Public Health

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Analyzing the relationship between leadership style, organisational factors and retention of professional nurses in public health care facilities in KwaZulu-Natal.
(2009) Nkosi, Zethu Zerish.
BACKGROUND : Many professional nurses have left the employment to work in developed countries. Quality patient care is declining because the few PNs that are rendering care have limited expertise. Literature review showed that nurse managers have a role to play in retention of staff. PURPOSE : The study aims to analyze the leadership styles and organizational factors toward the retention of professional nurses working in public health facilities. POPULATION : Professional nurses in four public hospitals, four union managers, twelve professional nurses working abroad and representative from SANe. A total of 188 participated in the study which formed part of the 70% of the sample. DESIGN : A Case study design which included both quantitative and qualitative approaches. Observations in the wards and document analysis were done guided by a case protocol. INSTRUMENTS : Revised Nursing Work Index and Revised Conditions of work effectiveness was administered among the professional nurse and chief professional nurses. Chief nursing service managers and union managers were interviewed using interview guides. Focus groups among professional nurses who had overseas experiences were conducted. Reliability was maintained by having a Cronbachs alpha of above 0.70 in all variables except leadership. RESULTS : Cases presented differently in all aspects, except Case C who was consistent in all the variables. The professional nurses in Case C viewed their CNSM as being visible and accessible. Case A and B were similar in terms of the organizational factors. All CNSM verbalized that they were willing to send PNs for educational programmes but the DOH policy was allowing nurses to work anywhere in the province. PNs had little access to resources on time to do tasks and paperwork as compared to access to support and opportunity.CONCLUSION : PNs are willing to stay in their organizations provided they will be given educational and promotional opportunities. There was a relationship between organizational factors and retention. Leadership factors showed a weak negative relationship with other variables.
A comparison of particulate matter (PM101) in industrially exposed and non exposed communities.
(2008) Moodley, Gonasagren.; Naidoo, Rajen.
BACKGROUND For many years, the Durban south community has raised concerns about ambient air pollution including particulate matter. The Durban South Industrial Basin (DSIB) may be high risk for exposure to significant levels ofPMI0 due to its geographic relationship with two major petroleum refineries, together with a pulp and paper manufacturing facility. While potential sources of elevated levels of PMlOin the south are industrial, the north is likely to be exposed to controlled burning of vacant fields and use ofbiomass fuels, particularly in informal settlements. Adverse health effects from particulate matter (PM) were well documented by extensive epidemiological observations by animal and human studies, following laboratory exposures. Studies across a variety of environmental settings have demonstrated a strong association between ambient air particulate matter (PMlO) and cardiopulmonary morbidity and mortality. Studies have reported that particulate matter is associated with adverse health effects resulting from inflammatory responses in the lower respiratory tract. Exposure to particulate matter may increase the risk of lung cancer. Some studies suggested that small temporal increases in ambient particulate matter are sufficient to cause health impacts. Other studies attributed strong seasonality to temperature inversions associated with temperature changes. Studies also illustrated the impact of temporal variation on PMl 0 levels across regions. OBJECTIVES The main objectives of this study were to determine and compare the levels of ambient PMIO in industry exposed and non-industry exposed communities, to determine temporal variation and to make recommendations. METHODS This study focused on determining the 24-hour ambient PMI0 levels in the Durban south community. The PMIO levels in Durban south (industry exposed) were compared with the PM10 levels in an area north of Durban (non-industry exposed). Relevant data obtained from the monitoring program of the South Durban Health Study (SDHS) was reviewed for the purposes of this study. The different techniques used to measure PMI0 are gravimetric sampling and tapered elemental oscillating microbalance (TEaM). Both methods were used to collect PMI0 data. The data comprised of quantitative and categorical variables. The dependent variable was the PM10 values and the independent variable was the sampling sites. Non-parametric tests were used to analyse the data. RESULTS PMI0 was recorded in all sites in north and south areas. The levels varied across all sites. Both the north and south areas recorded high PMI0 values at regular intervals. No particular trend was observed when the 24 hour PM10 concentration was compared against the standard. All sites recorded medians that were generally in the region of 40-S0,ug/m3. The site with the highest median (SIA,ug/m3 ) was Assegai. Briardale recorded the lowest median (34.9,ug/m3 ). Exceedances of the South African National Standard code 1929 maximum 24-hour concentrations of7S,ug/m3 were observed across all sites. Overall there were 163 (16.7 % of all samples) exceedances, and these ranged widely between the various sites, with no particular regional trend. Overall .June experienced the highest PMl 0 values. No differences in seasonal trends were observed in north and south. CONCLUSION On average the levels ofPMI0 do not exceed national or international standards. The findings did not reveal any statistical difference in exposure levels between the industry exposed and non-industry exposed areas.
Experiences of social support among volunteer caregivers of people with AIDS living in the Kwangcolosi community, KwaZulu-Natal.
(2009) Fynn, Sharl.
HIV/AIDS is a significant social problem impacting on families, communities, the public health sector and greater society. This qualitative study looked at the experiences of social support among volunteer caregivers of people living with AIDS and relationships of trust and solidarity between caregivers and members of the community. KwaZulu-Natal has the highest HIV infection rate in South Africa. This further compounds the burden of care and stigma surrounding caring for people living with HIV/AIDS .This study draws on aspects of social support theory, social capital framework and the theoretical resources of socio-ecological theory more broadly. Methodologically, in-depth interviews were conducted with 10 female volunteer caregivers with a minimum of three months care work experience and Ulin’s thematic analysis was utilized to highlight the salient themes around their experiences of social support. The findings of this study revealed that the burden of care, stigma experienced by the volunteer caregivers and the relationships between the volunteers and community members as well as social networks all played a significant role in the need for the provision of social support to the volunteers. Furthermore, the findings of the study highlighted the social consequences of care work and the need for support in this ambit. The study concluded that social support for the volunteers is severely lacking for the following reasons; there was a complete breakdown of social cohesion between the volunteers and their community; the relationships between the volunteer and surrounding social networks were under strain and as a result had a negative impact on the accessing of social support. Factors such as social trust, social bonding, social bridging and social linking were lacking between the volunteers and the community therefore accessing social support becomes problematic. Poverty is a factor that had a ripple effect on the volunteer and resulted in the urgent need for support in the form of tangible and emotional resources. Volunteerism is an undeniable necessity in the treatment or care of HIV/AIDS patients. The issues around social trust and social networks played a key role in the accessing of social support which ultimately impacted on the efficacy of care provided by the volunteer. The findings highlighted that there was a dire need to mobilize social capital within the KwaNgcolosi community in order to create relationships that would facilitate the social support needed by the volunteer.
A cost analysis of a stepdown antiretroviral programme at the KwaDukuza District Municipality Clinic in the Ilembe District in KwaZulu-Natal for the period 1st April 2005 to 31st March 2006.
(2008) Kista, Yogendiran.; Moodley, Indres.
Introduction: While the antiretroviral (ARV) coverage has been scaled- up in the last 3 years in South Africa, there is limited data on the operating costs and financial sustainabihty of an anti- retroviral programme. Study Aim: To conduct a cost analysis of the stepdown ARV programme at the Kwadukuza Municipality Clinic (KMC) in the Ilembe district from a healthcare providers' perspective for the period 1st April 2005 to 31st March2006. Study Objectives: To determine the total costs and cost per patient per visit for outpatients attending the ARV, Wellness and VCT clinics respectively at KMC. Study Methods: Study location: This study was conducted at the Kwadukuza Municipality Clinic located in the Ilembe district in Kwazulu- Natal, South Africa. Study population: The population that is included in this study for the purposes of costing comprised: all the patients who received ARVs for the period under study; all the patients who attended the Wellness and VCT clinics and all the staff attached to the ARV programme at the KMC clinic Study design: This is a retrospective and cross- sectional study with both a descriptive and analytical component. Results: Seventy- one percent of the patients on ARVs were female with 50% of the patients being between 31 and 40 years of age. The total operating costs of running the ARV programme was R2 439 940- 90. The total cost accrued to the ARV clinic was R 1 698 003- 60. The Wellness clinic had a total cost of R 460 279- 68 and the VCT clinic accounted for the least total operating cost of R 281 657-77. The cost per patient visit was R440- 13 for the ARV clinic; R133- 05 for the VCT clinic and an amount of R61- 71 for the Wellness clinic. Conclusion This study provides the basis for determining the three cardinal cost components of the ARV programme, namely human resources, the cost of ARVs and the costs of viral load testing for the purposes of future planning and sustainability. The cost- effectiveness of ARV drugs can be improved if the healthcare providers negotiate a lower price for these drugs. The high cost due to monitoring tests can be lowered by decreasing the frequency of these tests but this may allow ARV drug resistance to be undetected.
Investigating the quality of referral and support systems between fixed clinics and district hospitals in area 3 of KwaZulu-Natal Provincial Department of Health.
(2010) Hombakazi, Nkosi Phumla.; Reid, Stephen John Young.
Introduction A well-functioning primary health care system depends on all three levels of healthcare, that is, the primary, secondary and tertiary levels of care. District hospitals have a major role to play in the development of a strong referral system. This study was undertaken to evaluate whether the primary health care clinics in Area 3 possess all the key essential components for a strong referral system. Area 3 comprises 3 districts in northern KwaZulu-Natal, i.e. the Umkhanyakude, Uthungulu and Zululand districts. Aim The aim of the study was to evaluate referral support systems between fixed clinics and district hospitals in the three districts of Area 3 in KwaZulu-Natal province. Methods A descriptive study was undertaken in 58 randomly selected clinics in Area 3. Data was collected between July and August 2007, on availability of: communication technology, transport for patients being referred to the district hospital, and guidelines. Referral letters were reviewed to determine if they contained adequate information. Professional nurses were interviewed to determine the training they had attended. Results A third (34%) of clinic nurses on duty had been trained in Primary Health Care; 57% of clinics had at least one professional nurse on duty with a PHC diploma. The proportion of nurses trained in short courses ranged between 4% and 47%. Fifty-six out of fifty-eight (97%) of clinics had telephones; 57% reported problems with telephones. Eighty-eight out of one hundred and seven (88%) of selected referral letters did not have adequate information. Only 32% of urgently referred patients were collected by an ambulance within 1 hour. All 58 clinics had the Essential Drug List (EDL) available; availability of the other guidelines ranged between 29% and 79%. Discussion The percentage of clinic nurses with a PHC diploma or trained on short courses indicates that most clinic nurses render health services without or with inadequate knowledge and skills. Poor quality of referral letters and inefficient transportation of referred patients, especially emergencies, confirm a weak referral support system. User perceptions of the referral system have not been explored. Recommendations Training and support of clinic nurses needs to be prioritised to improve patient assessment and management, as well as the quality of referral letters. District management should advocate for improvement of patient transportation. Future studies should explore the use of referral letters by and training of, clinic nurses; as well as determine user perceptions.
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.
Impact of delayed introduction of sulphadoxine-pyrimethamine and artemether-lumefantrine on malaria epidemiology in KwaZulu-Natal, South Africa.
(2007) Junior, Anyachebelu Emmanuel.
Background The years 1985 to 1988 and 1997 to 2001, were periods of high morbidity and mortality due to malaria in KwaZulu-Natal, South Africa. One reason for the increased burden of disease was the emergence of drug resistant Plasmodium falciparum. The parasite was resistant initially to chloroquine and then to sulphadoxine-pyramethamine, the medication of choice for the treatment and prevention of malaria in different periods of time. The changing epidemiology of malaria in Mrica was exacerbated by policy makers not making timely and rational change to the failing malaria drug regimens to newer and effective ones. Purpose ofthe study This study was conducted to determine the impact of delayed introduction of sulphadoxine-pyramethamine (Fansidar®) and artemether-lumefantrine (Coartem®) as a first-line drugs for malaria in KwaZulu-Natal from 1985 to 1988 and 1997 to 2001 respectivel y, Study Design Observational, Analytic, Ecological Method The incidence of malaria in KwaZulu-Natal was compared during different phases of the period when chloroquine was the first line treatment. The baseline phase (1982 to 1984) was taken when chloroquine correctly should have been used and this was compared with the delayed phase (1985 to 1988), when it should have been replaced by of sulphadoxinepyramethamine. During the second period sulphadoxine-pyramethamine was the first line treatment of malaria, the baseline phase (1993 to 1996) when it correctly should have been used was compared to the delayed phase (1997 to 2001) of introduction of the alternate treatment of malaria with artemether-Iumefantrine. Ethical approval for this study was obtained from the Biomedical Research Ethics Committee, of the University of KwaZulu-Natal. Statistical Methods The relative association of malaria infection during the chloroquine baseline and change phases and the sulphadoxine-pyrametharnine baseline and change phases were compared with statistical significance at 0.05. Results The risk of malaria infection was 4.5 times (Incidence Risk Ratio = 4.5; 95% Confidence Interval: 4.1 to 5.0; P < 0.0001) higher in chloroquine change phase relative to the baseline phase. During the sulphadoxine-pyrametharnine period, the malaria risk was 3.5 times greater (Incidence Risk Ratio = 3.50; 95% Confidence Interval: 3.40- 3.60; p < 0.0001) in the change phase. In the chloroquine period, the malaria mortality risk was 9.1 times higher (95% Confidence Interval: 2.1 to 38.5; p=0.0003) and the case fatality rate was increased 1.3 times more (95% Confidence Interval: 1.0 to 1.7; p< 0.001) in the change period. The risk of death during the sulphadoxine-pyramethamine change phase was 4.8 times (95% Confidence Interval: 3.3 to 7.0; p
Perceptions of and attitudes to the compulsory community service programme for therapists in KwaZulu-Natal, 2005.
(2009) Khan, Nasim Banu.
Compulsory community service programmes have been initiated in many countries to recruit health care professionals to provide services in rural and under-served areas. However, the success or failure of the Community Service Programme depends largely on the attitudes of the professionals, their understanding of the programme's objectives, their preparedness for working in these areas and their ability to adapt to a new and challenging experience. Aim The aim ofthis study was to assess therapist's perceptions and attitudes about the compulsory Community Service Programme in KwaZulu-Natal in 2005 and to assess whether these changed during the year. Methods An observational cross sectional study with a descriptive and analytic component was conducted on commencement and after completion of community service. The therapists completed a self-administered questionnaire before and after their community service. Results A total of 126 (89% of 142) therapists responded to the initial questionnaire, 59 (42%) completed the exit questionnaire of which 47 (33%) completed both the questionnaire at commencement and completion of community service. Despite the poor response rate, similarities in perceptions and attitudes were noted with other studies conducted nationally and internationally. At onset 50% indicated that they would work in the public sector in the future and this proportion declined to 35% by exit. Even fewer (24%) said they would work in a rural area in the future. Only 16% reported that they would stay on at the same institution the year after community service. There was also no significant association between therapists collecting a rural allowance and expressing an interest to work in a rural area in the future (p=0.78) or staying at the same institution in the years after community service (p=0.32). However, therapists working in urban areas were more likely to say they would work in a rural area in the future (p=0.018). The comparisons between the occupational catergories showed that for support and supervision, the Speech Therapy and Audiology Forum was considered significantly (p=O.OOI) supportive compared to the Physiotherapy Forum. There was no significant difference within the occupational catergories in their perceptions of support, mentoring and supervision, attitude, psychological coping, personal and professional gains, safety issues and the amount of community outreach conducted. All groups were similarly resource constrained. Language was a barrier for 50% of all community service therapists and impeded their professional functioning. Discussion Despite the challenges experienced by community service therapists the majority felt that they had made a difference in the community in which they have been placed. The obligation to work in rural and under-served areas was personally and professionally rewarding. Particular concerns centred on support, supervision, training, resources and language barriers in providing better service delivery. Recommendations To achieve its objectives in relation to compulsory community service, which is to ensure an improved provision of health services to all citizens ofthe country, the Department ofHealth should consider multiple strategies including financial incentives such as rural allowances and non-financial incentives to retain health care personnel in rural and under-served areas. A long-term strategy that addresses human resources in a comprehensive manner needs to be developed to improve staffing and quality health services in these areas.
The epidemiology of motor vehicle collisions involving pedestrians in eThekwini Municipality, 2001-2006.
(2009) Hobday, Michelle Bridget.
Introduction Road traffic collisions in developing countries contribute towards the greatest burden of disabilities and fatalities globally. Concern has arisen about the high proportion of pedestrians involved in collisions in South Africa. Aim This study describes the epidemiology of motor vehicle collisions involving pedestrians in eThekwini Municipality from 2001 to 2006, aiming to identify opportunities for prevention and informing policy. Methods An analytic cross-sectional study design was used. Data was obtained from the eThekwini Transport Authority database (police accident reports), and the Nationallnjury Mortality Surveillance System (mortuary reports). Exposure variables included pedestrian and drivers' demographics and collision environment. Death and injury were the outcome variables measured. Population data was obtained from Statistics South Africa. Results Pedestrians' injuries decreased from 7 445 to 6 288 (incidence risk: 241 to 193 per 100 000) from 200 I to 2006. Annual case fatality rose from 4.9% (366 deaths in 200 I) to 6.8% (430 deaths in 2006). Child pedestrians aged 5 to 9 years had a 77% increased risk of injury relative to other children. The fatality risk ratio of male to female pedestrians was 3.8 (95% Confidence Interval: 1.7 to 9.3). Male drivers aged 30 to 34 years had a 68% increased collision risk relative to all other male drivers and eight times (Incidence risk ratio: 8.0; 95% Confidence Interval: 6.2 to 10.3) the risk of female drivers. Only 3.4% of collisions occurred on freeways but accounted for 19.6% of pedestrian fatalities. Few (1.5%) collisions involving pedestrians occurred at night in unlit conditions but constituted more than four times the number of fatalities as number of collisions in these conditions.
A comparison of direct observation of treatment methods used for treating pulmonary tuberculosis in Durban (eThekwini), KwaZulu-Natal.
(2008) Nair, Gonasagrie.; Knight, Stephen.
Introduction Tuberculosis (TB) causes approximately 2 million deaths every year. The problem is escalating explosively in sub-Saharan Africa and is directly related to the increase in the prevalence ofHuman Immunodeficiency Virus infection. South Africa was ranked as having the fourth highest global incidence of TB in 2006. In 1993, the World Health Organization introduced the Directly Observed Treatment Short-Course strategy to increase efficiency of national TB programmes. The Direct Observation of TB therapy element of the strategy has been contentious. An ideal method of direct observation remains elusive and its role in improving adherence is questionable. Aim The purpose ofthis research is to detennine the most effective directly observed method for pulmonary TB offered in an urban area of South Africa. Methods A retrospective cohort analysis was conducted at the Prince Cyril Zulu Communicable Diseases Centre in Durban, KwaZulu-Natal. The study population consisted of adult patients who commenced a course of TB therapy between July 2005 and June 2006. The effect of clinic based, family member, community health worker, lay community health volunteer and workplace based direct observation on TB treatment outcomes, and frequency of recurrence was detennined. A sub analysis was perfonned of the effect of the different methods ofdirect observation in employed patients. Results Workplace based direct observation resulted in a higher frequency of successful treatment outcomes than the other methods of Direct Observation. Being a re treatment patient was the only significant factor associated with recurrence, both for the entire study population and for those who were employed. Discussion The findings of this study are generalizable to other developing countries where challenges in implementation ofan effective TB programme such as poverty, high burden of HIV infection, a migrant population with strong rural ties and reliance on traditional practices to cure illness play a major role. Recommendations There is often no best treatment observer. Every case has to be individually evaluated and the most acceptable and accessible treatment observer chosen. The findings ofthis study strongly suggest that workplace Direct Obse ation can have a significant impact in improving TB treatment outcomes.
Health science faculty employees' perceptions of organisational culture in the merger of the University of Durban-Westville and the University of Natal.
(2010) Pillay, Shamla Devi.; Taylor, Myra.
No abstract available.
Health care waste management in public clinics in the iLembe District : situational analysis and intervention strategy.
(2007) Gabela, Sibusiso Derrick.; Knight, Stephen Eric.
INTRODUCTION All waste generated at health care facilities in the past was regarded as hazardous and needed to be incinerated first before it was disposed. The purpose of this study was to investigate health care waste (HCW) management practices employed in public health clinics in the iLembe District, with a view of developing a HCW management intervention strategy. METHODOLOGY The study design was observational, descriptive, and cross-sectional. Data was collected using a structured individual questionnaire, which was administered to key informants from 31 rural and urban government fixed public clinics in the iLembe District Municipality. RESULT Thirty public clinics in iLembe district participated in the study. A total of 210 kg/day (0.06 kg/patient/day) of HCW was estimated to be generated in public clinics, 69% was health care general waste (HCGW) and 31 % was health care risk waste (HCRW). The district's generation rate was 0.04 kg/patient/day and 0.018 kg/patient/day, for HCGW and HCRW, respectively. The study found that HCW was improperly managed in the district. DISCUSSION The findings are different when compared to World Health Organisation norms and this was attributed to improper segregation of waste categories other than sharp waste, which was given special treatment. Factors such as the number of patients, size of the clinic, types of health care services rendered, and socio-economics status of the patient played a pivotal role in the waste volume generated. It is evident that no proper HCW management plan was being implemented in the district public clinics. CONCLUSION The management of health care risk waste is of great concern. There is a need for development of a health care waste management intervention strategy that must be implemented consistently and universally in the district. RECOMMENDATIONS It is recommended that a proper health care waste management intervention strategy be developed and implemented in the whole district. This strategy must incorporate training programmes and a waste management plan.
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.
The epidemiology of parasuicide at RK Khan Hospital.
(1984) Bhamjee, M.
It was suspected that about 2 cases of parasuicide were admitted daily to RK Khan Hospital and this suspicion was confirmed by this study. Most of the cases were female, and in the 15 - 24 year age group. Patients were admitted mainly in the evenings and on Sundays. The majority earned less than R500 per month and were mainly manual-skilled and semi-skilled workers predominantly from Chatsworth. Non-violent means were the common mode of parasuicide, the causes being family, marital and romantic problems. The hospital social worker dealt with the cases and referred patients to relevant organisations outside the hospital for management. Certain patients were referred to the Psychiatric Outpatient Clinic at the Hospital as there was no resident psychiatrist.
Adapting the WHO Health Promoting Hospitals strategy for South African hospitals : an evaluation.
(2008) Geddes, Rosemary Veronica.; Jinabhai, Champaklal Chhaganlal.; Knight, Stephen Eric.
Objective To conduct an evaluation of the pilot implementation of the World Health Organization Health Promoting Hospitals initiative and its self-assessment tool in public hospitals in KwaZulu-Natal in 2004/2005 Study design This evaluation utilised a cross-sectional design that incorporated both qualitative and quantitative research methods. Main measures Throughout the Health Promoting Hospital pilot project the opinions and responses of those with a legitimate interest in the initiative were monitored. Data collection methods utilised in this evaluation included participant observation, the World Health Organisation metaevaluation questionnaire, records of workshops and feedback meetings and secondary analysis of all data collected by the six pilot hospitals during the implementation of the project in KwaZulu-Natal. Results Major constraints were found to be time, human and financial resources, lack of training and expertise and insufficient support for the project. The self-assessment tool was found to be insufficiently adapted and not all outcomes were found to be reliable and useful. Despite this, institutional staff found the Health Promoting Hospital project to be capacity building and morale boosting. Relationships between health service levels improved. All hospitals who participated recommended that other hospitals become Health Promoting Hospitals. Conclusion If the World Health Organisation Health Promoting Hospital initiative with its selfassessment tool is to be rolled out to the rest of KwaZulu-Natal province, then substantial changes have to be made to the process. Amongst these are: further adaptation of the selfassessment tool, improved methods of data collection, provision of sufficient resources and increased and sustained provincial support for the project. In addition it is imperative that outcome and impact evaluations be done.
An HIV/AIDS prevention intervention among high school learners in South Africa.
(2008) Frank, Serena V.; Taylor, Myra.; Jinabhai, Champaklal Chhaganlal.
Introduction Nearly half of all new HIV infections worldwide occur in young people aged 15-24 years. Risky sexual behaviours may lead to the development of lifelong negative habits like having multiple partners, thereby placing young people at risk of a broad range of health problems, including HIV/AIDS. Prevention is therefore critical and includes changing behaviours that are risky, such as the early age of sexual initiation, having many sexual partners and non-use of condoms. The study aimed to evaluate whether a theory based HIV/AIDS intervention, 'Be A Responsible Teenager' (B.A.R.T.), could produce behaviour change among high school learners in South Africa. Methods A pre-test /multiple post-test intervention study was undertaken. All Grade 10 learners (n = 805) from all three public high schools in Wentworth were included in the study. Eleven teachers were interviewed from these schools. Learners completed a questionnaire at baseline (Tl), immediately post intervention 1 (T2), post intervention 2 (T3) and after a period of seven months (T4). The B.A.R.T.intervention was implemented in the intervention schools while the control group did not receive any intervention. Qualitative data was analyzed according to themes, while quantitative data was analyzed cross sectionally and longitudinally. Results Teachers reported many obstacles in implementing the HIV/AIDS Life Skills' curriculum, including the poor quality of training and inadequate resources in schools. Further, learners practised high-risk sexual behaviours. Gender differences in sexual behaviour were reported with males predominately practising higher risk behaviours than females.The B.A.R.T. intervention did show changes in behaviour for alcohol use at last sex and for the determinants knowledge, attitudes, beliefs, self-efficacy and intentions to practise safer sex respectively, over time. However, the intervention didnot positively impact abstinence behaviours, condom use and the reduction in partners. Further, subjective norms did not change. Conclusion The major obstacles to AIDS prevention include the current practices of risky sexual behaviours including age mixing, early sexual initiation, multiple partners, forced sex and receiving money or gifts for sex among others. Social norms as potrayed by parents, peers and religious groups play a pivotal role in promoting protective sexual behaviours. The role of gender and the gaps in LHAP (Life Skills' HIV/AIDS programme) also require urgent attention.
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.
Rates and causes of child mortality in rural KwaZulu-Natal.
(2007) Garrib, Anupam Virjanand.; Herbst, Abraham J.; Jinabhai, Champaklal Chhaganlal.; Knight, Stephen Eric.
Background Recent gains in child survival are being threatened by the RN epidemic. Monitoring child mortality rates is essential to understanding the impact of the epidemic, but is constrained by a lack of data. A community-based survey was used to determine child mortality rates in a rural area with high RN prevalence, located in the Rlabisa subdistrict of the KwaZulu-Natal Province, South Africa. ii. Methods The study was conducted between 1 January 2000 and 31 December 2002 on deaths in children under the age of 15 years. Children were followed up through 4-monthly home visits. Cause of death was ascertained by verbal autopsy. Rates were calculated using Poisson methods. iii. Results Infant and under-5 mortality ratios were respectively, 59.6 and 97.1 deaths per 1000 live births. Infant and under-5 mortality rates were, respectively, 67.5 and 21.1 deaths per 1000 child-years. RN/AIDS was attributed to 41% of deaths in the under-5 age group, with a mortality rate of 8.6 per 1000 person years. Lower respiratory infections caused an estimated 24.9 deaths per 1000 person years in children under 1 year of age. iv. Discussion In rural South Africa, infant and child mortality levels are high, with RN/AIDS estimated as the single largest cause ofdeath. Improving the coverage of interventions known to impact on child mortality is required urgently.
A qualitative understanding of the socio-cultural and situational context of substance abuse and sexual risk-taking behaviours in women.
(2008) Phillip, Jessica Lyn.; Knight, Stephen Eric.; Bhana, Arvin.
South Africa is one of the six southern African countries where the HIV levels for childbearing women are 20% or higher. In South Africa, like most countries, behaviours such as multiple sexual partners, unprotected sex and drug use expose individuals to the risk of HIV infection and drive the HIV epidemic. Thus, research on sexual risk behaviours associated with HIV/AIDS is vital in identifying target groups at risk for HIV. Previous research has shown a link between substance use and sexual risk behaviour however in South Africa research within this field is still evolving. Furthermore, research on substance abuse among women in South Africa is limited. In the light of increasing HIV infection in women and the possible influence substance use has on sexual risk behaviours including HIV, exploring the association between substance use and sexual risk behaviours among women would provide valuable information. Socio-cultural and situational factors are explored within substance use and sexual risk behaviours as women's lives occur with realm of individual, family and community. The sample was drawn from an Alcohol and Drug Rehabilitation Centre situated in the Durban area. Study participants included Black/African, White, Indian and Coloured women who were admitted to the treatment centre for alcohol abuse. One focus group discussion and six in-depth interviews were conducted with women to understand the socio-cultural and situational context of substance abuse and sexual risk-taking behaviours (including HIV/AIDS). Substance abuse emerged from women's lack of coping mechanisms to deal with poor relationships and lack of employment which led to financial dependence on their partners. Women reported that within their settings, alcohol can be related to sexual risk behaviours because alcohol tends to lead to unsafe sexual behaviours. Women reported that alcohol use facilitates intimacy and rapport between couples thus some women tended to consume alcohol. Women reported that knowledge of safe and unsafe sex is known however implementation is difficult because condom use requires her partner's co-operation. Women were financially and emotionally dependent on their partners, social norms which determine women's role in society and sexual relationships governed their behaviour. Partner violence was a common feature among women which impacted on women's ability to negotiate condom use. The paper discusses the intrapersonal, interpersonal and contextuall situational factors that influence substance use and sexual risk behaviours in these women's lives.
A profile of children admitted to a rehydration unit.
(1988) Davies-Salter, Linda Ann.; Arbuckle, Derek Dennis.
The first twelve months operation of a five-bed rehydration unit at Osindisweni Hospital is described and data related to admissions presented. Osindisweni hospital is situated in a rural area north of Durban and has approximately 300 general beds with 60 000 outpatient attendances per year. A profile of children admitted to this unit was obtained and results are analysed according to the objectives of this study. The main findings of the study showed that 269 children were admitted to the unit during the study year and the majority of children were black African children, below three years of age, coming from rural areas. The children presented with acute diarrhoeal dehydration mostly of mild to moderate degree and were normally managed by oral rehydration therapy. Eighty-four percent of these children were successfully managed on the rehydration unit and only 13,7% received IV fluids. The majority of children requiring transfer to the ward had either persistent dehydrating diarrhoea or other complications such as malnutrition or septicaemia. No child died on the unit and no child died as a result of dehydration but 4 children died later as inpatients on the children's ward. The mortality of children admitted to the unit was therefore 1,5%. One hundred and nine patients were followed up (41,6% of questionnaires) and of these only 76 (69,7%) actually came for review the others presenting for other illnesses or else interviewed on the wards after transfer. However, most of these children had either no or minor complaints on follow up. Seventeen and a half percent of children were below the 3rd centile for age on discharge. Children with marasmus and/or kwashiorkor were not admitted to the unit. The availability of health care was poorly assessed but indicated a general lack of facilities for the rural population served. Also it was noted that the principles of G.O.B.I. had been poorly taught at Osindisweni in the past, particularly growth . charts. Mothers received health education on the unit and were found to have a good understanding of G.O.B.I. after their stay on the unit. On the whole the unit was well accepted by the mothers. It is thought that this short-stay oral rehydration unit offers a more appropriate and more cost effective alternative to previous methods of in-patient management of children with diarrhoeal dehydration and that it offers an excellent opportunity for health education.

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