Assessing the implementation of long-acting reversible contraceptive implant, Implanon NXT, roll out in East London, Eastern Cape, South Africa.
- Authors: Mdingi, Mildred Mandisa
- Date: 2020
- Subjects: Primary health care
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/18452 , vital:42267
- Description: Background: In 2014, South African Department of Health (SADOH) initiated use of Implanon NXT, a type of implant in addition to long-acting reversible contraceptives available in the country to expand contraceptives options for women of reproductive age. After its introduction, there were reports on early removals and frequent side effects. It is therefore vital to identify how successful the implementation of this method was in particular in East London area. Objectives: The purpose of this study was to evaluate how successful the implementation of Implanon NXT roll out was in East London, Eastern Cape. Additionally, the study also aimed to understand the views health care providers have of the Implanon NXT. Methods: A retrospective crosssectional design using existing data from family planning registers and distribution of questionnaires to Health Care Providers responsible for insertion and removal of the method (HCP). Results: February 2014 to March 2019, 1238 Implanon NXT insertions were done and only 266 removals in one study site. Out of the 266 participants, 67.7% of the participants removed the Implanon for reasons other than ill health (side effects), while the remaining 32.3% had experienced side effects and opted for early Implanon removal. Bleeding was the most common side effect reported by 44 of 266 (16.5%) participants. The health care providers who completed questionnaires for this study were overall confident in providing the Implanon NXT services. Conclusion: Implementation of a new contraceptive method requires clear standardised policies and guidelines on counselling and management of side effects. Findings of this study are reassuring that Implanon NXT had a role to play in prevention of unintended pregnancies. Implementation and rollout in one site reviewed has been demonstrated to be successful. The respondents in this study possesses knowledge about the Implanon NXT.
- Full Text:
- Date Issued: 2020
- Authors: Mdingi, Mildred Mandisa
- Date: 2020
- Subjects: Primary health care
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/18452 , vital:42267
- Description: Background: In 2014, South African Department of Health (SADOH) initiated use of Implanon NXT, a type of implant in addition to long-acting reversible contraceptives available in the country to expand contraceptives options for women of reproductive age. After its introduction, there were reports on early removals and frequent side effects. It is therefore vital to identify how successful the implementation of this method was in particular in East London area. Objectives: The purpose of this study was to evaluate how successful the implementation of Implanon NXT roll out was in East London, Eastern Cape. Additionally, the study also aimed to understand the views health care providers have of the Implanon NXT. Methods: A retrospective crosssectional design using existing data from family planning registers and distribution of questionnaires to Health Care Providers responsible for insertion and removal of the method (HCP). Results: February 2014 to March 2019, 1238 Implanon NXT insertions were done and only 266 removals in one study site. Out of the 266 participants, 67.7% of the participants removed the Implanon for reasons other than ill health (side effects), while the remaining 32.3% had experienced side effects and opted for early Implanon removal. Bleeding was the most common side effect reported by 44 of 266 (16.5%) participants. The health care providers who completed questionnaires for this study were overall confident in providing the Implanon NXT services. Conclusion: Implementation of a new contraceptive method requires clear standardised policies and guidelines on counselling and management of side effects. Findings of this study are reassuring that Implanon NXT had a role to play in prevention of unintended pregnancies. Implementation and rollout in one site reviewed has been demonstrated to be successful. The respondents in this study possesses knowledge about the Implanon NXT.
- Full Text:
- Date Issued: 2020
Contraceptive use and Sex Education among Teenagers in Mdantsane Township, Eastern Cape
- Authors: Ibikunle, Kehinde Olaoye
- Date: 2020
- Subjects: Sex instruction Primary Health Care
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/18411 , vital:42263
- Description: Uptake of contraceptives to prevent unwanted pregnancy among sexually active teenagers in South Africa remains low as evidenced by the high prevalence of unwanted pregnancy and unsafe abortions among adolescents. This is happening despite the wide availability of contraceptives which are also offered free of charge and in a context where comprehensive sexuality education is provided from primary school level. There is limited evidence regarding contraceptive use among teenagers in South Africa, which limits the decision making on targeting for promoting use of contraceptives. To address this gap, a quantitative cross sectional study of women aged 13 and above was conducted in Mdatsane Township to investigate the factors associated with contraceptive use among teenagers and compare this with young women aged 20 and above, as well as to assess if there are any associations in the use of contraceptives between the demographic characteristics of the teenagers and their caregivers. The study findings showed that non-use of contraceptives was 53.3%. Teenagers were significantly less likely to use contraceptives, OR 0.31, 95% CI (0.18 – 0.530), more likely to use injectables OR 3.48 95% CI 1.99 – 6.08, more likely to identify partner issues being reason for not using condoms OR 10.60, 95 % CI (2.01 – 55.94). Teenager were more likely to have Termination of unwanted pregnancy on the past (TOP), OR 2.13 95% CI (1.03 – 4.38), and would likely choose Depo/Petogen even if it increases HIV transmission OR 3.65, 95% CI (1.98 – 6.73). Teenagers were more likely to have been exposed to sex education and less likely to have a close relationship with caregivers OR 0.49 95% CI (0.27 – 0.90). In view of these findings it is logical to argue that although teenagers have accessed CSE they have not been able to translate it into action. Hence the need to develop the strategies that can help facilitate behaviour change. Further in-depth studies must be conducted to establish which types of contraceptives are preferred and acceptable to teenagers. Promote self-efficacy of teenagers to be empowered to make own decisions and not put their partners’ preferences on use of contraceptives and continue promoting primary and secondary abstinence while also encouraging delayed sexual debut
- Full Text:
- Date Issued: 2020
- Authors: Ibikunle, Kehinde Olaoye
- Date: 2020
- Subjects: Sex instruction Primary Health Care
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/18411 , vital:42263
- Description: Uptake of contraceptives to prevent unwanted pregnancy among sexually active teenagers in South Africa remains low as evidenced by the high prevalence of unwanted pregnancy and unsafe abortions among adolescents. This is happening despite the wide availability of contraceptives which are also offered free of charge and in a context where comprehensive sexuality education is provided from primary school level. There is limited evidence regarding contraceptive use among teenagers in South Africa, which limits the decision making on targeting for promoting use of contraceptives. To address this gap, a quantitative cross sectional study of women aged 13 and above was conducted in Mdatsane Township to investigate the factors associated with contraceptive use among teenagers and compare this with young women aged 20 and above, as well as to assess if there are any associations in the use of contraceptives between the demographic characteristics of the teenagers and their caregivers. The study findings showed that non-use of contraceptives was 53.3%. Teenagers were significantly less likely to use contraceptives, OR 0.31, 95% CI (0.18 – 0.530), more likely to use injectables OR 3.48 95% CI 1.99 – 6.08, more likely to identify partner issues being reason for not using condoms OR 10.60, 95 % CI (2.01 – 55.94). Teenager were more likely to have Termination of unwanted pregnancy on the past (TOP), OR 2.13 95% CI (1.03 – 4.38), and would likely choose Depo/Petogen even if it increases HIV transmission OR 3.65, 95% CI (1.98 – 6.73). Teenagers were more likely to have been exposed to sex education and less likely to have a close relationship with caregivers OR 0.49 95% CI (0.27 – 0.90). In view of these findings it is logical to argue that although teenagers have accessed CSE they have not been able to translate it into action. Hence the need to develop the strategies that can help facilitate behaviour change. Further in-depth studies must be conducted to establish which types of contraceptives are preferred and acceptable to teenagers. Promote self-efficacy of teenagers to be empowered to make own decisions and not put their partners’ preferences on use of contraceptives and continue promoting primary and secondary abstinence while also encouraging delayed sexual debut
- Full Text:
- Date Issued: 2020
Exploring challenges in implementing a health referral system in the Buffalo city metropolitan municipality in the Eastern Cape Province”
- Authors: Matolengwe, Aseza
- Date: 2020
- Subjects: Primary health care
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/18441 , vital:42266
- Description: The purpose of the study is to explore and describe challenges experienced by health professionals regarding implementation of the referral system used in Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape Province. A referral system in health care can be defined as a method whereby a health worker with insufficient skills and less resources in the primary health care setting, who has fewer remedies or options to manage medical conditions, seeks assistance from a more senior practitioner in a tertiary setting with better resources to provide guidance in managing the patient or to take over the management of the patient (Eastern Cape Department of Health, 2007:7). A qualitative descriptive explorative contextual design was used to explore and describe the challenges pertaining to the implementation of a referral system in the public health sector in Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape. A purposive sampling technique was employed with an inclusion criteria of health care professionals who are doctors, professional nurses, pharmacists and specialists. After obtaining ethical clearance from the respective departments, steps for data collection were implemented. Individual interviews were conducted using an interview guide that was prepared by the researcher. Findings in the study indicate that there are challenges in implementing a referral system in relation to infrastructure, workforce capacity, equipment, transport and drug availability. The participants provided suggestions according to their experiences on what they felt the Department of Health in BCMM could do to strengthen the referral system in place. The researcher then provided recommendations to the Department of Health of BCMM. The health referral system in BCMM needs to be strengthened through provision of adequate infrastructure, improving workforce capacity, and availability of medicines and equipment. A monitoring and evaluation plan must be affected by the Eastern Cape Department of Health. Education and training are needed for the health care workers and the community through their involvement in stakeholder meetings
- Full Text:
- Date Issued: 2020
- Authors: Matolengwe, Aseza
- Date: 2020
- Subjects: Primary health care
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/18441 , vital:42266
- Description: The purpose of the study is to explore and describe challenges experienced by health professionals regarding implementation of the referral system used in Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape Province. A referral system in health care can be defined as a method whereby a health worker with insufficient skills and less resources in the primary health care setting, who has fewer remedies or options to manage medical conditions, seeks assistance from a more senior practitioner in a tertiary setting with better resources to provide guidance in managing the patient or to take over the management of the patient (Eastern Cape Department of Health, 2007:7). A qualitative descriptive explorative contextual design was used to explore and describe the challenges pertaining to the implementation of a referral system in the public health sector in Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape. A purposive sampling technique was employed with an inclusion criteria of health care professionals who are doctors, professional nurses, pharmacists and specialists. After obtaining ethical clearance from the respective departments, steps for data collection were implemented. Individual interviews were conducted using an interview guide that was prepared by the researcher. Findings in the study indicate that there are challenges in implementing a referral system in relation to infrastructure, workforce capacity, equipment, transport and drug availability. The participants provided suggestions according to their experiences on what they felt the Department of Health in BCMM could do to strengthen the referral system in place. The researcher then provided recommendations to the Department of Health of BCMM. The health referral system in BCMM needs to be strengthened through provision of adequate infrastructure, improving workforce capacity, and availability of medicines and equipment. A monitoring and evaluation plan must be affected by the Eastern Cape Department of Health. Education and training are needed for the health care workers and the community through their involvement in stakeholder meetings
- Full Text:
- Date Issued: 2020
Knowledge of drowning risks amongst adolescents in the Nelson Mandela Metropole, Eastern Cape Province, South Africa
- Authors: Isaacs, Imeraan
- Date: 2020
- Subjects: Primary health care
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/18422 , vital:42264
- Description: The purpose of this research study was to explore and describe the knowledge and the level of awareness of drowning risks amongst adolescents in the Nelson Mandela Metropole, Eastern Cape Province, and South Africa. Drowning is defined as the “process of experiencing respiratory impairment from either submersion or immersion into a water medium” (van Beeck et al 2005:853). Global statistics place drowning as being the third foremost cause of unintentional death worldwide (WHO 2013). The World Health Organization reports that more than 90% of the estimated 370 000 drowning fatalities recorded in 2012 occurred in low and middle income countries (WHO 2014). A qualitative descriptive explorative contextual design was employed in this research study. A non-probability convenience sampling method was used. Adolescents aged 10- 13 years old who attend a public primary school and model C primary school in Nelson Mandela Metropole area in the Eastern Cape Province were the target population who had the specific characteristics of interest and significance to the research phenomenon (Asiamah et al 2017). Four focus group interviews were conducted. The groups consisted of five to ten participants grouped together to discuss the matter. Field notes were also taken by the researcher on what was heard, observed, thought and experienced during the interview process (Streubert & Carpenter 2007). Ethical principles were maintained as well as the concepts of trustworthiness were applied throughout this study.Data analysis was done using Tesch’s approach to open coding in qualitative research. A total of six themes and seven sub-themes arose during the analysis of the data and were completely discussed. The findings suggest that most of the participants are quite aware and knowledgeable of the potential risks that predispose an individual to drowning. The consequences of what happens when a victim is exposed to drowning, however, requires more insight. The risk of being unsupervised as well as not being able to swim was echoed in most of the group interviews. vii A noteworthy finding was the fact that the participants who were involved with some form of water safety programme/s at school were very articulate in their responses to the questions. It was recommended that educational programmes ought to be aligned with current evidence which is reflective of the region’s demographics and dynamics. Even though all researchers do not share the sentiments that swim proficiencies heighten the safety of the individual in and around water, the need for ongoing research initiatives is a significant stimulus that will generate new evidence and inform current preventive strategies. Identification and awareness of drowning risks require a foundation of comprehension in order to better understand and interpret the consequences of these risks. Learn to swim or swim orientation initiatives could potentially assist at primary school level with the safety levels of learners.
- Full Text:
- Date Issued: 2020
- Authors: Isaacs, Imeraan
- Date: 2020
- Subjects: Primary health care
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/18422 , vital:42264
- Description: The purpose of this research study was to explore and describe the knowledge and the level of awareness of drowning risks amongst adolescents in the Nelson Mandela Metropole, Eastern Cape Province, and South Africa. Drowning is defined as the “process of experiencing respiratory impairment from either submersion or immersion into a water medium” (van Beeck et al 2005:853). Global statistics place drowning as being the third foremost cause of unintentional death worldwide (WHO 2013). The World Health Organization reports that more than 90% of the estimated 370 000 drowning fatalities recorded in 2012 occurred in low and middle income countries (WHO 2014). A qualitative descriptive explorative contextual design was employed in this research study. A non-probability convenience sampling method was used. Adolescents aged 10- 13 years old who attend a public primary school and model C primary school in Nelson Mandela Metropole area in the Eastern Cape Province were the target population who had the specific characteristics of interest and significance to the research phenomenon (Asiamah et al 2017). Four focus group interviews were conducted. The groups consisted of five to ten participants grouped together to discuss the matter. Field notes were also taken by the researcher on what was heard, observed, thought and experienced during the interview process (Streubert & Carpenter 2007). Ethical principles were maintained as well as the concepts of trustworthiness were applied throughout this study.Data analysis was done using Tesch’s approach to open coding in qualitative research. A total of six themes and seven sub-themes arose during the analysis of the data and were completely discussed. The findings suggest that most of the participants are quite aware and knowledgeable of the potential risks that predispose an individual to drowning. The consequences of what happens when a victim is exposed to drowning, however, requires more insight. The risk of being unsupervised as well as not being able to swim was echoed in most of the group interviews. vii A noteworthy finding was the fact that the participants who were involved with some form of water safety programme/s at school were very articulate in their responses to the questions. It was recommended that educational programmes ought to be aligned with current evidence which is reflective of the region’s demographics and dynamics. Even though all researchers do not share the sentiments that swim proficiencies heighten the safety of the individual in and around water, the need for ongoing research initiatives is a significant stimulus that will generate new evidence and inform current preventive strategies. Identification and awareness of drowning risks require a foundation of comprehension in order to better understand and interpret the consequences of these risks. Learn to swim or swim orientation initiatives could potentially assist at primary school level with the safety levels of learners.
- Full Text:
- Date Issued: 2020
Knowledge, attitudes and behaviours of food preparers regarding food preparation in East London, South Africa
- Fundam, Thembeka, van Niekerk, Firstnames
- Authors: Fundam, Thembeka , van Niekerk, Firstnames
- Date: 2020
- Subjects: Primary health care Food service management
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/18400 , vital:42262
- Description: Background: Food preparers and food handlers seem to face difficulties in identifying activities that render food unsafe as a result of food contamination during food preparation. Research has shown that food preparation is a global problem and a potential health risk which can result in food-borne diseases as a result of a lack of knowledge on the principles of hygienic practices and negative attitudes when handling food. Aim: This study aims to determine the knowledge, attitudes and behaviours that motivate food preparers in safe food preparation. Method: Building on existing work in understanding this phenomenon it asks: A purposive sample of male and female participants who prepare food at home were asked to complete a questionnaire. The questionnaire items were developed through focus group interviews and after a pilot study, presented to participants to complete. The items were subjected to principal component analysis (factor analysis), yielding a six-factor solution. The factor means, standard deviations were calculated and reliability was determined for each factor using Cronbach’s alpha as a measure of internal consistency. Group differences were determined through independent samples t-tests and anova. Results: The quantitative analysis demonstrated that food preparers have a fair knowledge and perception of how to prevent contamination. However, their behaviour is various aspects of food preparation might at times put them at risk for contamination. With regards to attitude, when comparing groups, people who prepare food with love and care demonstrated a more positive attitude towards food preparation than those who are less passionate to prepare food. On this basis, hygiene education should focus on the perceived threat to health as cues to action in changing attitudes and adherence to recommendations on hygiene. Conclusion: Further research is required to solicit the views of respondents below the age of 18 with regard to food-handling practices in pre-prepared food to ascertain and prevent further contamination and ensure food safety.
- Full Text:
- Date Issued: 2020
- Authors: Fundam, Thembeka , van Niekerk, Firstnames
- Date: 2020
- Subjects: Primary health care Food service management
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/18400 , vital:42262
- Description: Background: Food preparers and food handlers seem to face difficulties in identifying activities that render food unsafe as a result of food contamination during food preparation. Research has shown that food preparation is a global problem and a potential health risk which can result in food-borne diseases as a result of a lack of knowledge on the principles of hygienic practices and negative attitudes when handling food. Aim: This study aims to determine the knowledge, attitudes and behaviours that motivate food preparers in safe food preparation. Method: Building on existing work in understanding this phenomenon it asks: A purposive sample of male and female participants who prepare food at home were asked to complete a questionnaire. The questionnaire items were developed through focus group interviews and after a pilot study, presented to participants to complete. The items were subjected to principal component analysis (factor analysis), yielding a six-factor solution. The factor means, standard deviations were calculated and reliability was determined for each factor using Cronbach’s alpha as a measure of internal consistency. Group differences were determined through independent samples t-tests and anova. Results: The quantitative analysis demonstrated that food preparers have a fair knowledge and perception of how to prevent contamination. However, their behaviour is various aspects of food preparation might at times put them at risk for contamination. With regards to attitude, when comparing groups, people who prepare food with love and care demonstrated a more positive attitude towards food preparation than those who are less passionate to prepare food. On this basis, hygiene education should focus on the perceived threat to health as cues to action in changing attitudes and adherence to recommendations on hygiene. Conclusion: Further research is required to solicit the views of respondents below the age of 18 with regard to food-handling practices in pre-prepared food to ascertain and prevent further contamination and ensure food safety.
- Full Text:
- Date Issued: 2020
Assessment of quality nursing care in healthcare facilities of Mnquma Sub-District
- Authors: Manyela, Nosiphiwo
- Date: 2019
- Subjects: Health facilities
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16747 , vital:40770
- Description: Aim: The purpose of the study was to assess the quality of patient care in the Primary Health Care (PHC) facilities of Mnquma Sub-district with the goal of improving or maintaining quality nursing in the area. Methodology: This study followed a quantitative research approach and it is descriptive in nature. The study involved 561 participants, of whom 406 participants were from urban clinics and 155 were from rural facilities, all these participants were attending clinics at Mnquma Sub-district. A structured questionnaire was used for data collection, since the participants were able to read and write in either English and or IsiXhosa. The data was analyzed with the help of a statistician using Statistical Package for Social Sciences (SPSS) program, software for windows version 21.0 Results: Results showed that participant’s responses to five of the twelve items on patient safety were found to have significant associations with residential setting. Rural participants were less likely to disagree with statements on availability of signage at the entrance of health establishment that indicates times when various services are offered, availability of the security guards to ensure patient safety, warning signs always put in place when the floors are wet, availability of at least one toilet for disabled patients in the health establishment and the fact that health professionals are always wearing name tags. This means that patient safety and security is practiced and implemented at the rural facilities according to the national core standards. The findings of the study confirmed that 13 items out of 19 under care and attitudes were found to have significant associations with residential setting. The items were patients spending less than 2 hours in the health facility; staff treating patients politely, illness being explained clearly to the patients, and ability of the patients to ask questions about their illness. Other items included nursing attitudes during opening and closing times of the health establishment, staff responding well when requested to assist, patients are being treated with empathy, patients are addressed by names and patients are being given all the treatment that they need, nurses explains the treatment side effects, and explains how to deal with side effects. This means that responses to these items depend on whether the patient is from a rural or urban clinic. Rural communities were found to be vi less likely to disagree with statements as compared to urban communities. This means that nurses are compliant with nursing care and attitudes in rural clinics. Findings of the study with respect to facility cleanliness, shows that there is no significant associations between the responses to the items which are: surroundings of the clinic are free of unpleasant smells, grounds of the clinic are clean, safe and clean grounds, bin waste inside and outside storage poses no health risks, and setting were detected. This means that the facilities are and cleanliness status remains the same across the residential settings. However, the younger age group was found be significantly more likely to disagree that toilets are clean and odorless and that grounds are safe and clean compared to the older age group. This suggests that the environment is clean except the toilets. Conclusion: Staffs at the facilities are at times ignorant and have negative attitudes at the opening and closing times and facilities have been reported to have long waiting times. The study indicated that the safety and security measures in the urban health facilities are not all practiced according to the National Core Standards checklist/Assessment tool, particularly wet warning signs, disabled toilets, and wearing of nametags. Majority of the participants indicated that, the status of cleanliness was on par at the urban and rural facilities.
- Full Text:
- Date Issued: 2019
- Authors: Manyela, Nosiphiwo
- Date: 2019
- Subjects: Health facilities
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16747 , vital:40770
- Description: Aim: The purpose of the study was to assess the quality of patient care in the Primary Health Care (PHC) facilities of Mnquma Sub-district with the goal of improving or maintaining quality nursing in the area. Methodology: This study followed a quantitative research approach and it is descriptive in nature. The study involved 561 participants, of whom 406 participants were from urban clinics and 155 were from rural facilities, all these participants were attending clinics at Mnquma Sub-district. A structured questionnaire was used for data collection, since the participants were able to read and write in either English and or IsiXhosa. The data was analyzed with the help of a statistician using Statistical Package for Social Sciences (SPSS) program, software for windows version 21.0 Results: Results showed that participant’s responses to five of the twelve items on patient safety were found to have significant associations with residential setting. Rural participants were less likely to disagree with statements on availability of signage at the entrance of health establishment that indicates times when various services are offered, availability of the security guards to ensure patient safety, warning signs always put in place when the floors are wet, availability of at least one toilet for disabled patients in the health establishment and the fact that health professionals are always wearing name tags. This means that patient safety and security is practiced and implemented at the rural facilities according to the national core standards. The findings of the study confirmed that 13 items out of 19 under care and attitudes were found to have significant associations with residential setting. The items were patients spending less than 2 hours in the health facility; staff treating patients politely, illness being explained clearly to the patients, and ability of the patients to ask questions about their illness. Other items included nursing attitudes during opening and closing times of the health establishment, staff responding well when requested to assist, patients are being treated with empathy, patients are addressed by names and patients are being given all the treatment that they need, nurses explains the treatment side effects, and explains how to deal with side effects. This means that responses to these items depend on whether the patient is from a rural or urban clinic. Rural communities were found to be vi less likely to disagree with statements as compared to urban communities. This means that nurses are compliant with nursing care and attitudes in rural clinics. Findings of the study with respect to facility cleanliness, shows that there is no significant associations between the responses to the items which are: surroundings of the clinic are free of unpleasant smells, grounds of the clinic are clean, safe and clean grounds, bin waste inside and outside storage poses no health risks, and setting were detected. This means that the facilities are and cleanliness status remains the same across the residential settings. However, the younger age group was found be significantly more likely to disagree that toilets are clean and odorless and that grounds are safe and clean compared to the older age group. This suggests that the environment is clean except the toilets. Conclusion: Staffs at the facilities are at times ignorant and have negative attitudes at the opening and closing times and facilities have been reported to have long waiting times. The study indicated that the safety and security measures in the urban health facilities are not all practiced according to the National Core Standards checklist/Assessment tool, particularly wet warning signs, disabled toilets, and wearing of nametags. Majority of the participants indicated that, the status of cleanliness was on par at the urban and rural facilities.
- Full Text:
- Date Issued: 2019
Challenges of the primigravida’s in accessing antenatal care early and regularly in Buffalo city Metropolitan Municipality, Eastern Cape Province, South Africa
- Seakamela, Khomotso Precious
- Authors: Seakamela, Khomotso Precious
- Date: 2019
- Subjects: Maternal health services Prenatal care
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16803 , vital:40775
- Description: According to National Department of Health (NDOH National :2015), antenatal care is free in South Africa’s public health system and nearly all pregnant women and girls attend an antenatal clinic at least once during their pregnancy. However, most pregnant women do not access antenatal care until the later stage of pregnancy. Such delays have been linked to nearly a quarter of avoidable maternal deaths in South Africa. According to World Health Organisation (WHO, 2016; 11), maternal mortality and morbidity are some of the most important global health issues facing the world today. Worldwide, approximately 1000 women die each day from pregnancy and childbirth related causes (WHO, 2016; 11). In addition, 99% of these maternal deaths occur in the developing world, with sub-Saharan Africa accounting for over half of these deaths. The international community has committed to improving maternal health by 2015 with Millennium Development Goal (MDG) number five, which aimed to reduce maternal mortality by three quarters and reach universal access to reproductive health care (www.worldbank.org/mdgs/). Even with this commitment, many countries like South Africa have failed to implement effective programs to reduce maternal mortality and morbidity, and women around the world continue to die and suffer from the complications of pregnancy and childbirth. According to NDOH (2015; 2), women who suspect that they might be pregnant should schedule a booking and visit to their clinic and begin antenatal care as soon as possible. These visits include a physical examination, which includes blood pressure checks, weight checks, providing a urine sample, testing for sexually transmitted infections and checking for tuberculosis. Depending on the stage of the pregnancy, healthcare providers may also do blood tests and examination, which includes an ultrasound. The purpose of the study was to to investigate the challenges of Primigravida’s in accessing antenatal care early and regularly in Buffalo City Metropolitan (BCM) and to assist in formulating recommendations for improving factors that are perceived as obstacles to the utilisation of antenatal care services in the BCM District. vii The study was conducted in five facilities at BCM (Dimbaza Community Health Centre, Empilweni Gompo Clinic, Moore Street Clinic, Central Clinic and Notyatyambo Clinic). BCM is one of the seven districts of Eastern Cape Province of South Africa. The seat of BCM is East London. The data was collected using cross-sectional, self-administered questionnaires that were conducted in selected health facilities of Buffalo City Metropolitan. In this study, the population consisted of primigravida’s between the ages of 18-35 who start clinic attendance in the second trimester of pregnancy at five facilities, Buffalo City Metropolitan. Findings: The biggest challenges, as expressed by the participants, were lack of money, unsuitable clinic times, work commitments, delays at clinic and family control. Most of the participants had good experiences of antenatal care. The timing of antenatal clinic attendance is not influenced by age, education, residential zone, employment status and proximity of clinic
- Full Text:
- Date Issued: 2019
- Authors: Seakamela, Khomotso Precious
- Date: 2019
- Subjects: Maternal health services Prenatal care
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16803 , vital:40775
- Description: According to National Department of Health (NDOH National :2015), antenatal care is free in South Africa’s public health system and nearly all pregnant women and girls attend an antenatal clinic at least once during their pregnancy. However, most pregnant women do not access antenatal care until the later stage of pregnancy. Such delays have been linked to nearly a quarter of avoidable maternal deaths in South Africa. According to World Health Organisation (WHO, 2016; 11), maternal mortality and morbidity are some of the most important global health issues facing the world today. Worldwide, approximately 1000 women die each day from pregnancy and childbirth related causes (WHO, 2016; 11). In addition, 99% of these maternal deaths occur in the developing world, with sub-Saharan Africa accounting for over half of these deaths. The international community has committed to improving maternal health by 2015 with Millennium Development Goal (MDG) number five, which aimed to reduce maternal mortality by three quarters and reach universal access to reproductive health care (www.worldbank.org/mdgs/). Even with this commitment, many countries like South Africa have failed to implement effective programs to reduce maternal mortality and morbidity, and women around the world continue to die and suffer from the complications of pregnancy and childbirth. According to NDOH (2015; 2), women who suspect that they might be pregnant should schedule a booking and visit to their clinic and begin antenatal care as soon as possible. These visits include a physical examination, which includes blood pressure checks, weight checks, providing a urine sample, testing for sexually transmitted infections and checking for tuberculosis. Depending on the stage of the pregnancy, healthcare providers may also do blood tests and examination, which includes an ultrasound. The purpose of the study was to to investigate the challenges of Primigravida’s in accessing antenatal care early and regularly in Buffalo City Metropolitan (BCM) and to assist in formulating recommendations for improving factors that are perceived as obstacles to the utilisation of antenatal care services in the BCM District. vii The study was conducted in five facilities at BCM (Dimbaza Community Health Centre, Empilweni Gompo Clinic, Moore Street Clinic, Central Clinic and Notyatyambo Clinic). BCM is one of the seven districts of Eastern Cape Province of South Africa. The seat of BCM is East London. The data was collected using cross-sectional, self-administered questionnaires that were conducted in selected health facilities of Buffalo City Metropolitan. In this study, the population consisted of primigravida’s between the ages of 18-35 who start clinic attendance in the second trimester of pregnancy at five facilities, Buffalo City Metropolitan. Findings: The biggest challenges, as expressed by the participants, were lack of money, unsuitable clinic times, work commitments, delays at clinic and family control. Most of the participants had good experiences of antenatal care. The timing of antenatal clinic attendance is not influenced by age, education, residential zone, employment status and proximity of clinic
- Full Text:
- Date Issued: 2019
Competencies of Qualified Primary Health Care professional nurses in Assessing, Diagnosing and Managing clients in health facilities in Buffalo City Metro”
- Authors: Falati, Patience Yoliswa
- Date: 2019
- Subjects: Primary health care
- Language: English
- Type: Thesis , Masters/Doctoral , MPH
- Identifier: http://hdl.handle.net/10353/16716 , vital:40766
- Description: The study investigated the competencies of qualified PHC professional nurses in assessing, diagnosing and managing clients in the facilities. Aim: The study aimed to explain the competences of qualified PHC professional nurses in assessing, diagnosing and managing clients in the facilities. The research study followed a descriptive and qualitative design. Data was collected from qualified PHC professional nurses in 79 clinics (both urban and rural), 4CHC’s and 4 hospital casualties. A structured questionnaire with closed ended questions was used. Data analysis was done by means of descriptive statistics. The study showed that the overall percentage of 90% denotes that these PHC professional nurses are competent in all the aspects of competences. Assessing competences of qualified PHC professional nurses in assessing, diagnosing and managing clients in the facilities is of vital importance for quality health care/ improving service delivery and client satisfaction. Recommendation were made to influence the implementation of policies and guidelines for quality service delivery
- Full Text:
- Date Issued: 2019
- Authors: Falati, Patience Yoliswa
- Date: 2019
- Subjects: Primary health care
- Language: English
- Type: Thesis , Masters/Doctoral , MPH
- Identifier: http://hdl.handle.net/10353/16716 , vital:40766
- Description: The study investigated the competencies of qualified PHC professional nurses in assessing, diagnosing and managing clients in the facilities. Aim: The study aimed to explain the competences of qualified PHC professional nurses in assessing, diagnosing and managing clients in the facilities. The research study followed a descriptive and qualitative design. Data was collected from qualified PHC professional nurses in 79 clinics (both urban and rural), 4CHC’s and 4 hospital casualties. A structured questionnaire with closed ended questions was used. Data analysis was done by means of descriptive statistics. The study showed that the overall percentage of 90% denotes that these PHC professional nurses are competent in all the aspects of competences. Assessing competences of qualified PHC professional nurses in assessing, diagnosing and managing clients in the facilities is of vital importance for quality health care/ improving service delivery and client satisfaction. Recommendation were made to influence the implementation of policies and guidelines for quality service delivery
- Full Text:
- Date Issued: 2019
experiences of female sex workers in Buffalo City Metropolitan Municipality, Eastern Cape
- Authors: Gcina, Boniswa Letticia
- Date: 2019
- Subjects: Prostitutes
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16730 , vital:40768
- Description: The phenomenon of female sex workers in South Africa is yet to be understood from both the cultural and legal perspectives. This gap leads to various challenges experienced by female sex workers in the country. The purpose of this study was to explore the experiences of female sex workers in Buffalo City Metropolitan, Eastern Cape Province. A descriptive phenomenological design was used to gain in-depth understanding and knowledge on the experiences of female sex workers’ in reality and social context. The study targeted female sex workers aged between 18-49 years for interviews. Purposive sampling technique was used to recruit female sex workers and four focus groups of five members in each group were interviewed to collect data. Due to the sensitivity of the research topic, ethical approvals were sought and granted by University of Fort Hare Research Ethics Committee and the Eastern Cape Department of Health. Further, informed consent was obtained from study participants before data collection begun. Data analysis was done by using Tesch’ method steps. The findings indicated that in Buffalo City Metropolitan the female sex workers were experiencing human rights violation, stigma and discrimination, they were at risk of contracting HIV due to the nature of their work, and they were at risk of being in conflict with the law due to the nature of sex work in South Africa. The study recommends on the decriminalization of sex work in order to decrease rate of violence, rape and exploitation of female sex workers; the closure of all Illegal brothels as they promote drugs and substance abuse among this vulnerable group; and provision of counselling sessions for female sex workers by the Department of Social Welfare. The study concludes that peer educators training and embarking on campaigns in the community, media and social networks to promote ‘Anti-violence against sex workers’ is necessary. Therefore, the female sex workers need to be protected by police from any form of abuse and violence by the community, clients and pimps. This can address the psychological stress displayed by female sex workers in the studydomain
- Full Text:
- Date Issued: 2019
- Authors: Gcina, Boniswa Letticia
- Date: 2019
- Subjects: Prostitutes
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16730 , vital:40768
- Description: The phenomenon of female sex workers in South Africa is yet to be understood from both the cultural and legal perspectives. This gap leads to various challenges experienced by female sex workers in the country. The purpose of this study was to explore the experiences of female sex workers in Buffalo City Metropolitan, Eastern Cape Province. A descriptive phenomenological design was used to gain in-depth understanding and knowledge on the experiences of female sex workers’ in reality and social context. The study targeted female sex workers aged between 18-49 years for interviews. Purposive sampling technique was used to recruit female sex workers and four focus groups of five members in each group were interviewed to collect data. Due to the sensitivity of the research topic, ethical approvals were sought and granted by University of Fort Hare Research Ethics Committee and the Eastern Cape Department of Health. Further, informed consent was obtained from study participants before data collection begun. Data analysis was done by using Tesch’ method steps. The findings indicated that in Buffalo City Metropolitan the female sex workers were experiencing human rights violation, stigma and discrimination, they were at risk of contracting HIV due to the nature of their work, and they were at risk of being in conflict with the law due to the nature of sex work in South Africa. The study recommends on the decriminalization of sex work in order to decrease rate of violence, rape and exploitation of female sex workers; the closure of all Illegal brothels as they promote drugs and substance abuse among this vulnerable group; and provision of counselling sessions for female sex workers by the Department of Social Welfare. The study concludes that peer educators training and embarking on campaigns in the community, media and social networks to promote ‘Anti-violence against sex workers’ is necessary. Therefore, the female sex workers need to be protected by police from any form of abuse and violence by the community, clients and pimps. This can address the psychological stress displayed by female sex workers in the studydomain
- Full Text:
- Date Issued: 2019
Psychosocial behaviour of male learners after traditional male circumcision in Mdantsane, Eastern Cape
- Authors: Bokolo, Nokwanda
- Date: 2019
- Subjects: Circumcision
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16709 , vital:40764
- Description: Male circumcision is an old Xhosa tradition that is still widely practised throughout South Africa. The Xhosa community in Eastern Cape, South Africa, values traditional male circumcision and regard it as a heritage from the ancestors, which prepares the initiate for transition to manhood. There are health problems and physical complications related to circumcision, although parental decisions regarding circumcision and the medical hygiene have been widely researched. However, scanty information exists on the psychological and social behaviours of male learners after male circumcision. The present study aims to fill the gap by exploring the psychosocial behaviors of male learners after traditional male circumcision in Eastern Cape, South Africa
- Full Text:
- Date Issued: 2019
- Authors: Bokolo, Nokwanda
- Date: 2019
- Subjects: Circumcision
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16709 , vital:40764
- Description: Male circumcision is an old Xhosa tradition that is still widely practised throughout South Africa. The Xhosa community in Eastern Cape, South Africa, values traditional male circumcision and regard it as a heritage from the ancestors, which prepares the initiate for transition to manhood. There are health problems and physical complications related to circumcision, although parental decisions regarding circumcision and the medical hygiene have been widely researched. However, scanty information exists on the psychological and social behaviours of male learners after male circumcision. The present study aims to fill the gap by exploring the psychosocial behaviors of male learners after traditional male circumcision in Eastern Cape, South Africa
- Full Text:
- Date Issued: 2019
Resilience towards adverse childhood experiences among public secondary school students in Alice, South Africa
- Authors: Obisesan , Matthew Tobiloba
- Date: 2019
- Subjects: Child development Child psychology
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16769 , vital:40772
- Description: Adverse childhood experiences (ACEs) are of great concerns in public health. They are traumatic experiences that occur during childhood. ACEs include various forms of abuse and maltreatment which can be emotional, physical, verbal and sexual, different degrees of household dysfunction such as growing up with substance abuse like drugs and alcohol, witnessing domestic violence, mental illnesses, crime in the home and parental disharmony. Although childhood adversities and traumatic experiences occur before the individual is 18 years of age, the effects of such experiences can last a lifetime causing mental and chronic medical illnesses. Resilience is perceived as an antidote to the detrimental effect of ACEs. It is a situation in which an individual displays a high level of effectiveness after a significant misfortune or adversity. This study was conducted to assess the level of resilience towards adverse childhood experiences among public secondary school children in Alice. Data were collected with the aid of a wellstructured questionnaire from 418 public high school students using Convenience sampling method. Factors influencing resilience among the learners were examined. Consequently, the data collected were analyzed using descriptive statistics and ordered logit regression model. From the results, it is observed that the majority of the learners live with their grandparents and the most prevalent form of ACEs is emotional abuse, followed by sexual abuse while community violence is the least common childhood adversity. This study further reveals that some of the respondents experienced more than one form of adverse childhood experience. In addition, irrespective of what the students have been through, they are largely observed to be resilient. Analysis from the ordered logit regression model shows that age, class in school, gender, religion, race and who the student lives with are significantly related to resilience. The study, therefore, recommends a functional counseling unit in the schools while student-teacher relationship must be encouraged
- Full Text:
- Date Issued: 2019
- Authors: Obisesan , Matthew Tobiloba
- Date: 2019
- Subjects: Child development Child psychology
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16769 , vital:40772
- Description: Adverse childhood experiences (ACEs) are of great concerns in public health. They are traumatic experiences that occur during childhood. ACEs include various forms of abuse and maltreatment which can be emotional, physical, verbal and sexual, different degrees of household dysfunction such as growing up with substance abuse like drugs and alcohol, witnessing domestic violence, mental illnesses, crime in the home and parental disharmony. Although childhood adversities and traumatic experiences occur before the individual is 18 years of age, the effects of such experiences can last a lifetime causing mental and chronic medical illnesses. Resilience is perceived as an antidote to the detrimental effect of ACEs. It is a situation in which an individual displays a high level of effectiveness after a significant misfortune or adversity. This study was conducted to assess the level of resilience towards adverse childhood experiences among public secondary school children in Alice. Data were collected with the aid of a wellstructured questionnaire from 418 public high school students using Convenience sampling method. Factors influencing resilience among the learners were examined. Consequently, the data collected were analyzed using descriptive statistics and ordered logit regression model. From the results, it is observed that the majority of the learners live with their grandparents and the most prevalent form of ACEs is emotional abuse, followed by sexual abuse while community violence is the least common childhood adversity. This study further reveals that some of the respondents experienced more than one form of adverse childhood experience. In addition, irrespective of what the students have been through, they are largely observed to be resilient. Analysis from the ordered logit regression model shows that age, class in school, gender, religion, race and who the student lives with are significantly related to resilience. The study, therefore, recommends a functional counseling unit in the schools while student-teacher relationship must be encouraged
- Full Text:
- Date Issued: 2019
Short regimen in the management of multi drug resistant tuberculosis in Buffalo City Metropolitan, Eastern Cape, South Africa
- Somfongo, Nomawethu Constance
- Authors: Somfongo, Nomawethu Constance
- Date: 2019
- Subjects: Tuberculosis Disease management
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16814 , vital:40776
- Description: Tuberculosis is an epidemic disease which is regarded as the tenth leading cause of death in the world (World Health Organization, 2014). New 580 000 cases of multidrug resistant tuberculosis have been reported by WHO (2014). Patients diagnosed with rifampicin/multi-drug resistant tuberculosis were usually treated for 18-24 months if they convert within the designated period of 4-6 months. Several trials were conducted in other countries like Burundi, Cameroon, Central African Republic, etc. on the use of short regimen of 9-12 months. Short regimen was introduced in January 2017 in South Africa and it has not been evaluated for its effectiveness in Buffalo City Metropolitan, South Africa. This study was conducted to examine RR/MDR TB outcomes following the introduction of a short regimen and the outcomes were based on the set target of 50% MDR TB success rate and 5.4% TB client lost to follow up rate as per the Annual Performance Plan (APP) of 2017/18. The conversion rate was also examined though the target was not set in APP. A retrospective study using a descriptive design was used to collect data at Nkqubela TB and Duncan Village Day hospitals which are in Buffalo City Metropolitan. The population of the study were all records of patients diagnosed, registered and initiated on rifampicin/multi-drug resistant TB in a short regimen in Nkqubela TB Hospital and Duncan Village Day Hospital between January 2017 and July 2017. All 118 patient records that met the inclusion criteria were enrolled in the study therefore convenience sampling was used. Ethical approval was obtained from the University of Fort Hare (ethical clearance number: MUP101SSOM01). Approval to conduct the study was also approved by the Eastern Cape Department of Health Ethics, BCM Health District Manager and two public hospitals. Two research assistants and one data capture signed oath of confidentiality prior data extraction. Unique codes were used to ensure anonymity and privacy and all data was treated in a confidential manner. Data was collected using a self-designed structured questionnaire which was tested for validity and reliability through pilot study. Data analysis was done by a statistician using Statistical Packages for Social Sciences version 24. RR/MDR TB outcomes of participants who were initiated on short regimen between January and July 2017 were examined between January and July 2018 at the end of 12 months. Findings showed that the majority of the affected age group was between the ages of 36-45 years in both genders (34.7%) with males (n=71) being highly affected than females (n=47). Bisho/King William’s Town sub-district was the most affected in Buffalo City Metropolitan (n=61). The majority of participants that were affected were the Africans (98.3%), unemployed (51.7%), people living with HIV/AIDS (62.7%) and those previously treated for TB (57.6%). Records revealed that participants living with HIV had a mean CD4 count of 194.5 and 202.4 and mean viral load of 203183.0 and 651888.7. Smokers and alcohol users were higher in males (20.3% and 16.9% respectively) than in females (2.5% and 5.1% respectively). Two patient records were missing and other four patient records were incompletely recorded to determine data on smoking and alcohol consumption. Findings revealed a smear conversion rate of 68.5% excluding 47 participants who had negative baseline smear results and one participant who had extra-pulmonary TB. Twenty one percent of the participants did not have consecutive smear results during the intensive phase. TB client lost to follow up rate was 13.5% (n=16) and 10 of all TB clients lost to follow up interrupted treatment for ≥5 months. Eleven TB clients lost to follow up were from Buffalo City Municipality Metropolitan. TB client lost to follow up was high in males (n=13). Rifampicin/multidrug resistant TB treatment success rate was 72.9% with mean response to treatment of 17.2 weeks. Weight (p0.005 and CI 2.750, 15.189) and body mass index (p0.004 and CI 1.232, 6.242) as well as duration of treatment interruption (p0.000 and CI -14.785, -8. 644) and duration of treatment (p0.001 and CI -65.385, -16.403) were statistically significant to treatment success. Based on these findings, it is therefore concluded that short regimen is effective in the management of RR/MDR TB despite high TB client lost to follow up rate. Decentralisation of drug resistant TB management; primary health care reengineering; use of NIMDR-trained nurses; tracing of TB interrupters; HIV management; electronic patient management system and review of how EDR register works; proper record keeping and proper recording; extensive and ongoing counselling, patient support, health education and patient monitoring; and political involvement; is recommended. Further research is recommended to identify patient and service related factors that affect TB treatment outcomes.
- Full Text:
- Date Issued: 2019
- Authors: Somfongo, Nomawethu Constance
- Date: 2019
- Subjects: Tuberculosis Disease management
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16814 , vital:40776
- Description: Tuberculosis is an epidemic disease which is regarded as the tenth leading cause of death in the world (World Health Organization, 2014). New 580 000 cases of multidrug resistant tuberculosis have been reported by WHO (2014). Patients diagnosed with rifampicin/multi-drug resistant tuberculosis were usually treated for 18-24 months if they convert within the designated period of 4-6 months. Several trials were conducted in other countries like Burundi, Cameroon, Central African Republic, etc. on the use of short regimen of 9-12 months. Short regimen was introduced in January 2017 in South Africa and it has not been evaluated for its effectiveness in Buffalo City Metropolitan, South Africa. This study was conducted to examine RR/MDR TB outcomes following the introduction of a short regimen and the outcomes were based on the set target of 50% MDR TB success rate and 5.4% TB client lost to follow up rate as per the Annual Performance Plan (APP) of 2017/18. The conversion rate was also examined though the target was not set in APP. A retrospective study using a descriptive design was used to collect data at Nkqubela TB and Duncan Village Day hospitals which are in Buffalo City Metropolitan. The population of the study were all records of patients diagnosed, registered and initiated on rifampicin/multi-drug resistant TB in a short regimen in Nkqubela TB Hospital and Duncan Village Day Hospital between January 2017 and July 2017. All 118 patient records that met the inclusion criteria were enrolled in the study therefore convenience sampling was used. Ethical approval was obtained from the University of Fort Hare (ethical clearance number: MUP101SSOM01). Approval to conduct the study was also approved by the Eastern Cape Department of Health Ethics, BCM Health District Manager and two public hospitals. Two research assistants and one data capture signed oath of confidentiality prior data extraction. Unique codes were used to ensure anonymity and privacy and all data was treated in a confidential manner. Data was collected using a self-designed structured questionnaire which was tested for validity and reliability through pilot study. Data analysis was done by a statistician using Statistical Packages for Social Sciences version 24. RR/MDR TB outcomes of participants who were initiated on short regimen between January and July 2017 were examined between January and July 2018 at the end of 12 months. Findings showed that the majority of the affected age group was between the ages of 36-45 years in both genders (34.7%) with males (n=71) being highly affected than females (n=47). Bisho/King William’s Town sub-district was the most affected in Buffalo City Metropolitan (n=61). The majority of participants that were affected were the Africans (98.3%), unemployed (51.7%), people living with HIV/AIDS (62.7%) and those previously treated for TB (57.6%). Records revealed that participants living with HIV had a mean CD4 count of 194.5 and 202.4 and mean viral load of 203183.0 and 651888.7. Smokers and alcohol users were higher in males (20.3% and 16.9% respectively) than in females (2.5% and 5.1% respectively). Two patient records were missing and other four patient records were incompletely recorded to determine data on smoking and alcohol consumption. Findings revealed a smear conversion rate of 68.5% excluding 47 participants who had negative baseline smear results and one participant who had extra-pulmonary TB. Twenty one percent of the participants did not have consecutive smear results during the intensive phase. TB client lost to follow up rate was 13.5% (n=16) and 10 of all TB clients lost to follow up interrupted treatment for ≥5 months. Eleven TB clients lost to follow up were from Buffalo City Municipality Metropolitan. TB client lost to follow up was high in males (n=13). Rifampicin/multidrug resistant TB treatment success rate was 72.9% with mean response to treatment of 17.2 weeks. Weight (p0.005 and CI 2.750, 15.189) and body mass index (p0.004 and CI 1.232, 6.242) as well as duration of treatment interruption (p0.000 and CI -14.785, -8. 644) and duration of treatment (p0.001 and CI -65.385, -16.403) were statistically significant to treatment success. Based on these findings, it is therefore concluded that short regimen is effective in the management of RR/MDR TB despite high TB client lost to follow up rate. Decentralisation of drug resistant TB management; primary health care reengineering; use of NIMDR-trained nurses; tracing of TB interrupters; HIV management; electronic patient management system and review of how EDR register works; proper record keeping and proper recording; extensive and ongoing counselling, patient support, health education and patient monitoring; and political involvement; is recommended. Further research is recommended to identify patient and service related factors that affect TB treatment outcomes.
- Full Text:
- Date Issued: 2019
Tuberculosis knowledge, attitudes and health-seeking behaviour among tuberculosis patients in Nelson Mandela Bay Municipality, sub district C, South Africa
- Authors: Onyango, Peggy
- Date: 2019
- Subjects: Tuberculosis
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16780 , vital:40773
- Description: The aim of this study was to examine the knowledge and attitude of Tuberculosis (TB) patients regarding TB disease, causes, treatment adherence and health seeking behaviour in Nelson Mandela Bay, sub district C, South Africa. A cross-sectional study was done in three community health centres in Nelson Mandela Bay Municipality sub district C, South Africa. It involved 327 respondents aged eighteen years and above who were on TB treatment for more than one month who were conveniently selected from the three clinics. 54.1% of the patients were males and 45.9% of the patients were females. A structured questionnaire was used to collect data. Frequency counts and percentages were used to analyse the data. Multivariate logistic regression analysis was used to examine the influence of demographic variables on the knowledge, attitude and health seeking behaviour towards TB. None of the demographic variables was statistically significant to determine the TB patients’ knowledge and attitude of TB disease, causes, treatment and adherence. Only housing was statistically significant (p<0.05) as a variable determining the knowledge of TB causes, treatment and adherence. Compared with the reference group (informal housing scheme), the knowledge of TB patients with formal housing scheme were 0.556 (95% CI: 0.316-0.977) higher to determine the correct knowledge. Spearman correlation was used to determine the statistical significance between knowledge-attitude (K-A), Knowledge-Health seeking behaviour (K-HSB) and attitude-health seeking behaviour (A-HSB). There was statistical significance association among the variables. Results show that TB knowledge was generally good amongst the TB clients. However, there was misconception that TB is caused by cold air, dust and that TB disease can change into HIV. More than half of the respondents felt that TB treatment is difficult, takes a long time, unpleasant and interferes with work /marriage. Health seeking behaviour was fair amongst the participants.
- Full Text:
- Date Issued: 2019
- Authors: Onyango, Peggy
- Date: 2019
- Subjects: Tuberculosis
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16780 , vital:40773
- Description: The aim of this study was to examine the knowledge and attitude of Tuberculosis (TB) patients regarding TB disease, causes, treatment adherence and health seeking behaviour in Nelson Mandela Bay, sub district C, South Africa. A cross-sectional study was done in three community health centres in Nelson Mandela Bay Municipality sub district C, South Africa. It involved 327 respondents aged eighteen years and above who were on TB treatment for more than one month who were conveniently selected from the three clinics. 54.1% of the patients were males and 45.9% of the patients were females. A structured questionnaire was used to collect data. Frequency counts and percentages were used to analyse the data. Multivariate logistic regression analysis was used to examine the influence of demographic variables on the knowledge, attitude and health seeking behaviour towards TB. None of the demographic variables was statistically significant to determine the TB patients’ knowledge and attitude of TB disease, causes, treatment and adherence. Only housing was statistically significant (p<0.05) as a variable determining the knowledge of TB causes, treatment and adherence. Compared with the reference group (informal housing scheme), the knowledge of TB patients with formal housing scheme were 0.556 (95% CI: 0.316-0.977) higher to determine the correct knowledge. Spearman correlation was used to determine the statistical significance between knowledge-attitude (K-A), Knowledge-Health seeking behaviour (K-HSB) and attitude-health seeking behaviour (A-HSB). There was statistical significance association among the variables. Results show that TB knowledge was generally good amongst the TB clients. However, there was misconception that TB is caused by cold air, dust and that TB disease can change into HIV. More than half of the respondents felt that TB treatment is difficult, takes a long time, unpleasant and interferes with work /marriage. Health seeking behaviour was fair amongst the participants.
- Full Text:
- Date Issued: 2019
A trend analysis of perinatal mortalities in Barberton Hospital between 2002 and 2016
- Modupe, Oluwarotimi Folorunsho
- Authors: Modupe, Oluwarotimi Folorunsho
- Date: 2018
- Subjects: Newborn infants -- Mortality Perinatology
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/11254 , vital:37630
- Description: Background and aim: There is no doubt that the quantification of data on the new born is imperative towards the design of effective public health policy interventions. However, the trend in under-five mortality rates in Barberton Hospital is not recognised as no empirical investigation has been undertaken to ascertain its position in this regard. A trend analysis of infant and maternal deaths in will therefore shed light on possible factors influencing this trend. The specific objectives of this study were to examine the trend and causes of perinatal mortality in Barberton Hospital from 2002-2016. It was hypothesized that there would be a downward trend in the infant and maternal mortality rates in Barberton Hospital from 2002-2016, possibly as a result of improved medical care. Methods: This retrospective study was conducted in Barberton Hospital, located in the Umjindi sub-district in Mpumalanga Province. The data was drawn from the Perinatal Problem Identification Programme (PPIP) database. Pregnancy related deaths of women, and of children from birth to one year in Barberton Hospital from 1999-2014 were extracted. The population study consists of a record review of all infant and maternal deaths in Barberton Hospital from 2002-2016 and captured in the data on the PPIP. The University of Fort Hare ethical review committee approved the study protocol. In addition, permission to use the data was granted by the Mpumalanga Department of Health after applying for approval for use of the data for academic purposes. The data was then exported into an Excel format document and fed to Statistical Package for Social Sciences (SPSS) program to allow for a more detailed analysis. Results: Over the period under review (2002-2016), a total of 21151 babies were delivered, 20593 babies were alive at discharge, 221 babies died in the first 28 days of delivery, and 337 babies were stillbirths. 18577 were normal weight (≥2500gram), 1581 weighed 2000-2499 grams, 568 weighed 1500-1999grams, 286 weighed 1000-1499 and 139 weighed below 1000grams. All the women who gave birth over the period under review, 27.3percent tested positive to HIV, 40.3 percent tested negative. Of all women that tested positive, 80.2percent received any form of ART. For over half of women that received ART (n=2981), the type of ART they received is unknown. Most women whose baby died were young. One in five women did not have their age captured in the database indicating an important gap that need to be addressed in order to ensure integrity of the database. Of all the 558 perinatal mortality, 75.3 weighed below 2500 grams. Low birth weight is major risk factor for child mortality. Babies weighing less than 2,500 grams are 20 times more likely to die than heavier babies. For all the perinatal deaths, the majority of their mothers received antenatal care services. About 86.6percent were delivered at Barberton Hospital and only 1 child was delivered in transit to the hospital. Of all the 558 deaths, only 7.5 percent was multiple births. Of the 558 babies that died, only 39.6percent were born alive, 37.1percent was macerated stillbirths. The syphilis serology test indicated that most mothers tested negative. The HIV serology test indicated that 28percent of mothers tested positive. The hospital recorded a total of 337 stillbirths between 2002 and 2016. This accounts for 60.2percent of all perinatal mortality over the period. Of all stillbirths, 61.6percent was macerated stillbirths. Yearly analysis of stillbirth rate did not clearly indicate whether stillbirth rate is increasing or declining. Not less than 56 primary obstetric causes of perinatal deaths were identified in this study. Many perinatal deaths were unexplainable due to lack of post-mortem. Idiopathic preterm labour was the main primary obstetric cause of early (34.5percent) and late neonatal (38.9percent) deaths, and the next was labour related intrapartum asphyxia. Labour related intrapartum asphyxia also accounts for 6.8percent of all stillbirths. The main known primary obstetric cause of stillbirth in the Hospital was Proteinuric hypertension/hypertension disorders. Over 60percent of perinatal mortality in Barberton Hospital was due to associated maternal conditions. Only 10.9percent was due to fetal related conditions and 26.4percent was unexplained. Few deaths were due to health system failure and domestic violence. Spontaneous preterm labour (18.4percent), abnormal labour or uterine rupture (14.5percent), maternal hypertension (12.4percent), antepartum haemorrhage (10.2percent) were the main associated maternal conditions causes of perinatal mortality in Barberton Hospital. Similarly, Fetal abnormality and infections were the main associated fetal condition causes of perinatal mortality. Of all the babies that were alive at birth, 85.2percent died due to maternal related conditions. Most neonates died due to spontaneous preterm labour (43.5percent) and abnormal labour or uterine rupture (23.1percent). Maternal HIV, diabetics and syphilis only accounted for a few neonatal deaths. For stillbirth babies that were alive at admission, abnormal labour or uterine rupture (33.1percent) and antepartum haemorrhage (19.7percent) were the main causes of their death. Over 60percent of all of macerated deaths have unexplained causes. Maternal hypertension is the main known cause of macerated stillbirth. For stillbirths that were dead on admission, maternal hypertension (13.1percent), antepartum haemorrhage (26.2percent) and abnormal labour or uterine rupture were the main causes of deaths. The majority of perinatal deaths in the hospital were caused by intrauterine deaths (58.8percent). Extreme multi-organ immaturity (13.1percent), Hyaline membrane disease (7.2percent) and Hypoxic ischaemic encephalopathy (5.2percent) were among the main final causes of perinatal deaths. The main behavioural factor causing perinatal mortality in Mpumalanga province was non-use of antenatal care services. The majority of perinatal mortality (60.4percent) was due to health system related causes. Most perinatal deaths were due to poor management of cases and delayed referral. Conclusion: The findings indicate that while stillbirths have slightly declined, neonatal deaths have not declined over the period. Perinatal have slightly declined in the hospital. The findings of this study also indicate that the majority of perinatal deaths in the hospital were caused by idiopathic preterm labour, unexplained intrauterine deaths, hypertension, and intrapartum asphyxia. Patient and health system related factors contributed significantly to perinatal deaths in the hospital. There is a need for yearly analysis of PPIP data to track progress and identify area for continuous improvement in provision of quality obstetric services. A greater community awareness of risk factors for perinatal deaths and importance of early and regular take up antenatal care services is needed.
- Full Text:
- Date Issued: 2018
- Authors: Modupe, Oluwarotimi Folorunsho
- Date: 2018
- Subjects: Newborn infants -- Mortality Perinatology
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/11254 , vital:37630
- Description: Background and aim: There is no doubt that the quantification of data on the new born is imperative towards the design of effective public health policy interventions. However, the trend in under-five mortality rates in Barberton Hospital is not recognised as no empirical investigation has been undertaken to ascertain its position in this regard. A trend analysis of infant and maternal deaths in will therefore shed light on possible factors influencing this trend. The specific objectives of this study were to examine the trend and causes of perinatal mortality in Barberton Hospital from 2002-2016. It was hypothesized that there would be a downward trend in the infant and maternal mortality rates in Barberton Hospital from 2002-2016, possibly as a result of improved medical care. Methods: This retrospective study was conducted in Barberton Hospital, located in the Umjindi sub-district in Mpumalanga Province. The data was drawn from the Perinatal Problem Identification Programme (PPIP) database. Pregnancy related deaths of women, and of children from birth to one year in Barberton Hospital from 1999-2014 were extracted. The population study consists of a record review of all infant and maternal deaths in Barberton Hospital from 2002-2016 and captured in the data on the PPIP. The University of Fort Hare ethical review committee approved the study protocol. In addition, permission to use the data was granted by the Mpumalanga Department of Health after applying for approval for use of the data for academic purposes. The data was then exported into an Excel format document and fed to Statistical Package for Social Sciences (SPSS) program to allow for a more detailed analysis. Results: Over the period under review (2002-2016), a total of 21151 babies were delivered, 20593 babies were alive at discharge, 221 babies died in the first 28 days of delivery, and 337 babies were stillbirths. 18577 were normal weight (≥2500gram), 1581 weighed 2000-2499 grams, 568 weighed 1500-1999grams, 286 weighed 1000-1499 and 139 weighed below 1000grams. All the women who gave birth over the period under review, 27.3percent tested positive to HIV, 40.3 percent tested negative. Of all women that tested positive, 80.2percent received any form of ART. For over half of women that received ART (n=2981), the type of ART they received is unknown. Most women whose baby died were young. One in five women did not have their age captured in the database indicating an important gap that need to be addressed in order to ensure integrity of the database. Of all the 558 perinatal mortality, 75.3 weighed below 2500 grams. Low birth weight is major risk factor for child mortality. Babies weighing less than 2,500 grams are 20 times more likely to die than heavier babies. For all the perinatal deaths, the majority of their mothers received antenatal care services. About 86.6percent were delivered at Barberton Hospital and only 1 child was delivered in transit to the hospital. Of all the 558 deaths, only 7.5 percent was multiple births. Of the 558 babies that died, only 39.6percent were born alive, 37.1percent was macerated stillbirths. The syphilis serology test indicated that most mothers tested negative. The HIV serology test indicated that 28percent of mothers tested positive. The hospital recorded a total of 337 stillbirths between 2002 and 2016. This accounts for 60.2percent of all perinatal mortality over the period. Of all stillbirths, 61.6percent was macerated stillbirths. Yearly analysis of stillbirth rate did not clearly indicate whether stillbirth rate is increasing or declining. Not less than 56 primary obstetric causes of perinatal deaths were identified in this study. Many perinatal deaths were unexplainable due to lack of post-mortem. Idiopathic preterm labour was the main primary obstetric cause of early (34.5percent) and late neonatal (38.9percent) deaths, and the next was labour related intrapartum asphyxia. Labour related intrapartum asphyxia also accounts for 6.8percent of all stillbirths. The main known primary obstetric cause of stillbirth in the Hospital was Proteinuric hypertension/hypertension disorders. Over 60percent of perinatal mortality in Barberton Hospital was due to associated maternal conditions. Only 10.9percent was due to fetal related conditions and 26.4percent was unexplained. Few deaths were due to health system failure and domestic violence. Spontaneous preterm labour (18.4percent), abnormal labour or uterine rupture (14.5percent), maternal hypertension (12.4percent), antepartum haemorrhage (10.2percent) were the main associated maternal conditions causes of perinatal mortality in Barberton Hospital. Similarly, Fetal abnormality and infections were the main associated fetal condition causes of perinatal mortality. Of all the babies that were alive at birth, 85.2percent died due to maternal related conditions. Most neonates died due to spontaneous preterm labour (43.5percent) and abnormal labour or uterine rupture (23.1percent). Maternal HIV, diabetics and syphilis only accounted for a few neonatal deaths. For stillbirth babies that were alive at admission, abnormal labour or uterine rupture (33.1percent) and antepartum haemorrhage (19.7percent) were the main causes of their death. Over 60percent of all of macerated deaths have unexplained causes. Maternal hypertension is the main known cause of macerated stillbirth. For stillbirths that were dead on admission, maternal hypertension (13.1percent), antepartum haemorrhage (26.2percent) and abnormal labour or uterine rupture were the main causes of deaths. The majority of perinatal deaths in the hospital were caused by intrauterine deaths (58.8percent). Extreme multi-organ immaturity (13.1percent), Hyaline membrane disease (7.2percent) and Hypoxic ischaemic encephalopathy (5.2percent) were among the main final causes of perinatal deaths. The main behavioural factor causing perinatal mortality in Mpumalanga province was non-use of antenatal care services. The majority of perinatal mortality (60.4percent) was due to health system related causes. Most perinatal deaths were due to poor management of cases and delayed referral. Conclusion: The findings indicate that while stillbirths have slightly declined, neonatal deaths have not declined over the period. Perinatal have slightly declined in the hospital. The findings of this study also indicate that the majority of perinatal deaths in the hospital were caused by idiopathic preterm labour, unexplained intrauterine deaths, hypertension, and intrapartum asphyxia. Patient and health system related factors contributed significantly to perinatal deaths in the hospital. There is a need for yearly analysis of PPIP data to track progress and identify area for continuous improvement in provision of quality obstetric services. A greater community awareness of risk factors for perinatal deaths and importance of early and regular take up antenatal care services is needed.
- Full Text:
- Date Issued: 2018
An assessment of quality health care in the operating theatres of Frere Hospital in the Eastern Cape
- Authors: Bennett, Fabion Charton
- Date: 2018
- Subjects: Medical care Surgical instruments and apparatus -- Safety measures
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/13425 , vital:39660
- Description: BACKGROUND: Operating theatres are one of most expensive resources in a hospital. The management of operating theatres is complex due to the conflicting priorities and preferences of all stakeholders. Operating theatres also pose one of the greatest medico legal risks to any hospital. This study was conducted at Frere Hospital in East London to assess the functioning of the operating theatre system. The focus of this study was on Pre-operative categorisation of emergency cases, the utilisation of the World Health Organisation Safety Checklist, compliance to the National Core Standards for Health, the effectiveness of governance and review processes, theatre staffing as well as theatre efficiency indicators (start time/tardiness, utilisation, turn-around time, re-admission to theatre rate, cancellation on day of procedure, slate under/over runs, Anaesthetic time as a percentage of theatre time). OBJECTIVE: The purpose of this study was to promote the adherence to the various operating theatre universal approaches by operating theatre staff with the goal of reducing costs and errors caused by poor quality in operating theatres and improving the overall health system. METHOD: In this research a convergent parallel mixed method research design was applied. The research was non-experimental and descriptive in approach, using a mixed method questionnaire, a structured open ended interview, a structured infrastructure assessment, a structured observation checklist and an audit of patient files for a review of emergency surgical cases. Data was collected during October 2016 and January 2017.The study population consisted of 13 operating rooms across 6 operating theatre suites, surgical management staff as well as clinical and nursing staff in the operating theatres at Frere Hospital in East London. RESULTS: The study showed opportunities for improvement in the overall management of the operating theatres to ensure efficient quality care; the data from the observations, questionnaires, interviews as well as the analysis of the efficiency indicators consistently showed that an effective process of operating theatre governance and performance is non-existent, the Pre- operative categorisation of emergency cases is inconsistently applied, the compliance to the principles of the World Health Organisation Safety Checklist Is very low, theatre nursing staff levels per case is low, staff are also demotivated and theatre efficiency indicators require improvement. During this study, the Paediatric theatre suite appeared to be well run and compliant with opportunity to increase theatre utilisation, the casualty theatre is underutilised and has potential to be utilised as an enabler to improve the efficiency of other theatres. The main theatre and endoscopy suites have opportunities to improve its compliance to universal operating theatre quality and efficiency standards, the Orthopaedics and Obstetrics theatre suites, however, require urgent improvement focus. DISCUSSION: According to the findings, a structured operating theatre governance and performance review processes should be implemented with the intention of ensuring consistency across the management of the 6 operating theatre suites in the hospital. A review of staffing allocation and relative task allocation should be conducted. Interventions should be implemented to increase utilisation rates, improve the pre-operative categorisation of emergency cases, improve the compliance to the principles of the World Health Organisation Safety Checklist, reduce case start time variance/tardiness, reduce cancellation on day of procedure, increase anaesthetic time as a percentage of theatre time by introducing pre- anaesthetic induction prior to the patient being wheeled into the operating room.
- Full Text:
- Date Issued: 2018
An assessment of quality health care in the operating theatres of Frere Hospital in the Eastern Cape
- Authors: Bennett, Fabion Charton
- Date: 2018
- Subjects: Medical care Surgical instruments and apparatus -- Safety measures
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/13425 , vital:39660
- Description: BACKGROUND: Operating theatres are one of most expensive resources in a hospital. The management of operating theatres is complex due to the conflicting priorities and preferences of all stakeholders. Operating theatres also pose one of the greatest medico legal risks to any hospital. This study was conducted at Frere Hospital in East London to assess the functioning of the operating theatre system. The focus of this study was on Pre-operative categorisation of emergency cases, the utilisation of the World Health Organisation Safety Checklist, compliance to the National Core Standards for Health, the effectiveness of governance and review processes, theatre staffing as well as theatre efficiency indicators (start time/tardiness, utilisation, turn-around time, re-admission to theatre rate, cancellation on day of procedure, slate under/over runs, Anaesthetic time as a percentage of theatre time). OBJECTIVE: The purpose of this study was to promote the adherence to the various operating theatre universal approaches by operating theatre staff with the goal of reducing costs and errors caused by poor quality in operating theatres and improving the overall health system. METHOD: In this research a convergent parallel mixed method research design was applied. The research was non-experimental and descriptive in approach, using a mixed method questionnaire, a structured open ended interview, a structured infrastructure assessment, a structured observation checklist and an audit of patient files for a review of emergency surgical cases. Data was collected during October 2016 and January 2017.The study population consisted of 13 operating rooms across 6 operating theatre suites, surgical management staff as well as clinical and nursing staff in the operating theatres at Frere Hospital in East London. RESULTS: The study showed opportunities for improvement in the overall management of the operating theatres to ensure efficient quality care; the data from the observations, questionnaires, interviews as well as the analysis of the efficiency indicators consistently showed that an effective process of operating theatre governance and performance is non-existent, the Pre- operative categorisation of emergency cases is inconsistently applied, the compliance to the principles of the World Health Organisation Safety Checklist Is very low, theatre nursing staff levels per case is low, staff are also demotivated and theatre efficiency indicators require improvement. During this study, the Paediatric theatre suite appeared to be well run and compliant with opportunity to increase theatre utilisation, the casualty theatre is underutilised and has potential to be utilised as an enabler to improve the efficiency of other theatres. The main theatre and endoscopy suites have opportunities to improve its compliance to universal operating theatre quality and efficiency standards, the Orthopaedics and Obstetrics theatre suites, however, require urgent improvement focus. DISCUSSION: According to the findings, a structured operating theatre governance and performance review processes should be implemented with the intention of ensuring consistency across the management of the 6 operating theatre suites in the hospital. A review of staffing allocation and relative task allocation should be conducted. Interventions should be implemented to increase utilisation rates, improve the pre-operative categorisation of emergency cases, improve the compliance to the principles of the World Health Organisation Safety Checklist, reduce case start time variance/tardiness, reduce cancellation on day of procedure, increase anaesthetic time as a percentage of theatre time by introducing pre- anaesthetic induction prior to the patient being wheeled into the operating room.
- Full Text:
- Date Issued: 2018
Analysis of the role of unions in health services delivery at Uitenhage district hospital
- Authors: Tshamase, Nozibele Yvonne
- Date: 2018
- Subjects: Public health Health services accessibility Labor unions
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/12348 , vital:39255
- Description: Purpose: According to Khan and Khan (2011:56), a trade union is an organization of employee tasked with activities which include negotiating on behalf of their members for “pay and conditions of employment”. Several authors have purported that these roles extend beyond ensuring not only that the rights of workers are not violated and that their working environment complies with health and safety standards, but also that unions may have an effect on management practices, generally and specifically, on efficiencies and performance (Zulu, 2009; McGuire, 2011; & Dhliwayo, 2012). Health care workers including professionals are organised by the unions in a bid to influence social and economic reforms in the South African democracy. The main aim of this study was to examine the role of public sector unions and how they exercise their functions in delivery of health services Method: A qualitative research method based on phenomenological and case approaches was applied. Semi-structured interviews with open ended questions were used to prompt discussions. Documents were used to obtain complementary data. Senior managers, middle managers, union/employee representatives and employees who are members of the unions in the district hospital of Nelson Mandela Bay health district constituted the target population. Purposive non-probability sampling, which was the preferred method for this study, yielded 16 participants. Results Analysis followed Creswell’s thematic analysis involving coding responses categorising them and identifying themes. This followed repeated and thorough listening to the recorded interviews and transcribing. Themes identified were organisational functioning in line with the service delivery context; worker’s rights protection; negotiating better service conditions; implementing legislation, policies and resolutions; union-management interaction; engaging in strikes and impact on services delivery. Conclusion and Recommendations: The study found that the presence of unions in health care services was necessary because there are various categories of employees – working class – whose interests must be served. The role of the unions leaned heavily towards protection of the rights of the workers. As far as the observation of legislation is concerned, the unions demonstrated knowledge of the legislation applicable to the health care personnel, that is, the BCEA, the LRA and the PSA. The study found that unions were a hindrance to health services delivery in their quest to exercise voice monopoly. The unions tended to exert undue influence on management resulting in lack of discipline and dereliction of duty. The strike actions compromised quality of health care and the rights of citizens to access health care. There was no active participation nor positive contributions in committees where advancement of service delivery standards were deliberated and promoted. Recommendations included training of shop stewards; capacitation and training of managers, and development and communication of departmental labour relations policies.
- Full Text:
- Date Issued: 2018
- Authors: Tshamase, Nozibele Yvonne
- Date: 2018
- Subjects: Public health Health services accessibility Labor unions
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/12348 , vital:39255
- Description: Purpose: According to Khan and Khan (2011:56), a trade union is an organization of employee tasked with activities which include negotiating on behalf of their members for “pay and conditions of employment”. Several authors have purported that these roles extend beyond ensuring not only that the rights of workers are not violated and that their working environment complies with health and safety standards, but also that unions may have an effect on management practices, generally and specifically, on efficiencies and performance (Zulu, 2009; McGuire, 2011; & Dhliwayo, 2012). Health care workers including professionals are organised by the unions in a bid to influence social and economic reforms in the South African democracy. The main aim of this study was to examine the role of public sector unions and how they exercise their functions in delivery of health services Method: A qualitative research method based on phenomenological and case approaches was applied. Semi-structured interviews with open ended questions were used to prompt discussions. Documents were used to obtain complementary data. Senior managers, middle managers, union/employee representatives and employees who are members of the unions in the district hospital of Nelson Mandela Bay health district constituted the target population. Purposive non-probability sampling, which was the preferred method for this study, yielded 16 participants. Results Analysis followed Creswell’s thematic analysis involving coding responses categorising them and identifying themes. This followed repeated and thorough listening to the recorded interviews and transcribing. Themes identified were organisational functioning in line with the service delivery context; worker’s rights protection; negotiating better service conditions; implementing legislation, policies and resolutions; union-management interaction; engaging in strikes and impact on services delivery. Conclusion and Recommendations: The study found that the presence of unions in health care services was necessary because there are various categories of employees – working class – whose interests must be served. The role of the unions leaned heavily towards protection of the rights of the workers. As far as the observation of legislation is concerned, the unions demonstrated knowledge of the legislation applicable to the health care personnel, that is, the BCEA, the LRA and the PSA. The study found that unions were a hindrance to health services delivery in their quest to exercise voice monopoly. The unions tended to exert undue influence on management resulting in lack of discipline and dereliction of duty. The strike actions compromised quality of health care and the rights of citizens to access health care. There was no active participation nor positive contributions in committees where advancement of service delivery standards were deliberated and promoted. Recommendations included training of shop stewards; capacitation and training of managers, and development and communication of departmental labour relations policies.
- Full Text:
- Date Issued: 2018
Assessment of the effect of the down-referral chronic medication distribution system on patients' adherence to chronic medication in the Buffalo City sub-district
- Authors: Ndwandwe, Miriam
- Date: 2018
- Subjects: Health services accessibility Pharmacology Patient compliance
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/13248 , vital:39626
- Description: The purpose of the study is to determine the effect of the down referral chronic medication distribution system on patient's adherence to chronic medicine in Buffalo City sub - district by ensuring that chronic patients receive their correct medication on time and in correct quantities every month so that they can take the medication as recommended by the health professional. Adherence to chronic medication lead to better health outcome and reduced hospital re-admission. A non-experimental and descriptive quantitative research methodology was used. A data abstraction form developed by the researcher was used to record data from the medical records of chronically ill patients. The results of the study revealed that most of the chronically ill patients who were admitted to hospital were not adherent to their chronic medication. Patients are non-adherent even if they have chronic medication with them. This was evident in the number of patients who do not remember how many days did they not take their treatment. Others indicated that they share their medication with other family members who suffer from the same chronic condition. The patients' lack of understanding of their chronic condition and the consequences of not taking medication as instructed by the health professional contribute to non-adherence. Strengthening of health promotion programmes to educate the patients about their chronic condition would improve adherence. Most of the chronic conditions are life-style modifiable diseases. Patients must be educated about the changes they can make to improve their quality of life.
- Full Text:
- Date Issued: 2018
- Authors: Ndwandwe, Miriam
- Date: 2018
- Subjects: Health services accessibility Pharmacology Patient compliance
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/13248 , vital:39626
- Description: The purpose of the study is to determine the effect of the down referral chronic medication distribution system on patient's adherence to chronic medicine in Buffalo City sub - district by ensuring that chronic patients receive their correct medication on time and in correct quantities every month so that they can take the medication as recommended by the health professional. Adherence to chronic medication lead to better health outcome and reduced hospital re-admission. A non-experimental and descriptive quantitative research methodology was used. A data abstraction form developed by the researcher was used to record data from the medical records of chronically ill patients. The results of the study revealed that most of the chronically ill patients who were admitted to hospital were not adherent to their chronic medication. Patients are non-adherent even if they have chronic medication with them. This was evident in the number of patients who do not remember how many days did they not take their treatment. Others indicated that they share their medication with other family members who suffer from the same chronic condition. The patients' lack of understanding of their chronic condition and the consequences of not taking medication as instructed by the health professional contribute to non-adherence. Strengthening of health promotion programmes to educate the patients about their chronic condition would improve adherence. Most of the chronic conditions are life-style modifiable diseases. Patients must be educated about the changes they can make to improve their quality of life.
- Full Text:
- Date Issued: 2018
Factors affecting patient perceptions of service delivery in Postmasburg Hospital in the Z.F. McGawu District, Northern Cape Province, South Africa
- Rakumakoe, Jacob Mogapi Chocky
- Authors: Rakumakoe, Jacob Mogapi Chocky
- Date: 2018
- Subjects: Public health -- South Africa -- Northern Cape Medical care -- South Africa -- Northern Cape Health services accessibility
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/17805 , vital:41262
- Description: Background: There is a requirement to provide proper and safe quality service to patients, hence a view from patients was deemed important as it can help the hospital to improve services rendered to them. There were two Provincial assessments done on National Core Standards in Postmasburg Hospital (overall scores were 32percent in 2013 and 48percent in 2014) and on both occasions, the Hospital failed to comply with the assessments and the implication were a suspected negative impact on the Hospital service delivery. The repercussions could be that the hospital might not be certified or not funded through National Health Insurance following a national assessment if the status quo remains. Aim: The aim of the study was to describe the factors affecting patients’ perceptions of service delivery in order to inform health policy decisions to improve service delivery. Methodology: A quantitative descriptive design was used to collect data on 133 adult patients admitted for a minimum of three days in the different hospital wards. Participants were administered a structured pre-tested questionnaire to collect data relating to their employment status, the number of hospital admissions and the reason for hospital admission. Results: About 41.4percent of participants were neutral or not sure whether the nurses/doctors came often to the ward where they were admitted. The majority (51.9percent) were neutral or not sure whether the quality of food in the hospital was good; 53.4percent expressed uncertainty concerning the adequacy of benches/chairs in the hospital for patients to sit while waiting to be seen by the health worker; and 55.6percent participants were neural or not sure whether the ward/room had enough space for consulting. Asked whether the hospital was user-friendly to disabled persons, 53.4percent participants were not sure. About 43.6percent participants expressed uncertainty regarding the registration satisfactory nature of the procedures in the hospital; the water cleanliness for patients in the hospital (42.1percent); whether their privacy was respected by all the staff within the hospital (51.9percent); permission to be examined and treated (51.1percent); the nurse/doctor who treated them being polite (53.4percent); and the nurse/doctor who treated them being able to answer all their questions about their illness (56.8percent). On whether they will visit the hospital again, 49.6percent participants were uncertain. The majority (69.7percent) agreed that all prescribed medicine was available in the hospital; the staff explained to them on how to use the medicine/pills (67percent); and they were told on how to store their pills/medication (47percent). Gender, education and employment status of the participants affect exactly one dimension each. Females, those with secondary education and employed were more satisfied on the respective dimensions. Conclusion: Patient involvement is an essential feature in healthcare services. Patients influence outcome quality through compliance, defining the right symptoms and physically experiencing treatment. Patient perceptions and satisfaction with service delivery is a multi-dimensional concept that should be studied by operationalising it within its context. Consequently, a conceptual model to understand and measure patient perception and satisfaction of service delivery and care quality in hospital health care services is proposed.
- Full Text:
- Date Issued: 2018
- Authors: Rakumakoe, Jacob Mogapi Chocky
- Date: 2018
- Subjects: Public health -- South Africa -- Northern Cape Medical care -- South Africa -- Northern Cape Health services accessibility
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/17805 , vital:41262
- Description: Background: There is a requirement to provide proper and safe quality service to patients, hence a view from patients was deemed important as it can help the hospital to improve services rendered to them. There were two Provincial assessments done on National Core Standards in Postmasburg Hospital (overall scores were 32percent in 2013 and 48percent in 2014) and on both occasions, the Hospital failed to comply with the assessments and the implication were a suspected negative impact on the Hospital service delivery. The repercussions could be that the hospital might not be certified or not funded through National Health Insurance following a national assessment if the status quo remains. Aim: The aim of the study was to describe the factors affecting patients’ perceptions of service delivery in order to inform health policy decisions to improve service delivery. Methodology: A quantitative descriptive design was used to collect data on 133 adult patients admitted for a minimum of three days in the different hospital wards. Participants were administered a structured pre-tested questionnaire to collect data relating to their employment status, the number of hospital admissions and the reason for hospital admission. Results: About 41.4percent of participants were neutral or not sure whether the nurses/doctors came often to the ward where they were admitted. The majority (51.9percent) were neutral or not sure whether the quality of food in the hospital was good; 53.4percent expressed uncertainty concerning the adequacy of benches/chairs in the hospital for patients to sit while waiting to be seen by the health worker; and 55.6percent participants were neural or not sure whether the ward/room had enough space for consulting. Asked whether the hospital was user-friendly to disabled persons, 53.4percent participants were not sure. About 43.6percent participants expressed uncertainty regarding the registration satisfactory nature of the procedures in the hospital; the water cleanliness for patients in the hospital (42.1percent); whether their privacy was respected by all the staff within the hospital (51.9percent); permission to be examined and treated (51.1percent); the nurse/doctor who treated them being polite (53.4percent); and the nurse/doctor who treated them being able to answer all their questions about their illness (56.8percent). On whether they will visit the hospital again, 49.6percent participants were uncertain. The majority (69.7percent) agreed that all prescribed medicine was available in the hospital; the staff explained to them on how to use the medicine/pills (67percent); and they were told on how to store their pills/medication (47percent). Gender, education and employment status of the participants affect exactly one dimension each. Females, those with secondary education and employed were more satisfied on the respective dimensions. Conclusion: Patient involvement is an essential feature in healthcare services. Patients influence outcome quality through compliance, defining the right symptoms and physically experiencing treatment. Patient perceptions and satisfaction with service delivery is a multi-dimensional concept that should be studied by operationalising it within its context. Consequently, a conceptual model to understand and measure patient perception and satisfaction of service delivery and care quality in hospital health care services is proposed.
- Full Text:
- Date Issued: 2018
The perceptions of professional nurses about the introduction of the National Health Insurance in a private hospital in Gauteng
- Molokomme, Victoria Khabonina
- Authors: Molokomme, Victoria Khabonina
- Date: 2018
- Subjects: Health insurance Hospitals Primary health care
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/13057 , vital:39444
- Description: The National Health Insurance is a relatively new concept in South Africa currently being piloted to ensure that all citizens have access to quality and affordable health care regardless of their socio-economic status. This study was prompted by concerns regarding the introduction of the NHI and its implications on the South African health system. Therefore it seeks to determine the professional nurses concerns about the introduction of the NHI in a private hospital in Gauteng and to describe recommendations based on these perceptions. This study used a qualitative, exploratory and descriptive design. Data was collected using a semi-structured individual interview schedule. The sample was purposive consisting of professional nurses employed in a private hospital in Gauteng. Thematic data saturation determined the number of professional nurses interviewed. Data analysis was done with the aid of Creswell’s theory (2014:1996). Ethical considerations were observed and trustworthiness maintained. The results of the study outlined that professional nurse’s perception about the NHI is centred on equal distribution of health services to benefit all South Africans. However, concerns were based on its financial implications for those mandated to pay towards the fund. The feasibility of its implementation in the midst of staff shortage, inadequate resources and its impact on the public health sector was seen as a major challenge. The notion of a joint effort between public and private health sector in creating one health system was anticipated by most participants. The NHI implementation raised concerns about the impact it will have on the private sectors viability in the future. Professional nurse’s non-involvement in policy making, poor communication, lack of transparency, concerns about governance and management were perceived to be stumbling blocks towards efficient and effective implementation of the NHI.
- Full Text:
- Date Issued: 2018
- Authors: Molokomme, Victoria Khabonina
- Date: 2018
- Subjects: Health insurance Hospitals Primary health care
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/13057 , vital:39444
- Description: The National Health Insurance is a relatively new concept in South Africa currently being piloted to ensure that all citizens have access to quality and affordable health care regardless of their socio-economic status. This study was prompted by concerns regarding the introduction of the NHI and its implications on the South African health system. Therefore it seeks to determine the professional nurses concerns about the introduction of the NHI in a private hospital in Gauteng and to describe recommendations based on these perceptions. This study used a qualitative, exploratory and descriptive design. Data was collected using a semi-structured individual interview schedule. The sample was purposive consisting of professional nurses employed in a private hospital in Gauteng. Thematic data saturation determined the number of professional nurses interviewed. Data analysis was done with the aid of Creswell’s theory (2014:1996). Ethical considerations were observed and trustworthiness maintained. The results of the study outlined that professional nurse’s perception about the NHI is centred on equal distribution of health services to benefit all South Africans. However, concerns were based on its financial implications for those mandated to pay towards the fund. The feasibility of its implementation in the midst of staff shortage, inadequate resources and its impact on the public health sector was seen as a major challenge. The notion of a joint effort between public and private health sector in creating one health system was anticipated by most participants. The NHI implementation raised concerns about the impact it will have on the private sectors viability in the future. Professional nurse’s non-involvement in policy making, poor communication, lack of transparency, concerns about governance and management were perceived to be stumbling blocks towards efficient and effective implementation of the NHI.
- Full Text:
- Date Issued: 2018
Towards the development of a conceptual framework for hospital performance assessment of a South African public hospital in the Eastern Cape province
- Authors: Wagner, Rolene Margaret
- Date: 2018
- Subjects: Public hospitals Hospital care Hospitals -- Administration
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/12249 , vital:39223
- Description: An integrated conceptual framework for measuring and comparing the performance of a South African teaching hospital in the Eastern Cape Province with other hospitals, is not available. The aim of this study was therefore to contribute to the development of a conceptual framework for assessing the performance of a SA public hospital in the Eastern Cape Province. The systematic literature review included all black and grey literature that relate to one of the two main themes- the purpose of measuring hospital performance and the methodology of assessing hospital performance. Relevant studies were identified through a Google search using the following descriptors: “Hospital Performance”, and “Hospital Performance Assessment”. There were 369 scholarly articles with the exact descriptors anywhere in the article with 59 articles released during the period 2012 to 2016. Ultimately, 7 articles met all the inclusionary criteria and described enterprise wide assessments of hospital performance. Other relevant articles, inclusive of grey literature, are included. Two of the studies in Morocco and Costa Rica were systematic reviews of hospital performance and covered the period 2000-2011. The Botswana case study assessed the use of the WHO PATH tool to measure the performance of its public hospitals. The Iranian, United States and Malaysian studies reflected on single aspect measures of hospital performance such as efficiency; the effect of weighting hospital performance indicators for patient harm on hospital profiles and payment; and Bed Occupancy rates, respectively. The review of the challenges associated with developing a hospital performance assessment framework was not found to be as useful as the other articles. The WHO PATH tool provides a high level integrated conceptual framework for measuring and comparing the performance of a South African teaching hospital in the Eastern Cape Province with other hospitals. This, however, needs to be adapted to the South African context with specific indicators being selected by local stakeholders that will promote best possible patient outcomes and a positive experience of patient-centred care at effective and efficient public health facilities. Lessons can be drawn from other countries’ experiences that have implemented hospital performance assessments and tested specific performance indicators.
- Full Text:
- Date Issued: 2018
- Authors: Wagner, Rolene Margaret
- Date: 2018
- Subjects: Public hospitals Hospital care Hospitals -- Administration
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/12249 , vital:39223
- Description: An integrated conceptual framework for measuring and comparing the performance of a South African teaching hospital in the Eastern Cape Province with other hospitals, is not available. The aim of this study was therefore to contribute to the development of a conceptual framework for assessing the performance of a SA public hospital in the Eastern Cape Province. The systematic literature review included all black and grey literature that relate to one of the two main themes- the purpose of measuring hospital performance and the methodology of assessing hospital performance. Relevant studies were identified through a Google search using the following descriptors: “Hospital Performance”, and “Hospital Performance Assessment”. There were 369 scholarly articles with the exact descriptors anywhere in the article with 59 articles released during the period 2012 to 2016. Ultimately, 7 articles met all the inclusionary criteria and described enterprise wide assessments of hospital performance. Other relevant articles, inclusive of grey literature, are included. Two of the studies in Morocco and Costa Rica were systematic reviews of hospital performance and covered the period 2000-2011. The Botswana case study assessed the use of the WHO PATH tool to measure the performance of its public hospitals. The Iranian, United States and Malaysian studies reflected on single aspect measures of hospital performance such as efficiency; the effect of weighting hospital performance indicators for patient harm on hospital profiles and payment; and Bed Occupancy rates, respectively. The review of the challenges associated with developing a hospital performance assessment framework was not found to be as useful as the other articles. The WHO PATH tool provides a high level integrated conceptual framework for measuring and comparing the performance of a South African teaching hospital in the Eastern Cape Province with other hospitals. This, however, needs to be adapted to the South African context with specific indicators being selected by local stakeholders that will promote best possible patient outcomes and a positive experience of patient-centred care at effective and efficient public health facilities. Lessons can be drawn from other countries’ experiences that have implemented hospital performance assessments and tested specific performance indicators.
- Full Text:
- Date Issued: 2018