Masters Degrees (Family Medicine and Primary Care)
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Browsing Masters Degrees (Family Medicine and Primary Care) by browse.metadata.advisor "Blitz, Julia"
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- ItemAcceptance of and adherence to full anti-retroviral therapy for prevention of mother to child transmission in HIV infected pregnant women with CD4 count above 350 at Nhlangano Health Centre, Swaziland.(Stellenbosch : Stellenbosch University, 2018-03) Ndakit, Manighuli Kambasu; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY : Epidemic of HIV infection is hitting Swaziland where the prevalence is among the highest in the world. Nhlangano Health Centre (NHC) in collaboration with Medecins Sans Frontiers Switzerland (MSF Switzerland) opted to hit early by starting Highly Active Anti-retroviral Therapy (HAART) among HIV infected pregnant women with CD4 count cells above 350. This new intervention raised concerns on acceptability and adherence which needed to be assessed. Study design: This was a descriptive study which explored the acceptance of and adherence of pregnant women to full anti-retroviral therapy at Nhlangano Health Centre in the period from 24th June 2014 to 23rd June 2015. The level of adherence was assessed by announced pill counts on subsequent visits. Then, 6 months after initiation, the viral load and a second CD4 count were determined. Results: 98 participants were recruited and initiated; one later died. 80.6% resided in the rural area. 80.6% attended secondary school. Majority were single (79.6%). Mean age was 25.4 years. 64.3% booked at 2nd trimester. Most were multiparous (75.5%). Mean haemoglobin was 11.1g/dl. After 6 months, mean CD4 count was 709.4 up from 554.4 (initial) and 66 (95.6%) had undetectable viral load risen from 14 (20.2%) at initiation. 69 participants (70.4%) were adherent to treatment; 3 (3.1%) of them failed to suppress completely the viral loads. 13 pregnant women refused HAART; of these 12 were interviewed and one declined. The rate of acceptance was 88.3%. Conclusion: Most of the HIV infected pregnant women who visited the clinic accepted the treatment, their CD4 count increased and had undetectable viral loads after 6 months. Anti-retroviral therapy is effective and can be successfully initiated in pregnant women with CD4 count above 350 but should be monitored closely to avoid loss to follow-up.
- ItemBarriers and enablers to implementation of Botswana’s national maternal mortality reduction guidelines : a qualitative study(Stellenbosch : Stellenbosch University, 2017-12) Mogatle, Mothusi; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY: Introduction: Like in many low-and-middle income countries, maternal mortality remains a challenge to Botswana. A number of initiatives such as maternal mortality audit with generation of recommendations, development of guidelines and occasional issuing of clinical directives have not resulted in the desired change. Factors such as staff attitude, lack of administrative or management commitment are often postulated as possible reasons, but these have not been well researched locally. The aim of this study was to explore the context specific attitudes and experiences of managers and health professionals towards the implementation of maternal mortality reduction guidelines in Botswana. Methods: Face to face interviews (Exploratory Qualitative Study) using pre-developed semi-structured questions was undertaken in 4 district hospitals in Botswana. A non-probability sampling technique was used to select both the study sites and the informants. Two facilities with no significant decrease in maternal mortality cases and two which have been recording fewer cases in the recent past were selected. Content data analysis was done with the help of Atlas.ti. Results: Effective change in the health system can broadly be divided into four areas; policy, administration, clinical practice and training. Some of the policy related issues noted were; shortage of staff and equipment, staff distribution and movement. Both study groups were equally affected by these issues, but facilities with lower maternal mortality seemed to have developed better coping mechanism. Administratively, long standing unresolved issues such as erratic stocking levels, weaker disciplinary procedures, limited services at some facilities etc. were reported. Generally, the staff morale was reported to below, mainly due to these unresolved administrative issues. Fewer administrative issues were reported at facilities with lower mortality. Regarding clinical practise, both clinicians and managers were well aware of the guidelines. Variable patient monitoring before, during and after delivery, poor team work, too much or repetitive documentation, were commonly reported. Under training; lack of concrete, consistent on-going learning among healthcare workers was more pronounced at facilities with higher maternal mortalities. Conclusion: Findings from this study revealed that unresolved administrative issues compounded by policy related issues were noted as the main barriers to implementation of the various guidelines. Furthermore, addressing staff welfare/concerns, negatives attitudes and investing on on-going learning were noted as areas which could enable effective guidelines’ implementation.
- ItemBeliefs and attitudes to obesity, its risk factors and consequences in a Xhosa community : a qualitative study(Stellenbosch : Stellenbosch University, 2012-12) Akinrinlola, Olatunbosun A.; Blitz, Julia; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health SciencesBackground: The issue of obesity is an important one because in some communities obesity is perceived in many ways such that it is not recognised as a problem as typified by the black community of Khayelitsha with high levels of obesity and associated diseases but low levels of concern and recognition of the problem. This study aimed to explore this by trying to understand how people think and feel about their obesity in a peri-urban Xhosa community, with a view to improving interventions that will reduce the burden of disease related to overweight and obesity as well as with prevention programmes targeted at obesity as a risk factor. Methods: A qualitative study was carried out using recorded interviews of 8 purposively selected subjects who are long term Xhosa-speaking residents, 18 years and older, with BMI more than 30 and no Diabetes, Hypertension or Osteoarthritis at Nolungile CHC, Khayelitsha, a peri-urban black community in Cape Town, South Africa. Results: Interviewed subjects identified various dietary factors for their obesity. These include overeating widely available fatty diets from street vendors, with a perception that cheap food is fatty food. They also attributed their obesity to other factors like poverty and clearly expressed that it is expensive to eat healthily. Other reasons given are a sedentary habit, fear of embarrassment, safety issues and a poor support system regarding exercise. Respondents also differ in their behaviours towards their obesity but generally accept their obesity. Furthermore, they experienced various effects of their obesity. Other than being viewed as affluent and in good health by the community, respondents are aware of effects like compromised daily activities, associated chronic illnesses, dressing difficulties, aging and other negative effects. Conclusions: A few concepts, in agreement with previous linked studies were identified in relation to the Burden of disease, diet, exercise, socio-economic and perception issues. However, the effects of environmental influence on perceptions and behaviour regarding exercise and diet were found. This seemed to indicate an evolving culture in transition. Based on these understandings, health intervention should be directed at addressing such local beliefs and behaviour at the community level, with a need for control of environmental factors. Further studies regarding weight loss was suggested.
- ItemCommunity assault and non-community assault among adults in Khayelitsha: A case count and comparison of injury severity(Stellenbosch : Stellenbosch University, 2015-07) Forgus, Sheron; Delva, Wim; Hauptfleisch, Christine; Govender, Srini; Blitz, Julia; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health SciencesENGLISH ABSTRACT: Background: Community Assault (CA) or vigilantism is rife in the township of Khayelitsha. Anecdotal evidence suggests that victims of CA are worse off than other assault cases. However, scientific data on the rate and severity of CA cases is lacking for South Africa. Aims and Objectives: To contribute to CA prevention and management strategies, by estimating the rate of CA among adults in Khayelitsha and comparing the injury severity and survival probability between cases of CA and other assault (non-CA) cases. Methods: We studied 4 health centres in Khayelitsha during July - December 2012. A consecutive case-series was conducted to capture all CA cases during this period and a retrospective folder review was performed on all cases of CA as well as on a control group of non-CA cases to compare injury severity and estimate survival probability. Results: One hundred and forty-eight adult cases of CA occurred (case rate 1.1/1000 person-years) over the study period. The Injury Severity Scores (ISS) in the CA group were significantly higher than in the non-CA group (P<0.001), with a median (Inter Quartile Range) ISS of 3 in CA cases (2-6) and 1 in non-CA cases (1-2). Comparison between the two groups showed that a GCS<15 (20.1% versus 5.4%), referral to the tertiary hospital (33.8% versus 22.6%), and crush syndrome (25.7% versus 0%) were all more common in CA cases. Survival probabilities were similar in both groups: 99.2% in the CA group versus 99.3% in the non-CA group. Conclusion: The rate of CA among adults in Khayelitsha is high, and the severity of injuries sustained by CA victims is substantially higher than in other assault cases.
- ItemA comparison of the quality of chronic care of hypertensive patients attending a fast lane clinic versus a standard clinic in Ditsobotla Sub District, Ngakamodirimolema District in North West Province in South Africa.(Stellenbosch : Stellenbosch University, 2012-12) Mampe-Tembo, S. P.; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY : Background: Ditsobotla Sub district is in NgakaModiriMolema District, North West province, South Africa. Patients with chronic diseases in the sub district are mainly taken care of at the clinics. There are two types of clinics that cater for chronic patients – fast lane and standard clinics. Fast lane clinics cater for patients with chronic diseases and family planning only whilst standard clinics cater for acute illnesses, chronic patients and family planning. Fast lane clinics were started because of dissatisfaction of chronic patients as a result of long waiting times. There were no standardised guidelines for the establishment of fast lane clinics. This study attempted to compare the quality of care given to patients between fast lane and standard clinics. Methods: This was a cross sectional descriptive study using a validated audit tool from Western Cape, Department of Health to assess facilities and patients folders. There were 145 and 55 files from fast lane and standard clinics respectively which were audited using systematic sampling. Selected patients needed to have been attending either of the clinics for hypertension treatment from January to December 2010. Results: The patients at the standard clinic had better adherence to their appointments than fast lane clinic (p<0.05).The standard clinic was doing much better than fast lane clinic in counseling of diet, exercise, smoking and alcohol (p<0.05).The recording of blood pressure and body weight was better at the standard clinic than fast lane clinic (p< 0.05). Fast lane clinic have more patients with well controlled blood pressure, normal creatinine level and normal random cholesterol than standard clinic (p<0.05). The differences in the findings on the facility audit regarding equipment and processes are not statistically significant (p>0.05). Conclusion: Fast lane clinic has better outcomes and thus quality of care than standard clinic therefore maintenance and expansion of this type of clinic in Ditsobotla sub district may be of value.
- ItemDietary knowledge, attitude and practices of diabetic patients at Nsambya Hospital Kampala, Uganda(Stellenbosch : University of Stellenbosch, 2015-12) Ntaate, Conrad; Blitz, Julia; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.ENGLISH ABSTRACT: Introduction. Diabetes Mellitus (DM) is on the increase globally and deemed to be at epidemic levels in Sub Saharan Africa. Lifestyle modification particularly following an appropriate dietary pattern is a cornerstone of management. One’s knowledge, attitude and practices (KAP) as well as culture and values influence one’s ability to make the required lifestyle changes. This study was carried out to establish the dietary KAP of diabetic patients attending the diabetic clinic of Nsambya hospital a tertiary private not for profit hospital in Kampala Uganda. Methods A convenient sample of 236 patients was used. Their dietary KAP was assessed using a locally modified version of the American Diabetes Association (ADA) Diabetes Self Management Assessment Research Tool (D-SMART) with some other questions from the University of Michigan Diabetes Research and Training Centre attitude, knowledge and practice questions. The modified version was validated by two local endocrinologists. The 24 hour diet recall method was also used to assess the participants’ regularity and/or frequency of meals and also to find out the commonest components of their diet. Results 67.4% of the respondents were older than 46 years of age and 63.1% were females. The females had a mean knowledge score of 57.4 (out of 60) and the males 54.1. Marital status and level of education were found to positively influence one’s knowledge. 82.7% of the respondents had the correct attitude towards DM and its management with marital status found to be the most positively contributing factor. All the respondents had poor scores on the practices section. Conclusion There is a gap between the knowledge/attitudes and the practices of the patients at Nsambya. More effective methods of delivery of the Diabetes Self Management Education (DSME) need to be used and longer term intervention programs established. Further studies especially those exploring factors affecting the DM dietary practices need to be done.
- ItemExploring lifestyle advice on healthy living given to obese patients by their obese doctors(Stellenbosch : Stellenbosch University, 2014-03) Oguns, Taiye Kemi; Blitz, Julia; Stellenbosch University. Faculty of Health Sciences. Department of Interdisciplinary Health Sciences.ENGLISH SUMMARY: Objective: The lifestyle choices of doctors can impact on their health promotion activities thereby influencing the health outcome of their patients. Doctors are a relevant source of information for patients about the health implications of lifestyle. This study was designed to explore and describe the lifestyle choices of obese doctors and also relate their lifestyle choices to the advice they give their obese patients. Study Design: A qualitative research study using in depth interview of 10 obese doctors in the Fraser Coast district of Queensland, Australia. From a local database, the names and contact information of all doctors in the district was obtained and a data sheet was sent to them to obtain information on their height, weight, age and gender. The BMI was calculated using weight (kg)/ height x height (m)2 and of those who fell into the category of BMI ≥ 30 kg/m2, 10 were systematically selected and interviewed. These in-depth interviews were audio recorded. Participants: The study group comprised of ten obese doctors systematically selected from an initial 15 respondents who fell into the obese category. Each of them volunteered information about their lifestyle activities and their counselling advices as well as expressed their perception of patients’ outcomes. Main outcome measures: Lifestyle of the doctors, content of lifestyle advices, confidence with patient counselling and the opinion of doctors on using themselves as example with respect to lifestyle Results: The lifestyle of most obese doctors is not completely healthy. They also engage in unhealthy lifestyle activities including high intake of alcohol and fizzy drinks, unhealthy eating habits and lack of exercise which is attributed to their busy schedule. Their lifestyle choices are not healthy although they were all confident in counselling their patients and reported positive outcome with many patients. The doctors however believe they can better motivate their patients to make conscious effort to live healthier if they adopt a healthier lifestyle Conclusion: Obese doctors are confident in counselling obese patients about lifestyle modification and most of them will use themselves as examples in an attempt to motivate their patients.
- ItemLate booking at the Michael Mapongwana antenatal clinic, Khayelitsha – understanding the reasons(Stellenbosch : University of Stellenbosch, 2015-07-23) De Vaal, Sybrand Johannes; Blitz, Julia; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health SciencesBackground: The initiation of antenatal care (“booking”) is universally recommended in the first trimester. While working in the Michael Mapongwana antenatal clinic (ANC) in Khayelitsha, the researcher noticed that late booking was prevalent, with consequent impaired antenatal care and increased potential for adverse outcomes. The objective of this qualitative study was to understand why women book late at this specific ANC. Methods: Twenty-three in-depth, open-ended interviews were conducted with 23 late bookers (i.e. who booked after 18 weeks) who attended the ANC between June and October in 2009. The interviews were recorded, transcribed, and analysed according to the “Framework” model. Results: The mean gestational age at booking was 26,4 weeks (range: 20 to 34 weeks). The majority were multigravid, unmarried and unemployed. A high incidence of previous or current obstetric problems was noted. Important personal barriers included ignorance of purpose of antenatal care, ignorance of ideal booking time, and denial or late recognition of an unplanned pregnancy. Provider barriers appeared to be significant, especially the cumbersome booking system, absence of an ultrasound service, and perceived poor quality of care. Conclusion: A combination of personal and provider barriers contributed to late booking at this clinic - it seems that the perceived effort of attending this antenatal service outweighed the perceived value thereof. Provider barriers should be addressed by accommodating patients’ needs, optimising nurse-patient interaction, provision of an ultrasound service and improvement of the booking system. Public awareness of early booking and the holistic value of antenatal care should also be enhanced.
- ItemModifiable pre-natal risk factors for stillbirth in pregnant women of the Omusati Region, Namibia(Stellenbosch : Stellenbosch University, 2015-12) Tshibumbu, Desire Dinzela; Blitz, Julia; Stellenbosch University. Faculty of Health Sciences. Department of Interdisciplinary Health Sciences.ENGLISH ABSTRACT : Background Reduction of stillbirth rates is one of the major concerns of the government of Namibia because of the social and economic implications of stillbirth. Access to quality antenatal care, especially at primary health care settings, is important in preventing the risk factors associated with stillbirth. This study assessed the prevalence of some of the modifiable risk factors to reveal potential gaps in their prevention. Aim To determine the prevalence of modifiable antenatal risk factors associated with stillbirth in order to determine possible gaps in their prevention. Setting The study was conducted at four district hospitals in the Omusati Region, Namibia. Methods A descriptive study using recorded antenatal data was used. Data was collected from the records of 82 women at the time that they had a stillbirth, during the period October 2013 to December 2014. The assessed risk factors included maternal characteristics, antenatal care received, medical conditions and obstetric complications. Results The study found that 95.1% of women who had a stillbirth had at least one modifiable risk factor. The average prevalence of each of the four categories of risk factors was as follows: quality of antenatal care (19.8%), maternal characteristics (11.4%), medical conditions (8.9%) and obstetric complications (6.5%). The most prevalent individual risk factors included the following: no folate supplementation (30.5%), positive HIV status (25.6%), advanced maternal age (20.7%), grand multigravidity (17.1%), late booking (16.7%), intrauterine foetal growth retardation (13.4%) and alcohol use (12.5%). Conclusion A total of 82.4% of the studied modifiable risk factors were prevalent among women who had a stillbirth. Risk factors associated with quality of antenatal care were the most prevalent. While further investigation is needed to determine the causes behind the most prevalent risk factors, health education on the availability and benefits of antenatal care, pregnancy timing and pregnancy spacing may contribute to the reduction of the prevalence of these risk factors.
- ItemNeurocysticercosis: knowledge, attitudes and practice of epileptic patients in northern Namibia(Stellenbosch : Stellenbosch University, 2016-03) Ogunsina, J. T.; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.ENGLISH SUMMARY : Background: The incidence of epilepsy continues to rise worldwide, particularly in developing countries, and studies have shown that most cases of epilepsy are associated with neurocysticercosis. Proper knowledge and the adoption of a hygienic life style could help in preventing the spread of taeniasis infection in developing countries. However, the knowledge, attitudes and practices of epileptic patients regarding neurocysticercosis have been inadequate. Aim: This study sought to establish the knowledge, attitudes and practices regarding neurocysticercosis in epileptic patients in northern Namibia. Methods: A cross-sectional study was done using a questionnaire to interview 120 epileptic patients seen in the medical outpatient department of Oshakati Hospital in Namibia. Demographic characteristics of the participants were obtained, and their knowledge, attitudes and practices regarding neurocysticercosis were assessed. Results: Out of the 120 participants in the study, 60% were female and the majority (81.7%) were pork eaters. A high percentage (61.8%) of the participants practised free-range pig husbandry, and the majority (72.8%) and their pigs (83.9%) were not treated for worm infestation. Conclusion: There were considerable gaps in the knowledge and healthy practices of epileptic patients regarding neurocysticercosis in northern Namibia. The participants still have behaviours that may favour the continued spread of neurocysticercosis in the community. Therefore, there is need for educational intervention or campaign to reduce the incidence of the infection in the community.
- ItemPerceptions of doctors and nurses of International Hospital Kampala (IHK) – Out Patient Department and Emergency Unit (OPD&EU), regarding introduction and use of the South African Triage Scale (SATS)(Stellenbosch : Stellenbosch University, 2015-12) Mulindwa, Francis; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY : Introduction: International Hospital Kampala has been having a challenge with how to standardize the triaging and sorting of patients. There was no triage tool to help prioritize which patients to attend to first. Very sick patients who needed urgent attention were often missed. Methods: This study using qualitative methods sought to introduce the SATS in the IHK OPD/EU and get the perceptions of doctors and nurses who used it for 3-6 months on its worthiness and sustainability. Specific questions were on challenges faced prior to its introduction, strengths and weaknesses, the impact it had on the practice of staff and their recommendations on the continued use of the tool. In-depth interviews were conducted with 4 doctors and 12 nurses. Results and discussion: The SATS tool was found to be necessary, applicable and recommended for use in the IHK setting. It improved the sorting of patients, nurse-patient and nurse-doctor communication. The IHK OPD/EU staff attained new skills with the nurses getting more involved in the care of patients. It is possibly useful in phone triaging and planning of hospital staffing. Conclusion: Adequate nurse staffing, computer application for automated coding of patients and regular training would foster consistent use and sustainability. Setting up a hospital committee to review the signs and symptoms would rubber stamp its sustainability. The SATS is valuable in the IHK setting because it has improved on the overall efficiency of triaging and care with significantly more strengths realized than weaknesses.
- ItemPredictors of pneumothorax in motor vehicle accident (MVA) survivors who sustain chest trauma(Stellenbosch : Stellenbosch University, 2014-04) Oguns, Oladele Joe; Blitz, Julia; Stellenbosch University. Faculty of Health Sciences. Department of Interdisciplinary Health Sciences.Pneumothorax is a relatively common1 and potentially fatal complication of MVA.2 The incidence of pneumothorax in MVA was found to be 38% in Cape Town1 and 54.6% in India.3 Pneumothorax may be missed during clinical assessment. An audit of paramedic records from 2000-2001 in Melbourne, Australia found that a significant number of tension pneumothoraces were missed prior to assessment at the hospital4. This led to a change in the clinical guideline for paramedics resulting in a 60% decrease in undiagnosed tension pneumothorax within the next 12months4. There has been no Australian study to establish the incidence of pneumothorax or its specific clinical predictors in MVA survivors. This could be a useful tool for doctors during assessment of chest injured MVA patients therefore the need for this study OBJECTIVES Pneumothorax (PTX) is a treatable yet potentially fatal surgical condition. Clinical diagnosis of this condition can be very unreliable. A review of medical records over a 5 year period was done with the aim of identifying common predictors of pneumothorax as well as defining the common forms of chest injuries associated with it in motor vehicle accident (MVA) survivors by embarking on a critical analysis of data collected from the study. MATERIALS AND METHODS A retrospective chart review was carried out on a total of 63 male and female patients of all age groups with chest injuries specifically resulting from motor vehicle accidents. A comparative analysis of data was carried out on these patients after categorising them based on age, sex, position of the victim at the time of occurrence of MVA, nature of the injury (blunt/penetrating), association with subcutaneous emphysema, rib fractures and intrathoracic organs RESULTS In this study, out of the 63 cases reviewed, there was a total of 18 cases of pneumothorax: 14 males (77.78%) and 4 females (22.22%) with an age range between 7 to 70years, a median age of 38.5years and average age of 41.44years. 7 of these patients were motorcyclists, 6 drivers, 2 bicycle riders, 2 pedestrians, 1 motorcycle passenger and all patients survived with no case fatality recorded. 88.89% resulted from blunt chest injuries while 11.11% resulted from penetrating chest injuries. All the penetrating chest injuries were associated with pneumothorax. 50% of pneumothoraces had an associated fracture of multiple ribs, 27.78% had an associated fracture of a single rib and 38.89% were associated with subcutaneous emphysema, 66.67% of pneumothorax had tube thoracostomy while 33.33% were conservatively managed by hospital admission and observation. CONCLUSION Pneumothorax occurs in 28% of MVA survivors with chest injuries with about three quarters of these cases (72.2%) accounted for by motorcyclists and vehicle drivers. Other strong predictors for pneumothorax are the presence of penetrating chest injury and fracture of one or more ribs. When diagnosed and appropriately managed, 100% survival from pneumothorax is achievable. Evidence was found in support of routine imaging investigation of MVA victims with chest injuries as clinical diagnosis of pneumothorax was insensitive. Also, either surgical intervention with tube thoracostomy or hospital admission for clinical monitoring should be routinely carried out on these patients.
- ItemThe prevalence of factors contributing to non-adherence to TB treatment in Lukhanji LSA (Queenstown), South Africa(Stellenbosch : University of Stellenbosch, 2012-03) Kayembe, C. K.; Blitz, Julia; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.ABSTRACT: Tuberculosis remains a problem in Lukhanji Local Service Area (LSA) where the number of patients notified to authorities is reportedly increasing. This study, undertaken at various clinics in Lukhanji LSA, shows that non-adherence to TB treatment remains a challenge. The aim of this study was to identify the main factors contributing to this situation and to make recommendations. Methods: This was an unmatched case-control observational study using the data relating to patients undergoing treatment. The collection of data took place from December 2010 to June 2011. Two groups were studied: (i) those who did not adhere and (ii) those who did adhere to the prescribed treatment. The data from these two groups was compared. Prevalence of non-adherence was determined. In addition, the prevalence of factors studied were estimated and odds ratios were used to determine factors significantly associated with non-adherence. Results: Data was obtained from 195 patients, 98(50.26%) of whom were non-adherent and 97(49.74%) adherent. The following factors were significantly associated with non-adherence to TB treatment in this community: loss of hope; school or work commitments; patients' marital status; patients' under arrest; lack of support; involvement in drug abuse; TB denial and tablets not available from the clinics. For these factors, the odds ratios were more than one indicating that these factors are more likely to contribute to non-adherence in the non-adherent group Conclusion: The prevalence of factors contributing to non-adherence to TB treatment in this community is high. This was despite the fact that there is no charge TB drug. There is an urgent need for health authorities in this community to take strong action to improve patients' adherence to TB treatment.
- ItemA qualitative study of weight loss maintenance in obese Nigerians(Stellenbosch : Stellenbosch University, 2015-12) John-Oko, Akpezi; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY : Abstract: The rising prevalence of overweight and obesity globally is a major public health concern. There are no simple solutions to obesity, weight management is a long term challenge influenced by behavioural, emotional and physical factors. In order to establish effective weight management strategies, overweight and obese people’s experiences with weight management need to be comprehensively understood. This study explores the experiences of adult Nigerians who have been successful at weight loss maintenance. Aim: To establish effective weight loss maintenance strategies used by overweight and obese adults in Abuja, Nigeria Method: Qualitative study with in-depth interviews of 7 successful weight losers in Abuja, Nigeria. Results: Participants employed a combination multiple dietary strategies and exercise to maintain their weight loss. They reported that they avoided certain meals, substituted meals, practiced portion control, skipped meals, counted calories, avoided eating out, ate many small meals, ate unprocessed foods, ate low calorie meal, and ate mainly fruits and vegetables. Most had a flexible eating restraint behaviour. For most, dancing was the favorite form of exercise. They viewed these changes as life goals. From their report, t a sustainable weight loss plan, setting weight loss goals, regular self -monitoring of weight, positive outcomes, positive thinking, positive feedback, self-encouragement and determination, helped them to maintain their weight loss. Conclusion: This study has helped us understand some of the factors that doctors should consider when giving advice to Nigerian women on maintenance of weight loss. The combination of multiple strategies is consistent with existing literature on successful weight loss maintenance.
- ItemA study of factors in the treatment support system that contribute to successful haart adherence at Tshepang Clinic(Stellenbosch : Stellenbosch University, 2012-12) Mbala, Lubilanji; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY : Background: HIV/AIDS is a chronic disease for which no cure has been found yet. The only effective way to give a better life to the infected patients is to suppress their viral loads. The Highly Active Antiretroviral Treatment (HAART) is what we have so far in hand to achieve that goal. Adherence is crucial in managing our patients. In South-Africa, Tshepang clinic is one of the facilities which offer HAART. Objectives: The aim of the study was to understand the relationship between patients adherent to HAART and their buddies in achieving successful adherence at Tshepang clinic. The objectives were to explore the views of adherent patients on ARVs about the role of their buddy and to describe the views of buddies of patients who are adherent to ARVs on their role as treatment supporters. Methods: A qualitative study using focus group was the method of data collection. The discussions were conducted both in English and in local languages. The discussions were audio and video recorded. 22 participants divided in 2 groups of patients adherent to HAART and 2 groups of their buddies were selected. Results: All respondents were aware that the buddy’s fundamental knowledge on HIV topics was important in improving adherence. The buddy should be aware of the expected benefits of HAART. Disclosure of the HIV status was a key element in the management of HIV/AIDS despite the barriers and the buddy was expected to assist the patient in that regard. The buddy should be trustworthy and capable of complying with the need for confidentiality. Mutual respect and good communication between the buddy and the patient were to be encouraged. A buddy is expected to take the patient through the process of acceptance of the HIV status even in cases where the patient has started HAART but is still in denial. The mindset of the buddy and the patient is the foundation on which every strategy should be built. Buddies of patients with other co-morbidities should be allowed to collect medications on their behalf. The buddies should take an interest in the life style and behaviors of patients. Conclusion: The 13 themes generated from the respondents were well known in our health facility but they have not been addressed deeply. The findings of this study can be applied at Tshepang clinic in order to help achieving the goals of the antiretroviral therapy.