Public Health

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An overview of occupational health in the Durban Metropolitan area.
(1981) Jinabhai, Champaklal Chhaganlal.
No abstract available.
Challenges facing a community health physician in Bophuthatswana.
(1981) Matjila, Maila John.
No abstract available.
A review of child health care in the Durban Metropolitan area.
(1981) Ramiah, Kowselia Ramaswami.
No abstract available.
Indicators of maternal child health.
(1981) O'Dowd, Patricia Bridget.
The introduction outlines the reasons for the priority of maternal and child health emphasizing the relatively simple resources required. The aims of such programmes must be identified and the results measured so that services can be monitored and evaluated. Categories of measurement are defined and indicators of maternal child health identified within these categories. A chapter is devoted to an outline of the principal non-medical determinants based on material from the Inter-American Investigation of Childhood Mortality. The significance of the principal indicators viz. the perinatal mortality rate, the infant mortality rate, the maternal mortality rate and growth and development data are compared. Chapter lV presents a report of a questionnaire study into local indices viz. Stillbirth rates, Caesarean Section rates and Maternal Mortality rates. The uptake of certain clinic services was also determined. Differences between groups and possible reasons for these are discussed. The final chapter points out the need for accurate birth and death registration and a reliable health information system and suggests methods for achieving this. Recommendations are made for upgrading the collection of data and for improving maternal and child health by research and peripheralization of services.
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.
The health needs and priorities of a semi-urban African community.
(1984) Shasha, Welile.
This commentary is essentially a report on various aspects of assessment of health needs and priorities in a peri-urban black community (mainly African) situated near Pinetown. The study was initially conducted under the auspices of the Pinetown Health Department, and the main findings are as follows (a) The geographical area of Mariannhill II Location includes what the local people call "Impola" and "Tshelimnyama", and sustains a population of 3 000 persons on some 500 hectares. (b) The origins of the population have been found, contrary to popular belief, to be 92% urban and semi-urban, and only 8% rural. (c) Demographic characteristics are those of an established stable community with a high mortality rate and high fertility (135 livebirths per 1 000 women aged 15 - 49 years per annum). The sex ratio is 99.4 males per 100 females, and there are no migratory characteristics. (d) The average number of individuals per household is 9, with a lot of overcrowding per room (not quantified). Of 1 346 adults of working age 43.68% are unemployed. (e) Morbidity and mortality studies conducted both at the level of the community and hospital revealed that children under the age of one year had the most sickness episodes, while the age groups 6.1 to 18 years had the least. (f) The disease profile is that of a typical third world developing country, with predominance of infections, accidents and physical violence. (g) Diarrhea disease constituted about 11% of the profile and was significantly associated with the water source for the household. (h) The most important cause of the 33 deaths reported over a one year period is motor vehicle accidents and physical violence (33.3%). (i) The major health resource is the local St Mary's Hospital with a 55% uptake of sickness episodes from the community. Nearly half of these ended up as in-patients. (j) 60% of children under the age of 6 years were estimated to have been fully immunized, and virtually all of it had been done by the hospital. (k) Community opinion on their problems and needs overwhelmingly pointed at water, clinic and lack of transport facilities as urgent matters. However, careful assessment of community concern pointed to the threat of removal as the most important single community problem, with implications for housing and all the other perceived problems. The majority of the people looked up to the Catholic Mission as a possible source of help to resolve the problem of availability of water. (l) As the study was initiated with a view to interventive strategies, the main findings are discussed against a background of information distilled from several literary sources, and recommendations for action are advanced. (m) Lastly, the most important problem in data collection has been that of inaccessibility of the Pinetown register of births and deaths to the Pinetown Medical Officer of Health. We regret the difficulty, but we hope to update our study when the problem has been overcome.
Community awareness of GOBI-FFF and its implementation in two urban communities
(1985) Dada, Ebrahim.
The health picture in the developing world is still very bleak. The varlOUS Black populations of South Africa (be they Africans, Indians or Coloureds) are part of this developing world. In a total world population of 4,607 million (of which 75 % are in the developing world); there are 10.3 million annual infant deaths (0-11 months) (of which 97 % are ln the developing countries); and 4.3 million annual child deaths (1-4 years) (of which 98 % are in the developing countries).*l The infant mortality rate (IMR) (infant deaths per 1,000 live births) in 1980 for the developing countries as a whole, and for Southern Africa specifically is 100; as compared to the IMR of 20 for developed countries. South Africa has an IMR of 90 (1982). However, a few relatively simple and inexpensive methods could enable parents themselves to bring about a revolution ln child survival and development. The idea that could make this revolution possible is primary health care. The vehicles that could make this revolution achievable are the spread of education, communications and social organization. The techniques which could make this revolution affordable even with very limited resources, are growth monitoring, oral rehydration therapy, breast-feeding and immunization (GOBI). These four principle life line techniques are low-cost, available now, achieve rapid results and a l most universally relevant. They involve people in taking more responsibility for their own health, and thus promote primary health care. In combination they offer an even greater degree of protection against the synergistic alliance of malnutrition and infection which is the central problem of child health and child development today. *3 In addition, three other changes-female education, family spacing and food supplementation (FFF) are also among the most powerful levers for raising the level of child survival and child health. Although more costly and more difficult to achieve, these changes in the lives of women are of such potential significance that they must also now be count ed among the breakthrough in knowledge which could change the ratio between the health and wealth of nations. *3 However, against this information is the stark reality that only up to 15 % of the world's families are using oral rehydration therapy (ORT), the revolutionary low-cost technique for preventing and treating diarrhoeal dehydration, the biggest single killer of children in the world. *4 This then rai ses the vital question that although the potential for child survival and a healthy and normal child development is there, to what extent is the average mother aware of and implementing these cost-effective methods of GOBI-FFF in her own situation? These questions are thus addressed in this study in an African and an Indian urban communities ln Natal/Kwa Zulu.
Primary health care needs of an urban and a rural African community.
(1986) Ngubane, B. S.; Arbuckle, Derek Dennis.
No abstract available.
Attitudes of African males to contraception.
(1986) Luthuli, H. V.; Arbuckle, Derek Dennis.; Naidoo, K.
The attitude of the African male to contraception and the role he plays in the acceptance of contraceptives by his racial group is presented. Over a period of one month the researcher interviewed 220 African males at a primary care private practice. In this study 186 (85%) were aware of contraceptives and 34 (15%) had no knowledge of contraception; 111 (60%) were married and 75 (40%) were unmarried. The 26 - 35 year age group were the most familiar with contraception (57%). The unemployed were the least users of contraceptives (8%), whereas 69% of the professional group were using contraceptives. The average ideal family size of the group was 4 children. No significant cultural barriers to contraception were found. Religion was found to have little effect on contraceptive practice by the African male. Fifty-three percent of the Urban dwellers were using contraceptives compared with only 30% of the Rural inhabitants. Modern methods of contraception are not yet sufficiently known by the African male to be useful to him. Health workers should educate the African male in matters of contraception to achieve the desired objectives of family planning campaigns among this racial group.
Outpatient catchment populations of hospitals and clinics in Natal/KwaZulu.
(1987) Dada, Ebrahim.
Catchment populations and cross-boundary flow characteristics of health facilities in Natal and KwaZulu have not previously been determined. As this information is essential to objective health service planning the present study was undertaken. Utilization. cross-boundary flow and catchment populations were determined in 1986 for each hospital and clinic in Natal and KwaZulu. All of the 61 hospitals and 178 clinics in Natal and KwaZulu which are operated by the public sector were included in the study. The ratio of clinics-to-hospitals was 2.9 1. The overall average population per hospital and clinic was 106775 and 36591 respectively. The size of the catchment populations of hospitals varied from 334972 to 272 and of clinics from 253159 to 877. Factors associated with these variations are discussed. Inter-regional cross-boundary flow of patients varied appreciably. The greatest influx of patients was experienced by the Durban sub-region where the teaching hospital is situated while the greatest influx of patients was experienced in the Port Shepstone sub-region. Attendance rates per person per annum. according to racial group, were 0.9, 2.1, 1.7 and 0.8 respectively for Blacks, Coloureds, Indians and Whites. Recommendations in respect of the distribution of health facilities and the routine collection and use of health information relevant to the management process are submitted.
Occupational health in South Africa.
(1987) Kistnasamy, Malcolm Barry.
Occupational health is concerned with health in its relation to work and the working environment. This study was undertaken to present an overview of occupational health in South Africa, with national and international perspectives on the discipline, in the light of : (a) the recent commissions of enquiry into aspects of occupational health in South Africa (b) the development of the national and self-governing states (c) new strategies by the authorities in the form of decentralization and deregulation. Information on the health profile of its workers, current legislative and service provisions and on policies for economic development and urbanization is vital for health administrators, occupational health and safety practitioners and policy makers. Data was collected through the use of literature surveys and postal questionnaires to the various interested persons and groups involved with occupational health. The findings reveal that (a) an inadequate occupational health policy exists in that the responsibilities of government(s), employers, workers and health professionals are not defined (b) there is an absence of an organizational and service framework for an occupational health system in South Africa although the morbidity and mortality data are significant (with their concomitant economic and social consequences) (c) there is a lack of financial and human resources for the practice of occupational health in South Africa. Recommendations are made taking into account the developed and developing components of South Africa.
Quality of paediatric care at King Edward VIII hospital.
(1987) Will, R. G.
The purpose of health service research is to produce knowledge that will contribute to the improvement in the delivery of health care and it is in this spirit that this study of the quality of paediatric care at King Edward VIII Hospital was undertaken. The main method utilized was an evaluation of aspects of the process of care of selected conditions, as measured against a predefined set of standards. This was accomplished by a retrospective review of patient records. Assessments were also made of the utilization of the Department's services, manpower and equipment. The surveys conducted involved the Outpatient's Department, the General and the Neonatal Wards of the Paediatric Department of the King Edward VIII Hospital, Durban. The Hospital Administration's routine and computerized data were also analyzed. Among the findings was that the routinely collected data is inadequate,providing only limited information for management purposes. The assertion that the utilization of the Department is high was confirmed, as was the claim that some resources are inadequate to cope with increasing demand. Many factors contribute to this, including high bed occupancy, high patient to doctor ratios, and several factors outside of direct hospital control (primary care services). The general clinical care of patients is high, but particular aspects were found to be in need of attention; for example, the metabolic and fluid management of the ill young patient and medical records in general. Immediate and long-term recommendations pertaining to the Paediatric Department and the Administration are presented.
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.
Inpatient catchment populations of public sector hospitals in Natal/KwaZulu.
(1988) Emerson, P.; Arbuckle, Derek Dennis.; Naidoo, K.; Will, R. G.
The Natal/KwaZulu Health Services Liaison Committee (HSLC) has been established to co-ordinate health care delivery in Natal and KwaZulu. This body has defined eight geographical Health Planning SubRegions (HPSRs) (Annexure E) of which each is a unit for planning and prioritising health service delivery in respect of its resident population. The HSLC considered that a study of inpatient catchment populations of hospitals under the control of the statutory Health Authorities would provide information which was essential to the planning processes of those authorities. The Department of Community Health was requested by the HSLC to undertake this study. A previous study, co-ordinated by the Department of Community Health (September 1987), dealt with "Outpatient Catchment Populations of Hospitals and Clinics in Natal and KwaZulu" (E DADA). No previous similar study on inpatients has been undertaken in South Africa. The expansion and improvement of basic services - particularly health care, water supply and basic education - should be perceived as essential elements in a strategy designed to enable all residents of a region to meet basic human needs and enjoy a minimum standard of living. Thus increased efforts have to be made to utilise health care resources effectively and efficiently and to plan future facilities carefully with regard to accessibility and appropriateness . This will require careful and objective management by all Authorities responsible for delivering health care to the people of Natal and KwaZulu. Accurately predicting the utilisation of hospital inpatient facilities is critical to efficient resource allocation in Health Services management. Catchment population studies and cross boundary flow characteristics provide valuable information on the utilisation of available facilities. This information is of value in the development of existing health services and the planning of additional health facilities with regard to size, situation and service type. Studies in other areas on utilisation of health service facilities, suggest that distance strongly influences hospital choice in both rural and metropolitan areas (Inquiry 1984 21(1) : 84-95) and this could explain some of the findings of this study with regard to cross boundary flow between Magisterial districts and HPSRs. For the efficient planning of resources, particularly with regard to situation and size, knowledge of the population size and demographic composition are important, as is a knowledge of the profile of disease in a community. The objectives of this study are directed to making available this information to each of the health authorities responsible for health care delivery and thus, to facilitate the management process.
Aspects of primary health care in a rural KwaZulu community : a descriptive study and literature survey.
(1990) Emerson, C. P. D.
No abstract available.
A prospective study of the value of the oesophageal electrocardiogram in the differentiation of wide complex tachycardias.
(1990) Moodley, Rajendran.; Sewdarsen, Mohan.
The accurate differentiation of a ventricular from a supraventricular origin of a wide QRS tachycardia (QRS > 120 milliseconds) is an important clinical problem. Misdiagnosis of this arrhythmia can lead to institution of inappropriate drug therapy acutely with potentially catastrophic consequences. Various diagnostic aids have been used to obtain electrocardiographic potentials to aid in the differentiation. This report assesses the clinical usefulness of oesophageal electrocardiography in the differentiation of wide complex tachycardias and describes a simple, safe technique to obtain oesophageal electrocardiograms. Eighteen consecutive patients between the ages of 27 and 71 years who were haemodynamically stable were selected for this study. The technique was performed in the following manner: A temporary pacing catheter was lubricated and passed nasally and advanced with the patient being instructed to swallow. Adjustments in catheter depth were made as necessary to obtain an optimal recording on a standard electrocardiograph recorder. Satisfactory placement with minimal patient discomfort was achieved within 6.5 minutes (average 4.5 minutes) in all cases. High quality tracings were obtained in every instance. In the 18 patients with tachyarrhythmia, AV dissociation consistent with ventricular tachycardia was demonstrated in 11 instances; in the remainder the diagnosis was supraventricular tachycardia. Of the 11 patients diagnosed as ventricular tachycardia, 9 were initially misdiagnosed as supraventricular tachycardia, whilst only 1 of 7 patients with supraventricular tachycardia was misdiagnosed. This study has demonstrated that oesophageal electrocardiography is useful in the differentiation of wide complex tachycardias. The technique outlined in this report is simple and offers the following advantages: the temporary pacing catheter is associated with minimal discomfort; the catheter allows easy manoeuverability within the oesophagus which allows proper depth to be easily obtained; the equipment used is routinely available. Therefore the technique offers a rapid, safe and simple method of obtaining an oesophageal electrocardiogram which is invaluable in the electrocardiographic differentiation of a wide complex tachycardia.
The nutritional status of pre-school children in Malukazi : a study of nutritional status using anthropometric measuments and dietary intake, and selected ecological factors which may impinge on nutritional status, in 3-6 year old children in Malukazi.
(1991) Peberdy, Carol Nicola.; Arbuckle, Derek Dennis.
Nutrition education is recognised as being of value in the prevention of malnutrition. However, in order for it to be effective, an in-depth study of the community prior to the implementation of any nutrition education programme is essential. A study of the nutritional status of pre-school children in Malukazi (an informal, unplanned Black township in the greater Durban area) together with background information on the household and the childminder was therefore undertaken, so that recommendations for a nutrition education programme in the area could be made. The relationship between nutritional status and certain ecological variables was also studied in order to determine which of these, if any, was a significant factor in the development of malnutrition. Nutritional status was assessed by using anthropometric measures (height and weight) and dietary intake (24-hour recall and food frequency). Background information obtained included socio-economic status; food purchasing, preparation and storage patterns; intrafamilial pattern of eating; food taboos; clinic attendance; and the childminder's sage, educational level, body size, nutritional knowledge and attitude towards nutrition education. Information was obtained by means of face-to-face interviews using a single, trained interviewer. The incidence of low weight-for-age was relatively low and that of low height-for-age ("stunting") considerably higher (14,2% and 47,3% below the 3rd percentile respectively), indicating that chronic malnutrition is a serious problem in this community. Information on dietary intake showed that intakes of several nutrients notably energy, calcium, vitamin A, ascorbic acid and vitamin D were low for the study population. The percentage of total energy provided by the various macronutrients was however in line with recommendations, which tends to indicate that the greatest need is for an overall increase in food intake. Of the ecological variables studied, only two were found to be significantly associated with the incidence of malnutrition. These were the number of children cared for by the childminder (p=0,04) and whether or not the household grew their own vegetables (p=0,02). The degree of malnutrition found to exist in this community, together with the unsatisfactory level of nutritional knowledge of the childminders and their apparent willingness to learn more, revealed the desirability for further nutrition education in this area. Recommendations regarding future nutrition education programmes for this community based on the findings of the study are submitted.
Effect of an immunisation campaign in Natal and KwaZulu on vaccination coverage rates 1990-1991.
(1992) Dyer, J. J.
In 1990 the Department of National Health and Population Development of South Africa launched a nationwide immunisation coverage campaign targetted mainly at measles. In order to measure the effect of the campaign on vaccination coverage rates for children pre- and post- campaign vaccination coverage surveys were performed using a modified EPI technique, stratified for race and urban/rural residence. The results in Natal/KwaZulu showed no significant changes in vaccination coverage rates as documented by Road-to-Health cards for any race, although the trend was towards a slight increase. The results bring into question the effectiveness of immunisation campaigns as a strategy for raising vaccination coverage levels, and having a sustained impact on the incidence of measles. Alternative strategies, such as the strengthening and expansion of existing primary health care services, and changes to the immunisation schedule for measles, should be considered.
An evaluation of needlestick injuries amongst staff at a large urban hospital.
(1993) Munro, G. D.
No abstract available.
Geriatric attendance at Outpatients Department Addington Hospital, Durban.
(1997) Walters, I. D.
This is a cross section study of the White elderly patients who attended Addington Hospital, Durban, Out-patient Department during a two week period in July 1985. Screening was by means of systematic sampling, a standard questionnaire was administered to 321 of them and their characteristics and needs were identified. In order to determine the attitudes of the medical and nursing staff who work in Addington Out-Patient Department, a further questionnaire was used. It was found that 88,37% of health professionals did not have a particular leaning towards looking after the elderly, but 88% agreed that the needs of the elderly were different in comparison with other age groups. 92,8% considered that geriatrics is a speciality in its own right. Recommendations are made for a 24 hour community geriatric service, the establishment of day centres to serve the needs of the greater Durban area, and for the establishment of a Chair of Geriatrics at the University of Natal.

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