Assessing South African medical interns’ experience and confidence in managing obstetric emergencies
- Date: 2021-10
- Subjects: Interns (Medicine) Obstetrical emergencies Article
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/7629 , vital:54737 , ("https://10.7196/SAMJ.2021.v111i11.15897")
- Description: Background. Medical doctors in South Africa (SA) are required to complete a 2-year internship at training hospitals, including a 4-month rotation in obstetrics and gynaecology. Following this, doctors are allocated to community service posts, many of which are at district- and primary-level facilities where supervision is limited. Recent triennial Saving Mothers reports identify district hospitals (DHs) as the second leading site for maternal deaths of all causes, the leading site for maternal deaths secondary to obstetric haemorrhage, and the most likely site for the lack of a skilled doctor to be identified as a factor in deaths associated with caesarean delivery. Objectives. To describe the self-perceived readiness of medical interns completing their training to manage obstetric emergencies, based on the Essential Steps in the Management of Obstetric Emergencies modules in the Health Professions Council of South Africa’s internship logbook. Methods. This cross-sectional descriptive study assessed medical interns in the last 3 months of their training, using a self-administered online questionnaire. Data collection took place between October and December 2019. Results. Cluster sampling of interns at training facilities throughout SA resulted in a total of 182 respondents from 17 hospitals in seven provinces in the country, with an overall response rate of 34.1%. Most interns had experience with and confidence in the management of miscarriage and hypertension in pregnancy. However, gaps in labour ward management, pregnancy-related sepsis and surgical skills were identified. Only 42.3% of respondents were confident in their ability to diagnose obstructed labour, 26.3% had performed an assisted delivery, 39.0% were confident in their knowledge of the indications for and contraindications to assisted deliveries, and 35.7% had been involved in the delivery of a baby with shoulder dystocia. Regarding pregnancy-related sepsis, 54.4% had experience with managing a wound abscess and 29.7% were confident managing puerperal endometritis. While 78.0% felt confident to perform a caesarean section (CS), only 28.6% had performed uterine compression suture for uterine atony at CS. Additionally, there was a statistically significant variation in scores between training hospitals. Conclusions. An incongruity exists between the shortcomings in DH obstetric services, the prioritisation of placement of community service doctors at primary healthcare facilities and DHs, and the self-perceived readiness of medical interns completing their training to manage obstetric emergencies safely. This situation highlights the importance of clinical support for junior doctors at DHs and standardisation of intern training at accredited facilities across SA.
- Full Text:
Assessing South African medical interns’ experience and confidence in managing obstetric emergencies
- Date: 2021-10
- Subjects: Interns (Medicine) Obstetrical emergencies Article
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/7629 , vital:54737 , ("https://10.7196/SAMJ.2021.v111i11.15897")
- Description: Background. Medical doctors in South Africa (SA) are required to complete a 2-year internship at training hospitals, including a 4-month rotation in obstetrics and gynaecology. Following this, doctors are allocated to community service posts, many of which are at district- and primary-level facilities where supervision is limited. Recent triennial Saving Mothers reports identify district hospitals (DHs) as the second leading site for maternal deaths of all causes, the leading site for maternal deaths secondary to obstetric haemorrhage, and the most likely site for the lack of a skilled doctor to be identified as a factor in deaths associated with caesarean delivery. Objectives. To describe the self-perceived readiness of medical interns completing their training to manage obstetric emergencies, based on the Essential Steps in the Management of Obstetric Emergencies modules in the Health Professions Council of South Africa’s internship logbook. Methods. This cross-sectional descriptive study assessed medical interns in the last 3 months of their training, using a self-administered online questionnaire. Data collection took place between October and December 2019. Results. Cluster sampling of interns at training facilities throughout SA resulted in a total of 182 respondents from 17 hospitals in seven provinces in the country, with an overall response rate of 34.1%. Most interns had experience with and confidence in the management of miscarriage and hypertension in pregnancy. However, gaps in labour ward management, pregnancy-related sepsis and surgical skills were identified. Only 42.3% of respondents were confident in their ability to diagnose obstructed labour, 26.3% had performed an assisted delivery, 39.0% were confident in their knowledge of the indications for and contraindications to assisted deliveries, and 35.7% had been involved in the delivery of a baby with shoulder dystocia. Regarding pregnancy-related sepsis, 54.4% had experience with managing a wound abscess and 29.7% were confident managing puerperal endometritis. While 78.0% felt confident to perform a caesarean section (CS), only 28.6% had performed uterine compression suture for uterine atony at CS. Additionally, there was a statistically significant variation in scores between training hospitals. Conclusions. An incongruity exists between the shortcomings in DH obstetric services, the prioritisation of placement of community service doctors at primary healthcare facilities and DHs, and the self-perceived readiness of medical interns completing their training to manage obstetric emergencies safely. This situation highlights the importance of clinical support for junior doctors at DHs and standardisation of intern training at accredited facilities across SA.
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Consequences of citizens’ non-reporting of crime to the Police: A survey of Mthatha Policing Precinct, South Africa
- Date: 2021-10
- Subjects: Citizen crime reporting Victims of crimes surveys Article
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/7962 , vital:57343 , ("https://iipccl.org/wp-content/uploads/2021/10/035.pdf")
- Description: Whilst citizens are at liberty to decide whether or not to report a crime to the police, nonreporting of crime to the police may come with a heavy price. This study evaluates the consequences of non-reporting of crime to the police in South Africa’s Mthatha policing area. It comes against a backdrop of a rise in criminal activities in South Africa. A survey was conducted among households in selected residential areas of Mthatha, from where 120 respondents were selected through stratified random sampling technique. Data analysis was done using SPSS to reveal both descriptive and inferential statistics. From the analysis, continued engagement in criminal activities by perpetrators, resulting in absence of investigations was found to be the major impact of non-reporting of crime to the police. Findings also revealed that the victims bear the most implications of non-reporting of crime. Inability to identify crime hot spots, misallocation of policing resources and inability to determine crime trends and tendencies were also viewed as significant impacts of non-reporting of crime to the police. A factor analysis revealed officials’ inability to determine trends and tendencies that could inform policing strategies as the most significant component.
- Full Text:
- Date: 2021-10
- Subjects: Citizen crime reporting Victims of crimes surveys Article
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/7962 , vital:57343 , ("https://iipccl.org/wp-content/uploads/2021/10/035.pdf")
- Description: Whilst citizens are at liberty to decide whether or not to report a crime to the police, nonreporting of crime to the police may come with a heavy price. This study evaluates the consequences of non-reporting of crime to the police in South Africa’s Mthatha policing area. It comes against a backdrop of a rise in criminal activities in South Africa. A survey was conducted among households in selected residential areas of Mthatha, from where 120 respondents were selected through stratified random sampling technique. Data analysis was done using SPSS to reveal both descriptive and inferential statistics. From the analysis, continued engagement in criminal activities by perpetrators, resulting in absence of investigations was found to be the major impact of non-reporting of crime to the police. Findings also revealed that the victims bear the most implications of non-reporting of crime. Inability to identify crime hot spots, misallocation of policing resources and inability to determine crime trends and tendencies were also viewed as significant impacts of non-reporting of crime to the police. A factor analysis revealed officials’ inability to determine trends and tendencies that could inform policing strategies as the most significant component.
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Knowledge, Attitudes and Perceptions Towards HIV Testing Among IsiXhosa-Speaking Men in The Zithulele Catchment Area of The Rural Eastern Cape Province, South Africa
- Authors: Scotcher, Philippa Claire
- Date: 2021-10
- Subjects: HIV infections
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/6842 , vital:51017
- Description: BACKGROUND South Africa carries the largest burden of Human Immunodeficiency Virus (HIV) in the world, with over 7.9 million people infected and over 70 000 HIV-related deaths in 2019. Men are 25% more likely to die from Acquired Immune Deficiency Syndrome (AIDS) compared to women, even though women are more likely to be infected. Despite these numbers, only 24.1% of HIV-positive men compared to 64.8% of HIV-positive women were aware of their status. Statistics indicate that men in South Africa are not testing for HIV until it is too late. In order to focus efforts on the prevention of HIV transmission, there is a need to understand why men are not accessing HIV testing and treatment services earlier. This study aims to explore the knowledge, attitudes, and perceptions towards HIV testing of isiXhosa-speaking men in the Zithulele catchment area of the rural Eastern Cape. METHODS This was a qualitative study using the phenomenological approach. It was conducted among a purposive sample of isiXhosa-speaking men from the Zithulele catchment area, in the OR Tambo district of the Eastern Cape Province. Ten semi-structured interviews and one focus group were conducted in isiXhosa. Interviews were audiorecorded, transcribed, and translated into English. The interviews were thematically analysed using an inductive approach. RESULTS Participants from the study had a good understanding of HIV and HIV transmission. They perceived HIV infection as a death sentence, a consequence of immoral behaviour and an indication of failure as man. Reluctance to test for HIV was due to the perception that testing hastens the onset of symptoms and death, whereas disclosure of an HIV-positive status was described as difficult due to the fear of stigmatization. Some of the barriers to accessing HIV testing services included masculine norms, the belief that sickness is equated with weakness, a perceived lack of confidentiality at health facilities and how female-dominated clinics were not male-friendly spaces. Suggestions to improve HIV testing among men included improving targeted education, home-based testing services and utilizing traditional meetings to address men. CONCLUSION The findings of this study may suggest that healthy men in the Zithulele catchment area of the rural Eastern Cape are not accessing HIV testing and treatment services. The reasons behind this reluctance include false beliefs around HIV and testing, the fear of discrimination, disruption of masculine norms and reluctance to access care at female-dominated health facilities. Further research is needed to explore ways to reach, educate and encourage men to test earlier for HIV. , Thesis (Masters) -- Faculty of Health Sciences, 2021
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- Authors: Scotcher, Philippa Claire
- Date: 2021-10
- Subjects: HIV infections
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/6842 , vital:51017
- Description: BACKGROUND South Africa carries the largest burden of Human Immunodeficiency Virus (HIV) in the world, with over 7.9 million people infected and over 70 000 HIV-related deaths in 2019. Men are 25% more likely to die from Acquired Immune Deficiency Syndrome (AIDS) compared to women, even though women are more likely to be infected. Despite these numbers, only 24.1% of HIV-positive men compared to 64.8% of HIV-positive women were aware of their status. Statistics indicate that men in South Africa are not testing for HIV until it is too late. In order to focus efforts on the prevention of HIV transmission, there is a need to understand why men are not accessing HIV testing and treatment services earlier. This study aims to explore the knowledge, attitudes, and perceptions towards HIV testing of isiXhosa-speaking men in the Zithulele catchment area of the rural Eastern Cape. METHODS This was a qualitative study using the phenomenological approach. It was conducted among a purposive sample of isiXhosa-speaking men from the Zithulele catchment area, in the OR Tambo district of the Eastern Cape Province. Ten semi-structured interviews and one focus group were conducted in isiXhosa. Interviews were audiorecorded, transcribed, and translated into English. The interviews were thematically analysed using an inductive approach. RESULTS Participants from the study had a good understanding of HIV and HIV transmission. They perceived HIV infection as a death sentence, a consequence of immoral behaviour and an indication of failure as man. Reluctance to test for HIV was due to the perception that testing hastens the onset of symptoms and death, whereas disclosure of an HIV-positive status was described as difficult due to the fear of stigmatization. Some of the barriers to accessing HIV testing services included masculine norms, the belief that sickness is equated with weakness, a perceived lack of confidentiality at health facilities and how female-dominated clinics were not male-friendly spaces. Suggestions to improve HIV testing among men included improving targeted education, home-based testing services and utilizing traditional meetings to address men. CONCLUSION The findings of this study may suggest that healthy men in the Zithulele catchment area of the rural Eastern Cape are not accessing HIV testing and treatment services. The reasons behind this reluctance include false beliefs around HIV and testing, the fear of discrimination, disruption of masculine norms and reluctance to access care at female-dominated health facilities. Further research is needed to explore ways to reach, educate and encourage men to test earlier for HIV. , Thesis (Masters) -- Faculty of Health Sciences, 2021
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