Health Systems and Public Health

Permanent URI for this community

https://scholar.sun.ac.za/handle/10019.1/100761

This division was formerly known as Community Health (prior to March 2017).

Browse

Now showing 1 - 20 of 73

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.
The adherence to effective vaccine stock management protocols in the government facilities, the availability of vaccines, and the effectiveness of the stock visibility system in OR Tambo District of the Eastern Cape Province of South Africa
(Stellenbosch : Stellenbosch University, 2019-12) Iwu, Chinwe Juliana; Wiysonge, Charles S.; Chikte, Usuf; Ngcobo, Ntombenhle Judith; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems & Public Health.
ENGLISH SUMMARY : Effective vaccine stock management is one of the criteria for a functional vaccine supply chain. It ensures that the quality of vaccines is maintained and that vaccines are continuously available at service delivery points. The continuous availability of vaccines is a vital component of the health system which is required to achieve public health goals such as improved immunisation coverage, and universal health coverage. Reports on vaccine availability and stock management of vaccines in OR Tambo district of the Eastern Cape Province are scarce. Also, since the implementation of the mobile device for stock reporting, stock visibility solution (SVS), no study has explored the experiences of the health care workers in order to identify potential barriers and facilitators to the implementation of the system. This study was therefore aimed at assessing the vaccine stock management status as well as availability of vaccines in the OR Tambo district, in Eastern Cape Province, South Africa. As part of the literature review, we firstly gathered evidence on occurrence of vaccine stock -outs at different levels of the supply chain; the national, district, health facility level in the WHO African region. A systematic search of the literature was conducted to identify studies reporting on vaccine stock-outs at these levels. Furthermore, a cross-sectional study was conducted to assess the occurrence of vaccine stock-outs and vaccine stock management practices in primary health care settings in the Eastern Cape province, South Africa. Data was collected from a total of 64 PHC facilities using a researcher administered questionnaire, record checks and direct observation. This was followed by a qualitative study to explore the perceptions and experiences of the SVS system amongst healthcare workers (HCWs) who are involved with managing stock levels of medicines in primary health care facilities in the Eastern Cape Province. Consequently, a scoping review was conducted to summarise currently available information on interventions for vaccine stock management. Quantitative data was managed using an electronic data capturing tool, REDCap, and descriptive statistics, and Pearson’s chi-squared test, were conducted using STATA® Version 14. The qualitative data was analysed using thematic analysis. Based on the JRF data, approximately 50% of the countries in Africa reported stock-outs of at least one vaccine for at least one month at national and district levels, in 2017. Fourteen (30%) countries reported vaccine stock-outs in 2017 at the national level. BCG vaccine is the most affected vaccine, with an increase from five countries in 2010 to 16 counties in 2015. There is an 86% chance of stock-out at the district level is caused by stock-out at the national level being linked to national level stock-outs and a 62% chance of this leading to interruption of immunisation services at the facility level. At the facility level stock-outs reports from Africa were few. We found a total of eight studies that reported vaccine stock-outs across Africa; South Africa (5); Nigeria (1); Guinea (1) and Kenya (1) and Ethiopia (1). Poor stock management, disease outbreaks, poor supply chain structure, delays in deliveries and lack of trained health personnel are possible causes of facility level stock-outs. Both stock cards and the stock visibility solution (SVS) device were used in all the facilities for vaccine stock management. However, the health care workers were reluctant to fill in the stock cards. Less than half of the facilities visited 27 (44%) filled their stock cards regularly. The ordering system was weak; as only about half 31(49%) of the respondents understood the concept of maximum and minimum stock levels, which are needed for proper quantification of needs. Delays in receiving supplies from the pharmaceutical depot were commonly reported by facilities, which could have contributed to stock-outs. Common reasons for delays from the depot include staff shortages at the pharmaceutical depot causing a backlog of orders, delay from the suppliers, procurement delays and possibly lack of proper communication between the depot and the facilities. A total of 49 (77%) health facilities had at least one stockout for at least one vaccine on the day of the visit. Furthermore, BCG and OPV were the most commonly affected vaccines in 37 (58%) and 28 (44%) facilities, respectively. Within the last two years (between February 2017- February 2019), BCG and OPV had the most prolonged median duration of 167 and 103 days, respectively. PCV experienced the most prolonged duration of stock-outs amongst the newer vaccines with a median duration of stock-outs of 85 days. Four studies met our inclusion criteria (three before-after studies and one randomised trial). Three studies were conducted in low- and middle-income countries, while one was conducted in Canada. All the studies had various limitations and were classified as having a high risk of bias. Study findings suggest that use of digital information systems to improve information and stock visibility, coupled with other interventions (such as training of health care workers on the use of innovative tools and redesign of the supply chain to tackle specific bottlenecks) have the potential to increase vaccine availability, reduce response times, and improve the quality of vaccine records. Although more of well-designed studies are needed to strengthen the evidence base. The SVS system was well understood by most HCWs, as a system for reporting stock levels to managers. They also displayed high commitment to ensuring the systems works. However, some factors were identified as potential barriers for efficient usage of the system. This includes staff shortages and high staff turnover, lack of responses from the managers, the extra workload that comes with the system, amongst others. The HCWs made various suggestions for how the system might be improved, most pertinently the need for more pharmacists and pharmacy assistants and for these cadres to be primarily in-charge of stock management and the use of the SVS. The OR Tambo district of South Africa, just like in other countries, suffers from vaccine stock-outs especially BCG, and OPV. Similarly, the lack of proper stock management linked to the use of manual stock cards, long response time from the pharmaceutical depot and inadequate fridge capacity may be responsible for stock-outs in the primary health care facilities in OR Tambo district. Interventions for improving vaccine availability should be considered, especially those focused on the factors highlighted above.
Adolescent mental health in the context of adversity : evidence from a longitudinal intervention study in Khayelitsha, South Africa
(Stellenbosch : Stellenbosch University, 2023-12) Du Toit, Stefani; Skeen, Sarah; Haag, Katharina; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
ENGLISH SUMMARY: The World Health Organization defines adolescents as individuals between the ages of 10 and 19 years, undergoing transition from childhood to adulthood [1, 2]. Adolescence is a rapid developmental phase during which an individual undergoes major physical and psychological changes [1]. The changes that occur during this period create a vulnerability that is accentuated by exposure to risk factors such as poverty, community violence, and lack of access to basic services [1-5]. Mental health conditions most commonly appear during adolescence [1]. Experiencing mental health conditions during this period can have lasting effects on an individual's health, as it can increase the risk of substance use, violence victimisation and perpetration, and suicidal ideation [6-8]. There is a critical gap in the exploration of mental health conditions among adolescents in low- and middle-income countries, particularly in sub-Saharan African countries, where most adolescents live in the context of widespread poverty [9]. Most of the research on adolescent mental health is conducted in high-income countries, despite nearly 90% of the world's adolescent population living in low- and middle-income countries [9, 10]. There is an urgent need to assess potential risk and protective factors, as well as interventions, to address the mental health of adolescents in these contexts. To design effective preventative initiatives that aim to protect adolescents from the adverse consequences of mental health conditions, it is crucial to understand risk and protective factors at various stages throughout the life course. In addition, a comprehensive understanding of support structures and interventions that can aid in the prevention of mental health conditions and the promotion of positive mental health among adolescents is crucial. This thesis is based on research reported on four articles. The first two articles report on predictors of mental health problems, exploring both early childhood and current environmental factors. The second two articles in this thesis report on potential interventions for adolescent mental health.
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.
Barrier to cervical cancer screening in Gwanda district, Zimbabwe : a mixed method analysis
(Stellenbosch : Stellenbosch University, 2022-12) Mantula, Fennie; Sewram, Vikash; Toefy, Yoesrie; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
ENGLISH SUMMARY: Background: Zimbabwe is among the countries that carry the highest burden of cervical cancer globally. Regular screening has been proved to significantly reduce the disease incidence and mortality if screening coverage is high. Whereas proven and cost-effective strategies for secondary prevention of cervical cancer are available, the national screening rate is low. This justified the need for a study to determine the barriers to uptake of screening in order to develop strategies for addressing them. Aim: This study explored factors that influence the low utilisation of cervical cancer screening services in Gwanda district, Zimbabwe, guided by the socio-ecological conceptual framework. The objectives of the study were to: Analyse socio-demographic factors associated with uptake of screening by local women aged 25-50 years; Assess their knowledge, attitudes and behaviours related to cervical cancer and screening; Identify factors perceived as barriers to screening; Determine factors health providers perceive as barriers to screening, and to examine screening uptake facilitators that could be incorporated into the programme. Methods: An explanatory sequential mixed-method research design was employed in the study. It was conducted in two phases: The first phase was a household-level cross-sectional survey of 609 screening-eligible women selected from 10 of 34 electoral wards in the district using multi-stage random sampling. The quantitative survey informed the content of the second qualitative phase that engaged 36 women, purposively selected from the first phase, in focus group discussions as well as 25 health providers, with different roles in the screening programme, in in-depth interviews. Data analysis utilised the socio-ecological model. Results: The first phase found knowledge about cervical cancer and screening inadequate among women, and screening prevalence among this cohort was 30.05%. Screening uptake was associated with urban and mine residency (p = 0.009), higher educational attainment (p < 0.001), being employed (p = 0.056) marginally, accessing health care from urban clinics and the provincial hospital that provides screening (p = 0.007), and a family history of cervical cancer (p = 0.045). Multivariable log-binomial regression showed the risk of encountering screening barriers to be lower for women who lived in urban and mine settings compared to those who lived in rural areas (p < 0.001). Women with adequate knowledge on cervical cancer were less likely to face barriers than less knowledgeable women (p < 0.001). Factor analysis identified knowledge gaps on screening, inaccessibility of screening services, and socio-cultural beliefs as major barriers to screening. Findings from the second phase confirmed inadequate knowledge, poor access to services and lack of men involvement as key barriers to screening. Screening facilitators were awareness and an adequate understanding of the benefits of screening, availability of services, and male involvement in the planning and implementation of screening programmes. Conclusions: Major barriers to cervical cancer screening were identified at all levels of the socio-ecological model implying that individual, interpersonal, community and health system-related factors contribute to challenges women face in accessing screening. This study’s findings provide policy makers, programme managers and implementers with better insights for developing targeted interventions to improve screening uptake.
Barriers to cervical cancer screening in Gwanda district, Zimbabwe : a mixed method analysis
(Stellenbosch : Stellenbosch University, 2022-12) Mantula, Fennie; Sewram, Vikash; Toefy, Yoesrie; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
ENGLISH SUMMARY: Background: Zimbabwe is among the countries that carry the highest burden of cervical cancer globally. Regular screening has been proved to significantly reduce the disease incidence and mortality if screening coverage is high. Whereas proven and cost-effective strategies for secondary prevention of cervical cancer are available, the national screening rate is low. This justified the need for a study to determine the barriers to uptake of screening in order to develop strategies for addressing them. Aim: This study explored factors that influence the low utilisation of cervical cancer screening services in Gwanda district, Zimbabwe, guided by the socio-ecological conceptual framework. The objectives of the study were to: Analyse socio-demographic factors associated with uptake of screening by local women aged 25-50 years; Assess their knowledge, attitudes and behaviours related to cervical cancer and screening; Identify factors perceived as barriers to screening; Determine factors health providers perceive as barriers to screening, and to examine screening uptake facilitators that could be incorporated into the programme. Methods: An explanatory sequential mixed-method research design was employed in the study. It was conducted in two phases: The first phase was a household-level cross-sectional survey of 609 screening-eligible women selected from 10 of 34 electoral wards in the district using multi-stage random sampling. The quantitative survey informed the content of the second qualitative phase that engaged 36 women, purposively selected from the first phase, in focus group discussions as well as 25 health providers, with different roles in the screening programme, in in-depth interviews. Data analysis utilised the socio-ecological model. Results: The first phase found knowledge about cervical cancer and screening inadequate among women, and screening prevalence among this cohort was 30.05%. Screening uptake was associated with urban and mine residency (p = 0.009), higher educational attainment (p < 0.001), being employed (p = 0.056) marginally, accessing health care from urban clinics and the provincial hospital that provides screening (p = 0.007), and a family history of cervical cancer (p = 0.045). Multivariable log-binomial regression showed the risk of encountering screening barriers to be lower for women who lived in urban and mine settings compared to those who lived in rural areas (p < 0.001). Women with adequate knowledge on cervical cancer were less likely to face barriers than less knowledgeable women (p < 0.001). Factor analysis identified knowledge gaps on screening, inaccessibility of screening services, and socio-cultural beliefs as major barriers to screening. Findings from the second phase confirmed inadequate knowledge, poor access to services and lack of men involvement as key barriers to screening. Screening facilitators were awareness and an adequate understanding of the benefits of screening, availability of services, and male involvement in the planning and implementation of screening programmes. Conclusions: Major barriers to cervical cancer screening were identified at all levels of the socio-ecological model implying that individual, interpersonal, community and health system-related factors contribute to challenges women face in accessing screening. This study’s findings provide policy makers, programme managers and implementers with better insights for developing targeted interventions to improve screening uptake.
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.
Continuity of care for tuberculosis patients between hospital and primary health care services in South Africa
(Stellenbosch : Stellenbosch University, 2020-03) Dudley, Lilian Diana; Volmink, Jimmy; Zwarenstein, Merrick; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems & Public Health.
ENGLISH ABSTRACT : Many tuberculosis (TB) patients in South Africa are admitted to acute care hospitals, but large numbers are lost to care after discharge, and few complete their TB treatment. This contributes to ongoing transmission of TB in communities, frequent hospital readmissions, a high mortality rate and avoidable costs to the health system and society. This thesis studied continuity of care for TB patients discharged from hospital in South Africa. It aimed to describe the problem, identify risk factors for poor continuity of care, synthesise evidence to inform, implement and evaluate an intervention, and produce a policy brief to translate the evidence into policy and practice. The research methods included an observational study, research synthesis, qualitative research, participatory action research, a quasi-experimental study as well as knowledge translation methods to address the various research questions. The study found that a third of TB patients discharged from hospital did not continue TB treatment, and that inadequate clinical management of TB patients in hospital showed a significant correlation with poorer continuity of care and an increased mortality rate. Evidence of strategies to improve continuity of care for chronically ill patients was identified in high-income countries, but no such evidence could be found for TB patients in low and middle-income countries. Using the available evidence and participatory action research, a multicomponent discharge planning and support intervention was designed and implemented in collaboration with a referral hospital in the Western Cape. A before-and-after evaluation found that continuity of care for TB patients improved significantly after implementing the intervention. A process assessment revealed that the characteristics of the intervention, the external context, the persons involved and the methods of implementation had a favourable impact on implementation. Yet the internal context of the hospital was unfavourable for implementation, and in-hospital intervention activities were not sustained. In contrast, information linkages and community-based follow-up and support of TB patients continued. More rigorous studies of interventions to improve continuity of care for TB patients discharged from hospital in similar settings are required. This should be complemented by implementation research to understand and address health systems challenges. Both types of research are needed to effectively translate evidence into practice in the health systems of low and middle-income countries.
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.
Determinants of maternal colonization with multidrug-resistant gram-negative bacteria
(Stellenbosch : Stellenbosch University, 2020-03) Bulabula, Andre Nyandwe Hamama; Mehtar, Shaheen; Dramowski, Angela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
ENGLISH ABSTRACT : This doctoral research explored the topic of maternal colonization with multidrug-resistant Gram-negative bacilli (MDR-GNB) in Africa, using analytical cross-sectional studies to generate novel data and systematic reviews and meta-analyses to synthesize existing data. Maternal colonization is an established risk factor for neonatal colonization, which is a precursor to neonatal infection (the third leading cause of neonatal deaths in Africa). Understanding the factors contributing to maternal colonization with MDR-GNB in Africa, will inform the development of preventive interventions and ultimately contribute to reduction of neonatal infection burden. Through a systematic review and meta-analysis, we underscored the major knowledge gaps regarding the burden of and risk factors for maternal colonization with MDR-GNB in Africa. The meta-analysis allowed us to provide a first estimate of the prevalence of maternal colonization with extended-spectrum beta-lactamases producing Enterobacteriaceae (ESBL-E) among pregnant and postpartum women in Africa (17%), which was 2 to 3-fold higher than that described from high-income countries. Utilizing an analytical cross-sectional study design, we generated unique data describing the prevalence of maternal colonization with antimicrobial resistance (AMR) genes in a South African cohort of 651 peripartum women. Cefotaxime-M15 (CTX-M15) and New Delhi Metallo-beta-lactamase (NDM) genes were isolated from 12.9% and 2.2% of specimens respectively. Communal taps as the primary water source was the only independent predictor of maternal colonization with CTX-M15. Poverty-related factors (lower educational achievement, low income group and rural residence), and a clinical factor (primiparous status), were independent predictors of maternal colonization with carbapenem-resistant pathogens. Comorbidities like HIV infection and diabetes, or exposures such as recent antibiotic use, did not predict maternal colonization with AMR genes. The knowledge, attitudes and practices regarding antibiotic use during pregnancy were assessed in a cohort of 301 pregnant South African women. Women with higher mean knowledge score (K-score) had lower reported proportions of antibiotic self-medication compared to women with lower mean K-scores. High monthly household income was an independent predictor of self-medication with The relationship between the density of hospital environmental contamination with AMR genes and colonization proportions in 180 hospitalized peripartum women and 92 neonates, was prospectively assessed. The level of hospital environmental contamination with AMR genes was low (5.8%); similarly, the number of colonized patients was small (2.8% of the peripartum women and 9.8% of the neonates), limiting the study’s power to determine a clear link between environmental contamination and patient colonization. Finally, in a second systematic review and meta-analysis, we produced a synthesis of molecular evidence linking MDR-GNB transmission from colonized mothers to their neonates. Although limited by the number and quality of studies, molecular evidence supports an overall 27% transmission proportion for MDR- and/or ESBL Enterobacteriaceae from colonized mothers to their infants, resulting in neonatal colonization. Further high-quality research is needed to determine the risk factors that promote mother-to-infant MDR-GNB transmission and evidence to link maternal MDR-GNB colonization and subsequent neonatal infection. This doctoral thesis has produced new findings on the magnitude of and risk factors for maternal colonization with MDR-GNB in an African context. The novel data will inform the development of interventions to prevent colonization with MDR-GNB in mothers and subsequently reduce neonatal infection.
Development and testing of an m-Health platform to reduce post-operative penetrative sex in recipients of voluntary medical male circumcision
(Stellenbosch : Stellenbosch University, 2017-12) Toefy, Mogamat Yoesrie; Skinner, Donald; Thomsen, Sarah; Diwan, Vinod; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
ENGLISH SUMMARY : Background: The widespread roll-out of voluntary medical male circumcision (VMMC) has been accompanied by reports of VMMC recipients, particularly men who are married or cohabiting, resuming sexual intercourse before the recommended healing period of six weeks. This behaviour carries an increased risk of transmission of STIs and HIV, for both partners. At the same time, it is unrealistic to assume that an already over-burdened health system will be able to provide repeated, intense messaging that recent recipients of VMMC may need to help them navigate the postoperative period sexually. There is an urgent need to develop culturally appropriate messages and innovative delivery strategies for behaviour modification in the postoperative period and in the longer term for medically circumcised men. Methods: As a step to better understand the behaviour of the VMMC patients during the six-week recovery period, we conducted nine single-gender focus groups with males who had undergone VMMC in the previous six months and their partners (Study 1). Armed with this information, we strove to create a contextuallyrelevant message regime by using a staggered qualitative methodology: (1) focus group discussions with 52 recently circumcised men and their partners to develop initial voice messages (2) thematic analysis and expert consultation to select the final messages for pilot testing, and (3) cognitive interviews with 12 recent VMMC patients to judge message comprehension and rank the messages. The message content and phasing were guided by the theory of planned behaviour, the health action process approach and the action research approach (Study 2). For the next two years, this intervention was evaluated using a two-armed, randomized, single-blind, controlled design. This sample was collected at 12 clinics in urban area of Cape Town in the Western Cape Province, South Africa. Patients were followed up at 42 days after enrolment (Study 3). As a final measure, the usability of the platform was evaluated. At follow-up, 597 participants completed questionnaires regarding the usability and user experience of the mobile audio platform. Usability was measured with the System Usability Scale (SUS). Five focus groups with a total of 25 patients were also conducted. The scale’s multidimensionality was shown with the emergence of three trends that explained more than 65% of the total variance of the scale (Study 4). Results: The primary motivation to VMMC uptake included religious injunction and hygiene reasons and protection against sexually transmitted infections not necessarily HIV. Both men and women felt that sex was important to maintain the relationship (Study 1). We received 245 messages with 42 themes. Expert review and cognitive interviews with more patients resulted in 42 messages with a clear division in terms of needs and expectations between the initial wound-healing recovery phase (weeks 1–3) and the adjustment phase (weeks 4–6). Participants were more positive and salutogenic than public health experts were (Study 2). The randomised controlled trial found a slightly larger positive effect in the Intervention Group (28.0%) than in the Control Group (32.3%)) but not significant (p=0.071) (Study 3). Participants gave the platform an overall usability score of 62.80 (SD 13.41). Most of them were positive about the messages (Study 4). Conclusions: VMMC counselling needs to take into account the real-life context of the circumcised men. Due to systematic, social and cultural factors, there is a real risk that men in this population may initiate sex before complete healing has occurred (Study 1). Consultation with potential m-Health recipients and using classic behavioural theories are vital to the success of a programme (Study 2). Early resumption of sex after VMMC is common, warranting better counselling. M-Health technology is a potential tool but it should be complemented by other behaviour-change methods (Study 3). The results suggest that the audio messaging system has good usability, user experience and user acceptance (Study 4).
Development of a best practice model for teaching and learning evidence-based health care at Stellenbosch University, South Africa
(Stellenbosch : Stellenbosch University, 2016-03) Young, Taryn; Volmink, Jimmy; Clarke, Mike; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Community Health.
ENGLISH ABSTRACT: This thesis used a mixed-methods approach to investigate how teaching and learning of Evidence-based Health Care (EBHC) could best be integrated in medical student training to enhance student EBHC knowledge, attitude and skills. An overview of systematic reviews assessing the effects of teaching EBHC showed that clinically integrated multifaceted strategies with assessment were more effective than single interventions or no interventions for enhancing knowledge, attitude and skills. Implementation of clinically integrated EBHC teaching and learning was further explored through interviews with programme coordinators from around the world. Informants were requested to provide data on the various approaches used, and on barriers and facilitators encountered with programmes aimed at teaching and learning EBHC in an integrated manner. By far the most common challenges were lack of space in the clinical setting, EBHC misconceptions, resistance of staff and lack of confidence of tutors, time, and negative role modelling. Critical success factors identified were pragmatism and nimbleness in responding to opportunities for engagement and including EBHC learning into the curriculum, patience, and a critical mass of the right teachers who have EBHC knowledge, attitudes and skills and are confident in facilitating learning. In addition, role modelling within the clinical setting and the overall institutional context were found to be important for success. The next phase involved conducting a set of studies to determine the opportunities for, and barriers to, implementing EBHC teaching and learning at Stellenbosch University’s (SU) Faculty of Medicine and Health Sciences. This included a curriculum document review, survey of recent graduates and interviews with faculty. EBHC teaching was found to be fragmented and recent graduates called for more teaching of certain EBHC competencies. Module convenors identified a number of factors that needed to be addressed: contextual factors within the faculty (e.g. recognition for teaching), health sector issues (e.g. clinical workload), access to research evidence, and issues related to educators (e.g. competing priorities) and learners (e.g. motivation). Interviewees also emphasised the importance of educators as facilitators and role models. A cross-sectional study of SU was conducted to assess SU educators’ knowledge of, attitude to and confidence in practicing and teaching EBHC as well as perceived barriers to practicing and teaching EBHC. Limitations to practicing EBHC identified included lack of time, clinical workload, limited access to internet and resources, knowledge and skills. Respondents’ called for reliable internet access, easy point-of-care access to databases and resources, increasing awareness of EBHC, building capacity to practice and facilitate learning of EBHC, and a supportive community of practice. Finally, drawing on the findings of the preceding quantitative and qualitative studies, and taking into account the context of various EBHC initiatives in the African region, an outline proposal is presented for a cluster randomised trial to evaluate alternative options for implementing a clinically integrated EBHC curriculum in an African setting.
Economic support to improve TB treatment outcomes in South Africa : a pragmatic cluster randomized controlled trial
(Stellenbosch : Stellenbosch University, 2013-12) Lutge, Elizabeth Eleanor; Volmink, J. A.; Lewin, S. A.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Division of Community Health.
ENGLISH ABSTRACT: This thesis focused on the provision of economic support to improve the outcomes of patients on TB treatment. Although the association between poverty and tuberculosis is generally acknowledged, there is little evidence to guide the use of economic interventions to improve tuberculosis control. In South Africa, a high burden country with extensive poverty, such evidence is particularly important. The first part of this thesis is a Cochrane systematic review of evidence from randomized controlled trials regarding the effectiveness of economic support among patients with tuberculosis. Eleven trials were included: ten conducted among marginalised groups in the United States on economic support for people on prophylactic treatment for latent TB; and one from Timor-Leste on economic support for patients with active TB. The review found that the use of economic interventions in patients with latent TB may increase the return rate for reading tuberculin skin test results, probably improves clinic re-attendance for initiation or continuation of prophylaxis and may improve completion of prophylaxis, compared to normal care. However, it is uncertain if economic support improves treatment completion in patients with active TB (low quality evidence). The second part of the thesis reports the findings of a pragmatic, cluster randomized controlled trial to evaluate the feasibility and effectiveness of delivering economic support to patients on treatment for active TB in South Africa. Patients with drug sensitive pulmonary TB were offered a monthly voucher valued at ZAR120 until completion of treatment or a maximum of eight months. Patients in control clinics received usual TB care. A parallel process evaluation provided contextual information to explain the trial findings. The qualitative component of this evaluation consisted of in-depth interviews with a sample of trial participants, including patients, nurses and health managers, to assess responses to the voucher and its administration. The quantitative component included a survey of patients’ household expenditure to assess patients’ levels of poverty and the effects of the voucher on these, and an analysis of the goods on which patients spent their vouchers. 4091 patients were included in the trial: 1984 in the control arm (10 clinics) and 2107 in the intervention arm (10 clinics). Intention to treat analysis showed a small but non-significant improvement in treatment success rates in intervention clinics (intervention 76.2%; control 70.7%; risk difference 5.6% (-1.2; 12.3%), p = 0.107). Fidelity to the intervention was low, partly because nurses preferred to issue vouchers based on perceived financial need, rather than on eligibility. Logistical difficulties in delivering vouchers to clinics also undermined fidelity. The vouchers did not significantly increase patients’ household expenditure, but were experienced by patients as helpful, especially in providing more food with which to take their tablets. Factors related to the administration of economic support may undermine its effectiveness in improving TB treatment outcomes. Further research is needed to explore how best to deliver such economic support to those eligible to receive it, particularly in low and middle income countries where the burden of tuberculosis is highest.
Edentulousness and complete denture care in the Western Cape Province with specific reference to the need for and feasibility of establishing denturists as a new occupational category in the oral health care work force
(Stellenbosch : Stellenbosch University, 1998) Hartshorne, Johannes Enoch; Louw, N. P.; Stellenbosch University. Faculty of Medicine & Health Sciences. Department of Restorative Dentistry.
ENGLISH ABSTRACT: see item for full text.
Envisioning enabling environments for young women with perinatal infections of Human Immunodeficiency Virus in Africa : a participatory creative new-materialist approach.
(Stellenbosch : Stellenbosch University, 2023-12) Hendricks, Lynn Avril; Hannes, Karin; Young, Taryn; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
ENGLISH SUMMARY: Background: Targeted due to gender and age in South Africa, young women often must negotiate health and safety in their homes and communities – this is even more challenging for young women living with perinatal infections of Human Immunodeficiency Virus (YWLPHIV). Young people living with perinatal infections face a chronic disease, with treatment including adherence to lifelong Antiretroviral treatment (ART). We set out to learn more about young women perinatally infected with Human Immunodeficiency Virus (HIV) in Cape Town, their experience with HIV, how they negotiated adherence to ART regimens within their environments, and how environments could be enabled to support their adherence. Methods: This study used qualitative evidence synthesis (QES) and multisensory arts-based community participatory research methods, working together with six young women as allies. In phase 1, we synthesised the evidence landscape on adherence to ART. In phase 2, we conceptualised the Adherence Assemblage conceptual model of ART and the methodological approach of the third sphere for allyship. In phase 3, we co-explored with YWLPHIV their experiences and co-produced creative artworks and a research documentary, More than a pill. In phase 4, we focused on recommendations for enabling environments. Our multimodal approach included methods such as QES, artistic co-creations, body mapping, collaborative filmmaking, collecting material objects of meaning, community mapping, individual and group conversations including walking and driving interviews, journalling, multisensory home and clinic interviews, a research camp, and storytelling. Analytically, we used a new materialist lens to develop a new enabling environments framework from the innovative Adherence Assemblage model and applied analysis such as mega-aggregation framework synthesis, synthesis by storyboarding, creative synthesis, and thematic analysis. Results: Drawing on the findings of multiple types of qualitative data, which captured the perspectives of various role players, and amplified the voices of YWLPHIV, while considering the social-material-natural environment context in Africa, this PhD delivers: an innovative method of Mega-Aggregation Framework synthesis, a new qualitative evidence synthesis analytic method called Analysis by Storyboarding, a new conceptual model for adherence – the Adherence Assemblage, advances allyship in qualitative methods with the concept of the third sphere, actualised collaborative film production and creative works as synthesis, had a sustainable impact for both researchers and participants alike, and provides tangible recommendations for enabling environments to support adherence to ART for YWLPHIV. To enable environments for YWLPHIV, recommendations included supportive disclosure practices, self-efficacy and self-acceptance, supportive relationships and caring communities, mitigating violence as a barrier to adherence and safe outdoor spaces, acknowledging the material dimension, integrated and holistic health care, compassionate educational systems, and advancing knowledge systems and research practices. Conclusion: This study is one of the first to go beyond barriers and facilitators to adherence for people living with HIV and explores the role of the socio-natural-material environment in depth. Young women living in challenging communities in Cape Town, South Africa, struggled with adherence due to environmental and community-level factors such as violence, economic inequities, lack of social support, inadequate health systems, and disadvantageous structural community layouts. Risking their lives to travel to clinics in unsafe communities, silencing their voices in their households, and being at high risk for domestic violence and femicide in their romantic relationships demands of us to bring to light their experiences, which is in line with Sustainable Development Goals (SDG) 5 (gender equality) and ending all forms of discrimination against all women and girls in private and public spheres. Working from a multimodal perspective allowed us to venture deeper together and opened the research space for multiple stakeholders for rich engagement throughout the research process. The findings of this PhD contribute to the African evidence that future research and interventions can be built to support young women and their families as they navigate their journeys of adherence to ART.
Epidemiological and laboratory investigations of the hazardous effects of wine on human enamel
(2005-04) Chikte, Usuf M. E.; Grobler, S. R.; Dreyer, W. P.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Community Health.
ENGLISH ABSTRACT: The purpose of this study was to investigate the erosive effect of wine on human permanent teeth. A multidimensional research approach utilising epidemiological investigations, Microhardness tests, Scanning Electron Microscopy and Confocal Laser Scanning Electron Microscopy (CLSM) were employed. The combination of these three scientific methods enabled the researcher to arrive at new concepts about the physical characteristics of the influence wine has on the dentition with special reference to enamel. A difference in erosion between teeth of wine-makers (and/or wine-tasters) and those who are not wine-makers, was clearly demonstrated. It is, however, possible that this difference might partially be attributed to the fact that the two main comparative groups were of opposite genders. In comparative epidemiological studies the design is constructed to have the groups similar with respect to background aetiology and different only to the factor under investigation, in this instance the frequent exposure to wine (high frequency and long duration of contact between wine and the teeth). In all likelihood the continuous, frequent exposure of wine-makers to wine is the major factor in the differences obtained (e.g. tooth surface loss and dentition status) in this study. A strong positive relationship was noted between statistically weighted tooth surface loss and the chronological age of wine-makers. A similar positive relationship could not be demonstrated in the case of years employed in the wine industry and tooth surface loss. All the Microhardness tests and microscopic investigations conducted confirmed the deleterious influence of wine on enamel. A clear 'dose-response' relationship was demonstrated by means of the Microhardness tests. The Scanning Electron Microscope and the Confocal Scanning Laser Electron Microscope (CLSM) work both corroborated the effects determined by the Microhardness tests. Differences were also demonstrated in the surface morphology of enamel with respect to the exposure to the wines investigated in the Scanning Electron Microscope (SEM) (three wines) and CLSM (two wines) studies. Differences with respect to severity were well established by means of the SEM investigations. Surface and subsurface lesions were observed with the aid of CLSM on the enamel exposed to the two wines.

Browse

Browsing Health Systems and Public Health by browse.metadata.type "Thesis"

Results Per Page

Sort Options