyclic Curriculum Development Model. The fourth stage dealt with programme implementation and evaluation. Knowles' Andragogy model and Kolb's experiential learning theory guided this phase. The educational programme was evaluated during and after its implementation. The findings indicated that the education programme was useful and supportive
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    Evaluation of HIV test and treat strategy in Windhoek, Namibia: Development of an operational framework
    (University of Namibia, 2024) Jonas, Anna
    Namibia started with the implementation of the Human Immunodeficiency Virus (HIV) Test and Treat strategy in July 2016 as a pilot phase in three high-volume sites in the Zambezi, Ohangwena, and Khomas regions. In 2017, the strategy was expanded to all the regions in the country. The HIV Test and Treat strategy is envisaged to serve as treatment and as prevention based on scientific evidence that supports the use of Antiretroviral Therapy (ART) treatment for the prevention of HIV. The study aims to develop an operational framework based on the assessment and identification of pitfalls in the current HIV Test and Treat strategy implemented in Namibia, specifically Windhoek. The researcher used a concurrent mixed-method design with retrospective and cross-sectional quantitative data collected from the electronic patient system as well as from patients attending ART clinics in Windhoek. A qualitative design was used to explore the views of the HCWs and managers on the implementation of HIV Test and Treat. Also employed were the systems and resource-based theories on which the study was anchored. The study was subdivided into four phases. The situational analysis in Phase I consisted of both qualitative and quantitative data collection approaches. The first quantitative part was conducted by retrospectively analyzing patients’ outcomes in terms of retention in care and viral load suppression of patients who initiated ART due to WHO clinical stage and patients who initiated ART due to HIV Test and Treat strategy. An abstraction tool was used to retrospectively abstract data from the electronic patient monitoring system (ePMS) by following a cohort of patients that initiated ART between 2010- 2016 before the HIV Test and Treat implementation as well as patients that started ART between 2017-2018. About 17,570 adult patient records were included in the study of which 2,399 were allocated to HIV Test and Treat, and 15,171 were assigned to the WHO clinical stage arm. Moreover, three hundred and eighty-five (385) patients above the age of eighteen (18) years collecting their treatment at different facilities in the Khomas region completed a structured questionnaire to obtain information on factors associated with HIV Test and Treat. Quantitative data analysis was performed using STATA version fourteen (14). In addition, to describe and analyze factors associated with HIV Test and Treat, Key informant interviews (KIIs) were conducted with nine (9) Healthcare workers (HCWs) as well as nine (9) KIIs inclusive of II policymakers and program managers. The data were collected through in-depth interviews and the NVIVO version ten (10) was used for analysis. The findings were that HIV Test and Treat strategy is reaching its objectives. However, the implementation of the strategy had challenges such as lack of space, insufficient health care workers, medicine stock out, and lack of training for the HCWs. Also, viral load suppression (VLS) was associated with the regimens that the patient was taking and the patient’s status on ART. The study's quantitative and qualitative findings informed the conceptual framework developed in Phase II. Amongst the findings that informed the conceptual framework is the fact that overall, 31.8% of the patients were lost to follow-up, while retention in care was 57.6% amongst the patients that initiated ART due to HIV Test and Treat compared to 43.1% amongst the patients in the WHO clinical stage category (Table 4.3). This, therefore, requires more resources in order to conduct patient tracing as well as to do continuous adherence counseling. In addition, about 38.10% (Table 4. 28) of the patients recommended fewer clinic visits which will require sufficient ARV storage at facilities that was mentioned as not enough during HCWs interview (006). The researcher used the systems theory, resource-based theory, and central concepts to guide the development of the conceptual framework. Phase III developed and described the operational framework to facilitate the implementation of the HIV Test and Treat strategy in Windhoek using the main findings from Phase I. The framework was described in terms of its goal, purpose, structure, and assumptions. The key attributes of the framework are that it is made up of interrelated and interlinked components that are derived from the systems theory, resource-based theory, the logic model, and the six steps of Dickoff’s orientation theory. Lastly, the researcher developed the guidelines to operationalize the framework based on the central concepts and the theories used to guide the development of the framework in Phase IV. Peer evaluation of the framework was conducted in terms of its clarity, simplicity, generality, accessibility, importance and it was found to be compliant (Chapter 6, 6.9). The guidelines provide a detailed plan for the implementation of the framework
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    The experiences of health care workers on prescribing PrEP to adolescent girls and young women at public health centers in Windhoek, Khomas region, Namibia
    (University of Namibia, 2023) Shipena, Kristine
    Oral pre-exposure prophylaxis (PrEP) is the usage of antiretroviral medications by HIV uninfected persons to prevent HIV. It has the potential to significantly reduce HIV acquisition among adolescent girls and young women (AGYW) aged 15–24 who have not yet been exposed to HIV. The purpose of this study was to explore health care workers’ experiences on prescribing Pre-exposure prophylaxis to adolescent girls and young woman at high risk of HIV in Windhoek. The objectives of the study were to explore health care workers’ experiences to prescribing PrEP to adolescent girls and young woman at high risk of HIV infections and to explore health care workers views on PrEP delivery services among AGYW at public health centers. A qualitative, phenomenology design was conducted at public health centers in Windhoek, Khomas region to explore health care workers’ experiences to prescribing PrEP to adolescent girls and young woman at high risk of HIV infections and explore their views on PrEP service delivery among AGYW. Population of the study were nurses that are PrEP prescribers and health centers contain of 58 nurses. Convenience sampling method was used to recruit nurses into the study. A semi-structured interview guide was used as a data collection instrument. Data were analyzed using thematic content analysis. Majority of HCWs indicated that they promoted PrEP uptake among AGYW and were willing and comfortable with prescribing Prep to AGYW. Few HCWs were not comfortable prescribing PrEP to AGYW citing that it promotes the reduction in condom use. The study highlighted a need to sensitize PrEP and sexual reproductive health for AGYW in all departments within the health centers. PrEP introduction among AGYW requires more than solely training HCWs on the clinical aspects of prescribing PrEP. It involves addressing HCWs’ biases and preference regarding sexual health services to AGYW and preparing the health facilities organization for the introduction of PrEP among AGYW. Furthermore, health care workers need to conduct community health education to AGYW for them to develop a culture of voluntarily visiting the health facility and request PrEP when the need arise. Most importantly there is a need for health care workers to educate the community on PrEP to reduce stigma based on PrEP initiation in the society
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    Experiences of Okahandja park informal settlement residents with the COVID-19 preventative measures in Khomas region
    (University of Namibia, 2023) Shiweva, Libertina
    About seventy percent (70%) of Namibia's population comprises of people who live in circumstances that provide limited protection against the Coronavirus disease (COVID 19). One of Windhoek's informal communities, Okahandja Park lacks access to potable water, proper sanitation, and basic housing. It is also overcrowded. This study's goal was to discover and characterise how Okahandja Park informal settlement residents experienced the COVID-19 prevention guidelines. The study used the Theory of Reasoned Action (TRA) method and was qualitative. The study’s sample comprised of twenty-seven residents from Okahandja Park who were older than eighteen years. The data gathered was collected with high ethical standards in line with the University of Namibia’s (UNAM) ethical clearance standards. Data was collected using four focus group discussions, in-depth face-to-face interviews as research techniques. The Theory of Tesch, which produces themes and subthemes, was used to analyse the data. The investigation found that the Okahandja Park informal settlement residents were required to wear face masks at all times. The local stores and clinic were overcrowded due to the long lines that resulted from a limited number of people being permitted to enter facilities at a given time. Due to COVID 19, many citizens lost their employment since their employers could no longer afford to pay their monthly salaries. During COVID-19, participants struggled to live due to a lack of food and had to resort to a few coping techniques. Most of the inhabitants lacked sufficient cosmetics to maintain their hygiene practices at home. The study concluded that the WHO preventive measures during the lock down had both an adverse and favourable influence on the Okahandja Park informal settlement residents. The study recommends that public health measures for a pandemic like COVID-19 should be put in place, such that the Office of the President in Namibia and significant NGOs provide food distribution packages to vulnerable populations. In order to improve the informal settlers' abilities and knowledge to run their enterprises successfully, the Namibian Ministry of Industrialisation, Trade, and SMEs Development should offer them training and workshops on SMEs development
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    Experiences of Okahandja park informal settlement residents with the covid-19 preventative measures in Khomas region
    (University of Namibia, 2023) Shiweva, Libertina
    About seventy percent (70%) of Namibia's population comprises of people who live in circumstances that provide limited protection against the Coronavirus disease (COVID 19). One of Windhoek's informal communities, Okahandja Park lacks access to potable water, proper sanitation, and basic housing. It is also overcrowded. This study's goal was to discover and characterise how Okahandja Park informal settlement residents experienced the COVID-19 prevention guidelines. The study used the Theory of Reasoned Action (TRA) method and was qualitative. The study’s sample comprised of twenty-seven residents from Okahandja Park who were older than eighteen years. The data gathered was collected with high ethical standards in line with the University of Namibia’s (UNAM) ethical clearance standards. Data was collected using four focus group discussions, in-depth face-to-face interviews as research techniques. The Theory of Tesch, which produces themes and subthemes, was used to analyse the data. The investigation found that the Okahandja Park informal settlement residents were required to wear face masks at all times. The local stores and clinic were overcrowded due to the long lines that resulted from a limited number of people being permitted to enter facilities at a given time. Due to COVID-19, many citizens lost their employment since their employers could no longer afford to pay their monthly salaries. During COVID-19, participants struggled to live due to a lack of food and had to resort to a few coping techniques. Most of the inhabitants lacked sufficient cosmetics to maintain their hygiene practices at home. The study concluded that the WHO preventive measures during the lock down had both an adverse and favourable influence on the Okahandja Park informal settlement residents. The study recommends that public health measures for a pandemic like COVID-19 should be put in place, such that the Office of the President in Namibia and significant NGOs provide food distribution packages to vulnerable populations. In order to improve the informal settlers' abilities and knowledge to run their enterprises successfully, the Namibian Ministry of Industrialisation, Trade, and SMEs Development should offer them training and workshops on SMEs development
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    Exploring factors associated with abortion in Walvis Bay community in Erongo region, Namibia
    (University of Namibia, 2023) Shaker, Amir Eskander
    Walvis Bay is one of Namibia’s districts, which recently recorded a significant increase in the number of threatened abortion cases. For the period 2009 to 2015, Walvis Bay town recorded an average 2000 abortion cases per year which accounts for 4 to 6 cases per day for women aged between 15-28 years old (Erongo Health Directorate’s Annual Report: 2014). Ninety-eight percent of the diagnostic abortion (Threatened Abortion) conducted at Walvis Bay hospital, were treated with dilatation and curettage in order to safely complete the abortion process whilst remaining 2% was treated for other pregnancy disorders. The increase in abortions and increase of maternal death due to bleeding is a big concern in the harbour town. Thus, the increase in teenage abortion is becoming a public health concern that needs to be addressed. The study purpose of the study was to explore factors associated with abortion in Walvis Bay community. It was essential for a study to be conducted in order to investigate the factors leading women to engage in unsafe abortions, and find an amicable solution to help them access maternal health services, and help policy makers to find solutions to address the abortion problem in the region. A qualitative, phenomenological approach was applied. The researcher conducted in depth interviews with key informants including community members, health care workers and teenagers who had abortion. Population for the study was Walvis Bay community of which key informants were made up of patients (abortion victims), Social workers, doctors, nurses, community and religious leaders, secondary school teachers and police officers working at women and child protection welfare. A non- ii probability purposive sampling was used to recruit the participants and a total of eight participants were recruited and participated in the study. The study findings revealed that there are several factors that contribute to abortion such as burden to look after the baby while the mother is still at school, humiliation by peers, fathers do not want the responsibility of pregnancies, some ladies have affairs with married men, and some have multiple partners. These are some of the factors that make young women to go for illegal abortion. Therefore, the researcher recommended that health education programme should be strengthened to improve awareness, the use of family planning, support system and creation of adoption centres
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    Facilitating the mental health of individuals living with chronic mental illness in the Northwest health directorate - Northern Namibia: A community involvement approach
    (2014) Shifiona, Ndapeua N.
    Living with chronic mental illness in Namibia is a challenge. It often means a permanent fight against stigma and a daily struggle to make ends meet. The impact of living with the illness produces enormous subjective sufferings for the individuals, as well as untold psychological and financial burdens for many families. Through the researcher‟s interactions with individuals living with chronic mental illness, it became clear that they are not adequately supported by relatives and other members of the communities in which they live. Sometimes they are deprived access to basic needs namely, shelter, medications, freedom of movement and of expression. There is an exaggerated fear of, as well as a negative attitude towards those living with mental illness. In the Northwest Health Directorate of Namibia, there are no community care facilities for individuals living with chronic mental illness. There are no alternative community aftercare modes for discharged individuals living with chronic mental illness. Post-discharge of the patient from the hospital, there are no follow-ups regarding the social circumstances they find themselves in. As a result, the home-care for someone living with chronic mental illness after hospitalization remains the sole responsibility of the relatives who rarely know how to look after the patient. On many occasions the public has been very ignorant about mental illness, resulting in them having a very negative attitude towards persons living with chronic mental illness. The main purpose of this research was to explore and describe the lived experiences of individuals living with chronic mental illness, and the experience of the family members, community members, and health care workers dealing with individuals living with chronic mental illness. Thereafter, the researcher developed a mental health nursing model, which provides a theoretical frame of reference for the advanced psychiatric mental health nurse practitioner to facilitate constructive interactions through communicating, relating and sharing by discharged individuals living with chronic mental illness in Namibia...
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    Factors associated with COVID-19 vaccine hesitancy among students at the University of Namibia, main campus, Khomas region
    (University of Namibia, 2025) Heita, Justine Ndahepuluka; Amukugo, Hans
    The emergence of the COVID-19 pandemic heightened global health concerns, leading governments to engage in research endeavours focused on forecasting, mitigating, and managing the disease. Despite the recognized efficacy of vaccination in controlling the spread and severity of COVID-19, vaccine hesitancy poses a significant challenge, particularly in low to middle-income countries like Namibia.This study aimed to investigate the factors associated with COVID-19 vaccination and vaccine hesitancy among students at the University of Namibia's main campus in the Khomas Region, Namibia.Employed a quantitative cross-sectional analytical approach, data was collected from 331 students using a self-administered questionnaire. The participants, selected through stratified random sampling, represented four faculties at the University of Namibia's main campus. Informed consent was obtained, and SPSS version 27 facilitated data analysis through univariate, bivariate, and multivariate techniques.The study revealed a low vaccination rate (24.2%) and high hesitancy (48%) among students, with females exhibiting more hesitancy than males. Factors such as gender, faculty of study, safety and side effect concerns, lack of trust in vaccine development and healthcare providers, political influences, information from friends, and attitude were significantly associated with vaccine hesitancy (p<0.05).This study contributes to existing knowledge by highlighting a low vaccination rate and high hesitancy among university students. While various factors showed associations with vaccine hesitancy, concerns about safety (OR=3.278: CI;1.403-7.659), concerns about side effects (OR=7.374: CI;3.709-14.658) and other concerns (OR=19.188: CI;2.057-178.992) emerged as predictors of vaccine hesitancy. Recommendations include targeted educational campaigns within faculties, policy incentives for vaccination, fostering peer-led discussions, and ongoing research collaboration. Implementation of these measures aims to address vaccine hesitancy among University of Namibia students, promoting a safer campus environment and contributing to broader public health efforts
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    Factors associated with delay in starting anti-retroviral treatment among confirmed HIV positive individuals in state health facilities in Northern Namibia
    (University of Namibia, 2024) Hlahla, Elsie T.
    The purpose of this study was to investigate the factors associated with the delay in starting anti-retroviral treatment (ART) among confirmed HIV-positive individuals in Northern Namibia, specifically the four (4) districts of the UTAP region (Andara, Nyangana, Oshikuku and Tsumeb). The study employed the time series analytical (quantitative) research design that used secondary data retrieved from the Electronic Patient Management System (ePMS) database. The characteristics of data obtained from the ePMS included the Who-stage, age, gender, facility type, CD4 count and District. The study’s population was 1824, and the sample size was 1824, as total population sampling was used in this desktop analysis. Descriptive statistics were used to help explore more on objectives one and two of the study. The multivariate (LOGIT) regression model was used to ascertain factors behind the delay in starting the ART among confirmed HIV+ individuals. The study’s results indicated that most confirmed HIV+ individuals opted for an early ART start, whereby the age, facility, gender, CD4+ counts were statistically significant. The highest rate of confirmed HIV+ patients starting ART on the same day was in March 2018 (86.3%), followed by June 2018 (80.3%) and February 2018 (80.3%). The study recommended that treatment literacy for service providers and health care workers on the importance of starting treatment early, enhanced counselling, support for men by male champions, easy of access to ART as essential to ensure confirmed HIV+ people to access the ART in time from day of diagnosis up to day seven. Also, the cost-effectiveness of ART related services, such as decentaralization and equipping of facililities equitably as relevant in reducing the delay in starting ART initiation
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    Factors associated with road traffic accidents among young drivers in Khomas region, Namibia
    (University of Namibia, 2023) Shaduka, Emma
    As per the current statistics, road traffic accidents (RTAs) are among the leading causes of deaths and disabilities among young people worldwide. The deaths and injuries attributed by the RTAs are a major public health crisis faced by Namibia, just as in many countries all over world. There is a need to investigate the risk factors contributing to RTAs in Namibia, therefore, this study was conducted with a purpose of determining the factors associated with RTAs among young drivers in Khomas region, Namibia. The study utilised a mixed methods convergent-parallel design to collect data from the National Road Safety Council (NRSC) of Namibia, as well from the traffic law enforcement officers in Khomas region. The relationship between independent variables and dependent variables was analysed using multiple logistic regression analysis based on p-value <0.05, while interviews were analysed using inductive thematic analysis. The quantitative data revealed that a total 21 574 RTAs were recorded in Khomas region between 2017 and 2019, with male young drivers being responsible for the majority (83%) of the RTAs in the region. Most (17.2%) of the recorded RTAs occurred on Fridays. The least (5.7%) RTAs were recorded in the month of December. The study found a strong association between days of the week and no injury (p=0.000), and between visibility of the road due to different weather conditions and RTAs (p=0.000). Risky driving behaviours among young drivers such as driving under the influence of alcohol, speeding, and driving whilst using mobile devices are some of the risk factors revealed by the qualitative data contributing to the high rates of RTAs among young drivers in Khomas region. The study recommends “road safety awareness” as a key measure to reducing the rates of RTAs in Khomas region
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    Factors associated with stillbirth and assessment of maternal health awareness among residents of northern Ghana
    (University of Namibia, 2025) Frimpong, Joseph Asamoah; Mitonga, Kambwebwe Honore
    Globally, 14 stillbirths per 1,000 births occur annually. Most of these deaths occur in Asia and sub-Saharan Africa. Ghana’s stillbirth rate ranges from 13 – 20 per 1,000 births. The northern zone is as high as 20 per 1,000 births. The Early Newborn Action Plan aims at 12 per 1,000 births. This study sought to assess risk factors associated with stillbirth and assess maternal health awareness in northern zone of Ghana to develop a policy brief to inform strategies in reducing stillbirths. The study employed a convergent mixed method of qualitative and quantitative approach (Case-Control study, survey and grounded theory) among residents in the northern part of Ghana from November 2021 – May 2023. Muti-stage sampling was used to select participants for the survey, population proportionate to size was used for the case control, In-depth interviews was based saturation and focus group discussions were based on availability of respondents. Data was collected using a semi-structured questionnaire and interview guide through focused group discussions, in-depth interviews, and records review. Descriptive and analytic statistics were performed using Stata 16. Multivariate logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for stillbirth. Qualitative data was analysed using the thematic content analysis approach with Nvivo version 10. Risk factors for stillbirth included being unmarried (aOR=9.78, 95%CI:16.48-57.98), family history of stillbirth (aOR=2.63, 95%CI: 1.67-4.12), no patograph use (aOR=2.14,95%CI:1.45- 3.16), partner’s tobacco use (aOR=2.19,95%CI:1.16-4.16), Rhesus negative (aOR=1.75,95%CI:1.12-2.73), sickle cell trait (aOR=2.29,95%CI:1.27-4.10), foetal malpresentation (aOR=2.67,95%CI:1.33-5.35), eclampsia (aOR = 9.00,95%CI:2.91- 27.87) and premature rupture of membranes (aOR=2.64, 95%CI:1.17-5.95). Attending >4 antenatal care visits (aOR=0.53, 95%CI:0.30-0.93) was protective. Overall, 22.89%(276/1206) of the women studied had good knowledge of maternal health, 47.60%(574/1206) of them had good attitude, and 89.55%(1080/1206) had good practices towards maternal healthcare. Community members practiced both orthodox and traditional remedies, perceived some stillbirths are caused by evil spirits. Healthcare workers perceived their responsibilities included routine prenatal, antenatal and postnatal care, with many facilities reporting incapacity of handling severe maternal health conditions. In conclusion, risk factors for stillbirth in Northern Ghana include being unmarried, family history of stillbirth, not using patograph, tobacco use, rhesus negative, sickle cell trait, premature rupture of membrane, foetal malpresentation and eclampsia. Knowledge and attitude on maternal health was poor but practice was high. Maternal healthcare was influence by traditional beliefs with mainly husbands having the right to decision making on maternal health seeking behaviour. Healthcare workers incapacity of handling severe maternal health conditions was identified. A policy brief has been developed to guide interventions by Ghana Health Service with recommendations on improving healthcare capacity, improving collaboration with traditional healers and empowering women to take up their role before and during pregnancy