Browsing by Author "Ross, Andrew John."
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Item Characteristics of women having first trimester termination of pregnancy in a district/regional hospital in KwaZulu-Natal.(2011) Ngene, Nnabuike Chibuoke.; Ross, Andrew John.Introduction: Despite the availability of contraceptives, some women still seek an induced abortion. If these women are known, they can be targeted for intensive contraceptive counseling. An accessible termination of pregnancy health facility can also be provided to those who still wish to have an abortion. Aim: To determine the characteristics of women having first trimester induced termination of pregnancy in Newcastle Provincial Hospital in Amajuba district. Methods: Quantitative retrospective chart review. Seven hundred and fifty eight women had an induced first trimester abortion between 1st January and 31st December 2008 at Newcastle Provincial Hospital. The medical records of 254 were systematically sampled and the data obtained from these medical records were analyzed descriptively. Results: Most women (75%) were aged between 20 and 34 years. The commonest age was 23 years while the mean age was 25.27 years. Two percent were less than 16 years of age. Ninety seven percent of the sample were of African race, 75.6% reported having at least one child alive, 93.3% were single, 70.1% of the women reside in Newcastle sub-district while 19.7% reside outside Amajuba district. Eighty nine percent of the women were not using any contraception before the pregnancy that was terminated. Four (1.6%) women had previously had a termination of pregnancy. Fifty eight percent of the women requested abortion between 9 and 12 weeks of gestation (commonest gestational age was 8 weeks). Seventy four percent of the women were self-referred. Ninety six percent of the women reported having an abortion because of socio-econornic reasons. Only 69.7% disclosed their intention to procure abortion to a second person. Every woman was counseled before her pregnancy was terminated. Conclusions: In our patient population, women who are more likely to have an induced first trimester abortion are: in their twenties; African; single; parous; sexually active and not using any contraceptive; residing in Newcastle sub-district and of poor socioeconomic status. These groups of women should be targeted for intensive contraceptive counseling. The proportion of women who are less than 16 years of age shows that statutory rape is still a challenge in South Africa and deserves more attention. Further study is needed to establish if the location of Newcastle Provincial Hospital is denying women living in other sub-districts in Amajuba (apart from Newcastle sub-district) the opportunity to procure an induced abortion. Such a study will thus guide the place where future termination of pregnancy services may be established in Amajuba.Item Determining the factors related to patients in the uMuziwabantu sub-district of KwaZulu-Natal bypassing primary health care facitilities in 2010 and accessing the district hospital as their point of first contact.(2011) Ntleko, Thandazile Lillian.; Ross, Andrew John.Primary health care (PHC) is the first component of the health system that provides patients with first-level care. PHC must be supported by a strong referral system whereby PHC nurses can refer patients with conditions beyond their capabilities to medical officers for further management using referral letters. The medical officers also using referral letters refer stable patients back to the PHC clinics for follow up and management. The aim of study was to determine factors related to patients bypassing primary health care facilities and accessing the district hospital as point of first contact in the Umuziwabantu health sub-district of KwaZulu-Natal. This research investigates the referral patterns of patients as well as the factors affecting the referral patterns of patients between PHC facilities and the district hospital. The study was conducted at the Gateway Clinic of St Andrew’s Hospital and its outpatient department. The following groups were excluded from the study: any patients who arrived at the clinic with a referral letter from another facility, any children who were brought there by another child, and any who were unwilling to take part in the study. The researcher made use of open-ended and structured questions to interview 720 patients over a period of six months. The overall findings show that a large part of the Umuziwabantu sub-district is still served by mobile clinics. Since mobile clinics do not visit each point daily, patients from mobile points often go to the hospital for any health-related problems. There is the widespread perception that a hospital provides better service than a PHC clinic. The Local Government (LG) clinic only sees a limited number of patients. The main reasons given by patients for bypassing their local PHC clinics are: 1. Mobile clinic unavailability on that day; 2. The hospital is closer. 3. Patients are used to coming to the hospital. 4. Patients are doing things in town and then decide to combine this visit with hospital visit. Three-hundred-and-sixty-one patients had only minor ailments and a further 95 required chronic treatment which could have been dispensed at PHC clinics. Only 264 of patients surveyed should have been seen at the Hospital. Conclusions from the study were that patients would use their local PHC clinics if there were enough fixed clinics and the LG clinic had more staff to attend to more patients than the number they are currently attending. The clinic-upgrading programme needs to be improved and fast-tracked.Item An exploration of anaemia in low birth weight infants exposed to perinatal zidovudine at the neonatal unit in King Edward VIII Hospital.(2013) Hanley, Sherika.; Ross, Andrew John.; Adhikari, Miriam.Large clinical trials beginning with the PACTG-076 trial and other trials across Europe and America have showed that perinatal exposure to Zidovudine (AZT) results in haematological side effects in the neonate, mainly anaemia, which are clinically insignificant and reversible. There is however limited data in sub-Saharan Africa on the impact of intrauterine exposure to AZT on neonates, particularly low birth weight neonates, at the height of the HIV/PMTCT era. The aim of the study was to evaluate the prevalence and clinical significance of anaemia among low birth weight neonates, in a diverse South African setting. This observational descriptive study looked at medical records of HIV-exposed, low-birth weight neonates (less than 2500g) admitted to the neonatal unit at King Edward VIII Hospital from May 2008 to February 2010, who have had intrauterine exposure to AZT. A total of 95 neonatal birth and medical records were analysed. The total prevalence of anaemia was 47%. The neonates were placed into categories according to gestational age. The prevalence of anaemia was 16.7% and the mean Hb was 17g/dL in the 26-28 week gestational age category, prevalence of anaemia was 37% and mean Hb was 16g/dL in the 29-31 week category, and the prevalence of anaemia was 54.8% with a mean of 17g/dL in the over 31 week gestational age category. The minimum haemoglobin was 11.0g/dL and maximum haemoglobin was 24g/dL. The mean haemoglobin in the neonates exposed to more than 28 days of Zidovudine was lower than the mean Hb in neonates exposed to less than 28 days in the 29-31week and over 31 week gestational age categories. The haematological side effects of anaemia in neonates resulting from AZT exposure inutero were found to be prevalent but of a mild and clinically insignificant nature in keeping with existing international and continental studies. The severity of anaemia in low birth weight/ pre-term neonates appears to be the same as in term neonates of normal birth weight depicted in these studies. The presence of neonatal anaemia at birth has been shown to be related to the duration of exposure to intrauterine AZT in one of the three age groups. There were no identified issues that would warrant amending current recommendations for the routine use of AZT for the prevention of mother-child HIV transmission however these findings require further research involving larger numbers and follow up of neonates in order to adequately analyse current PMTCT guidelines.Item On being a rural origin health care professional: lives, learnings and practice.(2016) Ross, Andrew John.; Pillay, Daisy Guruvasagie.Rural origin health care professionals (HCPs) have been identified as those who are most likely to work in rural areas after graduation. However, there are significant challenges of access, selection and throughput for South African rural students wanting to train as HCPs. Many studies have focused on strategies for staffing rural healthcare facilities. However a life history approach has not previously been used to study the educational experiences of rural origin HCPs in South Africa, and there is a paucity of data about the lived personal and professional educational experiences of rural origin HCPs and their experiences of returning to work in rural areas after graduation. A deeper understanding of these issues using a life history approach may help in supporting rural origin students and contribute to improved staffing levels at rural healthcare institutions. Social identity theory and a generative understanding of rurality provided the theoretical framing for this study. A life history approach complemented by arts-based methods generated stories through which to gain an understanding of the complex, multidimensional, multi-layered lives of HCPs who grew up in rural areas, their personal lives in relation to others, and the context in which they grew up (time, person and place). Their developing identity is seen in their performances through the choices they make in response to everyday situations. Their learning experiences are complex and reveal that as active and critical thinkers they adopted a range of strategies to succeed at institutions of higher learning, and found platforms and communities to develop as those with knowledge and agency to change/challenge dominant and stereotypical ways of being. They demonstrate their willingness and ability to work in rural contexts, leading transformation in the healthcare setting. The findings of this study point to a new understanding of rurality – that of home and a sense of belonging where the possibility for better healthcare services exists. A junctional hub is presented as a theoretical ‘model’ to frame lived experiences and to understand rural origin HCPs’ personal and professional identity and work in a complex, interconnected, negotiated space where different forces are negotiated. This provides a platform to open up the opportunity for other ways of being, knowing and practising.Item A review of the management of patients with Type 2 diabetes at Leratong Hospital, 2010.(2012) Owanga, Ukulu Grevisse.; Ross, Andrew John.Introduction: The Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) acknowledge in their guidelines that diabetic care is complex and requires that numerous issues, beyond glycaemic control, be addressed. To further ensure a high quality of care, it is necessary that healthcare workers constantly check whether the standard of care offered is effective, equitable, efficient and humane. Aim: The aim of the study was to review the clinical management of patients with type 2 diabetes at Leratong Hospital in relation to the SEMDSA guidelines for Diagnosis and Management of Type 2 Diabetes Mellitus for Primary Health Care – 2009. Methods: This was a observational descriptive study using data from the charts of 388 patients with type 2 diabetes who access care at Leratong Hospital. Results: The majority of participants were male. Their average age was 55.7 years (range: 33 to 83 years). The glycosylated haemoglobin was documented in 64.95% of patients, weight in 5.67%, blood pressure in 96.39%, lipid in 21.39%, serum creatinine in 90.46%, urine dipstick in 90.91%, patient education in 98.2%, eye examination in 51.8%, foot examination and micro albumin in less than 1%. Optimal control of glycosylated haemoglobin, systolic blood pressure, diastolic blood pressure, cholesterol and triglyceride was noted in 5.56%, 46.72%, 16.8%, 80.77% and 74.67% respectively. Thirty eight percent of patients were on two oral anti diabetic agents, the majority of patients (94.32%) were receiving an ACE inhibitor for blood pressure control, 34.02% were on statin therapy, and 92.01% were on aspirin. Less than 1% were on Clopidogrel and fibrate. Conclusion: overall the quality of management of patients with type 2 diabetes is poor and there is a need for improvement.