Browsing by Author "Coetzee, N"

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    From people to places: Focusing AIDS prevention efforts where it matters most
    (2003) Weir, S; Pailman, C; Mahlalela, X; Coetzee, N; Meidany, F; Boerma, J T
    Objectives: To develop and implement a method to identify and characterize places where people meet new sexual partners and to assess HIV prevention program coverage in those places. Methods: In three townships (populations 60 000-100 000 each) and one business district (population < 20 000) in South Africa, interviewers asked over 250 informants per area to identify public sites where people meet new sexual partners. All reported sites were visited and mapped. A knowledgeable person onsite was interviewed about the site and its patrons. Individuals socializing at sites were interviewed about their sexual behavior. Results: More than 200 sites in each township and 64 sites in the central business district were identified and visited. The male to female ratio among site patrons was approximately 2:1. In each area, men and women socializing at sites reported high rates of new sexual partner acquisition and low condom use. Almost half of the 3085 men and 1564 women interviewed while socializing reported having a new sexual partner in the last 4 weeks. A third reported meeting a new partner at the site of the interview. Commercial sex was rare in the townships but available at 31% of central business district sites. Fewer than 15% of township and only 20% of business district sites had condoms. Conclusion: The PLACE method successfully identified sites where people with high rates of new sexual partnerships can be reached for prevention programs. Sexual networks in these areas are extensive, diffuse, and characterized by high rates of new partnership formation and concurrency with little acknowledged commercial sex.
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    Quality assessment of malaria case management in public primary health care clinics in Namibia : development of an instrument to be used by the district primary health care supervisors in clinics
    (2003) Haidula, Leena; Coetzee, N
    Malaria is a major public health problem in Namibia and this problem warrants special attention in terms of monitoring the trends and formulating controls and prevention strategies at all levels of the health care system and the community. Malaria accounts for more than 40 % of the diagnosed outpatients cases in the health facilities. Malaria is the leading cause of ill health and deaths among both children and adults, particularly in the northern regions of Namibia where about 60% of the population lives. This disease is seasonal with the potential for epidemic proportions, which are related to exceptionally heavy rainfall. There is increasing evidence that malaria cases are poorly managed and the staffs is poorly supervised, especially at clinic levels where all malaria cases are clinically diagnosed A number of health workers have been trained in various aspects of malaria control including case management; there is a need to evaluate their performance in order to sustain high quality care. Their performance must be evaluated regularly and feedback given so that practices could be adjusted and improved. What is required is a validated, acceptable, applicable and useful instrument that can be used routinely for assessment clinic based quality care performance. The Ministry of Health and Social Services developed a national guideline for malaria case management used at different facilities and levels in the country. There is no affordable and applicable continuous assessment instrument of the quality of health care that can be used by primary health care supervisors to assess the quality of malaria case management at health care clinics. The aim of this study is to develop and pilot a performance based quality assessment instrument for routine quality assessment of malaria case management to be used by district supervisors in public health care clinics in Namibia. The instrument developed was found to be useful by the district supervisors and the clinic staff interviewed during the assessment period. Poor referral systems, lack of training on malaria case management and poor supervision were the major problems identified in this pilot study. These problems have been discussed with the clinic staffs and the district supervisors concerned for appropriate action. The developed instrument has enabled me to obtain a rapid and general overview of the clinic performances related to quality services provided to malaria patients. The information obtained evidenced the usefulness of this instrument. This pilot study has established the baseline information for quality assessment of malaria case management for the primary health care clinics assessed. However, it has been noted that continuous assessment of health services performances is very important if the quality of malaria case management is to be achieved.
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    The outpatient situation in the Cape Peninsula
    (1995) Taylor, Stephen Paul; Klopper, J M L; Coetzee, N
    This dissertation is based on a study commissioned by the Cape Provincial Administration's hospital department into ambulatory care in the Cape Peninsula. The aim of the study was to investigate the whole picture of the provision of outpatient services by that hospital department in the Cape Peninsula. The investigation was to specifically isolate and assign problem areas and propose realistic solutions in order to overcome the "implementation gap" between research and policy implementation. The focus of the investigation was to be the Day Hospital Organisation and Paediatric Care. This very broad aim was to be met by five specific objectives which were (i) to determine the demographic characteristics of the population of the Cape Peninsula, (ii) to determine utilisation of ambulatory services; (iii) to quantitate problems, determine resources used, and (iv) determine attitudes to the service as perceived by medical staff. The study consisted of over 20 individual epidemiological investigations. These investigations varied in methods from cross-sectional analyses to simple descriptive epidemiology. Two substantial descriptive studies were performed. The· first was a crosssectional study of doctors' attitudes and practices in all hospital / day hospital ambulatory settings in the Cape Peninsula. The second was a descriptive study of all patients who attended the Day Hospital Organisation in 1987. An overall picture was obtained as to utilisation rates, demography, resources deployed and attitudes of staff. A comprehensive literature review revealed a relative dearth of information concerning the subject in South Africa. Where information was available, it was piecemeal and often operationally directed. A review of organisational and other factors impacting on ambulatory services revealed that although past commissions and National Plans have had noble objectives, those objectives were never attained. Major findings of the study were that although overall attendances to the service had increased by 10 % between 1980 and 1987, the attendance number by whites had decreased by 16 % while that of blacks had increased by 62 %. The Day Hospital Organisation had had a static workload which had only increased with the addition of new clinics in the latter years. The rapid rate of increased attendances placed a burden on many hospitals. Four organisations were rated to have a crisis which in order of severity were: Red Cross Hospital, Conradie Hospital, Day Hospital and Groote Schuur Hospital.