Masters Degrees (Health Systems and Public Health)

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    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.
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    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.
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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.
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    The prevalence and associated factors responsible for delayed return to work after the mandatory isolation period post-Covid-19 at Tygerberg Hospital, 2020 a cross-sectional study
    (Stellenbosch : Stellenbosch University, 2022-12) Weinand, Fredrick John; Meintjes, Willem Albertus Jacobus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    ENGLISH SUMMARY: Background: Covid-19 had a negative impact not only on the individuals but also on the organisation. While most employers wish the employee to resume duty just after the employee is out of isolation that might unfortunately not be the case. Some employees may continue to be unfit even after completing the isolation period. Aim: To determine the prevalence and associated factors responsible for delayed return to work post-COVID-19 isolation at Tygerberg Hospital. Methods: A cross-sectional study was conducted by extracting clinical information of the health care worker files of employees who attended Tygerberg Hospital Occupational Health Clinic. Data were collected from patient folders, symptom monitoring forms, compensation forms and the Covid-19 questionnaires completed during the return to work assessments. Results: A total of 1014 participants were analysed; 43% (436/1014) had delayed return to work post Covid-19 isolation, 95% CI (39.98-46.07) with the median days of 14.0 (IQR=12-17). Factors associated with the delayed return in the multivariate analysis included: Being hospitalised (OR 4.58, 95%CI=1.56-13.45; p= 0.006), having ongoing Covid-19 symptoms (OR=1.72, 95%CI=1.05-2.82; p=0.031) the professional nurse (OR 1.38, 95%CI=1.00-1.91; p=0.049) and employees from obstetrics and gynaecology section (OR 1.68, 95%CI=1.06-2.66; p=0.026). Other factors included employees with diabetes (OR 2.02, 95% CI=1.34-3.06; p= 0.001), hypertension (OR 1.76, 95%CI=1.30-2.38; p=0.020), the symptoms of shortness of breath (OR 2.22, 95%CI=1.69-2.93; p<0.001. Additional factors included employees above 60 years of age, (OR 3.52, 95%CI=1.44-8.57; p= 0.006) and the Covid-19 testing facility attended: public vs private (OR 0.64, 95%CI=0.47-0.88; p=0.004). Conclusions: Various, in some cases several, factors were found to affect employees' return to work post-Covid-19 isolation. A holistic approach, rather than a focus on the pathophysiology of the virus, should be encouraged. Follow up studies on the long-term impact of Covid-19 infection on the employees' health is advised.
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    Knowledge, attitudes and practices of COVID-19 infection prevention and control among nurses in the intensive care unit at Groote Schuur Hospital, Cape Town
    (Stellenbosch : Stellenbosch University, 2022-03) Onga, Bangani; English, Rene; Dramowski, Angela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    ENGLISH ABSTRACT: Introduction: Critical care environments rapidly adapted infection prevention and control (IPC) practices in response to the COVID-19 pandemic. Critical care nurse’s knowledge, attitudes, and practices (KAP) regarding COVID-19 IPC may impact the risk of healthcare-associated COVID-19 transmission. Methods: A mixed-methods study was conducted among intensive care unit (ICU) nurses at Groote Schuur Hospital, Cape Town, South Africa between 20 April and 30 May 2021. Participants completed anonymous, self-administered, 33-item KAP questionnaires and individual interviews regarding their lived experiences and perceptions of COVID-19 IPC in critical care. Results: One hundred and sixteen ICU nurses participated (93.5% response rate) including 57 professional nurses (49.0%), 34 enrolled nurses (29.0%) and 25 enrolled nursing assistants (22.0%) with young females (31-49 years) predominating (99; 85.3%). Nurses’ overall COVID-19 IPC knowledge scores were moderate-good (78%), with professional nurses having significantly better knowledge regarding the route of SARS-CoV-2 transmission (p<0.001). ICU nurses’ attitude scores to COVID-19 IPC were low (55%), influenced by limited IPC training, insufficient time to implement IPC precautions and shortages of personal protective equipment (PPE). Respondents’ scores for self-reported COVID-19 IPC practices were moderate (65%); the highest compliance was reported for performing hand hygiene after touching patient surroundings (68%). Only half of the respondents (47%) had undergone N95 respirator fit-testing, despite working in a high-risk environment for COVID-19 transmission. Conclusion: Regular and intensive training on COVID-19 IPC precautions should be provided to equip ICU nurses with the requisite knowledge and skills to prevent healthcare-associated COVID-19 transmission. Enhanced IPC training and consistent PPE availability may contribute to more favourable attitudes and better IPC practices among ICU nurses.