Masters Degrees (Health Systems and Public Health)

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Acceptability and accessibility of pre-exposure prophylaxis modalities for HIV prevention (oral daily PrEP, dapivirine vaginal ring and long-acting cabotegravir injectable) among female sex workers in Salt River, Cape Town : a cross-sectional study
(Stellenbosch : Stellenbosch University, 2022-12) Mbuyamba, Rachel; Cois, Annibale; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
ENGLISH SUMMARY: Background: Female sex workers (FSWs) are at high risk of contracting HIV and have poor access to health care. Evidence is being collected in real world settings on the acceptability and accessibility of pre-exposure prophylaxis (PrEP) amongst FSWs. We explored oral PrEP accessibility, associated factors and acceptability of alternative PrEP modalities. Methods: This cross-sectional study involved 100 HIV-negative FSWs aged >18 years receiving services at the Wits RHI Sex Worker Clinic in Salt River. We tested the association between oral PrEP uptake status and independent variables using logistic regression models. Poisson regression models were used to identify factors associated with oral PrEP accessibility levels. Linear regression was used to identify factors associated with acceptability of alternative PrEP modalities. Results: FSWs with median age 32.6 years (interquartile range 11.7 years) participated in this study, with 97% indicating that they were at risk for HIV infection. Oral PrEP uptake was 33%. Condom use with the main partner (OR = 0.2, 95% CI: 0.0-0.9, sometimes vs. never) was negatively associated with oral PrEP uptake and no previous experience with long-acting drugs (OR = 5.4, 95% CI: 2.2-13.4) was positively associated with oral PrEP uptake. Accessibility of oral PrEP was lower among FSWs for whom sex work was their secondary source of income compared to those for whom sex work was a primary source of income (aIRR for accessibility score = 0.8, 95% CI: 0.7 – 0.9). Acceptability of alternative PrEP modalities was lower among FSWs with previous treatment for sexually transmitted diseases (differences in acceptability scores -5.1, 95% CI: -14.9– 4.6). Long waiting times (72% of participants), PrEP unavailability (27%), PrEP side effects (38%), limited privacy (31%) and nurse unavailability were the main barriers to PrEP uptake. The perceived risk of HIV infection, and the availability (43%) and cost (71%) of PrEP uptake were PrEP uptake facilitators. Conclusions: Oral PrEP uptake among FSWs is currently low. Limited privacy and side effects were the main barriers to PrEP uptake. FSWs were willing to use the new PrEP modalities when available. This study provides valuable lessons for a successful introduction of new PrEP modalities.
Accommodation of accessibility survey in primary care clinics of a rural Alberta community
(Stellenbosch : Stellenbosch University, 2014-12) Van der Linde, Erich; Pather, Michael; Stellenbosch University. Faculty of Health Sciences. Department of Interdisciplinary Health Sciences.
ABSTRACT Introduction: According to the Society of Rural Physicians of Canada’s National Rural Health Strategy, 21% of Canadian residents are rural but only 9.4% of Canadian physicians live in rural areas.1,2 Aim: To evaluate patient experience and the accommodation of accessibility to four primary care clinics in Brooks, Alberta. Objectives were to: • measure and compare the actual versus expected waiting times in the physician’s office. • assess patient satisfaction with the current organization of access and quality of care. • elicit ideas from patients on how to improve the accommodation of access. • elicit feedback from patients regarding the employment of alternative practitioners in the clinics. Methods: Design: cross-sectional survey. Setting: Four primary care clinics in the city of Brooks. Subjects: The study sample (n=391) included registered patients including emergency walk-in consultations, consultations for office procedures, short visits for prescription refills as well as annual physical examinations. Results: The mean perceived waiting room time was 12.35 minutes versus 5-15 minutes actual waiting room time for 60.5% of the participants. The mean perceived exam room waiting time was 10.58 minutes versus 5-15 minutes actual exam room waiting times for 81.4 % of the participants. Mean perceived time spent with the physician was 11.65 minutes versus 5-15 minutes actual time spent with the physician for 67.1 % of the participants. Patients who felt that they can get a timely appointment were 8.4 times more likely to be happy with the quality of care received. Patients who got prompt return of their calls are 10.4 times more likely to be happy with access to primary care clinics. Patients who felt that the clinic hours of operation were acceptable were 15.6 times more likely to agree that they received adequate health care. Patients who felt that the waiting time for an appointment at the clinic were acceptable to them were 8.1 times happier with the quality of care. Conclusion No major differences exist between perceived and actual waiting times in the physician’s offices. The waiting time for scheduled appointments is generally too long. The most satisfied patient appears to be someone whom waits no longer than 5-15 minutes in the waiting room, then no longer than 5-15 minutes in exam room for a 5 -15 minute consultation. The shorter the waiting times for an appointment and the shorter the different waiting times during a consultation in the clinic the more satisfied the patient.
Accuracy 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.
An assessment of user satisfaction with outpatient mental health consultation services from rural and urban areas in southern Malawi
(Stellenbosch : Stellenbosch University, 2018-12) Chikasema, Blessings; Tomlinson, Mark; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems & Public Health.
ENGLISH SUMMARY : Background: The assessment of user satisfaction with outpatient mental health services is essential in mental health service. It influences the mental health care that addresses the unmet needs of patients living with mental health problems. In developing countries such as Malawi there is a dearth of mental health studies to assist in evidence based mental health practices. Aim: To evaluate user satisfaction with outpatient mental health consultation services in southern Malawi and to assess social demographic variables that predict user satisfaction. Methods: The study used a quantitative descriptive cross-sectional study design. The assessment was conducted in Malawi at (Blantyre) and (Thyolo) outpatient psychiatric clinics. The study included randomly sampled participants who met the inclusion criteria and consented to be recruited. A total of 216 exit interviews were conducted using Charlestone Psychiatric Outpatient Satisfaction Scale (CPOSS). Results: Of the participants, 57.4% were males and 42.6% were females, with 55.1% being 29 years and older. Of all the study participants, 80% were satisfied with the outpatient mental health services. Participants presenting to the rural clinic were less likely to be satisfied than participants presenting at the urban clinic (AOR = 0.31; 95% CI: 0.13-0.76; p<0.05). Any admission due to mental illness significantly predicted user satisfaction at the rural (Thyolo) study site (AOR = 0.11; 95% CI 0.02-0.54; p< 0.05). Conclusion: The study reveals high satisfaction levels with outpatient psychiatric services, and that participants presenting at the rural facility were less likely to be satisfied with outpatient psychiatric services as compared to the urban facility. Any admission due to mental illness significantly predicted user satisfaction at the rural facility. There is need for policy makers to formulate guidelines to strengthen mental health practices and education at all health levels as well as the need for further studies in patient satisfaction with psychiatric services.
Community poultry farmer knowledge, attitudes and practices contributing to antimicrobial resistance in high density areas of Bulawayo, Zimbabwe
(Stellenbosch : Stellenbosch University, 2024-03) Ndlovu, Patience; Meintjes, Willem Albertus Jacobus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
ENGLISH SUMMARY: Background: Antimicrobial use in poultry poses a risk of resistance and transmission thereof to human populations, and poses a global public health risk. No previous studies considered Knowledge, Attitudes and Practices of community (backyard) poultry farmers in dense settlement areas in Zimbabwe Methods: We used self-administered questionnaires to assess knowledge, attitude and practice items in addition to general and demographic variables. We describe our findings and evaluate associations with practices. Results: Fifty-six participants completed questionnaires. A range of practices (good and bad) was reported. Practices with risk for antimicrobial resistance developing were associated with males, having previously experienced an incident of high mortality among the poultry, and if knowledge and attitude scores were low. Individuals trained by church organisations and practicing chicken farming as their only occupation was associated with good practices. Poor knowledge scores were predictive of poor practices in the study. The study also found that individuals who do chicken farming as their only occupation were more likely to adhere to international regulations than those who did it as a part time occupation. Factors associated with good practices were those that were trained by church organisations. Despite its limitations such as measurement bias, the study highlighted gaps in the one health concept which might reduce antimicrobial resistance in both clinical and community settings.
A community-based survey in a low-income area of the City of Cape Town of the information contained in the Road-to-Health booklet of children under 5 and their actual health status.
(Stellenbosch : Stellenbosch University, 2021-12) George, Lance Michael; Barnes, Johanna Maria; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
ENGLISH SUMMARY: Background: The present study is a community-based survey in certain low-income areas of the City of Cape Town of the information contained in the ‘Road to health booklet’ of children under 5 and their actual health status. A cross-sectional survey design with a systematic sampling strategy was employed in this study. Methods: The study took place in four low-income areas in the Kuils River area of the Cape Metropole, namely, Kalkfontein, Wesbank, Happy Valley and Eerste River. In total 250 households were randomly selected for participation in the study, when a child under the age of 5 was not present in the home, the next house with such a child was selected. The RtH booklets or cards were analysed for completeness of information. The information on demographics and health was obtained through a structured interview with the main caregiver in each household. A home inspection was performed in order to determine general living conditions. Results: A total of 278 children under the age of 5 years were included in this study. A reported 22.3% had the older RtH card, 65.5% had the newer booklet, while 11.9% had no card or a lost or missing card. When looking at the quality of information contained in the RtH cards/booklets, 18% was classified as good, 59.6% as fair and 22.4% as poor. A reported 88.6% of RtH cards/booklets were up to date but only 13.5% had complete information. The study found that both immunizations and weight-for-age were completed 91% of the time. Vitamin A was completed 83.3% of the time while deworming was 77.1% completed. The least completed sections were height-for-age at 22.4% and mid upper arm circumference at 18%. Sixty three percent of dwellings were brick houses while 37% were shacks. A reported 31.7% of household occupants had full time employment while 57.5% were unemployed. Almost 10% of households had an income of less than R600 per month while 38.8% of households had a total income between R600 and R2500. A reported 24.8% of households suffered from food insecurity. Almost 53% of households living conditions was classified as in a poor state. Conclusion: Results of that study indicated that many of the RtH cards or booklets were incomplete with the exception of weight-for-age and immunization which had an over 90% completion. Major data missing was the completion of the height-for-age and mid upper arm circumference. The RtH system is the major strategy to track development, health needs and health status of young children. It is vital to utilize all aspects of the RtH system in order to alert healthcare workers of a child with a health issue so that immediate corrective action can be taken. The study identified a need to improve the training of healthcare workers as well caregivers on all aspects of the RtH booklet in order to utilize its full potential in improving the health of children under the age of five years old. The information that could potentially be collected by an optimal RtH system can be of immense value for health planning. At present this opportunity is lost due to the poor information available from the RtH system.
A cross-over study investigating specific aspects of neuropsychological performance in hyperbaric environments
(Stellenbosch : Stellenbosch University, 2014-04) Van Wijk, Charles Halloran; Meintjes, Willem Albertus Jacobus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Community Health.
ENGLISH ABSTRACT: The commercial and military deep diving environment is typically a low visibility environment, where dependence on the visual senses often needs to be replaced by a reliance on tactile senses. This thesis reviewed the current knowledge regarding neuropsychological manifestations of nitrogen narcosis and exposed a number of shortcomings in the current body of knowledge. In particular, the human performance effects of hyperbaric exposure on tactile perception and memory have not been systematically studied. It is further not clear, how exactly psychological factors (e.g. anxiety, mood states) and biographical factors (e.g. age, education, technical exposure, experience) might influence tactile perception and memory performance under conditions of hyperbaric exposure. The correlation between subjective experiences of narcosis, tactile performance, and psychological and biographical variables is also unknown. This study thus set out to investigate certain neuropsychological aspects of nitrogen narcosis, with special reference to tactile perception and memory, and to examine the relationships of tactile performance with other psychological and biographical factors. The effects of experimental hyperbaric exposure (EHE) on tactile (form) perception and tactile shape memory were examined by testing these functions at 6 ATA and 1 ATA, using a cross-over design where two groups completed the same tasks, in opposite sequence. The psychological variables included trait anxiety, transient mood states, and subjective ratings of narcosis, while the biographical variables included age, education, and previous technical exposure. The results demonstrated the detrimental effect of nitrogen narcosis on tactile form perception and manipulation, irrespective of the sequence of testing. It also demonstrated this effect on tactile form memory, although the sequence of testing also played a role here. Higher trait anxiety was associated with poorer recall, and tension was associated with a larger decrement in recall performance, while fatigue was associated with poorer task completion. Subjective experiences also played a role, where feelings of physical anxiety (i.e. increased arousal) were associated with better recall, and feelings of cognitive suppression (decreased arousal) were associated with a larger decrement in recall performance. Lower academic attainment was associated with poorer recall, while higher diving qualification was associated with better recall. Performance on the surface was a good predictor of performance at depth. Qualitative analysis rendered three themes, namely focus vs. distraction, following instructions, and shape memory. Psychometric properties of the subjective narcosis measure were also reported. Theoretical implications include support for the slowed information processing model when completing complex neuropsychological tasks, as well as support for the memory model, thus suggesting that this particular pattern of memory impairment occurs because encoding under narcosis produces a weaker memory trace than normal. Lastly, the study has a number of implications for industry. For example, divers need to compensate for slowed task completion by, firstly, planning more time to complete complex tasks, and secondly, by practicing those tasks prior to the actual deep dive (either on the surface or in shallow water). The need for using additional forms of recording of events or objects at depth, to aid memory encoding and subsequent recall at surface was also emphasised.
A cross-sectional study of tuberculosis among workers in Tygerberg Academic Hospital, Western Cape province, South Africa
(Stellenbosch : Stellenbosch University, 2013-12) Ayuk, Julius Nkongho; Meintjes, Willem Albertus Jacobus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Division of Community Health.
ENGLISH ABSTRACT: Introduction: The morbidity and mortality associated with tuberculosis (TB) disease is of grave consequences for the health and employment of afflicted individuals. Healthcare workers are identified amongst high risk groups in communities. The prevalence/incidence of TB is dependent on the presence of associated risk factors which varies in diversity and intensity in different communities and workplaces. Understanding the risk factors operating in any given environment is indispensable to any tuberculosis control programme. Objective: The objective of this study was to describe the occurrence and trends of TB disease as well as to determine the risk factors associated with the disease among Tygerberg hospital employees. Method: A cross-sectional descriptive study design with a nested case-control component was used to determine the occurrence (and trends) and risk factors of TB disease respectively. Occurrence and trends of tuberculosis: The frequencies, distribution and trends of TB disease from 2008 to 2011 were obtained by calculating and comparing the annual incidence rates for each variable. Cases were identified from the occupational health clinic TB register, while the various denominator data were obtained from the Human Resource database. Determination of risk factors: Cases were recruited from the occupational health clinic TB register and controls were randomly selected from unaffected workers during the study period. Self-administered risk factor questionnaires were completed by both cases and controls. Multivariate logistic regression analysis was used to determine the association between known and suspected risk factors and the occurrence of TB disease amongst employees. Results: Sixty six cases of TB disease occurred in the workforce during the study period resulting in an annual average incidence rate of 397/100,000 population (95% CI: 307/100,000-505/100,000). Twenty three (34.8%) of the 66 cases occurred in Housekeeping staff, making them the most affected sub-group [1181/100,000 population (95% CI: 747/100,000-1768/100,000)]. The rate of TB disease in nurses was 1.7 times (95%CI: 1.4-2.0) that of doctors. Workers in the 40-49 years age-group experienced the highest incidence [490/100,000 population (95%CI: 329.6/100,000-706.8/100,000)] of TB disease compared to the other age-groups. There was no obvious difference in gender occurrences. Disease rates varied among different racial groups, with the highest rate in black employees [1473/100,000 population, (95%CI: 924/100,000-1981/100,000)]. Distribution of TB disease in the institution was widespread, with security department being the most affected [2500/100,000 population (95%CI: 311/100,000- 9262/100,000)]. There was a downward but statistically insignificant (annual range 9-23; p=0.28) trend in the rate of disease occurrence over the study period. No previous training on TB prevention (OR: 2.97, 95% CI: 1.15 - 7.71), HIV (OR: 67.08, 95% CI: 7.54 – 596.64) and working without knowledge of TB risk profile of the workplace (OR: 8.66, 95% CI: 1.10 – 67.96) were associated with TB disease occurrence. Conclusion: Occurrence of TB disease among Tygerberg hospital employees was low compared to that of the general population of its drainage areas. Disease occurrence in the facility was wide and varied with respect to occupational groups, workplaces and time. Well-established risk factors for TB infection (and disease) were found to be determinants of disease occurrence in the facility.
A descriptive study of clinicians’ experiences of giving feedback to final year medical students
(Stellenbosch : Stellenbosch University, 2024-03) Mouton, Jannie; Blitz, Julia; Schmutz, A. M. S.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
ENGLISH SUMMARY: The translation of the science of learning to improve models of training should form part of the delivery of clinical services and the process of transforming health systems. Though good clinical teaching is at the centre of medical education, there are concerns about maintaining this in current pressured healthcare environments. Research revealed that feedback on student performance plays a crucial part of learning in the workplace and thus also as part of educational programs in health professions education. The importance of an educator’s role in feedback and how that role can improve achievement of learning outcomes via quality feedback have been reported. We are also reminded that experience-based learning of medical students plays an important role in competency-based medical curricula, and its value depends greatly on how clinicians and students use the exposure to achieve learning. Furthermore, it identified inadequate training in the giving of feedback as one of the key shortcomings of experience-based learning. Despite the importance of educators’, or in this case, clinicians’ roles in feedback and learning outcomes, my experience is that many of the clinicians, in our and in neighbouring training hospitals, have not been properly orientated or trained with regard to their responsibilities and simply had to assume this role of a clinician teacher as part of their duties. This experience is corroborated by research, who informs us that clinicians are sometimes unclear on how their teaching fits into the curriculum and that they feel unprepared for the tasks of giving feedback and of teaching and highlighted the need for faculty development of this area. The aim of this study, therefore, was to gain a better understanding of the perceptions of clinicians on giving feedback by exploring their experiences of doing this with final-year year medical students at rural teaching sites of Stellenbosch University, and in doing so, finding ways to improve the giving of feedback. This was an interpretivist study, generating qualitative data and using thematic analysis to analyse the data. This study was conducted at two rural district hospitals in the Western Cape (WC) Province of South Africa, namely that of Hermanus and Ceres, which form part of the LIC model of training of the Ukwanda Rural Clinical School of Stellenbosch University. Data was generated by conducting interviews with the clinicians, who are involved in teaching at these hospitals. Individual perspectives and experiences were explored by using a semi-structured interview schedule for the asking of the questions. Five overarching themes were developed from the findings of the study, and these highlight the important roles and responsibilities that both the clinical teacher and the student have in the feedback process, as well as the different aspects involved in the process of the giving of feedback itself. The overarching themes are the importance of relationship building between medical officer and student, the environment in which the feedback occurs, clinicians’ general experiences of feedback, more personal experiences of giving feedback and fifthly, considerations with regard to students, as the other party in the feedback process. Probably the most significant point that emerged was the importance of establishing a relationship between the medical officer and the student, and that connection between the two parties needed to take place before a relationship could be built. This was also crucial for the establishment of mutual trust and for feedback to translate into learning for the student. It was also revealed that this relationship or connection should entail a two-way discussion and was not a one-way monologue where the teacher or clinician just commented on what the student did wrong, as was very much a practice in the past. What was interesting was the various ways in which the process of feedback was described. According to some responses, the feedback process was something that should be specific and focused, but also should be carefully and skillfully done and therefore required thinking, preparation and more efficient orientation of the clinical teacher. It is well summarised in this quote: “Feedback should be a learning opportunity and not a scoring episode”. The need for training and capacity building for clinicians to improve the quality of the feedback they gave was another aspect that emerged almost unanimously from the data. The most prominent challenges identified in giving feedback that translated to learning were sufficient time and appropriate space to deliver the feedback. The envisaged contribution of the study is that gaining a better understanding of how clinicians experience giving feedback, could contribute towards planning and implementing appropriate training to improve the capacity of clinicians to provide feedback and therefore potentially improve quality of teaching and learning on this platform.
The effect of phlebotomy training on blood sample rejection and phlebotomy knowledge of primary health care providers in Cape Town : a quasi-experimental study
(AOSIS publishing, 2017-04) Abbas, Mumtaz; Mukinda, Fidele K.; Namane, Mosedi
Background: There is an increasing amount of blood sample rejection at primary health care facilities (PHCFs), impacting negatively the staff, facility, patient and laboratory costs. Aim: The primary objective was to determine the rejection rate and reasons for blood sample rejection at four PHCFs before and after a phlebotomy training programme. The secondary objective was to determine whether phlebotomy training improved knowledge among primary health care providers (HCPs) and to develop a tool for blood sample acceptability. Study setting: Two community health centres (CHCs) and two community day centres (CDCs) in Cape Town. Methods: A quasi-experimental study design (before and after a phlebotomy training programme). Results: The sample rejection rate was 0.79% (n = 60) at CHC A, 1.13% (n = 45) at CHC B, 1.64% (n = 38) at CDC C and 1.36% (n = 8) at CDC D pre-training. The rejection rate remained approximately the same post-training (p > 0.05). The same phlebotomy questionnaire was administered pre- and post-training to HCPs. The average score increased from 63% (95% CI 6.97‒17.03) to 96% (95% CI 16.91‒20.09) at CHC A (p = 0.039), 58% (95% CI 9.09‒14.91) to 93% (95% CI 17.64‒18.76) at CHC B (p = 0.006), 60% (95% CI 8.84‒13.13) to 97% (95% CI 16.14‒19.29) at CDC C (p = 0.001) and 63% (95% CI 9.81‒13.33) to 97% (95% CI 18.08‒19.07) at CDC D (p = 0.001). Conclusion: There is no statistically significant improvement in the rejection rate of blood samples (p > 0.05) post-training despite knowledge improving in all HCPs (p < 0.05).
An epidemiological study of lower respiratory tract infections in Harare, Zimbabwe
(Stellenbosch : Stellenbosch University, 2016-12) Mapondera, Prichard Tawanda; Whitelaw, Andrew Christopher ; Myles, Puja R.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Community Health
ENGLISH SUMMARY : Background: Lower respiratory tract infections (LRTI) are a leading cause of mortality and morbidity in all age-groups. In Zimbabwe, few epidemiological studies have mapped the aetiology and distribution of LRTIs as well as risk factors for LRTI-related mortality. Understanding the epidemiological profile of LRTIs is important in many ways. The aim of this study was to describe the aetiology and clinical aspects of LRTIs in patients reporting to a referral hospital in Harare, Zimbabwe. Methods: The study was a cross-sectional survey of 103 patients who had microbiology reports associated with a clinical diagnosis of LRTI at the Harare Central Hospital during 2014. The records showed bacterial cultures were done on the majority of adult samples while most children samples were sent for viral testing. The record books had a lot of missing data. Results: Enterobacteriaceae were the most frequently isolated organisms in the laboratory (11.7%). Pneumonia (45.6%) and influenza (44%) were the most prevalent acute respiratory illnesses in the study. HIV infection and underlying cardiovascular disease were significant risk factors for mortality with odds ratio of 4.78, p= 0.016 and 4.42, p= 0.0028 respectively. Conclusion: Enterobacteriaceae were the most common isolates from patients with LRTI; with respiratory syncytial virus associated LRTIs being most common among children under 5. Being HIV positive and having cardiovascular disease is a strong predictor of death in patients with LRTIs. The amount of missing data also emphasized the importance of robust data management systems in hospitals to better inform epidemiological studies.
Epidemiological study of tuberculosis in Macassar Camp
(Stellenbosch : University of Stellenbosch, 1995-12) Mohammed, Ashraf; Prinsloo, F. R.; Donald, P. R.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences
Please refer to full text for abstract
Evaluating point of care testing for glycosylated haemoglobin in primary care facilities in the Western Cape
(Stellenbosch : Stellenbosch University, 2016-03) Vos, Johannes Jacobus; Mash, Bob; Stellenbosch University. Faculty of Health Sciences. Department of Interdisciplinary Health Sciences.
ENGLISH ABSTRACT : Background HbA1c testing helps to reduce the risk of complications associated with diabetes mellitus and is accepted to be an accurate measure of long-term glycaemic control. Immediacy of results through point of care testing can promote early treatment intensification and lifestyle modification. Currently point of care (POC) testing for HbA1C is not available in primary health care facilities in the Western Cape. Aim and objectives The main aim was to explore the effect of POC testing for HbA1C on treatment intensification, patient education, glycaemic control and the amount of patients who would receive an annual HbA1C test. Cost implications and technical quality was also assessed. Methods This was a quasi-experimental study comparing clinics with and without POC testing over a period of 1-year. This assignment reports on half of the larger study and presents data from two clinics. A POC machine for HbA1C was introduced at the intervention site. 150 patients (N=300) were randomly selected from each site. Data was collected retrospectively from the patient records for the preceding 12 month period at baseline and follow up. A peer focus group at the intervention site explored experience and perceptions of staff with POC testing. Technical quality was assessed by monitoring compliance with internal and external quality control. Results There was a significant increase in the % of patients receiving an annual HbA1C (control -8%, POC +24%; p<0.001). The turn-around time for HbA1C results was greatly reduced (control 38.2 days, POC 1.2 days; p<0.001). There was no effect on intensification of treatment or counselling. The effect on glycaemic control must be followed up later. Staff reported that the POC testing was feasible. There was poor compliance with quality control checks. There was an incremental cost to POC testing of R1451 per 100 tests. Conclusion The increase in patients having an annual HbA1C test and reduced turn-around time for results will hopefully result in improved feedback to patients and glycaemic control. The lack of a response in terms of treatment and counselling to the results suggests a degree of clinical inertia that should be addressed in other ways. The initial results do not suggest a favourable cost to benefit ratio.
Factors influencing job satisfaction and intention-to-leave among nurses at Mbabane public hospital, Swaziland
(Stellenbosch : Stellenbosch University, 2018-03) Mafara, Emma; Begg, Kerrin; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
ENGLISH SUMMARY: Background: There is sufficient empirical evidence to show that job satisfaction of nurses tends to affect organizational and health outcomes. However, a clear understanding of workplace variables that influence retention of nurses at an organization is required. Several studies on overall job satisfaction among health care workers have been conducted globally and in sub-Saharan Africa, however, no studies have been conducted in Swaziland on overall job satisfaction and retention of the nurse cadre, in a context where HIV has increased the workload on existing health facilities and consequently on staff. This study was conducted to assess factors influencing overall job satisfaction and intention-to-leave among nurses at Mbabane government hospital in Swaziland. Methods: A cross sectional study was carried out on 147 nurses using both quantitative and qualitative data collection methods from October 1st, 2016 to March 21st, 2017. Participants were nurse assistants, staff nurses, and nursing sisters working full time in the hospital during the study period1. Questionnaire data was analyzed using Stata, version 14.0. Univariate and Multivariate analyses between dependent variables (time pressure, opportunity- to- develop, quality of care, staff relations and work environment) and independent variables (overall job satisfaction and intention- to- leave) were performed using logistic regression. Qualitative data was analyzed using NVivo software. Results: Response rate was 97%, with 147 of 151 nurses participating. Of 147 participants 78 (54.9%) indicated overall satisfaction with their job while 98 (67.1%) indicated that they intended to leave their current position. Opportunity to develop (AOR: 4.11 [95% CI: 1.41-11.10] and Staff relations (AOR: 4.91 [95% CI: 1.75-13.77] were the final significant predictors of overall job satisfaction. After controlling for other factors, the adjusted odds ratio for association between opportunity -to -develop and intention- to- leave increased (0.23 [95% CI: 0.06-0.86]. While adjusted odds ratio for staff relations and intention- to- leave increased (0.22 [95% CI: 0.08-0.61]. Conclusion: The evidence shows that the greatest impact in retention of nurses in organizations will come from improved staff relations and enhanced opportunity-to-develop.
Financing of medical products in South Africa
(Stellenbosch : Stellenbosch University, 2019-12) Mamdoo, Punithasvaree; Begg, Kerrin; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems & Public Health.
ENGLISH SUMMARY : Background: Medical products (encompassing medicines and medical devices) are critical health system building blocks; access to medical products (ATM) impact clinical outcomes. However, cost and operational inefficiencies in the health system limits ATM. Funding strategies and policy reforms are key instruments in managing the supply and demand side determinants of ATM. Objectives: This study aimed to 1) analyse the South African(SA) regulatory framework for medical products; 2) review expenditure on medical products at Private, Public and Household levels; and 3) describe ATM using the WHO Building Blocks framework and 4) gauge the status of supply and demand side determinants of ATM. Methodology: A mixed methods study design was used to represent ATM complexity in the health system. USAID’s Health System Assessment Approach was used to analyse the enabling legislative and regulatory landscape for ATM in SA. Unpublished National Treasury, provincial Departments of Health and Council for Medical Schemes Annual Reports were sources for the descriptive trend analysis of public and private sector medical products expenditure. Household out-of-pocket expenditure was analysed from Statistics SA national household survey data. With data from key informant interviews, a systems diagram was constructed. District Health information system and national survey data was used to present current system performance using supply and demand side indictors of ATM. Results: Medical products expenditure is a major cost driver in the private sector. Households with medical aid, spent more OOP on medical products than the uninsured; province, household size and income sources were not significant factors in estimating medical products expenditure. In the public sector, trends demonstrate increasing investment in medical products, however indicators of supply side ATM determinants show poor performance. In 2014, health contributed 0.9 %( R935) of total household expenditure; which does not constitute catastrophic expenditure levels. A larger proportion of total health spending is on medical products (0.7%) than outpatient medical services (0.6%) in average SA households; pharmaceutical expenditure dominates (90%) compared to therapeutic appliances and other medical products combined (10%). In uninsured households NC and LP provinces and Indian and White population groups were the only statistically significant variables in estimating expenditure. Male headed households spend more actual Rands on medical products than female headed households. A R31.00 decrease in expenditure for rural insured households was calculated for each increase in expenditure by urban insured households. Households in FS, NW, EC and NC had the highest OOP expenditures on medical products. Households in LP had the lowest OOP expenditure on medical products in the survey period. Conclusions and Recommendations: There are opportunities in the scale up to UHC to implement policy options to increase ATM. Capacity building is needed to ensure equitable fiscal allocations, ability to absorb resources and optimise service delivery within government. Need for improved monitoring and data analytics of cost, access and utilisation of medical products at public health facilities; OOP spending on medical products in private sector in terms of outpatient and hospitalisation and survey data at household level spending. Managed care Organisations can contribute to ATM through quality and clinical governance in the private sector.
Health 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.
The 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.
Hospital cleaners’ knowledge, attitude and practices and the influence of training regarding cleaning roles in two government hospitals in the Erongo Region, Namibia
(Stellenbosch : Stellenbosch University, 2022-12) Geurtze, Etheline Olivia; Begg, Kerrin; English, Rene; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
Introduction: Healthcare associated infections may arise following transfer of microorganisms from the hospital environment to patients. Effective cleaning and disinfection of hospital surfaces reduces the risk of pathogen transmission. This study explored the knowledge, attitudes and practises concerning their cleaning role and training influences of hospital cleaners at two governmental hospitals in the Erongo region, Namibia. Methods: A cross-sectional, mixed-methods design was used. Data were collected using a structured interviewer-administered questionnaire. Participants’ hospital cleaning knowledge, attitudes and practices were evaluated using quantitative analysis Open-ended questions explored their training experiences and thematic analysis was conducted. Results: Sixty-one hospital cleaners were interviewed. Eight participants (13,1%) received formal training. In terms of knowledge 68,9% knew they could carry germs without getting sick, and 55,7% reported that wearing gloves could sufficiently protect against germs. Sixty-five percent felt that they were not supported by other staff. In terms of practices, most of the reported challenges related to absence of necessary resources. Regarding the association between current knowledge, attitudes and practices and training, significant associations were shown for most measures. With regards to whether cleaners can protect themselves against germs without getting sick, and whether they can infect others with germs that they carry, knowledge levels were lowest for those with informal training (59,7%) and job-shadowing (60,1%) (p=0,01). Conclusion: This research study highlights limited formal training for hospital cleaners at two large Namibian hospitals, and demonstrates the need for formal training and better resource allocation of hospital cleaners who play a vital role in IPC and patient and healthcare worker safety.
The impact of COVID-19 on the cascade of care for tuberculosis : a systematic review
(Stellenbosch : Stellenbosch University, 2022-09) Fapohunda, Tomiwa Temitayo; Chivese, Tawanda; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
ENGLISH SUMMARY: Background: Globally, the effect of the coronavirus pandemic on tuberculosis (TB) cascade of care is not well described. Objectives: To describe the impact of the 2019 coronavirus disease (COVID-19) pandemic on the TB care cascade, particularly on testing, case notifications and treatment of TB. Methods: In this systematic review, the Cochrane library, Scopus, CINAHL, Ebscohost, and PubMed databases were comprehensively searched from December 1st, 2019, the onset of the pandemic, till May 5th, 2022, without language restrictions. Eligible studies were observational studies documenting changes in the TB cascade of care one year before and one year during the COVID- 19 pandemic. The authors could not conduct a meta-analysis due to the expected differences in the contexts of the included studies, thus, a narrative synthesis was conducted. The Hoy et al.'s (2012) risk of bias tool was used for the quality assessment. Results: Twenty-seven studies from Asia, North America, Africa, South America, and Europe were included. TB screening suspected cases decreased between 1.3% and 49.5% (n= 5 studies), and multidrug resistance tuberculosis (MDR-TB) screening decreased by 17% in new patients and by 15% in existing patients (1 study). The diagnostic delay increased by11 and 45 days and 25.1% and 60% (2 studies), contact tracing decreased by 36.1% (1 study), case notification decreased between 2.9% and 63.3% (18 studies) and positivity rate increased between 0.1% and 4.5% (4 studies). General and community detection rates decreased by 11.8% and 44.7%, respectively (1 study), clinically diagnosed TB decreased between 10.4% and 46.0% (5 studies), presumptive TB diagnoses decreased between 12.8% and 45.6% (4 studies) and pulmonary TB diagnoses decreased between 20.0% and 50.7% (2 studies). Treatment enrolment decreased between 15.7% and 35.0% (4 studies), the diagnostic and treatment delay increased by 28 and 36 days, respectively, treatment completion decreased by 8.0% (1 study) and the treatment success rate decreased between 0.1% and 17.0% (7 studies). Conclusion: These results suggest that the pandemic likely had a detrimental impact on the TB care cascade. In future pandemics, stakeholders and governments must protect the care cascade of infectious diseases like TB and other diseases. The results of this study must be applied with caution since only observational studies, mostly without standardized population data, were included.
An 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.

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