Browsing Faculty of Community & Health Sciences by Title
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Blaauw, Phillip (Derick); Pretorius, Anmar; Schoeman, Christie; Schenck, Catherina (Rinie) (The Clute Institute, 2012)[more][less]
Abstract: There has been an increasing inflow of migrants and refugees into South Africa during the last two decades. The origin of these migrants is mainly from South Africa’s long-established sources of migrant workers, including countries from the Southern African Development Community. Over the last decade, African immigrants have encountered brutal manifestations of resentment at their presence in South Africa. The reasons for this are multifaceted, but one of the pertinent perceptions is that immigrants from the country’s northern borders are taking South Africans’ jobs. It is often claimed that casual immigrant workers are willing to work for very low daily wages. In doing so, they get temporary employment in the informal and formal economy at the expense of South African workers, who have much higher reservation wages in the same informal labour market. This is the first study to focus on the wages of migrant day labourers in South Africa by investigating the determinants of day labour wages for migrant day labourers from Zimbabwe. The respondents for this study were interviewed during the first countrywide survey of day labourers in South Africa during 2007. The paper concludes that the income from migrant day labourers from Zimbabwe often exceeds that of the average day labourer in South Africa. The Zimbabweans are, in many cases, better qualified than the average day labourer in South Africa. The main determinants of these migrant wages are their formal level of schooling, language proficiency and the completion of vocational training courses URI: http://hdl.handle.net/10566/649 Files in this item: 1
BlaauwZimbabweanLabourers2012.pdf (265.3Kb) -
Stern, Ruth; Puoane, Thandi; Tsolekile, Lungiswa (Centers for Disease Control and Prevention, 2010)[more][less]
Abstract: Introduction Noncommunicable diseases are increasing in developing countries, exacerbated by growing urbanization. We examined the experiences and perceptions about noncommunicable diseases of people who migrated from rural areas to urban Cape Town, South Africa. Methods We conducted a qualitative study in an impoverished periurban township that has a noncommunicable disease prevention program, including health clubs. We used in-depth interviews, participatory reflection and action groups, and focus group discussions. Results Participants described changes in eating patterns and levels of physical activity. These changes were a result of socioeconomic and environmental constraints. However, respondents were not concerned about these changes. Despite hardships, they were pleased with their urban lifestyle. Furthermore, they approved of their weight gain because it signified dignity and respect. Participants who attended health clubs found them informative and socially and emotionally supportive. Conclusion The study highlighted the complexity of the risk factors for noncommunicable diseases and the need to develop prevention strategies that extend beyond the traditional focus on diet and exercise. URI: http://hdl.handle.net/10566/292 Files in this item: 1
PuoaneExplorationNCD2010.pdf (381.1Kb) -
Nankwanga, Annet; Phillips, Julie; Neema, Stella (Faculty of Community and Health Sciences, University of the Western Cape, 2009)[more][less]
Abstract: Introduction: This paper presents HIV/AIDS experiences of elderly persons in Uganda as revealed by an ongoing descriptive cross-sectional study covering eight districts, namely: Pallisa, Kampala, Jinja, Lira, Nebbi, Ntungamo, Luwero and Mbarara. These districts represent both the rural and urban areas of the four regions of Uganda, including: Western, Northern, Eastern and Central region. Methods: The study employed a mixed method approach using a sequential exploratory strategy. Data was collected using not only focus group discussions and in-depth interviews held with 165 elderly persons but also a validated interview schedule administered to 50 key informants. Elderly persons participated in the study by providing data on their HIV/AIDS-related experiences. Key respondents were selected to provide data on strategies that could be adopted to curb the effects of the epidemic. This paper is based on one of the study's objectives, which focussed on exploring the effects of HIV/AIDS on Uganda's elderly people; coping mechanisms used to deal with HIV/AIDS; and strategies for curbing its effects. Data was analysed using content analysis and the descriptive method of SPSS. Results: Results show that HIV/AIDS affected most of the elderly people in Uganda by killing their children and spouses, and leaving them with a big burden of taking care of AIDS orphans; yet majority of these people were financially too incapacitated to shoulder it amply. HIV/AIDS also infected the elderly people. The epidemic introduced the need for ARVs and other health services that elderly people found too difficult to access due to poor health service delivery systems in Uganda. Most elderly people used food cultivation as a mechanism for coping with the burden of orphans. These results lead to recommending that government should economically empower elderly people through formulation and effective implementation of welfare policies regarding pension and special fund for these people. Conclusion: There is a need for the government to provide adequate and free HIV/AIDS-related health services and also increase educational support for HIV/AIDS orphans. URI: http://hdl.handle.net/10566/121 Files in this item: 1
AnnetHIV2009.pdf (178.8Kb) -
Moshabela, Mosa; Schneider, Helen; Silal, Sheetal; Cleary, Susan (BioMed Central, 2012)[more][less]
Abstract: Background: In low-resource settings, patients’ use of multiple healthcare sources may complicate chronic care and clinical outcomes as antiretroviral therapy (ART) continues to expand. However, little is known regarding patterns, drivers and consequences of using multiple healthcare sources. We therefore investigated factors associated with patterns of plural healthcare usage among patients taking ART in diverse South African settings. Methods: A cross-sectional study of patients taking ART was conducted in two rural and two urban sub-districts, involving 13 accredited facilities and 1266 participants selected through systematic random sampling. Structured questionnaires were used in interviews, and participant’s clinic records were reviewed. Data collected included household assets, healthcare access dimensions (availability, affordability and acceptability), healthcare utilization and pluralism, and laboratory-based outcomes. Multiple logistic regression models were fitted to identify predictors of healthcare pluralism and associations with treatment outcomes. Prior ethical approval and informed consent were obtained. Results: Nineteen percent of respondents reported use of additional healthcare providers over and above their regular ART visits in the prior month. A further 15% of respondents reported additional expenditure on self-care (e.g. special foods). Access to health insurance (Adjusted odds ratio [aOR] 6.15) and disability grants (aOR 1.35) increased plural healthcare use. However, plural healthcare users were more likely to borrow money to finance healthcare (aOR 2.68), and incur catastrophic levels of healthcare expenditure (27%) than non-plural users (7%). Quality of care factors, such as perceived disrespect by staff (aOR 2.07) and lack of privacy (aOR 1.50) increased plural healthcare utilization. Plural healthcare utilization was associated with rural residence (aOR 1.97). Healthcare pluralism was not associated with missed visits or biological outcomes. Conclusion: Increased plural healthcare utilization, inequitably distributed between rural and urban areas, is largely a function of higher socioeconomic status, better ability to finance healthcare and factors related to poor quality of care in ART clinics. Plural healthcare utilization may be an indication of patients’ dissatisfaction with perceived quality of ART care provided. Healthcare expenditure of a catastrophic nature remained a persistent complication. Plural healthcare utilization did not appear to influence clinical outcomes. However, there were potential negative impacts on the livelihoods of patients and their households. URI: http://hdl.handle.net/10566/547 Files in this item: 1
MoshabelaAntiretroviralTherapy2012.pdf (419.5Kb) -
Kanyoni, Maurice; Phillips, Julie (Faculty of Community and Health Sciences, University of the Western Cape, 2009)[more][less]
Abstract: Background: The size of the elderly population both in numbers and proportions of the whole world is increasing rapidly. The increase in the number of elderly people in the world will exert a big impact on health and social services. It is established that physical activity is one way of limiting age related disabilities. Objectives: This study aims to asses the levels of physical activity and the factors associated with it among older adults in selected institutions for the elderly in the Southern Province of Rwanda. Method: A cross-sectional descriptive study was conducted at 2 institutions for older adults in Rwanda. An interview questionnaire with close-ended questions was used to collect data. Results: More than one-third of the study sample was categorized as sedentary. Physical activity levels decrease with age. Females reported higher prevalence of physical activity than males. Conclusion: Older adults should be encouraged to engage in physical activity to gain the physical and mental health benefits associated with it. URI: http://hdl.handle.net/10566/114 Files in this item: 1
KanyoniPhysicalActivity2009.pdf (62.78Kb) -
Mabunda, Jabu; Bradley, Hazel A. (LAM Publications Ltd, 2011)[more][less]
Abstract: The purpose of the study was to assess factors contributing to poor performance of Directly Observed Treatment Short-Course (DOTS) in Mopani district of Limpopo Province, South Africa. An exploratory qualitative approach was used to investigate the factors that contribute to poor performance of the DOTS Strategy. Four focus group discussions were conducted, two with Directly Observed Therapy (DOT) Supporters and two with patients on treatment for more than 6 months. The focus groups (4) discussions were tape-recorded. Data collected were descriptively analyzed using thematic methods. The patients generally found supervision of TB treatment helpful as they were motivated and encouraged to continue treatment. Some of the aspects identified as being unhelpful were the inconvenient times for treatment support and stigma due TB supporters’ visit to patients home. Patients often preferred family members as supporters, whereas health workers favoured trained volunteers as DOT supporters. Other factors affecting DOTS were poverty, food shortage, cultural beliefs, and side-effects of the medication. Patients receiving disability grants prefer to remain uncured so as to continue receiving the grant. Behavioural factors seem to play a major role in noncompliance with TB treatment. The findings of the study support the importance of initial counseling and motivation of patients in improving adherence in the programme. Self-motivation was mentioned rather than the motivation from the DOT supporters. Further exploration of alternative DOTS supporters other than trained volunteer demands further investigation. URI: http://hdl.handle.net/10566/315 Files in this item: 1
MabundaTBDOTS2011.pdf (108.3Kb) -
Figaji, Tamara; Phillips, Julie (Faculty of Community and Health Sciences, University of the Western Cape, 2010)[more][less]
Abstract: BACKGROUND: Although the health benefits of physical activity have been proven, many children and adolescents still do not meet the recommended guidelines for sufficient physical activity. The purpose of this investigation was thus to examine the levels of PA, and learners perception of support from teachers, family and friends at an independent school in the Western Cape. Furthermore, the investigation aimed to examine the influence of social support on physical activity. METHOD: A cross-sectional design using quantitative methods was used in this study, which included 100 learners in the senior phase of the school (i.e. grades 5 to 7). The data was obtained with a self-admininstered questionnaire. The data was analyzed with the Statistical Package for Social Sciences (SPSS) version 16.0. The Chi-square test was used to explore associations between nominal and numerical data. The T-test was used to determine statistical significance between groups (independent t-tests) and within groups (paired sample t-test). RESULTS: Overall the sample responded positively when asked about support for physical activity from teachers. Furthermore, the study sample had a positive perception of both physical education (PE) and physical activity (PA) enjoyment. Boys participated in vigorous physical activity significantly more regularly than girls. CONCLUSION: As children are spending a considerable time at school, teachers, friends and parents should be encouraged to be supportive of their participation in physical activity. URI: http://hdl.handle.net/10566/181 Files in this item: 1
FigajiPhillips2010.pdf (58.32Kb) -
Hughes, Gail; Hoyo, Catherine; Puoane, Thandi (South African Medical Association, 2006)[more][less]
Abstract: BACKGROUND: In South Africa, former apartheid laws encouraged rural males seeking employment to migrate to urban areas, moving weekly, monthly or annually between their rural families and urban workplaces. The combination of the migrant labour system and long family separations caused an explosion of serious health consequences, among others sexually transmitted infections (STIs) in the migrant population. OBJECTIVE: To describe some correlates of male migration patterns for the rural women left behind, especially the fear of STIs that this engendered in them and their risk-avoidance behaviour. Setting and subjects. In KwaZulu-Natal, 208 prenatal patients who were partners of oscillating male migrant workers were interviewed to determine their demographic and behavioural characteristics, and their fear of STIs. RESULTS: Thirty-six per cent of the rural women said that they were afraid of contracting STIs from their returning migrant partners. Women who saw their partners infrequently were more fearful of STI transmission, and were less able to have sexual communication. However, almost none of the women protected themselves, while only 8% used condoms, primarily for contraceptive purposes. CONCLUSIONS: These results reflect the gender-based power relationships of South African male migrants and their rural partners, the social and economic dependency of the women on their migrant partners, and the women’s social responsibility to bear children. The results point to the need to go beyond interventions that simply seek to modify behaviour without altering the forces that promote risk taking and discourage risk reduction, and the need to develop appropriate interventions to curb STIs and decrease HIV. URI: http://hdl.handle.net/10566/260 Files in this item: 1
PuoaneSTIs2006.pdf (563.5Kb) -
Dewing, Sarah; Matthews, Catherine; Schaay, Nikki; Cloete, Allanise; Simbayi, Leickness; Chopra, Mickey (Springer, 2011)[more][less]
Abstract: This case study with one lay adherence counsellor assessed the implementation of Options for Health, a sexual risk-reduction intervention based on Motivational Interviewing (MI), in an antiretroviral clinic in Cape Town, South Africa. In most cases Options was not delivered with fidelity and less than one-third of intended recipients received it; the counsellor often forgot to do Options, was unsure how to deal with particular cases and felt that there was not always time to do Options. Options was not implemented in a way that was consistent with MI. Revisions to the implementation plan and training programme are required. URI: http://hdl.handle.net/10566/473 Files in this item: 1
DewingAntiretroviralClinic2011.pdf (162.5Kb) -
Schneider, Helen; Govender, Veloshnee; Harris, Bronwyn; Cleary, Susan; Moshabela, Mosa; Birch, Stephen (Blackwell Publishing Ltd, 2012)[more][less]
Abstract: Objectives: A mixed methods study exploring gender differences in patient profiles and experiences of ART services, along the access dimensions of availability, affordability and acceptability, in two rural and two urban areas of South Africa. methods Structured exit interviews (n = 1266) combined with in-depth interviews (n = 20) of women and men enrolled in ART care. results Men attending ART services were more likely to be employed (29% vs. 20%, P = 0.001) and were twice as likely to be married ⁄ co-habiting as women (42% vs. 22% P = 0.001). Men had known their HIV status for a shorter time (mean 32 vs. 36 months, P = 0.021) and were also less likely to disclose their status to non-family members (17% vs. 26%, P = 0.001). From both forms of data collection, a key finding was the role of female partners in providing social support and facilitating use of services by men. The converse was true for women who relied more on extended families and friends than on partners for support. Young, unmarried and unemployed men faced the greatest social isolation and difficulty. There were no major gender differences in the health system (supply side) dimensions of access. conclusions Gender differences in experiences of HIV services relate more to social than health system factors. However, the health system could be more responsive by designing services in ways that enable earlier and easier use by men. URI: http://hdl.handle.net/10566/474 Files in this item: 1
SchneiderART-Services2012.pdf (66.55Kb) -
Zarowsky, Christina (BioMed Central, 2011)[more][less]
Abstract: The papers in this important collection reflect a mature and confident way of doing global health research which is anything but business-as-usual. In the context of increasing competition for individual or institutional “leadership” of the field (and business) of gobal health, these contributors instead speak of active and sustained collaboration -- listening, responsiveness, flexibility, willingness and capacity to follow as well as to lead -- in learning what to transform or sustain, and how, in order to move towards greater equity in both health and health research. Each paper and the collection as a whole is an important contribution to the evidence base for a range of issues from maternal health, HIV and access to services, to chronic disease, health system strengthening, occupational health, ecosystemic approaches to health, and social inclusion, exclusion, and neglect. In addition, they challenge conventional models of research focused on narrowly defined research questions and a narrow range of pre-specified research methods, documenting instead how both the research questions and the methods most appropriate to address them change over time. Finally, they challenge both the idea of “pure” science undertaken by independent researchers on behalf of science and specific communities, and the conventional wisdom that North-South and research-research user-community partnerships are necessarily either North and researcher-driven, or scientifically dubious. URI: http://hdl.handle.net/10566/460 Files in this item: 1
ZarowskyGlobalHealthPartnership2011.pdf (155.1Kb) -
London, Leslie; Schneider, Helen (Elsevier Ltd, 2012)[more][less]
Abstract: While neoliberal globalisation is associated with increasing inequalities, global integration has simultaneously strengthened the dissemination of human rights discourse across the world. This paper explores the seeming contradiction that globalisation is conceived as disempowering nations states' ability to act in their population's interests, yet implementation of human rights obligations requires effective states to deliver socio-economic entitlements, such as health. Central to the actions required of the state to build a health system based on a human rights approach is the notion of accountability. Two case studies are used to explore the constraints on states meeting their human rights obligations regarding health, the first drawing on data from interviews with parliamentarians responsible for health in East and Southern Africa, and the second reflecting on the response to the HIV/AIDS epidemic in South Africa. The case studies illustrate the importance of a human rights paradigm in strengthening parliamentary oversight over the executive in ways that prioritise pro-poor protections and in increasing leverage for resources for the health sector within parliamentary processes. Further, a rights framework creates the space for civil society action to engage with the legislature to hold public officials accountable and confirms the importance of rights as enabling civil society mobilization, reinforcing community agency to advance health rights for poor communities. In this context, critical assessment of state incapacity to meet claims to health rights raises questions as to the diffusion of accountability rife under modern international aid systems. Such diffusion of accountability opens the door to 'cunning' states to deflect rights claims of their populations. We argue that human rights, as both a normative framework for legal challenges and as a means to create room for active civil society engagement provide a means to contest both the real and the purported constraints imposed by globalisation. URI: http://hdl.handle.net/10566/475 Files in this item: 1
LondonGlobalInequalities2012.pdf (178.5Kb) -
Njoki, Emma; Frantz, Jose M.; Mpofu, Ratie (Informa Healthcare, 2007)[more][less]
Abstract: Purpose. To determine the health promotion needs through an exploration of health-related behaviours and the factors that influence the behaviour of physically disabled youth with spinal cord injury. Methods. A descriptive and exploratory study that utilized a qualitative approach was carried out among ten participants aged between 15 and 29 years who were purposely selected. Information was obtained from individual face-to-face interviews and a focus-group discussion. Results. The participants were involved in risky health behaviours including sedentary lifestyles, use of alcohol, tobacco, and drugs. Various factors that influenced their participation in these behaviours were identified including personal struggles with identity and adjustment issues. Conclusions. The results emphasize that participants were involved in health-risk behaviours, which are associated with development of secondary conditions such as respiratory problems, heart diseases, and stroke. Health-promotion strategies employed for these individuals should address the psychological impact of spinal cord injury (SCI) on the individual as an influence to participation in health risk behaviours. URI: http://hdl.handle.net/10566/399 Files in this item: 1
FrantzHealthPromotion2007.pdf (246.3Kb) -
Uwimana, Jeannine; Jackson, Debra; Hausler, Harry; Zarowsky, Christina (Wiley-Blackwell, 2012)[more][less]
Abstract: In South Africa, the control of TB and HIV co-infection remains a major challenge despite the availability of international and national guidelines for integration of TB and HIV services. This study was undertaken in KwaZulu-Natal, one of the provinces most affected by both TB and HIV, to identify and understand managers’ and community care workers’ (CCWs) perceptions of health systems barriers related to the implementation of collaborative TB⁄ HIV activities, including prevention of mother to child transmission of HIV (PMTCT). We conducted 29 in-depth interviews with health managers at provincial, district and facility level and with managers of NGOs involved in TB and HIV care, as well as six focus group discussions with CCWs. Thematic analysis of transcripts revealed a convergence of perspectives on the process and the level of the implementation of policy directives on collaborative TB and HIV activities across all categories of respondents (i.e. province-, district-, facility- and communitybased organizations). The majority of participants felt that the implementation of the policy was insufficiently consultative and that leadership and political will were lacking. The predominant themes related to health systems barriers include challenges related to structure and organisational culture; management, planning and power issues; unequal financing; and human resource capacity and regulatory problems notably relating to scope of practice of nurses and CCWs. Accelerated implementation of collaborative TB⁄ HIV activities including PMTCT will require political will and leadership to address these health systems barriers. URI: http://hdl.handle.net/10566/457 Files in this item: 1
UwimanaHealthSystemBarriers2012.pdf (205.7Kb) -
Wegner, Lisa; Flisher, Alan J; Caldwell, Linda L; Vergnani, Tania; Smith, Edward A (Oxford University Press, 2008)[more][less]
Abstract: There is a need for effective prevention programmes aimed at reducing risk behaviour among South African adolescents. Health Wise South Africa is a school-based programme designed to reduce sexual and substance use risk behaviour, and promote positive use of leisure time among high-school learners (students). Based on successful programmes in the United States of America, Health Wise was developed for use in South Africa and pilot tested in four South African high schools. We carried out a process evaluation to establish the fidelity of implementation and make sure HealthWise was culturally relevant. Data sources comprised focus groups with educators and learners, lesson evaluations and observations, and interviews with school principals. Qualitative analysis of data highlighted pertinent cultural and contextual factors and identified areas for modifying Health Wise in order to promote better programme-consumer fit. These areas centred on time, language, and leisure. We noted a dynamic tension between the educators’ desire to adhere to plan, and to make adaptations in accordance with learners’ needs and the context. Ultimately, researchers need to find a balance between fidelity of implementation and programme adaptation to obtain effective programmes that are culturally acceptable to local consumers. URI: http://hdl.handle.net/10566/686 Files in this item: 1
WegnerHealthwiseAdolescent2008.pdf (2.119Mb) -
Moodley, Colleen; Phillips, Julie (Africa Association for Health, Physical Education, Recreation, Sport and Dance/LAM Publications Limited, 2011)[more][less]
Abstract: The impact of the HIV/AIDS pandemic is mostly felt by adolescents as half of all new HIV/AIDS infections have occurred in people aged 15-24 years. Statistics show that campaigns implemented by the South African government have failed to bring about positive behavioural change among young people. The aim of this study was to determine the HIV/AIDS-related knowledge among students at a college and the association between knowledge, self-efficacy, self-concept in sexual practices. This study was conducted at a Further Education and Training College in Cape Town. Data were collected using self-administered questionnaires consisting of five sections including demographic information; sexual practices; knowledge of HIV/AIDS, levels of self-efficacy; and self-concept. Fifty four percent of the participants indicated no condom use when having sex, either by themselves or by a partner; 43% indicated that they had more than 2 sexual partners in the 12 months prior to the study. The odds that a person with higher HIV/AIDS knowledge will use a condom were 1.047 times greater than someone with less HIV/AIDS knowledge. The odd’s ratio for self-efficacy indicates a positive relationship with the number of partners of an individual. The findings of the present study suggest adequate/high HIV/AIDS knowledge among the study sample. The study further highlights that for males, there is a greater likelihood that lower self-efficacy would predict more sexual partners in comparison to females. The results further suggest that although governmental organisations’ efforts improved knowledge of HIV/AIDS, programmes avidly promoting self-efficacy for males should be implemented. URI: http://hdl.handle.net/10566/505 Files in this item: 1
MoodleySexualHealth2011.pdf (139.7Kb) -
Scott, Vera; Chopra, Mickey; Conrad, Liz; Ntuli, Antoinette (Health and Medical Publishing Group, 2005)[more][less]
Abstract: OBJECTIVES. To assess the extent of inequalities in availability and utilisation of HIV services across South Africa. DESIGN. Cross-sectional descriptive study. Setting. Three districts reflecting different socio-economic conditions, but with similar levels of HIV infection, were purposively sampled. Outcome measures. Availability and utilisation of HIV services and management and support structures for programmes were assessed through the collection of secondary data supplemented by site visits. RESULTS. There were marked inequalities in service delivery between the three sites. Compared with two poorer sites, clinics at the urban site had greater availability of HIV services, including voluntary counselling and testing (100% v. 52% and 24% respectively), better uptake of this service (59 v. 9 and 5.5 clients per 1 000 adults respectively) and greater distribution of condoms (15.6 v. 8.2 condoms per adult male per year). Extra counsellors had also been employed at the urban site in contrast to the other 2 sites. The urban site also had far more intensive management support and monitoring, with 1 manager per 12 health facilities compared with 1 manager per more than 90 health facilities at the other 2 sites. CONCLUSION. The process of scaling up of HIV services seems to be accentuating inequalities. The urban site in this study was better able to utilise the extra resources. In contrast, the poorer sites have thus far been unable to scale up the response to HIV even with the availability of extra resources. Unless policy makers pay more attention to equity, efficacious interventions may prove to be of limited effectiveness. URI: http://hdl.handle.net/10566/172 Files in this item: 1
ScottHowEquitable2005.pdf (307.4Kb) -
Puoane, Thandi; Hughes, Gail (South African Medical Association, 2005)[more][less]
Abstract: HIV/AIDS continues to ravage sub-Saharan Africa, and in South Africa accounts for 30% of all mortality, making it the leading cause of death. The epidemic has had other negative effects, which have not been fully realised. Among these is the fact that, paradoxically, the awareness programmes implemented to prevent major spread of HIV/AIDS have complicated the prevention of non-communicable diseases (NCDs). URI: http://hdl.handle.net/10566/283 Files in this item: 1
HIV and NCDs m_samj_v95_n4_a6.pdf (219.2Kb) -
Labonte, Ron; Sanders, David; Baum, Fran; Schaay, Nikki; Packer, Corinne (CSIRO, 2008)[more][less]
Abstract: Primary health care (PHC) is again high on the international agenda. It was the theme of The World Health Report in 2008, thirty years after the Alma-Ata Declaration, and has been the topic of a series of significant conferences around the world throughout 2008. What have we learnt about its impact in improving population health and health equity? What more do we still need to know? These two questions framed a four-year international research/capacity-building project, “Revitalizing Health for All” (RHFA), funded by the Canadian Global Health Research Initiative, which began in 2007. The findings of a global literature review conducted by this Initiative, and focusing on comprehensive primary health care - and how it has been implemented since Alma Ata are presented. The way in which the political context has affected the comprehensiveness of PHC is considered - along with a series of proposed future PHC research areas. URI: http://hdl.handle.net/10566/476 Files in this item: 1
LabontePrimaryHealthCare2008.pdf (235.2Kb) -
Puoane, Thandi; Sanders, David; Ashworth, Ann; Chopra, Mickey; Strasser, Susan; McCoy, David (Oxford University Press, 2004)[more][less]
Abstract: OBJECTIVE. To improve the clinical management of severely malnourished children in rural hospitals in South Africa. STUDY DESIGN. A pre- and post-intervention descriptive study in three stages: assessment of the clinical management of severely malnourished children, planning and implementing an action plan to improve quality of care, and monitoring and evaluating targeted activities. A participatory approach was used to involve district and hospital nutrition teams in all stages of the research. SETTING. Two rural Wrst-referral level hospitals (Mary Theresa and Sipetu) in Mount Frere District, Eastern Cape Province. MAIN MEASURES. A retrospective record review of all admissions for severe malnutrition to obtain patient characteristics and case fatality rates, a detailed review of randomly selected cases to illustrate general case management, structured observations in the paediatric wards to assess adequacy of resources for care of malnourished children, and in-depth interviews and focus group discussions with nursing and medical staff to identify barriers to improved quality of care. RESULTS. Before the study, case fatality rates were 50% and 28% in Mary Theresa and Sipetu hospitals, respectively. Information from case studies, observations, interviews, and focus group discussions revealed many inadequacies in knowledge, resources, and practices. The hospital nutrition team developed and implemented an action plan to improve the quality of care and developed tools for monitoring its implementation and evaluating its impact. In the 12-month period immediately after implementation, case fatality rates fell by ∼25% in both hospitals. CONCLUSION. Participatory research led to the formation of a hospital nutrition team, which identiWed shortcomings in the clinical management of severely malnourished children and took action to improve quality of care. These actions were associated with a reduction in case fatality rates. URI: http://hdl.handle.net/10566/294 Files in this item: 1
PuoaneHospitalManagement2004.pdf (2.647Mb)