Masters Degrees (Health Systems and Public Health)
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Browsing Masters Degrees (Health Systems and Public 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.
- 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.