Department of Global Health
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Browsing Department of Global Health by browse.metadata.advisor "Barnes, J. M."
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- ItemAccuracy and completeness of notification of tuberculosis in two high incident communities in Cape Town, South Africa(Stellenbosch : Stellenbosch University, 2011-12) Dunbar, Rory; Barnes, J. M.; Beyers, Nulda; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Community Health.ENGLISH ABSTRACT: Introduction: Tuberculosis (TB) treatment registers and laboratory records are essential recording and reporting tools in TB control programmes. Reliable data are essential for any TB control programme but under-registration of TB cases has been well documented internationally, due to under-reporting of patients on treatment or failure to initiate treatment. The accuracy and completeness of routinely collected data are seldom monitored. Aim: This study used record linking to assess the accuracy and completeness of TB treatment register data and the feasibility of estimating the completeness of bacteriological confirmed pulmonary TB registration in two high incident communities in South Africa with capturerecapture methods. Methods: All cases of bacteriologically confirmed TB defined as 2 smear-positive results and/or at least one culture-positive result were included. Record linking was performed between three data sources: (1) TB treatment registers; and (2) all smear and culture results from (a) the nearest central laboratory, and (b) the referral hospital laboratory. To estimate the completeness of TB treatment recording three-source log-linear capture-recapture models were used, with internal validity analysis. Results: The TB treatment registers had 435 TB cases recorded of which 204 (47%) were bacteriologically confirmed cases. An additional 39 cases that were recorded as nonbacteriological cases in the TB treatment register, were reclassified as bacteriologically confirmed. In addition, there were 63 bacteriologically confirmed cases identified from the laboratory databases which were not recorded in the TB treatment register. The final total number of bacteriologically confirmed TB cases across all 3 databases was 306, an increase of 50% over what had initially been recorded in the TB treatment register. The log-linear capture-recapture model estimated the number of bacteriologically confirmed TB cases not found in any of the data sources at 20, resulting in a total number of bacteriologically confirmed TB cases of 326 (95% CI 314-355). The completeness of registration of bacteriologically confirmed pulmonary TB cases was 79% after record linking and 75% after the capture-recapture estimate. Conclusions: The results presented in this thesis highlighted the concern regarding the accuracy and completeness of routinely collected TB recording and reporting data. A high percentage of bacteriologically confirmed cases from both laboratories were not recorded in the TB treatment registers. Capture-recapture can be useful, but not essential, for evaluation of TB control programmes, also in resource-limited settings, but methodology and results should be carefully assessed. The present study estimated the extent of the problem of underreporting of TB in South Africa and identified challenges in the process. Interventions to reduce underreporting of TB are urgently needed.
- ItemThe health and sanitation status of specific low-cost housing communities as contrasted with those occupying backyard dwellings in the city of Cape Town, South Africa(Stellenbosch : Stellenbosch University, 2011-12) Govender, Thashlin; Barnes, J. M.; Pieper, C. H.; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Community Health.ENGLISH ABSTRACT: South Africa embarked on an ambitious program to rehouse the informally housed poor. These initiatives were formerly called the RDP and later the BNG programmes. This was aimed at improving the living conditions of the urban poor and consequently their health and poverty status. These low-cost houses were quickly augmented by backyard shacks in almost all settlements. The present study is an epidemiological assessment of the health and sanitation status of inhabitants of specific low cost housing communities in the City of Cape Town as contrasted with those occupying ‘backyard dwellings’ on the same premises. The study was undertaken in four low-cost housing communities identified within the City. A health and housing evaluation, together with dwelling inspections were carried out in 336 randomly selected dwellings accommodating 1080 inhabitants from Tafelsig, Masipumelela, Driftsands and Greenfields. In addition, the microbiological pollution of surface run-off water encountered in these settlements was assessed by means of Escherichia coli levels (as found by ColilertTM Defined Substrate Technology) as an indication of environmental health hazards. The study population was classified as ‘young’ - 43% of the study population was aged 20 years or younger. Almost a third of households were headed by a single-parent female. In all four communities combined, 47.3% of households received one or other form of social grant. At the time of inspection 58% of the toilets on the premises were non-operational, while all the houses showed major structural damage - 99% of homeowners reported not being able to afford repairs to their homes. In 32% of dwellings one or more cases of diarrhoea were reported during the two weeks preceding the survey. Five percent of the participants willingly disclosed that they were HIV positive, while 11% reported being TB positive (one of them Multiple Drug Resistant TB). None of the HIV positive or TB positive persons was on any treatment. The E. coli levels of the water on the premises or sidewalks varied from 750 to 1 580 000 000 organisms per 100 ml of water - thus confirming gross faecal pollution of the environment. Improvements in health intended by the re-housing process did not materialise for the recipients of low-cost housing in this study. The health vulnerability of individuals in these communities has considerable implications for the health services. Sanitation failures, infectious disease pressure and environmental pollution in these communities represent a serious public health risk. The densification caused by backyard shacks also has municipal service implications and needs to be better managed. Policies on low-cost housing for the poor need realignment to cope with the realities of backyard densification so that state-funded housing schemes can deliver the improved health that was envisaged at its inception. This is in fact a national problem affecting almost all of the state funded housing communities in South Africa. Public health and urban planning need to bridge the divide between these two disciplines in order to improve the health inequalities facing the urban poor.
- ItemHealth concerns related to housing, sanitation, water access and waste disposal in a poor mixed urban community, Mbekweni in Paarl(Stellenbosch : Stellenbosch University, 2021-03) Ngakane, Lerato; Barnes, J. M.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.ENGLISH SUMMARY : South Africa's rapid population growth and fast in-migration into already densely populated urban areas are placing great strain on municipal services. Numerous municipalities outside the major cities are not able to provide adequate infrastructure or safe standards of basic services in these low-income areas. In urban poor communities, the sustainable management of recovery or recycling of waste is carried out poorly or not at all. Hygiene, sanitation, and proper waste disposal are of great concern to both the public and the environment. Poor waste management leads to the degradation of the environment and poor sanitation results in the spread of communicable diseases. This study aimed to investigate the degree to which human behaviour results in direct and/or indirect health risks for a low-income community with mixed informal and semiformal housing. The impact on the immediate environment is also investigated. The problems facing such communities outside of the main cities are not well researched. A cross-sectional survey that covered topics of demography, housing, waste and waste disposal, health and hygiene features was designed. The survey targeted residents living in informal settlements in Mbekweni as well as low-income houses. Systemic sampling with random starting points was used to collect the necessary data. A total of 117 structures representing 512 inhabitants were investigated and a series of water samples was collected at various location points near the residences in order to assess the level of environmental pollution. Forty-eight percent of the respondents lived in shacks, while 52% lived in brick-and-mortar houses. The whole community can be classified as falling into the low-income bracket with households receiving an average monthly income of R3736. Findings also showed that 45% of the community had to make use of communal toilets and taps, many of which were not fully functional. Nineteen percent of the participants reported gastrointestinal symptoms during the survey, 10% possible TB symptoms and 9% other infections. The E. coli counts detected in the environmental water samples varied from 2300 organisms to 32 million organisms per 100 ml water, indicating extensive sewage contamination. In this indigent community, the study found poor waste disposal behaviour, poorly maintained sanitation facilities resulting in high levels of environmental pollution. Such factors are linked to high risks of infectious diseases in the community. The study found that the community had little knowledge concerning the ways in which they can be involved in minimizing the spread of communicable diseases and keeping their community clean. The study participants displayed an adequate basic knowledge of home hygiene. The qualitative assessment of their domestic sanitation and hygiene however did not reflect that knowledge. There is an urgent need for reform of basic service delivery to such communities as well as education to improve their sanitation approach.
- ItemThe health status of the elderly receiving an old age pension in urban communities in the City of Cape Town(Stellenbosch : Stellenbosch University, 2012-12) Govender, Thashlin; Barnes, J. M.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences.ENGLISH ABSTRACT: In developing countries the increasing number of the aged are often viewed as a problem. In particular, the indigent elderly residing in poor urban areas are at risk of becoming marginalised and underserved. The Western Cape has the third largest elderly population in proportion to the total population in the country. Social assistance in the form of a monthly pension is paid out to all elderly who pass a national means test carried out by South African Social Security Agency (SASSA). An assessment of the characteristics and health status of the elderly collecting old age pensions living in low-income urban poor communities in the City of Cape Town was carried out at pension pay points across four communities, i.e. Gugulethu, Khayelitsha, Mitchells Plain and Bonteheuwel. In community health surveys, choices regarding the methodology have to be made that can have profound effects on the study design and study outcomes. The milieu of the present study is one of urban poverty and specifically those urban elderly who qualify for non-contributory pensions (also called social cash transfers or government grants). The paucity of existing community-based studies on old-age pensioners in the City of Cape Town meant that a cross-sectional survey with wide-ranging coverage of demographic, social and health factors was the most logical design to employ in order to determine the extent of present needs and generate hypotheses for further controlled studies. A systematic random sample of 703 elderly was drawn at nine pension pay-out points in Cape Town Metropole. No pensioners refused to participate in the study. Structured interviews were carried out covering demographics, number of dependents, living conditions, socioeconomic circumstances, health status and needs and utilisation of health services. A reported 43% of participants lived in shacks and 88% reported regularly eating less than 3 meals a day. Eighty-seven percent of respondents reported waiting 3 hours or longer for medication at a clinic while 90% reported being dissatisfied with the service at their clinic. Fifty-eight percent of pensioners reported not being able to see well while 83% did not know where to get their eyes tested. Almost 70% of pensioners said that they have been ill-treated by a family member and 64% scored as severely depressed on the geriatric depression scale. In this study, 266 pensioners solely supported 471 children of which 65 (14%) were disabled children. In 95% of cases the pensioner does not receive any support from the child's parents. The study found that the elderly on a state grant had considerable unmet health needs and required assistance with activities of daily living. The indigent pensioners in this study bore a huge duty of care for minor children as custodial grandparents while not receiving a high level of health support themselves.
- ItemAn investigation into the hygiene practices and food safety of street vendors outside pension pay-out points in urban poor communities in the City of Cape Town(Stellenbosch : Stellenbosch University, 2021-03) Rohith, Shamiska; Barnes, J. M.; English, R.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.ENGLISH SUMMARY : Street vended food is an affordable form of sustenance in many developing countries like South Africa. They provide urban low-income communities with an essential food supply chain. Social grants are used to purchase street foods sold by vendors who are strategically located at pension pay-out points. Food products sold by street vendors can be seen as a public health issue affecting the health and well-being of the low-income urban communities. Street Food Vendors (SFVs) may operate without due regard for the basic requirements critical to the hygienic preparation and storage of foods. A few studies on street vended foods have been performed in Gauteng and the Free State, however, there is a paucity of data within the Western Cape. A cross-sectional study was performed to obtain demographic information on SFVs present at pension points within selected lower-income urban areas in the city of Cape Town and to concurrently assess their knowledge on food safety. Food, water and swab samples of surfaces were collected and tested for their microbiological safety expressed as the Total Microbial Activity (TMA) and Colony Forming Units (CFU). A questionaire was also sent to the Environmental Health Practitoners (EHPs) to assess their needs and challenges. A reported 68% of the SFVs in the study were female and 40% of the street vendors lived in informal dwellings. A reported 52% of the SFVs prepared their foods at the stall, 32% at home and the stall; but only 20% had access to ablution facilities at the stall. The street vendors who cooked foods over a wood fire comprised 64%, and 12% reported having resold leftovers. With regards to washing up, 60% were unsure about the frequency of changing the washing-up water and 12% did not wash their utensils. It is of concern that 32% of the SFVs did not wear any protective clothing. The Total Microbial Activity (TMA) activity for most of the food and water samples showed some very high counts (>100000), which is an indication of food spoilage and potential bacterial growth. The samples of hot food showed no growth, but the water samples showed the presence of a variety of gram-positive and gram-negative organisms. The swab samples were only tested for E. coli of which, 3 vendors tested positive (<103) for E. coli on their hands. Thirtyone percent of the swabs from various surfaces at the food stalls indicated that the hygiene levels posed a risk. Food safety knowledge of SFVs was found to be deficient in certain areas as 60% did not understand the importance of using safe products and 36% did not know the safe storage temperatures of cooked foods. It is compulsory to have certification to operate as a street vendor, but 80% of SFVs did not. SFVs (52%) did acknowledge that there were inspections by EHPs. In conclusion, the samples of hot foods were safe to consume but the hygiene of the street vendors is questionable, as indicated by the quality of the water and swab samples. SFVs require further food safety and hygiene training, proper supervision as well as access to basic facilities.
- ItemAn investigation of early childhood caries in the lower socio-economic areas surrounding Tygerberg Oral Health Centre in order to plan a community appropriate intervention strategy(Stellenbosch : Stellenbosch University, 2014-12) Mohamed, Nadia; Barnes, J. M.; Nel, E. D. L. R.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept.of Interdisciplinary Health Sciences. Division of Community Health.ENGLISH ABSTRACT: The long waiting lists for general anaesthesia and sedation services for children with Early Childhood Caries (ECC) at the Tygerberg Oral Health Centre highlighted the problem of ECC in this area. This was confirmed by a retrospective study of patient records at the Centre. ECC is largely caused by a combination of lifestyle factors, especially feeding and oral hygiene practices. Socio-economic status and parental factors such as education and employment have also been shown to play a role in the development of ECC. In order to address this problem, a study was designed to determine the prevalence of ECC in children from the lower socio-economic communities which drain to the Tygerberg Oral Health Centre and assess the knowledge of the caregivers of these children. A total of 659 children were examined at crèches and schools as well as community health clinics. The children examined at the clinics accompanied others and did not have any health reason for the visit themselves. As the aetiology is largely behaviour-driven and children are dependent on their caregivers to meet their basic needs, 366 caregivers attending the community health clinics with their children, were interviewed to determine their practices and knowledge of oral health. A total of 83 health care workers at these clinics were also interviewed to assess their knowledge of oral health matters and determine the role that they can play in the prevention of this disease. A cross-sectional community survey was carried out by means of clinical assessments and structured interviews with the aid of questionnaires. The survey was divided into 3 parts: 1. Prevalence of ECC amongst the children 2. Knowledge of the caregivers about oral health care 3. Knowledge of health care workers at the clinics in these communities about ECC The prevalence study revealed that 71.6% of children in the study population presented with caries. This is extremely high and highlights the need for serious interventions. Parents/ caregivers were shown to be ill-informed regarding their children’s oral health care needs which include dietary and oral hygiene practices as well as how this disease can be prevented. It is clear that caregivers need to be educated regarding feeding practices, weaning time, dietary content and the importance of basic oral health. The importance of preserving the primary dentition and regular dental attendance also needs to be emphasized in this community where dental health does not seem to be a priority. Health care workers such as nurses who come into contact with children from an early age would be the ideal vehicle to impart this information. However, as revealed from the results of this study, there is a serious lack of knowledge amongst these professionals regarding oral health matters. Time and resources therefore have to be invested to improve their knowledge and lessen their load so that more emphasis can be placed on prevention. Small changes can make a big difference towards addressing the burden of this disease on the health care system.