Determinants of Type 2 diabetes mellitus among HIV/AIDS patients on antiretroviral drugs in the OR Tambo District, South Africa
- Authors: Bam, Nokwanda Edith
- Date: 2018
- Subjects: HIV/AIDS Diabetes mellitus (DM) -- Patients Antiretroviral drugs -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , PhD Health Sciences
- Identifier: http://hdl.handle.net/11260/1476 , vital:35976
- Description: Type 2 diabetes mellitus (DM) is a frequent adverse effect of antiretroviral drugs for those who are on ARVS. People with type 2 DM can suffer multiple complications that hinder the quality of life. In South Africa research has shown significant increase in neuropathy, heart and kidney diseases among patients living with type 2 DM and HIV/AIDS compared to DM without HIV. Accessed knowledge lacked consistency on the predictors of DM in HIV/AIDS patients with regards to the type of ARVS with higher risks of DM. Research needed to be done to find the determinants of type 2 DM in HIV/AIDS context. The purpose of this study was to describe the determinants of type 2 DM among HIV/AIDS patients on ARVS in the OR Tambo District, SA in order to develop intervention strategies to mitigate the long-term effects of type 2 DM. A quantitative research methodology using a case control retrospective study was used. A sample of 177 (33%) cases with HIV/AIDS and type 2 DM was selected using a one stage stratified sampling with allocation proportional to size of each stratum of the four sub-districts of OR Tambo District. Two non-diabetic patients with HIV/AIDS were selected as controls per case unpaired and totalled up to 354 (67%) controls. A self-administration questionnaire adopted from the WHO (2011) STEPwise surveillance tool for chronic diseases was used for data collection. Stata (standard version 13.0, Stata Corp., Lakeway Drive USA) was used for data management and analysis. Findings of the study revealed determinants of type 2 DM grouped as the socio-demographic determinants; tertiary education and marital status, levels of physical activities; lack of vigorous activity and sport, types of diets; high fruits and vegetables and healthy eating out at restaurants, arterial blood pressure; lack of routine BP check and known HPT and types of ARVS used in HIV/AIDS therapy. Compared with patients who received FDC, the risk of type 2 DM was 43 times and 22 higher when a tri-therapy regimen contained Ritonavir and Lopinavir respectively . The majority of DM patients (n=177) were diagnosed type 2 DM after ARVS at n=108 (61%). In managing the diabetic patients a shift from a single disease to multiple-chronic disease focus is required to mitigate the complex drug interactions that exist in the control of NCDs such as HIV/AIDS, DM, HPT and other long-term diseases. The HIV/AIDS and type 2 DM awareness and care intervention strategy is recommended as healthy lifestyle, monitoring of side effects and drug interactions, enhanced FDC roll out and elimination of unsafe ARVS to improve the health outcomes of type 2 DM patients in an HIV/AIDS context in OR Tambo District.
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- Date Issued: 2018
The evaluation of continuous quality improvement amongst the Community Health Centers of Lukhanji sub-district, of Chris Hani District Municipality, Eastern Cape
- Authors: Qotoyi, Ntombesitatu
- Date: 2015
- Subjects: Health Standard Compliance Health Care -- Quality improvement Community health centrers -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters/Doctoral , MSc Nursing
- Identifier: http://hdl.handle.net/11260/1465 , vital:35973
- Description: Continuous Quality Improvement is a system that seeks to improve the provision of services with an emphasis on future results (Tomey, 2009). It is a process that involves evaluation, actions and mindset to strive constantly for excellence (Sullivan, 2012). Evaluation of quality in health care has evolved into a dynamic and modern science which plays a significant role in patient safety, quality assurance (QA), benchmarking and continuous quality improvement (CQI). Improved quality has a positive impact on patient and staff satisfaction, improving the efficiency and effectiveness of healthcare provision in both the public and private sector, eventually leading to increased trust in the health system (Whittaker, Burns, Doyle and Fenney, 1998). The purpose of this study was to explore and describe the factors that influence continuous quality improvement amongst the Community Health Centers of Lukhanji sub district, of Chris Hani District Municipality, Eastern Cape. The standards of the community health centers were assessed against the National Core Standards of the South African National Department of Health. Donabedian‟s tripartite model (1988) which addresses three elements of quality assessment, namely structure, process and outcome, led this study. A quantitative, descriptive design was adapted, using National Core Standard checklists and assessment questionnaires to collect data from two community health centers. Respondents were sampled through simple random sample. Data were collected through staff and patient interviews, document reviews, patient record assessment and observations. The raw data were transferred to the District Health Information System (DHIS) Assessment Questionnaire CHC/CDC programme which generated the results into colour coded tables (dashboard view). According to DHIS software version: 1.4.1.12 data base version: 19 June 2013 each community health center is listed in the DHIS programme for each district to capture data. The researcher consolidated and interpreted the results according to the expected level of performance and compliance as per the South African Office of the Health Standard Compliance. The results highlighted a need for improvement in the six priority areas for the Community Health Centers (CHCs) to reach the acceptable performance of 80% and above. CHC A scored 85% in availability of medicines and supplies however CHC B obtained 68 %. For cleanliness both CHCs obtained 54% which need more than 20% effort to reach the acceptable performance of 80%. In patient safety CHC A obtained 48% whilst CHC B had a score of 36%. For infection prevention and control CHC A scored 61% and CHC B obtained 53%. In the assessment of positive and caring attitudes CHC A had a score of 77% whereas CHC B obtained 40% indicative of noncompliance. In waiting time measures CHC A was compliant with a score of 82% however CHC B had a score of 71%. The results of this study indicated that there is a need for the CHCs to put systems in place to strengthen PHC effectiveness and ensure patient safety. The results and recommendations would assist in service delivery and continuous quality improvement in the community health centers.
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- Date Issued: 2015
The integration of previously hospital based Antiretroviral sites into Primary Health Care clinics in Lukhanji sub district of Chris Hani District Municipality
- Authors: Pakade, Nonkoliso
- Date: 2015
- Subjects: HIV/AIDS -- Antiretroviral(ARV) -- Eastern Cape -- South Africa Human Immune Virus(HIV) -- Antiretroviral therapy(ART) treatment
- Language: English
- Type: Thesis , Masters/Doctoral , MSc Nursing
- Identifier: http://hdl.handle.net/11260/1431 , vital:35585
- Description: The first country to take note of HIV/AIDS was United States of America in the report published by Atlanta based Centers for Disease Control (CDC) and Prevention (Barnett and Whiteside, 2006). In the past years ARV program was largely hospital-based where clients were assessed by doctors, discussed with multidisciplinary team which involved social workers, dieticians and pharmacists before initiated on treatment. The integration of ARV services into PHC was one of the strategies proposed to increase access to treatment for people living with HIV/AIDS (WHO, 2010). The study sought to describe the integration of previously hospital based ARV sites into PHC clinics in Lukhanji sub-district of Chris Hani Health District in Eastern Cape. A qualitative research design was followed and a phenomenological approach was used to examine the experiences of clients who previously took ARV treatment at Frontier hospital and were transferred to take treatment at Ezibeleni, Ilinge, Philani and Sada clinics. An interview guide was used for data collection. Participants were sampled through purposive sampling. The study was composed of four focus groups for clients with a total of forty (18 males and 22 females) and 10 professional nurses for semi structured individual interviews. In the analysis of data, the collected data from voice recordings were transcribed verbatim and translated from isiXhosa to English. The researcher immersed herself into the data, re read, and themes and sub-themes emerged. Related topics to each other were grouped together in order to reduce the number of categories and to create themes. The similar categories were grouped and analyzed. Findings indicated that integration of ART sites into PHC clinics was a strategy put in place to increase accessibility and availability of ARV treatment to all communities. Both participants stated that integration brought services nearer to people and caused much relief from spending more money for travelling long distances. Ambulance delays were reported by both participants as the major challenge in the referral system between clinics and the hospital. Other challenges facing integration of ART services into PHC clinics included long waiting times caused by shortage of staff in the clinics, lack of consulting rooms for nurses and waiting areas for clients. Also lack of other health care professionals including social workers, dieticians, and psychologists was mentioned. The recommendations made by the researcher on the conclusion of this study addressed all the challenges mentioned by participants. The aim was to increase accessibility and availability of ART services to all the communities.
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- Date Issued: 2015
An intervention study to develop a male circumcision health promotion programme at Libode Rural Communities in the Eastern Cape Province, South Africa
- Authors: Douglas, Mbuyiselo
- Date: 2013
- Subjects: Circumcision Health promotion Penis surgery South Africa -- Libode
- Language: English
- Type: Thesis , Doctoral , Ph D
- Identifier: vital:18476 , http://hdl.handle.net/11260/d1007187
- Description: The purpose of this study was to develop an intervention health promotion programme to prevent circumcision related health problem such as sepsis, botched circumcision, dehydration, penile amputation and reduce the number of deaths. The intervention programme was aimed at promoting a safe male circumcision practice affecting boys aged 12-18 years at Libode rural communities in Eastern Cape Province of South Africa. This was achieved through a mixed method design using both quantitative and qualitative approaches utilizing sequential transformative strategy to allow for the convergence of multiple perspectives of the traditional male circumcision in Libode. The study was conducted in 22 schools of the rural communities of Libode because most of the participants are still attending school. Frequencies and percentages were used to analyse the quantitative data, utilizing the Statistical Package for Social Sciences (SPSS). A total of 1036 participants, AmaXhosa circumcised young men (abafana) and uncircumcised boys (amakhwenkwe) participated in the cross-sectional survey, quantitative phase of the study. Qualitative phase of this study was composed of 7 focus group discussions with a total of 84 circumcised and uncircumcised male participants and 10 key informants’ interviews were conducted. In analysis qualitative data, the researcher found the most descriptive words for each topic and turned them into categories or sub-themes. Topics that related to each other were then grouped in order to reduce the number of categories and to create themes. The similar categories of data were grouped and analysed using Tesch’s method. Findings indicated that traditional circumcision is performed during winter and summer holidays in order to cater for the boys who are attending schools. The circumcision age at Libode ranges from 12 and 18 years of age which is against the Health Standards in Traditional Circumcision Act (Act No. 6 of 2001). Although the participants were aware of the complications of male circumcision in Libode, there was a high preference for traditional circumcision (92.3% of participants) to hospital circumcision. The participants were of the view that the benefits of traditional circumcision outweigh the complications or challenges related to traditional circumcision. They wanted to be socially accepted and wanted to learn about manhood values in the traditional circumcision which are values that cannot be achieved through the hospital based circumcision. As male circumcision initiation is seasonal and the intervention programme needed to be approved by different stakeholders, the testing of intervention programme could not happen before the programme was approved by all the stakeholders.
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- Date Issued: 2013