Browsing Research Articles (SOPH) by Title
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Schneider, Helen; Lehmann, Uta (Routledge, 2010)[more][less]
Abstract: One of the consequences of massive investment in antiretroviral access and other AIDS programmes has been the rapid emergence of large numbers of lay workers in the health systems of developing countries. In South Africa, government estimates are 65,000, mostly HIV/TB care-related lay workers contribute their labour in the public health sector, outnumbering the main front-line primary health care providers and professional nurses. The phenomenon has grown organically and incrementally, playing a wide variety of care-giving, support and advocacy roles. Using South Africa as a case, this paper discusses the different forms, traditions and contradictory orientations taken by lay health work and the system-wide effects of a large lay worker presence. As pressures to regularise and formalise the status of lay health workers grow, important questions are raised as to their place in health systems, and more broadly what they represent as a new intermediary layer between state and citizen. It argues for a research agenda that seeks to better characterise types of lay involvement in the health system, particularly in an era of antiretroviral therapy, and which takes a wider perspective on the meanings of this recent re-emergence of an old concept in health systems heavily affected by HIV/AIDS. URI: http://hdl.handle.net/10566/458 Files in this item: 1
SchneiderHealthSystems2010.pdf (278.2Kb) -
Nkonki, Lungiswa L.; Doherty, Tanya M.; Hill, Zelee; Chopra, Mickey; Schaay, Nikki; Kendall, Carl (BioMed Central, 2007)[more][less]
Abstract: Background: The objective of this study was to examine missed opportunities for participation in a prevention of mother-to-child transmission (PMTCT) programme in three sites in South Africa. A rapid anthropological assessment was used to collect in-depth data from 58 HIV-positive women who were enrolled in a larger cohort study to assess mother-to-child HIV transmission. Semistructured interviews were conducted with the women in order to gain an understanding of their experiences of antenatal care and to identify missed opportunities for participation in PMTCT. Results: 15 women actually missed their nevirapine not because of stigma and ignorance but because of health systems failures. Six were not tested for HIV during antenatal care. Two were tested but did not receive their results. Seven were tested and received their results, but did not receive nevirapine. Health Systems failure for these programme leakages ranged from nonavailability of counselors, supplies such as HIV test kits, consent forms, health staff giving the women incorrect instructions about when to take the tablet and health staff not supplying the women with the tablet to take. Conclusion: HIV testing enables access to PMTCT interventions and should therefore be strengthened. The single dose nevirapine regimen is simple to implement but the all or nothing nature of the regimen may result in many missed opportunities. A short course dual or triple drug regimen could increase the effectiveness of PMTCT programmes. URI: http://hdl.handle.net/10566/429 Files in this item: 1
NkonkiNevirapineStudy2007.pdf (184.6Kb) -
Chopra, Mickey; Kendall, Carl; Hill, Zelee; Schaay, Nikki; Nkonki, Lungiswa L.; Doherty, Tanya M. (Lippincott Williams & Wilkins, 2006)[more][less]
Abstract: Interviews conducted in South Africa found that awareness of antiretroviral therapy was generally poor. Antiretroviral drugs were not perceived as new, but one of many alternative therapies for HIV/AIDS. Respondents had more detailed knowledge of indications, effects and how to access alternative treatments, which is bolstered by the active promotion and legitimization of alternative treatments. Many expressed a lack of excitement about the introduction of antiretroviral therapy, and little change in their attitudes concerning the epidemic. URI: http://hdl.handle.net/10566/478 Files in this item: 1
ChopraARV2006.pdf (1.056Mb) -
Puoane, Thandi; Hughes, Gail; Bradley, Hazel A. (Kamla-Raj Enterprises, 2005)[more][less]
Abstract: Obesity and associated non-communicable diseases such as Type 2 diabetes, hypertension, and ischaemic heart disease were previously thought to be diseases of affluent countries, but they are becoming increasingly prevalent in developing nations. Accessibility to cheap unhealthy food, global trade and market development influence nutrition transition towards diets with high fat and sugar contents. A decrease in physical activity due to urbanisation and other environmental factors such as crime and violence are thought to lead to an increased risk of obesity. Positive beliefs about body weight among black African women, together with the idea of association of thinness with HIV/AIDS virus infection are believed to fuel the obesity epidemic amongst this population This paper describes some of the contributory factors which black South African women are faced with in making choices about healthy living. A multisectoral approach will be needed to fight the epidemic of obesity and associated diseases. URI: http://hdl.handle.net/10566/243 Files in this item: 1
PuoaneObesity2005.pdf (29.48Kb) -
Kruger, Salome H; Puoane, Thandi; Senekal, Marjanne; Van Der Merwe, Theresa M (Nutrition Society, 2005)[more][less]
Abstract: OBJECTIVES: To review data on the prevalence, causes and health consequences of obesity in South Africa and propose interventions to prevent and treat obesity and related outcomes. METHODS: Data from existing literature were reviewed with an emphasis on changing eating and activity patterns, cultural factors, perceptions and beliefs, urbanisation and globalisation. Results of studies on the health consequences of obesity in South Africans are also reviewed. RESULTS: Shifts in dietary intakes and activity patterns to higher fat intakes and lower physical activity are contributing to a higher prevalence of obesity. Few overweight black women view themselves as overweight, and some associate thinness with HIV/AIDS. Glucose and lipid toxicity, associated with insulin resistance, play roles in the pathogenesis of the co-morbid diseases of obesity. Elevated free fatty acids in the black population predispose obese black patients to type 2 diabetes. CONCLUSION & RECOMMENDATIONS: Obesity prevention and treatment should be based on education, behaviour change, political support, intersectoral collaboration and community participation, local actions, wide inclusion of the population, adequately resourced programmes, infiltration of existing initiatives, evidence-based planning, and proper monitoring and evaluation. Interventions should have the following components: reasonable weight goals, healthful eating, physical activity and behavioural change. Genes and mutations affecting susceptibility to the development of co-morbidities of obesity and vulnerable periods of life for the development of obesity should be prioritised. Prevention should be managed in community services, identification of high-risk patients in primary healthcare services and treatment of co-morbid diseases in hospital services. URI: http://hdl.handle.net/10566/285 Files in this item: 1
PuoaneObesityChallenges2005.pdf (160.4Kb) -
Puoane, Thandi; Steyn, Kristela; Bradshaw, Debbie; Laubscher, Ria; Fourie, Jean; Lambert, Vicki; Mbanangwa, Nolwazi (Nature Publishing Group, 2002)[more][less]
Abstract: To ascertain the anthropometric profile and determinants of obesity in South Africans who participated in the Demographic and Health Survey in 1998. RESEARCH METHODS AND PROCEDURES: A sample of 13,089 men and women (age, _15 years) were randomly selected and then stratified by province and urban and nonurban areas. Height, weight, mid-upper arm circumference, and waist and hip circumference were measured. Body mass index (BMI) was used as an indicator of obesity, and the waist/hip ratio (WHR) was used as an indicator of abdominal obesity. Multivariate regression identified sociodemographic predictors of BMI and waist circumference in the data. RESULTS: Mean BMI values for men and women were 22.9 kg/m2 and 27.1 kg/m2, respectively. For men, 29.2% were overweight or obese (_25 kg/m2) and 9.2% had abdominal obesity (WHR _1.0), whereas 56.6% of women were overweight or obese and 42% had abdominal obesity (WHR _0.85). Underweight (BMI _18.5 kg/m2) was found in 12.2% of men and 5.6% of women. For men, 19% of the variation of BMI and 34% of the variation in waist circumference could be explained by age, level of education, population group, and area of residence. For women, these variables explained 16% of the variation of BMI and 24% of the variation in waist circumference. Obesity increased with age, and higher levels of obesity were found in urban African women. DISCUSSION: Overnutrition is prevalent among adult South Africans, particularly women. Determinants of overnutrition include age, level of education, ethnicity, and area of residence. URI: http://hdl.handle.net/10566/291 Files in this item: 1
PuoaneSurvey2002.pdf (63.15Kb) -
Igumbor, Ehimario U.; Puoane, Thandi; Gansky, Stuart A.; Plesh, Octavia (South Africa Academy of Family Physicians, 2012)[more][less]
Abstract: Background: The burden of pain in primary care has not been described for South Africa. This study aimed to determine the prevalence of pain in primary care and to characterise pain among adult patients attending a rural and a periurban clinic in the Eastern Cape (EC) Province. Method: cross-sectional descriptive survey was conducted among adult patients attending a rural and periurban clinic over four days. Consecutive patients were asked whether they were in the clinic because of pain and whether the pain was the major reason for their visit. Pain was characterised using an adaptation of the Brief Pain Inventory and the Pain Disability Index. The prevalence percentage and the 95% confidence interval (CI) of pain were estimated, and the relationship with demographic variables was determined at a significance level of P < 0.05. Results: Seven hundred and ninety-six adult patients were interviewed, representing a response rate of 97.4%. Almost three-quarters (74.6%; 95% CI: 63.2-81.4%) reported visiting the clinic because of pain. Pain was the primary reason for 393 (49.4%; 95% CI: 32.1-61.0%) visits and was secondary in 201 (25.3%; 95% CI: 12.8-33.7%) visits. The common sites of pain were the head, back and chest. The median pain score was eight on a scale of 0-10 (interquartile range: 6-8). Respondents experienced limitations in a number of activities of daily living as a result of pain. Conclusion: Pain is a central problem in public primary care settings in the EC Province and must therefore be a priority area for primary care research. Strategies are needed to develop to improve pain management at primary care level in the province. URI: http://hdl.handle.net/10566/428 Files in this item: 1
IgumborPeriurbanHealthClinic2012.pdf (197.4Kb) -
Puoane, Thandi; Tsolekile, Lungiswa; Steyn, Nelia (International Society on Hypertension in Blacks, 2010)[more][less]
Abstract: OBJECTIVE: To assess beliefs about body size (fatness and thinness) and body image in Black girls aged 10–18 years living in Cape Town. DESIGN: Exploratory using qualitative methods. SETTING: Cape Town, South Africa. METHOD: Participants were Black African girls (n5240), aged 10–18 years, who attended 5 primary and 6 high schools in Black townships in Cape Town. The schools and the girls were randomly selected. This paper presents qualitative data from 6 focus groups among 60 girls regarding their beliefs about thinness and fatness, and the advantages and disadvantages of being overweight or thin. RESULTS: Beliefs regarding body image indicate that two thirds of the girls perceived fatness as a sign of happiness and wealth. Socially, fatness was accepted but one third of the girls had contradictory views about its advantages. Among obese girls who believed that being obese was preferable, the dominant reasons were that being fat allowed one to engage in sport activities that need strength and also makes one look respectable. On the other hand fatness was viewed as associated with diseases such as diabetes and hypertension and with increased difficulty in finding appropriate clothing sizes. Three quarters of the girls associated thinness with ill health particularly HIV and AIDS and tuberculosis. An advantage of thinness was being less prone to develop chronic non-communicable diseases. CONCLUSION: The study shows that opinions and beliefs about body image start in adolescence. It is therefore important to consider these perceptions when designing interventions for preventing obesity and other chronic non-communicable diseases during early childhood URI: http://hdl.handle.net/10566/293 Files in this item: 1
PuoanePerceptionsCapeTown2010.pdf (178.9Kb) -
Matoti-Mvalo, Tandi; Puoane, Thandi (MedPharm Publications, 2011)[more][less]
Abstract: OBJECTIVE: To explore the perception among black South African women that people who are thin are infected with HIV or have AIDS. SETTING: Khayelitsha, an urban township in Cape Town. SUBJECTS: 513 women aged 18-65 years. METHODS: This was an exploratory study employing both quantitative and qualitative research methodology. Data were collected in two phases. The first phase involved collecting quantitative data among 513 participants. During the second phase, qualitative data were collected in a purposely selected sub-sample of 20 women. For the qualitative data collection, participants were shown eight body figures, ranging from thin to obese, and asked to choose a figure representing the ideal figure, a preferred figure and a figure thought to symbolise health. They were also invited to choose a figure that they thought represented a person infected with HIV or who had AIDS. They had the option of saying that they did not associate any of the figures with people infected with HIV or who had AIDS. Weight and height measurements were also taken. After the quantitative analysis was completed, focus group discussions explored perceptions about body image and the relation to HIV among purposely selected participants. Data were summarised by content based on questions discussed. RESULTS: Sixty-nine per cent of the participants associated a thin figure with a person infected with HIV, or who had AIDS. Only 10.2% thought the thin figure symbolised health. Fifty per cent preferred a normal-weight figure, while 34.2% thought that normal weight symbolised health. Only 2% thought that people in the normal-weight category were infected with HIV or had AIDS.Thirty-four per cent preferred to be overweight and 31% thought that being overweight symbolised health. None of the participants thought the overweight figure represented people infected with HIV or who had AIDS. Only 8% preferred the obese figure. The results of the qualitative data analysis suggested that participants preferred to be overweight and at risk of acquiring cardiovascular diseases, rather than being thin and stigmatised as a person infected with HIV or who had AIDS. CONCLUSION: This study revealed that the stigma associated with HIV and AIDS may undermine strategies for prevention of chronic noncommunicable diseases among urban black South African women. URI: http://hdl.handle.net/10566/271 Files in this item: 1
PuoanePerceptions2011.pdf (304.5Kb) -
Igumbor, Ehimario U.; Puoane, Thandi; Gansky, Stuart A.; Plesh, Octavia (James Cook University, 2011)[more][less]
Abstract: Background: Despite the acknowledgement that chronic pain may be a problem for adults in rural settings, there is a lack of epidemiological investigations on its occurrence in rural South Africa. Objectives: To estimate the prevalence of chronic pain among adults in a rural community in South Africa and characterize the localization, severity, risk indicators and responses of pain sufferers. Methods: Cross-sectional analytical study using face-to-face interviews. Interviews elicited information on socio-demographic characteristics, general health status and presence of pain. Among those reporting pain, the duration, frequency, severity, activity limitation and impact was determined. Univariate statistics were used to describe the prevalence of chronic pain while bivariable χ2 tests and multivariable logistic regression models were used to assess the relationship of socio-demographic characteristics and reported health status with chronic pain. Results: A total of 394 adults were interviewed representing a response rate of 92.8%. Of these, 169 (42.9%; 95% CI: 37.4%-47.1%) reported suffering from chronic pain. The common sites were the back, knee, ankles, head and shoulders. The median pain score was 6 on a scale of 0-10 (IQR= 5-8) and the median number of sites of pain was 1 (IQR= 1-2). The type of pain slightly varied with age with younger adults reporting more back pain and headaches while older people reported more joint pain. Female gender (adjusted odds-ratio AOR= 2.2, 95% CI: 1.9-2.8) and being older than 50 years (AOR= 3.1, 95% CI:2.7-3.9) were identified as risk indicators for chronic pain in the sample. Respondents reported that they self-treated (88.3%); consulted with a doctor or nurse (74.3%); traditional-healer (24.5%) and spiritual-healer (4%). Most respondents (63.4%) reported only transient relief of their pain. Conclusions: Chronic pain is an important health problem in the surveyed community. Further comparative studies on the relationship with risk factors are needed meanwhile interventions targeting females and the elderly are recommended. URI: http://hdl.handle.net/10566/430 Files in this item: 1
IgumborChronicPain2011.pdf (180.6Kb) -
Bradley, Hazel A.; Puoane, Thandi (International Society on Hypertension in Blacks, 2007)[more][less]
Abstract: The project aimed to identify factors that contribute to hypertension and diabetes and to design and implement appropriate local interventions to prevent these non-communicable diseases and promote healthy lifestyles. This was a community-based participatory action research project in which researchers and community health workers (CHWs) were the main participants. The triple A approach to planning interventions was used, that is, the process of assessing the situation, analyzing the findings, and taking action based on this analysis. Both qualitative and quantitative methods were employed. Twenty-two CHWs working in site C, Khayelitsha, a deprived urban area of Cape Town, South Africa, participated in the study. Findings from the situational assessment indicated a lack of knowledge among CHWs and the community about hypertension and diabetes and the risk factors for these non-communicable diseases. Economic constraints and cultural beliefs and practices influenced the community’s food choices and participation in physical activity. On the basis of these findings, a training program was proposed that would provide CHWs with the skills to prevent hypertension and diabetes in their community. A program was developed and piloted by the project team. A health club that focuses on promoting healthy lifestyles is currently being piloted. This paper illustrates the unique involvement of CHWs in a successful participatory action research project on the prevention of hypertension and diabetes and promotion of health in a deprived urban setting. The project emphasizes the importance of involving local people in community-based initiatives to promote health and identifies that the primary role of health services is to develop appropriate skills in the local community, monitor activities, and facilitate a link with primary health services. URI: http://hdl.handle.net/10566/182 Files in this item: 1
BradleyPuoanePrevention2007.pdf (184.0Kb) -
Scott, Vera; Stern, Ruth; Sanders, David; Reagon, Gavin; Mathews, Verona (BioMed Central, 2008)[more][less]
Abstract: BACKGROUND: While the importance of promoting equity to achieve health is now recognised, the health gap continues to increase globally between and within countries. The description that follows looks at how the Cape Town Equity Gauge initiative, part of the Global Equity Gauge Alliance (GEGA) is endeavouring to tackle this problem. We give an overview of the first phase of our research in which we did an initial assessment of health status and the socio-economic determinants of health across the subdistrict health structures of Cape Town. We then describe two projects from the second phase of our research in which we move from research to action. The first project, the Equity Tools for Managers Project, engages with health managers to develop two tools to address inequity: an Equity Measurement Tool which quantifies inequity in health service provision in financial terms, and a Equity Resource Allocation Tool which advocates for and guides action to rectify inequity in health service provision. The second project, the Water and Sanitation Project, engages with community structures and other sectors to address the problem of diarrhoea in one of the poorest areas in Cape Town through the establishment of a community forum and a pilot study into the acceptability of dry sanitation toilets. METHODS: A participatory approach was adopted. Both quantitative and qualitative methods were used. The first phase, the collection of measurements across the health subdistricts of Cape Town, used quantitative secondary data to demonstrate the inequities. In the Equity Tools for Managers Project further quantitative work was done, supplemented by qualitative policy analysis to study the constraints to implementing equity. The Water and Sanitation Project was primarily qualitative, using in-depth interviews and focus group discussions. These were used to gain an understanding of the impact of the inequities, in this instance, inadequate sanitation provision. RESULTS: The studies both demonstrate the value of adopting the GEGA approach of research to action, adopting three pillars of assessment and monitoring; advocacy; and community empowerment. In the Equity Tools for Managers Project study, the participation of managers meant that their support for implementation was increased, although the failure to include nurses and communities in the study was noted as a limitation. The development of a community Water and Sanitation Forum to support the Project had some notable successes, but also experienced some difficulties due to lack of capacity in both the community and the municipality. CONCLUSION: The two very different, but connected projects, demonstrate the value of adopting the GEGA approach, and the importance of involvement of all stakeholders at all stages. The studies also illustrate the potential of a research institution as informed 'outsiders', in influencing policy and practice. URI: http://hdl.handle.net/10566/171 Files in this item: 1
ScottResearchToAction2008.pdf (299.6Kb) -
Scott, Vera; Chopra, Mickey; Azevedo, Virginia; Caldwell, Judy; Naidoo, Pren; Smuts, Brenda (BioMed Central Ltd, 2010)[more][less]
Abstract: BACKGROUND: In South Africa the need to integrate HIV, TB and STI programmes has been recognised at a policy and organisation level; the challenge is now one of translating policies into relevant actions and monitoring implementation to ensure that the anticipated benefits of integration are achieved. In this research, set in public primary care services in Cape Town, South Africa, we set out to determine how middle level managers could be empowered to monitor the implementation of an effective, integrated HIV/TB/STI service. METHODS: A team of managers and researchers designed an evaluation tool to measure implementation of key components of an integrated HIV/TB/STI package with a focus on integration. They used a comprehensive health systems framework based on conditions for programme effectiveness and then identified and collected tracer indicators. The tool was extensively piloted in two rounds involving 49 clinics in 2003 and 2004 to identify data necessary for effective facility-level management. A subsequent evaluation of 16 clinics (2 per health sub district, 12% of all public primary care facilities) was done in February 2006. RESULTS: 16 clinics were reviewed and 635 records sampled. Client access to HIV/TB/STI programmes was limited in that 50% of facilities routinely deferred clients. Whilst the physical infrastructure and staff were available, there was problem with capacity in that there was insufficient staff training (for example, only 40% of clinical staff trained in HIV care). Weaknesses were identified in quality of care (for example, only 57% of HIV clients were staged in accordance with protocols) and continuity of care (for example, only 24% of VCT clients diagnosed with HIV were followed up for medical assessment). Facility and programme managers felt that the evaluation tool generated information that was useful to manage the programmes at facility and district level. On the basis of the results facility managers drew up action plans to address three areas of weakness within their own facility. CONCLUSIONS: This use of the tool which is designed to empower programme and facility managers demonstrates how engaging middle managers is crucial in translating policies into relevant actions. URI: http://hdl.handle.net/10566/173 Files in this item: 1
ScottScalingUpIntegration2010.pdf (627.0Kb) -
Puoane, Thandi; Matwa, Princess; Hughes, Gail; Bradley, Hazel A. (Kamla-Raj Enterprises, 2006)[more][less]
Abstract: The present study was undertaken to examine socio-cultural factors that influence food intake in different groups of people residing in a black township in Cape Town. Focus group discussions and in-depth interviews were used to explore these factors in men, and women of different age groups. Discussions were recorded, transcribed and analysed according to emerging themes. The main findings of the study indicated that in addition to nourishing the body, food is a sign of warmth, acceptance and friendship. Meat consumption on a daily basis is associated with a high socioeconomic status, while consumption of vegetables only is associated with a low socioeconomic status. Eating large portions of food is associated with affordability. Food is used for celebrations, rituals, and for welcoming guests. Food is also used during social occasions when people get together and meet socially. Sweets, ice cream and cakes are consumed on happy occasions. Fatty meat is a sign of generosity; lean meat and black tea is often used during mourning periods. Eating behaviours are learned during socialization, and carried over from generation to generation. There are socially accepted norms and values surrounding people’s understanding of what food is. This information needs to be used in a more constructive way to help people choose food wisely to prevent over nutrition and associated risks. In conclusion, this paper illustrates the impact of socio-cultural factors on eating patterns in this population and emphasizes the need to take these factors into consideration in development of interventions to promote healthy eating. URI: http://hdl.handle.net/10566/253 Files in this item: 1
JHE-SI-14-12-089-093-Puoane-T-Text.pdf (145.3Kb) -
Lehmann, Uta (Health Systems Trust, 2008)[more][less]
Abstract: This chapter reviews the progress made in recent years to strengthen human resources to deliver health care within a Primary Health Care approach. It focuses specifically on the availability and preparedness of old and new cadres of health workers, their distribution within the South African health system, as well as their training and development. Findings suggest that overall the health workforce is substantially weaker today than it was in the mid-1990s. There are fewer doctors and nurses available for the vast majority of public sector dependent population, as production has not kept up with population growth, increasing care needs and attrition. Disparities between provinces remain, and disparities between the private and public sectors have grown. The nursing sector faces a serious crisis brought on by an aging professional population. Progress with the development of mid-level cadres has been slow, with pharmacy being the exception. Furthermore, the implementation of community health worker programmes remains fragmented and uneven. Importantly, while there has been curriculum reform in many medical schools, there has been no fundamental shift in the orientation and resourcing of health professions. Health workers entering primary or community care services, thus, often remain illprepared and find themselves poorly supported and resourced. It is suggested that the following areas must be a priority in the human resource agenda in coming years: an accelerated production of professionals and mid-level cadres; comprehensive curriculum audits; the regulation and integration of community health workers; and an integrated and comprehensive reconfiguration of Primary Health Care teams. URI: http://hdl.handle.net/10566/437 Files in this item: 1
LehmannPrimaryHealthCare2009.pdf (692.3Kb) -
Shamu, Simukai; Abrahams, Naeemah; Temmerman, Marleen; Musekiwa, Alfred; Zarowsky, Christina (Public Library of Science, 2011)[more][less]
Abstract: Background: Intimate partner violence (IPV) is very high in Africa. However, information obtained from the increasing number of African studies on IPV among pregnant women has not been scientifically analyzed. This paper presents a systematic review summing up the evidence from African studies on IPV prevalence and risk factors among pregnant women. Methods: A key-word defined search of various electronic databases, specific journals and reference lists on IPV prevalence and risk factors during pregnancy resulted in 19 peer-reviewed journal articles which matched our inclusion criteria. Quantitative articles about pregnant women from Africa published in English between 2000 and 2010 were reviewed. At least two reviewers assessed each paper for quality and content. We conducted meta-analysis of prevalence data and reported odds ratios of risk factors. Results: The prevalence of IPV during pregnancy ranges from 2% to 57% (n = 13 studies) with meta-analysis yielding an overall prevalence of 15.23% (95% CI: 14.38 to 16.08%). After adjustment for known confounders, five studies retained significant associations between HIV and IPV during pregnancy (OR1.48–3.10). Five studies demonstrated strong evidence that a history of violence is significantly associated with IPV in pregnancy and alcohol abuse by a partner also increases a woman’s chances of being abused during pregnancy (OR 2.89–11.60). Other risk factors include risky sexual behaviours, low socioeconomic status and young age. Conclusion: The prevalence of IPV among pregnant women in Africa is one of the highest reported globally. The major risk factors included HIV infection, history of violence and alcohol and drug use. This evidence points to the importance of further research to both better understand IPV during pregnancy and feed into interventions in reproductive health services to prevent and minimize the impact of such violence. URI: http://hdl.handle.net/10566/461 Files in this item: 1
ShamuPartnerViolenceReview2011.pdf (319.5Kb) -
Lehmann, Uta; Van Damme, Wim; Barten, Francoise; Sanders, David (BioMed Central, 2009)[more][less]
Abstract: Ever since the 2006 World Health Report advocated increased community participation and the systematic delegation of tasks to less-specialized cadres, there has been a great deal of debate about the expediency, efficacy and modalities of task shifting. The delegation of tasks from one cadre to another, previously often called substitution, is not a new concept. It has been used in many countries and for many decades, either as a response to emergency needs or as a method to provide adequate care at primary and secondary levels, especially in understaffed rural facilities, to enhance quality and reduce costs. However, rapidly increasing care needs generated by the HIV/AIDS epidemic and accelerating human resource crises in many African countries have given the concept and practice of task shifting new prominence and urgency. Furthermore, the question arises as to whether task shifting and increased community participation can be more than a short-term solution to address the HIV/AIDS crisis and can contribute to a revival of the primary health care approach as an answer to health systems crises. In this commentary we argue that, while task shifting holds great promise, any long-term success of task shifting hinges on serious political and financial commitments. We reason that it requires a comprehensive and integrated reconfiguration of health teams, changed scopes of practice and regulatory frameworks and enhanced training infrastructure, as well as availability of reliable medium- to long-term funding, with time frames of 20 to 30 years instead of three to five years. The concept and practice of community participation needs to be revisited. Most importantly, task shifting strategies require leadership from national governments to ensure an enabling regulatory framework; drive the implementation of relevant policies; guide and support training institutions and ensure adequate resources; and harness the support of the multiple stakeholders. With such leadership and a willingness to learn from those with relevant experience (for example, Brazil, Ethiopia, Malawi, Mozambique and Zambia), task shifting can indeed make a vital contribution to building sustainable, cost-effective and equitable health care systems. Without it, task shifting runs the risk of being yet another unsuccessful health sector reform initiative. URI: http://hdl.handle.net/10566/316 Files in this item: 1
LehmannTaskShifting2009.pdf (219.6Kb) -
Puoane, Thandi; Sanders, David; Ashworth, Ann; Ngumbela, Modesta (Democratic Nursing Organisation of South Africa, 2006)[more][less]
Abstract: A qualitative study with a pre- and post-intervention component was undertaken among 66 professional nurses at 11 hospitals in the Eastern Cape to assess their perceptions and attitudes towards severely malnourished children and their mothers/caregivers. Nurses’ attitudes were compared before and after attending a 5-day training course to improve the management of malnutrition along with implementing World Health Organization (WHO) guidelines. Severe malnutrition is a major cause of death among paediatric patients in many hospitals in South Africa. A qualitative study with a pre- and post-intervention component was undertaken among 66 professional nurses at 11 hospitals in the Eastern Cape to assess their perceptions and attitudes towards severely malnourished children and their mothers/caregivers. Nurses’ attitudes were compared before and after attending a 5-day training course to improve the management of malnutrition along with implementing World Health Organization (WHO) guidelines. Focus group discussions were conducted in isiXhosa following a semi-structured discussion guide. Three themes emerged from these discussions, i.e. blame was placed on the mothers for not giving adequate care, malnourished children were valued less than those with other conditions, and resentment that nurses felt towards caregivers. underlying reasons for negative attitudes towards severely malnourished children and their caregivers were misunderstandings of the causes of severe malnutrition, misinterpretation of clinical signs,especially poor appetite and and high mortality during treatment.However, successful application of the treatment guidelines altered these perceptions and helped nurses to have a better understanding of the causes of the presenting clinical signs. These nurses have begun advocating for raised awareness and the need to include the WHO Ten Steps of treatment in the nursing curricula and in-service training. A cadre of volunteer nurse-trainers has been formed in Eastern Cape. Experience in this province has shown that in-service training changes attitudes to malnutrition and treatment practices, as well as saving lives. URI: http://hdl.handle.net/10566/297 Files in this item: 1
PuoaneTrainingNurses2006.pdf (666.8Kb) -
Goggin, Kathy; Puoane, Thandi (University of KwaZulu-Natal, 2010)[more][less]
Abstract: This study reports on the cultural and language translation of measures for use with Zulu speakers in South Africa. The translation process was purposefully used to integrate our diverse 14 person study team by employing Community Based Participatory Research (CBPR) strategies. Measures included: the Medical Outcomes Study HIV Health Survey (MOS-HIV), Center for Epidemiologic Studies Depression Scale (CES-D), and Perceived Stress Scale (PSS). The translation was made complex by the variation in Zulu dialects across regions and even between two cities only forty-five minutes apart. Carefully conceived translations can simultaneously produce good translations and deepen team members’ understanding of each other. URI: http://hdl.handle.net/10566/270 Files in this item: 1
13 Goggin FIN.pdf (125.1Kb) -
Cleary, Susan; Birch, Stephen; Moshabela, Mosa; Schneider, Helen (BMJ Publishing Group, 2012)[more][less]
Abstract: INTRODUCTION: South Africa has the world's largest antiretroviral treatment (ART) programme. While services in the public sector are free at the point of use, little is known about overall access barriers. This paper explores these barriers from the perspective of ART users enrolled in services in two rural and two urban settings. METHODS: Using a comprehensive framework of access, interviews were conducted with over 1200 ART users to assess barriers along three dimensions: availability, affordability and acceptability. Summary statistics were computed and comparisons of access barriers between sites were explored using multivariate linear and logistic regressions. RESULTS: While availability access barriers in rural settings were found to be mitigated through a more decentralised model of service provision in one site, affordability barriers were considerably higher in rural versus urban settings. 50% of respondents incurred catastrophic healthcare expenditure and 36% borrowed money to cover these expenses in one rural site. On acceptability, rural users were less likely to report feeling respected by health workers. Stigma was reported to be lowest in the two sites with the most decentralised services and the highest coverage of those in need. CONCLUSIONS: While results suggest inequitable access to ART for rural relative to urban users, nurse-led services offered through primary healthcare facilities mitigated these barriers in one rural site. This is an important finding given current policy emphasis on decentralised and nurse-led ART in South Africa. This study is one of the first to present comprehensive evidence on access barriers to assist in the design of policy solutions. URI: http://hdl.handle.net/10566/477 Files in this item: 1
ClearyRuralUrbanART2012.pdf (2.260Mb)