Browsing by Author "Voce, Anna Silvia."

Now showing 1 - 20 of 22

An integrated model of aftercare for substance use disorder clients in KwaZulu-Natal.
(2023) Mpanza, December Mandlenkosi.; Govender, Pragashnie.; Voce, Anna Silvia.
Background: There is currently a high global burden of substance use, which is burdensome to the public health and welfare system. Adequate treatment, including aftercare services, tends to be limited worldwide. In South Africa (SA), substance abuse contributes considerably to morbidity and mortality and treatment services are not only limited but also fragmented among stakeholders. These problems are compounded by a number of factors, including the absence of aftercare policies, treatment models, a lack of resources, and an absence of norms and standards for aftercare services. Consequently, most persons with Substance Use Disorders (SUDs) do not receive aftercare. Furthermore, there is high relapse and many re-admissions of persons with SUDs, which exacerbates the burden on the health care and welfare systems. The situation appears to be worse in rural districts. South African policies have called for the development of an aftercare model of care for persons with SUDs, which has not been realised to date. Aim: The aim of the study was to propose an integrated model of aftercare for persons with SU post-inpatient treatment phase in a public facility in KwaZulu-Natal. Methodology: A qualitative study in two phases. The first phase: policy analysis, and the second phase had two stages: Stage one was semi-structured and focus group interviews with forty-six participants who represented all five levels of the Beer’s Viable System Model (VSM) from governmental and non-governmental organisations (NGOs). Stage two semi-structured interviews with five persons with SUDs and their family members (n=5). Data was analysed thematically using the Braun and Clarke approach. Results: Findings indicated that South African policies did not provide clear guidelines on aftercare. Aftercare was found to be lacking, fragmented, poorly coordinated among service providers and not well integrated into the substance use treatment system. The needs of service users demonstrated the extent and nature of aftercare required. Conclusion: The extent and nature of aftercare services warranted aftercare services that are integrated into SUD treatment systems, lifelong orientated, and responsive to the needs of persons with SUDs and their families. An integrated recovery management model of care is proposed together with relapse management strategies.
Association between health systems performance and treatment outcomes in patients co-infected with MDR-TB and HIV in KwaZulu-Natal, South Africa: implications for TB programmes.
(Public Library of Science., 2014) Loveday, Marian Patricia.; Padayatchi, Nesri.; Wallengren, Kristina.; Roberts, Jacquelin.; Brust, James C. M.; Ngozo, Jacqueline.; Master, Iqbal.; Voce, Anna Silvia.
Objective: To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the relationship between health system performance and patient treatment outcomes at 4 decentralised MDR-TB sites. Methods: In this mixed methods case study which included prospective comparative data, we measured health system performance using a framework of domains comprising key health service components. Using Pearson Product Moment Correlation coefficients we quantified the direction and magnitude of the association between health system performance and MDR-TB treatment outcomes. Qualitative data from participant observation and interviews analysed using systematic text condensation (STC) complemented our quantitative findings. Findings: We found significant differences in treatment outcomes across the sites with successful outcomes varying from 72% at Site 1 to 52% at Site 4 (p<0.01). Health systems performance scores also varied considerably across the sites. Our findings suggest there is a correlation between treatment outcomes and overall health system performance which is significant (r = 0.99, p<0.01), with Site 1 having the highest number of successful treatment outcomes and the highest health system performance. Although the 'integration' domain, which measured integration of MDR-TB services into existing services appeared to have the strongest association with successful treatment outcomes (r = 0.99, p<0.01), qualitative data indicated that the 'context' domain influenced the other domains. Conclusion: We suggest that there is an association between treatment outcomes and health system performance. The chance of treatment success is greater if decentralised MDR-TB services are integrated into existing services. To optimise successful treatment outcomes, regular monitoring and support are needed at a district, facility and individual level to ensure the local context is supportive of new programmes and implementation is according to guidelines.
Community-based care vs. centralised hospitalisation for MDR-TB patients, KwaZulu-Natal, South Africa.
(International Union Against Tuberculosis and Lung Disease., 2015) Loveday, Marian Patricia.; Wallengren, Kristina.; Brust, James C. M.; Roberts, Jacquelin.; Voce, Anna Silvia.; Margot, Bruce.; Ngozo, Jacqueline.; Master, Iqbal.; Cassell, Gail H.; Padayatchi, Nesri.
Abstract available in pdf.
Comparing early treatment outcomes of MDR-TB in a decentralised setting with a centralised setting in KwaZulu-Natal, South Africa.
(International Union against Tuberculosis and Lung Disease., 2012) Loveday, Marian Patricia.; Wallengren, Kristina.; Voce, Anna Silvia.; Margot, Bruce.; Reddy, T.; Master, Iqbal.; Brust, James C. M.; Chaiyachati, K.; Padayatchi, Nesri.
Setting—In KwaZulu-Natal, South Africa, a TB and HIV endemic setting, prolonged hospitalisation for the treatment of the growing number of MDR-TB patients is not possible or effective. Objective—We compared early treatment outcomes in patients with MDR-TB, with and without HIV co infection, at a central, urban, referral hospital with four decentralised rural sites. Design—This is an operational, prospective cohort study of patients between 1 July 2008 to 30 November 2009, where culture conversion, time-to-culture-conversion, survival and predictors of these outcomes were analysed. Results—Of the 860 patients with MDR-TB, 419 were at the decentralised sites and 441 at the central hospital. Overall, 71% were HIV co-infected.
A description of growth monitoring and promotion activities at primary care level in Grahamstown, Makana Sub-District, Eastern Cape.
(2017) Mfono, Zitandile Hlombekazi.; Voce, Anna Silvia.; Chhagan, Meera Kurson.
Aim To describe growth monitoring and growth promotion (GMP) activities in children aged 0-24 months at primary healthcare facilities in Grahamstown, Makana Sub-District, Eastern Cape. Methods A cross-sectional descriptive study design was implemented. A sample of one hundred and sixty-four children from birth to twenty four months attending seven clinics in Grahamstown for well-baby visits, sick visits and growth monitoring and promotion from November 2012 to January 2014were included in this study. A Road-to-Health Booklet audit checklist and caregiver questionnaire were used to collect the data. Frequency distributions were reported for appropriate GMP activities. Appropriate GMP was defined as: correct use of weight-for-age index; growth interpreted correctly and discussed with caregiver; interventions promoted or given as indicated; and follow-up scheduled according to the relevant Department of Health policies. Results From the Road-to-Health Booklets sampled at the seven clinics and from caregiver interviews forty-seven (28.7%) of the children had evidence of appropriate GMP, although the majority of children sampled were weighed at their clinic visit. One hundred and twenty (80.0%) of the caregivers reported that their children were weighed by community health workers. The prevalence of appropriate GMP was significantly different according to the primary healthcare facility attended by the child (p=0.046 for the seven facilities using Fisher’s exact test). In the children sampled, seventeen (18.1%) had a recorded length in their Road-to-Health Booklet and for only nine (10.0%) of the children was the length for age plotted. There was no documented evidence in any of the Road-to-Health Booklets indicating that length measurements were interpreted. Discussion There is over emphasis on the technical aspects of GMP such as weighing of children, i.e. growth monitoring compared to growth promotion. Optimal GMP practice requires growth measurement, interpretation and intervention, e.g. nutritional counselling for growth promotion, with caregiver engagement in discussions about child growth. Sub-optimal GMP persists after the implementation of the new Road-to-Health Booklet, as evidenced by: inadequate interpretation of growth indices; lack of appropriate interventions for growth faltering; and poor follow-up. Length-based measurements are not used routinely in child growth assessment since their addition to the RTHB in 2010. Conclusion Implementation of quality growth monitoring and promotion activities at primary care facilities in Grahamstown remains problematic after the introduction of the revised Road-to-Health Booklet and additional growth indices.
Description of health seeking behaviours and experiences of homeless people in South Central Durban, South Africa.
(2009) Wentzel, Dorien Lesley.; Voce, Anna Silvia.
The study aimed to describe the health seeking behaviours and experiences of homeless people in South Central Durban. Homelessness is a broad and complex term that affects many people in South Africa. Homelessness inevitably causes serious health problems, conditions that are closely associated with poverty. Health problems experienced by homeless people are numerous and multifaceted. Homelessness is a complex issue that not only damages both physical and mental health, but also contributes to the spread of disease to the non-homeless (National Health Care for the Homeless Council, 2008:1). Drawing on interviews with homeless participants and healthcare workers, this study depicted the experiences, and the observed, felt and perceived needs of homeless people in accessing healthcare. The study reveals why, when and where homeless people access healthcare and the factors facilitating and hindering their access to healthcare. The researcher primarily used a qualitative methodology with a small quantitative component. The qualitative component comprised one on one in-depth interview. The quantitative component comprised a record review showing frequency distribution of health problems experienced by homeless people presenting at the Kathleen Voysey clinic. The findings highlight the unique lived experiences which include health problems, basic needs, accommodation, safety and security, community networks, access to pensions and grants. Findings show that homeless people are accessing healthcare facilities however there are mixed responses as to the service that they have received. A number of recommendations were suggested by both homeless participants and healthcare workers for policy makers, healthcare services, and homeless people and for future research regarding the care of homeless people.
Developing an implementation strategy for the free health care policy for persons with disabilities at public hospitals in KwaZulu-Natal.
(2013) Simbeye, Daniel.; Voce, Anna Silvia.
ABSTRACT This study focuses on the implementation strategy of free health care policy for disabled persons at hospital level in KwaZulu-Natal. Since the introduction nationally, in 2003 of free health care policy for disabled persons, no evaluation has been conducted in KwaZulu- Natal to inform health service managers and the KwaZulu-Natal Department of Health on the implementation of this policy. A provincial implementation strategy is needed for effective implementation of the policy. To date, no such provincial implementation strategy is available and the lack of an implementation strategy for this policy motivated this study. METHODS An exploratory qualitative study design was implemented to elicit information from health service providers and representatives of persons with disabilities to inform the development of an implementation strategy for the free health care policy for disabled persons at public hospitals in KwaZulu-Natal. Data was collected through interviews and focus group discussions. Data was analysed by utilising a thematic approach. RESULTS Respondents reported a variety of understandings with regard to policy context of the Free Health Care Policy for disabled persons, policy content in terms of purpose and eligibility, policy implementers and their roles in implementing the policy, and the implementation process of this policy at state hospitals of KwaZulu-Natal. CONCLUSION There is limited understanding of the Free Health Care Policy among some health service personnel and some disability groups, and this may have contributed to the erratic and poor implementation of the policy at public hospitals in KwaZulu-Natal. Factors necessary for policy implementation such as a communication strategy, guidelines for implementation, assessment of availability of resources, training of implementers, monitoring and evaluation strategy are crucial for effective implementation of any policy including the Free Health Care Policy for disabled persons.
The development of a district-based model of intervention for improving the quality of maternal health care at primary level.
(2005) Voce, Anna Silvia.; Uys, Leana Ria.
The Limpopo MCWH Directorate, concerned about the high perinatal and maternal mortality rates arising from the poor quality of maternal health care provided at primary level, commissioned this study to explore what would be the appropriate interventions that could be applied province-wide to improve the quality of maternal health care at municipal and district level. Thus the study aimed to develop a useable and replicable model of intervention with Reproductive Health Management Teams (RHMTs) at municipal and district level that would lead to improvements in the quality of maternal health care. The study objectives were to: 1. Identify indicators and the method for a baseline assessment of the quality of maternal health care at municipal and district level. 2. Identify indicators that would permit an analysis of the factors that influence the key issues emerging from the baseline assessment. 3. Develop a programme of intervention, with its monitoring and evaluation procedures, that would address the factors that influence the key issues. 4. Recommend a strategy for replicating the intervention programme. An action-research approach was adopted in this study, and was implemented in a series of cyclical action-research steps in cooperation with the RHMTs. The study was implemented in 25 municipalities in Limpopo Province and was implemented over a period of 28 months, from December 2001 to March 2004. Both qualitative and quantitative methodologies were used. Indicators were identified to conduct a baseline assessment of the quality of maternal health care; the tools were developed to collect the data necessary to calculate these indicators; the indicators were applied to achieve a baseline assessment of the quality of care, and the information analysed to identify priority key issues affecting the quality of maternal health care. These key issues were identified as: the poor quality of the 1st ANC visit and poor management of labour. These key issues were analysed in order to identify what were the most important influencing factors affecting the quality of maternal health care. Staffing, supervision, referral systems, support services and the planning and organisation of the health facilities were found to be the most influential factors. Indicators were developed to measure these factors, with the data collection tools required to collect the data necessary to calculate the indicators. The indicators were measured to describe the current situation with regards to each. Once the influencing factors had been identified, interventions were identified, prioritised and planned for implementation in each municipal area. The priority interventions that could be implemented at municipal level were: in-service training in antenatal care and the management of labour; supervision of antenatal care and labour; audit of the service and improving referral systems. Tools were developed to monitor the implementation of these interventions and the outcomes of monitoring reported. The model to improve the quality of maternal health care developed in Limpopo Province is possible to implement within the context of health services in South Africa. A limiting factor to full implementation may well be staffing shortages, although this study did not set out to establish the degree of influence that staffing shortages do actually exert. The real challenge to full implementation, however, lies in the ability of managers at different levels to work together to support quality service delivery, and for providers to deliver an integrated, comprehensive service to pregnant women. Municipal and district level Reproductive Health Management Teams, with a full mandate and good leadership, managerial, clinical and public health skills, have the potential to address the most critical factors at the local level that are influencing the quality of care.
The dynamics of HIV transmission in out of school young heterosexual men in South Africa : a systematic scoping review protocol.
(BioMed Central., 2017) Ntombela, Nonzwakazi.; Mashamba-Thompson, Tivani P.; Mtshali, Andile.; Voce, Anna Silvia.; Kharsany, Ayesha Bibi Mahomed.
Abstract available in pdf.
Examination of management roles and functions of the clinic registered nurse-in-charge in Ethekwini District.
(2008) Shandu, Victoria Nonsikelelo.; Voce, Anna Silvia.
Background: South Africa, similar to most developing countries is faced with ever increasing demands for health care emanating from various reasons, which include a quadruple burden of disease. More appropriate health policies have been developed since the new government dispensation post-1994. Most of these have been implemented. These include, inter alia, the District Health System (DHS) as a vehicle to deliver Primary Health Care services. The decentralization principle was key to the implementation of the DHS and was intended to shift decision making to the periphery to improve overall responsiveness to local health needs. Study Aim: The study aimed at exploring the management roles and functions of the Registered Nurse-In-Charge of Primary Health Care clinics in eThekwini District, both from a policy and operational perspective. It is envisaged that this body of knowledge will contribute to policy development for effective, efficient and economical management of PHC service delivery at clinic level. Methodology: The study was conducted in eThekwini District and adopted a qualitative design. The target population was the Registered Nurses-In-Charge of clinics. The sampling method employed was purposive, a priori heterogeneous sampling. Data collection methods used included in-depth interviews with key informants and focus group discussions. Eight indepth interviews were conducted on key informants. Two were from a municipal clinic, two were from a provincial clinic and two were from a state subsidized clinic. One was conducted on the District Programme Manager and one on the District Primary Health Care Coordinator. Three focus group discussions were conducted: one with clinic nurses, one with Registered Nurses-In-Charge, and one with Primary Health Care Clinic Supervisors. Data analysis was undertaken using the deductive content analysis which was done according to the predetermined categories guided by the objectives. Within these broad groupings of responses, themes, sub-themes and patterns were established, noting particular similarities and differences between respondents. The patterns were aligned to the study objectives in order to keep focus on the research question Findings: The study revealed that although the Registered Nurses-ln-Charge of clinics possessed certain particular theoretical knowledge on the management roles and functions required of them at clinic level, most of these functions were not being performed. The policy documents, including the Registered Nurses-In-Charge's job descriptions, indicated gaps in relation to the management roles and functions required of Registered Nurses-In- Charge. In certain instances the policy omitted functions that were in the job descriptions and vice versa. This showed that the policy documents were not considered in the development of job descriptions. Major gaps were in leadership and planning, human resource management, financial management and information management. The gaps in the policy documents and job descriptions were attributed to the narrow decision space transferred to the clinics. Most management functions of clinics are still held at support institutions be it at a hospital or community health centre. Some of the reasons reported by the Registered Nurses-In-Charge themselves, as limiting the fulfillment of management roles and functions, were lack of orientation and training on management, lack of dedicated clinic managers, staff shortage and lack of support from clinic supervisors and the support institution. Conclusion: The recommendations include building management capacity, and reviewing the degree of decision space transferred to clinics if they are to succeed in fulfilling the function of being the first entry point into the health system.
The experiences of professional nurses in caring for patients with HIV and AIDS at Ngwelezana Hospital, Empangeni, KwaZulu-Natal, South Africa.
(2010) Lawal, Adebisi M. A.; Voce, Anna Silvia.
Human Immunodeficiency Virus (HIV) infection and Auto-Immune Deficiency Syndrome (AIDS) have spread globally during the past twenty-eight years and 67% of people living with HIV live in sub-Saharan Africa. HIV and AIDS are now the leading cause of death in this region. Worldwide, it is the fourth biggest killer. Nurses in health institutions in South Africa face challenges as result of increased number of very sick and terminally ill patients who are admitted to the hospital due to HIV and AIDS epidemics. Workloads have increased with no concomitant increase in number of staff to care for the patients. Aim: This study aims to identify dynamics of care of professional patients with HIV and AIDS by nurses and make recommendations that will deal with these problems. Methods: A qualitative study was conducted with the study population drawn from professional nurses who were involved in the care of patients with HIV and AIDS in the medical wards at Ngwelezana Hospital for at least five years. One focus group discussion was also conducted. The sample was selected purposively. Results: The study revealed many issues affecting the care nurses gave to patients with HIV and AIDS and the personal challenges (physical and emotional) they faced in the course of their work. Amongst these are contextual challenges which pertained mainly to health system issues- lack of institutional support and incentives, heavy workload with concomitant increase in number of patients attended to by nurses, training needs of nurses and multidisciplinary team work. Nurses had to deal with personal challenges such as helplessness, frustration, anger, death anxiety, physical and emotional stress. However, there were positive experiences such as empathy and self-actualisation in being able to care for terminally ill patients and seeing some of them get better with treatment. Recommendations: These include the need to address the training needs of nurses about management of HIV and AIDS, institutional support for nurses, critical incident debriefing and community awareness.
Factors associated with HIV seroconversion during pregnancy in Manzini region, Swaziland in 2012.
(2013) Wusumani, Sibongile.; Voce, Anna Silvia.
Background: The HIV epidemic has greatly affected sub-Saharan Africa, with the highest prevalence in the world found in Swaziland. One in three pregnant women in Swaziland has HIV. One of the PMTCT strategies is primary prevention of HIV among women who are uninfected. Understanding the reasons why pregnant women continue to seroconvert is the key in meeting this strategy. Purpose: The purpose of this study is to determine the factors associated with seroconversion among pregnant women utilizing Raleigh Fitkin Memorial Hospital in 2012. Objectives: The objectives of this study are to: determine the proportion of HIV non-infected pregnant women who are retested for HIV during pregnancy; determine the gestational age at which pregnant women are retested for HIV; establish the proportion of women who were initially HIV non-infected and seroconverted during pregnancy; and establish the factors associated with seroconversion during pregnancy. Methods: An observational cross-sectional study design with both descriptive and analytic components was carried out at Raleigh Fitkin Memorial Hospital. Systematic sampling was used for the recruitment of 381 pregnant women who were initially HIV non-infected. An interviewer-administered questionnaire and chart review were used to collect demographic and clinical data. The data was analyzed using descriptive and analytic statistics. Results: The results of the study show that demographic factors such as age and educational level are associated with HIV seroconversion during pregnancy. The findings also highlight how partner factors play a role in HIV seroconversion. The results indicate that sexual behaviours 333of the pregnant women contribute greatly to HIV seroconversion. Conclusion: Pregnant women continue to engage in risky sexual behaviours during pregnancy and there is need to strengthen counseling on preventive measures throughout the antenatal care period. There is also need for programs to explore possibility of providing antiretroviral drugs for pre-exposure prophylaxis to all HIV negative women during pregnancy.
Knowledge, attitudes, and practices of healthcare workers about healthy lifestyles : a study in an urban-based district hospital in KwaZulu-Natal.
(2008) Reddy, S.; Voce, Anna Silvia.
Background: There is global concern about the impact of lifestyle related diseases which have been on a steady increase in recent years. Poor nutrition, reduced physical activity and cigarette smoking have been documented as the main lifestyle behaviors that result in an increase in prevalence of the three most common occurring chronic diseases of lifestyle namely: diabetes, hypertension and cardiac diseases. Healthcare workers are frontline personnel and are seen as role models by their family, friends and the community they serve. It is therefore important that positive healthy lifestyle behaviors are practiced and encouraged by healthcare workers themselves. Objectives: To develop an initial descriptive profile of hospital employees with regards to their general knowledge, attitudes and practices about healthy lifestyles and to make appropriate recommendations to the hospital management on how the workplace can support the adoption of healthy lifestyles. Methods: The study was conducted at one health institution using the permanently employed staff as the study population. An exploratory descriptive study design was used in context of the precede-proceed planning framework. Self-administered questionnaires and consent forms were distributed in English and isiZulu. Collection boxes were placed in all wards and departments. Data was captured using the SPSS version 13 statistical package. Results: The response rate was 42%. Respondents were classified into the administrative, general staff and health professional categories. There was a significant difference (p=0.03) between the staff body mass index and their weight perception. Knowledge and attitude had mean indices of greater than 70% and the practice indices were lower for all three categories at less than 45%. A significant difference was found between certain staff categories in the knowledge and attitude indices but no significant difference existed in their practices. Conclusion: All categories of staff possessed adequate knowledge and attitudes but this is not transferred into positive health promoting practices. The possibility of workplace health promoting interventions was well supported by staff especially with regards to healthier meal choices at the staff dining room and an onsite gym facility. The main limitations of the study were the non-standardized data collection tool, and the poor response rate, which make the generalization of the study findings difficult.
MDR-TB patients in KwaZulu-Natal, South Africa: cost-effectiveness of 5 models of care.
(Public Library of Science., 2018) Loveday, Marian Patricia.; Wallengren, Kristina.; Reddy, Tarylee.; Besada, Donela.; Brust, James C. M.; Voce, Anna Silvia.; Desai, Harsha.; Ngozo, Jacqueline.; Radebe, Zanele.; Master, Iqbal.; Padayatchi, Nesri.; Daviaud, Emmanuelle.
Abstract available in pdf.
Measuring skilled attendance in the uThungulu District, KwaZulu-Natal in 2008.
(2010) Mianda, Solange.; Voce, Anna Silvia.
Background The Millennium Development Goals call for two-third and three-quarter reductions in Perinatal Mortality Rates and Maternal Mortality Ratios. The main strategy towards achieving these reductions is to increase access to skilled attendance. However, it cannot be confirmed that all health professionals are skilled in managing women in labour, nor that they are functioning in enabling environments. To measure the provision of skilled attendance, this study was undertaken in five Level 1 Hospitals in the uThungulu Health District of KwaZulu-Natal. The objectives of the study were: 1. To establish perinatal outcomes for each Level 1 Hospital in uThungulu Health District. 2. To evaluate the quality of intrapartum care provided in Level 1 Hospitals in uThungulu Health District. 3. To evaluate the obstetric knowledge of health workers attending births in Level 1 Hospitals in uThungulu Health District. 4. To evaluate the obstetric skills of health workers attending births in Level 1 Hospitals in uThungulu Health District. 5. To evaluate the environment in which births are attended in Level 1 Hospitals in uThungulu Health District. 6. Compare the quality of care, the knowledge, skills and environment with perinatal outcomes. Methods Perinatal outcomes (PNMR, FSBR, ENNDR and PCI) were calculated for each hospital; maternity case records of women who have delivered in these Level 1 Hospitals were audited to assess the quality of intrapartum care; obstetric knowledge and skills of midwives were assessed; as was the enabling environment within which midwives worked, which included a measurement of their workload. A correlation between perinatal outcomes and the quality of intrapartum care, knowledge and skills and the enabling environment was performed to determine whether variables were associated. Results The overall PNMR for five hospitals in uThungulu Health District was 31 per 1000 births. Three hospitals demonstrated PNMRs below 30 per 1000, while the other two showed rates above 45 per 1000. The combined FSBR for the five hospitals was 6 per 1000 births, the combined ENNDR was 12 per 1000 live births. The PCI in all hospitals ranged between 3 and 4. An audit of maternity case records revealed that all hospitals have a high overall mean percentage score per record. However, analysis of subsets showed good performance in recordings on the labour graph, but poor performance in the admission assessment and in the management of labour. The Kruskal-Wallis Non-Parametric Test showed a statistically significant difference in overall scores amongst hospitals (p=0.01), suggesting differences in performance in all five hospitals in terms of the quality of care provided. Overall, all hospitals scored poorly on tests of obstetric knowledge and skills. There were no statistically significant differences in the overall knowledge median scores and subsets median scores amongst hospitals (p=0.07), indicating that all five hospitals performed on a similar level in terms of obstetric knowledge. However, all hospitals performed differently in relation to obstetric skills, as there was a statistically significant difference in the overall skill median scores amongst hospitals (p=0.002). Three hospitals met the enabling environment standard. All hospitals but one scored poorly on referral, and the availability of supervision on both shifts. One hospital scored poorly on drugs and supplies. Overall no hospitals reported the presence of all the elements of the enabling environment. Three hospitals had acceptable workloads. No association could be detected between variables. However, there were trends that can be traced in different hospitals. Conclusions In South Africa, from the Demographic and Health Survey, 84% of deliveries are assisted by skilled attendant. While an attendant may be present, one cannot say that skilled attendance has been provided, as it has been shown for uThungulu Health District.
Patterns of disclosure : an investigation into the dynamics of disclosure among HIV-positive women in two PMTCT settings in an urban context, KwaZulu-Natal, South Africa.
(2011) Crankshaw, Tarmaryn Lee.; Voce, Anna Silvia.
Introduction: Little guidance is given to health professionals over how to deal with HIV disclosure complexities in the biomedical setting. Given the paucity of related research in this context, there is also little consideration of the actual effect of HIV disclosure in a given context. Social constructionist theory is an important contribution to disclosure research because it shifts the focus from a biomedical perspective to one that incorporates an individual's experience with HIV infection in a specific context. The task of this study was to develop substantive theory, with the aim of providing a theoretical framework for public health and health care practitioners to better understand HIV disclosure dynamics in the PMTCT setting. Methods: This was a qualitative study which explored the experience of disclosure amongst HIV positive pregnant women in the PMTCT context. Between 5 June – 31 November 2008, a total of 62 participants were recruited from two urban-based PMTCT programmes located within the eThekwini District, KwaZulu-Natal, South Africa. Results: Participants disclosed to two main groups: sexual partners, and family/others. Structural and relationship network factors shaped transmission risk behaviour, subsequent disclosure behaviour and outcomes. The circumstances which placed participants at risk for HIV acquisition also affected the likelihood of disclosure and health behaviour change. HIV and pregnancy diagnoses often occurred concurrently which profoundly impacted on participant's social identities and disclosure behaviour. Current HIV testing protocols within PMTCT settings often recommend disclosure to sexual partners under the assumption that couples will engage in safer behaviours, yet findings from this study indicate that this assumption should be challenged. Discussion: The study findings are synthesized in a conceptual model which offers substantive new theory over the concepts and interrelated factors that were identified to shape HIV disclosure and outcomes in the PMTCT context. The model identifies the following domains: 1) social networks and social support; 2) identity; 3) risk behaviour; 4) HIV and pregnancy diagnoses; and 5) HIV disclosure process to partners and others. Recommendations: Assumed pathways to risk reduction and HIV prevention need to be relooked and reconsidered. The conceptual model provides a proposed framework for future research, intervention design and implementation planning in the PMTCT setting.
Patterns of utilization of sexual and reproductive health services by secondary school-going adolescents in Gaborone, Botswana, 2012.
(2014) Maotwe, Tshegofatso.; Voce, Anna Silvia.
Background: Adolescents in Botswana, especially women, face many sexual and reproductive health (SRH) challenges including high maternal mortality, sexually transmitted infections (STIs) including HIV, and unintended pregnancies, despite available SRH services. The youth friendly service (YFS) concept has been initiated and various strategies developed to address adolescents concerns. However, services remain underutilized and barriers to accessing services still exist. Aim: The aim of this study was to determine patterns of utilization of sexual and reproductive health services by adolescents attending senior secondary schools in Gaborone in 2012. The specific objectives were to: identify SRH services utilized by adolescents in the district; identify factors associated with adolescent utilization of YFS in the district; and determine barriers and facilitators to utilization of available YFS by adolescents. Design: This was a health systems research, which was conducted through an observational study, with descriptive and analytic components. Methods: 506 adolescents attending at the three (3) senior secondary schools in Gaborone were sampled through a simple random sampling strategy in each school. Parental consent and assent from participants was requested before respondents completed a self-administered questionnaire which was designed for the data collection. The questionnaire was pilot tested prior to the study. SPSS version 16 was used to analyse the data. A chi-squared test and logistic regression were used investigate association, and a p-value <0.05 was considered as statistically significant. Results: The findings of this study revealed that utilization of SRH by adolescents was low and the level of awareness of youth friendly services was also low. The study revealed that utilization of SRH was higher among female adolescents compared to their male counterparts. The study identified factors which hinder adolescents YFS utilization, which include: location of the facility, no interest in YFS, staff attitudes and behaviours, and inconvenient hours of operation. Conclusion: Identifying patterns of utilization of SRH services by adolescents attending senior secondary schools in Gaborone can help strengthen programmes at all levels of service delivery and the country at large. The Botswana Ministries of Health, and Education and Skills Development can re-orientate, or develop new initiatives that will deal with barriers to access and assist adolescents to fully utilize the available services.
Prevalence of low back pain amongst nurses at Edendele hospital.
(2010) Dlungwane, Thembelihle Patricia.; Voce, Anna Silvia.
Introduction. Low back pain is an important public health problem affecting 70-85% of the population worldwide and is a common cause of work-related disability. At Edendale Hospital, the physiotherapy nursing case load related to the management of low back pain increased from 30% to 45% over the past 3 years. The risk factors for low back pain at Edendale Hospital remain unclear and it is not clear whether low back pain is more prevalent in certain wards. Knowing the risk factors contributing to the prevalence of low back pain at the Hospital will assist nursing and hospital managers to plan appropriate interventions to minimize the occurrence. Methods. An observational cross sectional study with an analytic component was implemented. Data was collected utilizing a self- administered questionnaire to determine the prevalence of low back pain amongst nurses at the Hospital. Bivariate analyses and logistic regressions were performed to determine the risk factors associated with low back pain. Results. The point prevalence of current low back pain was 59%, of chronic low back pain was 47% and occupational low back pain was 57%. Logistic regression revealed bending and working in orthopaedic, surgery, paediatrics, obstetrics and gynaecology is significantly associated with low back pain. Conclusion. Occupational factors are strongly associated with low back pain. Thus workplace interventions are required.
Quality of deep fried chip cooking oil at fast food outlets in the South Central Operational Entity within Ethekwini Municipality.
(2006) Padayachee, Theresa.; Voce, Anna Silvia.
The demand for deep fried chips by public and the number of people entering the fast food industry in the form of fast food outlets has increased tremendously. Frying oils are very expensive and are the most important ingredient used in the preparation of fried foods. Due to high oil costs and lack of knowledge, frying oils are used to their maximum. This has resulted in the abuse of deep fried chip cooking oils. The overall quality of the deep fried chip cooking oil used in the South Central Operational Entity of the eThekwini Municipality is not known but abused cooking oils have been identified by Environmental Health Practitioners (EHP's) during routine inspections of fast food outlets. Considering all of the above, the objectives of the proposed research were: (l) Determine the overall prevalence of the use of abused deep fried chip cooking oils at fast food outlets in the South Central Operational Entity of the eThekwini Municipality. (2) Determine in which supervision areas in the South Central Operational Entity the use of abused cooking oil is most prevalent. (3) Determine current/reported practices in preserving the quality of chip oil. (4) Make appropriate recommendations to owner/managers of the fast food outlets and to Environmental Health Practitioners. The study design was observational utilizing a Rapid Epidemiological Assessment (REA) technique, with both a descriptive and analytical component. All fast food outlets making deep fried chips in the South Central Operational Entity registered with the eThekwini Health Department at the time of the study were included in the study population. The Lot Quality Assurance Sampling (LQAS) method was used to determine the overall prevalence of the use of abused oil and to determine supervision areas reached the predetermined service target. A total of 100 fast food outlets were sampled. An oil sample from each fast food outlet, which was taken and sent to a laboratory where an Oxifrit Test was done on every oil sample taken. The Oxifrit Test was the benchmark in this study. EHP's of eThekwini Municipality collected further data by means of an observational checklist and a closed-ended questionnaire, which aimed to establish cooking oil preservation practices. The study revealed that 60 of the outlets had oil that was acceptable whereas 40 had oil that was unacceptable (abused oil). In the multivariate analysis the only factors significantly associated with abused oil were the condition of the fryer and frequency of oil change. Supervision Areas 6, and 4 had more abused deep fried chip cooking oil than average in the South Central Operational Entity. For further prioritization, Supervision Areas 6 and 4 fell below the decision rule for majority of acceptable oil preservation practices, thus Supervision Areas 6 and 4 will be targeted for intervention. Intervention will include education, monitoring and ultimately enforcing the law by EHP's to ensure safe use of deep fried chip cooking oil in the South Central Operational Entity within eThekwini Municipality.
A situation analysis of the PMTCT programme between 2013 and 2014 in the eThekwini Municipality.
(2015) Khan, Munira.; Voce, Anna Silvia.
Background The contribution of the human immunodeficiency virus (HIV) epidemic to morbidity and mortality in pregnancy has been well documented. Effective antiretroviral treatment (ART) improves maternal and newborn health as well as preventing mother-to-child transmission (PMTCT); yet access to ART for PMTCT in low and middle income countries only reached 62% (66-85%) in 2012. Of the pregnant women who required ART for their own health, 58% accessed treatment. Provider initiated HIV counseling and testing in a number of health care facilities including antenatal clinics, was recommended in an attempt to improve health outcomes within the expanding HIV epidemic. Further, screening for tuberculosis and initiation of isoniazid prophylaxis is advised in high risk groups. The main aim of the study was to explore the implementation of guidelines for the management of both seropositive and seronegative pregnant women as limited information is available in three key areas in the continuum of care for pregnant women: firstly, time to initiation of ART in women living with HIV; secondly, the implementation of the TB screening processes during pregnancy; and thirdly, follow-up (HIV) testing in uninfected pregnant women. Methods An exploratory, observational, cross sectional study design presenting both descriptive and analytic statistics was used. A two stage cluster sampling using a 30X7 strategy was applied in the selection of antenatal clinics within the metropolitan district. Data from records of eligible women between 32 and 36 weeks gestation was captured onto a data collection sheet. Demographic data and details of ART initiation, TB screening and repeat HIV testing practices were collected. All data was then entered onto a Microsoft Excel spreadsheet for importing into SPSS for processing and analysis. Measures of central tendency were used and chi squared tests and the Mann Whitney tests were applied for the analytic component of the study. Results Data was collected from records of 420 women, 210 were recorded seropositive and 210 were recorded seronegative at initial presentation. Overall, records show 202 women (48%) presented before 20 weeks gestation. Nurse initiation of ART occurred upon diagnosis of HIV infection was documented in 97% of women; TB screening practices however did not appear to be consistent and differed statistically according to administrative authority. The offer of a repeat HIV test to those women who initially tested uninfected was recorded to be offered at a standard rather than an individualised time point. Acute seroconversion was recorded in eight women. Statistically significant associations between HIV status and both median gestational age at first antenatal contact and age (in years) as well as between administrative authority and TB screening practices were found. Discussion, conclusion and recommendations Implementation of national guidelines for the management of pregnant women does not appear to be consistent within or across sampled clinics. Successful integration of HIV services was documented; however TB screening processes and feedback mechanisms following referral require strengthening. Deferment and delays in repeat testing in women who initially test seronegative are particularly concerning. Training and support of health care workers on the value of complete medical records for the overall management and continuity of care of a pregnant female is essential. Further, the benefit in implementation of national guidelines in relation to PMTCT must be highlighted.