Masters Degrees (Family Medicine and Primary Care)
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Browsing Masters Degrees (Family Medicine and Primary Care) by browse.metadata.advisor "De Villiers, Pierre J. T."
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- ItemCompliance of St. Joseph’s Hospital Roma, Lesotho with the National Tuberculosis Programme of Lesotho, 2007/2008(Stellenbosch : Stellenbosch University, 2011-03) Oladoyinbo, Olarotimi Samuel; De Villiers, Pierre J. T.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.ENGLISH SUMMARY : Background and Objective: Most National Tuberculosis Programmes ( NTPs) have focused their efforts on reaching the short-term internationally recommended TB control targets set in 2005 by the World health assembly;-a case detection of 70% with successful treatment of 85% of the detected cases. The National TB programme of Lesotho registered 3976 sputum smear positive cases for TB treatment in 2008, 73.5% (2834) of which were successfully treated. This falls short of the global target of at least 85% treatment success rates. The national TB programme has lamented over the last 5 years for its inability to meet targets set by the WHO for measuring effective TB programmes, because of the inability of most of the hospitals to fully implement the national TB programmes as recommended. Most of the hospitals running TB programmes in the country still have difficulty blending the clinical and programmatic components of TB treatment together, hence explained the poor treatment outcome seen over the past years. In view of this perceived gap, an investigation into programme compliance by the hospitals serving as TB roll out centres is warranted. The aim of the study was to evaluate the implementation of the national TB program in St. Joseph’s hospital Roma, Lesotho (which happens to be one of the district hospitals in Lesotho providing TB service delivery), and also to come up with recommendations that will improve TB treatment outcome where gaps are identified and subsequently improve the TB programme in the hospital and contribute towards improving the overall TB programme for Lesotho. Methods: A retrospective cohort study design was used. The study was carried out on the records of TB patients who were treated at St. Joseph’s hospital Roma, Lesotho in 2007 and 2008. All patients treated for TB within the specified period were consecutively selected for the study, except for those who did not meet the inclusion criteria. Nine hundred and ninety three (993) TB patients’ records were evaluated, for 2007 (509 records were evaluated) and for 2008 (484 records were evaluated). Results: There was a marginal improvement in the case detection of smear positive patients, sputum conversion rate, TB treatment outcome such as cure rate, mortality, treatment failure, defaulters, transferred outcome and TB/HIV collaborative activities such as HIV testing among TB patients, cotrimoxazole and antiretoviral uptake among TB/HIV co-infected. In terms of comparison of the targets achieved with the targets set by the national TB programme of Lesotho, targets were met in defaulter and treatment failure rates, but were not met in case detection of smear positive pulmonary TB, sputum conversion rate, cure rate, mortality rate, treatment success rate, HIV testing uptake among TB patients, cotrimoxazole uptake among TB/HIV positive patients and ARVs uptake among TB/HIV positive patients. Conclusions: Although the national TB programme has got good monitoring and evaluation tools, these are mainly reporting tools. In- house result analysis, individual case studies and overall programme management evaluation are invaluable assets to control and improve programmes. There was a significant improvement in St. Joseph’s TB programme, especially in the case detection of smear positive PTB, defaulter and treatment failure rates, TB/HIV co-infection detection and ARVs uptake among eligible patients, in 2008. However, meeting targets in sputum conversion, treatment outcome is still a big challenge, hence the need for implementation of the recommendations made in this document to close the identified gaps and Improve TB service delivery in the hospital.
- ItemA description of patients with recurrence of pulmonary tuberculosis in TB hospital, Ermelo(Stellenbosch : University of Stellenbosch, 2015-07) Akpabio, Ubon S.; De Villiers, Pierre J. T.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences.South Africa is one of the high burden countries for TB in Sub Sahara in Africa with Mpumalanga as one of the provinces with a high burden of disease. Data available on tuberculosis in Msukaligwa indicate the following: Cure Rate 40%; Smear conversion at the end of intensive phase 35% and Defaulter Rate 27.5%. The problem of TB is made worse by the twin epidemic of HIV, with a prevalence of 38.9% in our district -the highest among the 3 districts in the province. Retreatment TB carries the risk of developing TB drug resistance with severe consequences for the patient and the population. Understanding the characteristics of these patients will help in designing interventions to prevent the problem, promote a high cure rate for patients with TB in our health care system and reduce to minimum the burden of re-treatment pulmonary TB on our health care facilities and community. One critical precondition for Retreatment TB is non adherence to TB treatment. Factors responsible for non adherence could be classified as individual patient factors; Co-morbid conditions; Health system; treatment related and Community factors. The outcomes of Retreatment TB could be, cure, and death and failure of treatment leading to drug resistance. The Setting of this study is the 58-bedded TB hospital in Ermelo. The Aim of the study was to describe the occurrence, characteristics and management outcome of Retreatment Pulmonary Tuberculosis in patients in the Ermelo TB hospital. The specific Objectives were to describe the socio-demographic, behavioural and clinical factors related to recurrence of the TB in patients; to determine the contribution of non adherence to treatment on recurrence of TB in the study population; to identify the prevalence of resistance to TB medication among patients with Retreatment TB ; to identify treatment outcomes in patients who have been followed up for the duration of Retreatment TB and finally to make recommendations to the Department of Health, Mpumalanga towards minimizing Retreatment TB and improving the overall TB programme. The Study design is cross sectional and descriptive; the study population comprised of patients admitted with TB at Ermelo TB hospital aged 15 years and older between 1 January 2005 and 31 December 2007.No specific probability sampling was applied in the selection of the patients. Data Collection involved visits to the TB hospital during the period and extracting the relevant information from the patient medical records and the TB register using a predesigned data collection form. Data analysis was done by the statistician from the Centre for Statistical Consultation, University of Stellenbosch. Being a descriptive study, the data analysis expresses the prevalence of various factors associated with retreatment TB. This study met the Ethical approval of the University of Stellenbosch as well as the Research Ethics Committee of the Department of Health & Social Services, Mpumalanga. Findings All the three hundred and eighty eight patient records with retreatment TB forming 19.6% of TB patients admitted between 2005 and 2007 were reviewed. The distributions of the patients were: males 66%; mean age of 41.4 years; females 34%; mean age 35.3 years. They were mostly unemployed; primary education 93%; unmarried 43% and married 34%.Retreatment TB was diagnosed with sputum smear microscopy in 71% with bacilli load of 3+ in 45%.The sources of referral to TB hospital were: public hospital 71 %; private doctors 2%. 74% of the patients have had TB 1-3 years before the episode under study. Retreatment TB categories were: after treatment completed 69%; default 19%; after cure 8% and treatment failure 4%. 98% of patients tested had +ve HIV status; the median CD4 cell count was 106 cells/µl at the time of retreatment; very few (5%) were on ART. Drug resistance to primary TB drugs was as follows: Rifampicin 16%; Isoniazid 29%; Ethambutol 19% and Streptomycin 23%. The treatment outcomes for those whom data were available were: successful 49.1%, death 23.8%; treatment default 22.9%. MDR-TB complicated 3.3% of the patients. Conclusion: Majority of the retreatment TB patients were males with an average age of 41years and unemployed. More than two thirds of the patient had completed TB treatment previously and default on treatment accounted for less than one quarter of retreatment categories. The process of care was better in terms of diagnosis of TB with sputum smear. Improvement in the documentation of key factors like smoking, alcohol, drug use among patients and co-morbidity as well as counselling and testing for HIV and provision of ARTs is required. Treatment outcomes with regards to successful outcome need to be monitored and improved upon.
- ItemThe prevalence of HIV in adult Tuberculosis patients in Stellenbosch(Stellenbosch : Stellenbosch University, 2009-12) Niland, B. M. Delmence; De Villiers, Pierre J. T.; Laubscher, Jaco; University of Stellenbosch. Faculty of Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY : Objective: To determine the prevalence of HIV in, and the profile of, adult tuberculosis (TB) patients seen at Stellenbosch district hospital and the four surrounding clinics. Methods: A retrospective descriptive study design was used. The files of all the recently diagnosed adult TB patients who were admitted to the wards of Stellenbosch district hospital, seen at the hospital Out Patient Department (OPD) or seen in the four surrounding clinics during the period January –June 2008 were used to extract all the necessary information. Results: During the six month period dedicated to the investigation, 278 patients were found to have proven new onset TB. There were 56% male TB patients and 44% female TB patients. Most of the TB was in the 20 to 40 year old age group. Of the TB patients, 33.1% were HIV positive, 28.4% were HIV negative, 29.5% were not tested and 9% refused to be tested. Of those tested 53% were HIV positive and 46% were HIV negative. Conclusion: The prevalence of HIV in the tested TB patients was 53%. The reasons why 29% of the patients did not receive Voluntary Counselling and Testing needs to be investigated and addressed. Although the Western Cape has been found to have the lowest HIV prevalence in TB patients in South Africa, it is of great concern that it is still rising, having more than doubled in the past ten years. More needs to be done to curb the spread of both HIV and TB.