Browsing by Author "Henley, Lesley"

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    Changes to the law on consent in South Africa: implications for school-based adolescent sexual and reproductive health research
    (BioMed Central Ltd, 2012) Zuch, Melanie; Mason-Jones, Amanda; Mathews, Catherine; Henley, Lesley
    BACKGROUND:The National Health Act, No 61, 2003 in South Africa is the first effort made by the government to protect health-related research participants under law. Implemented on March 1, 2012, the law mandates active consent from a parent or legal guardian for all research conducted with research participants under the age of 18 years. This paper focuses on the Act's implications for school-based adolescent sexual and reproductive health research.DISCUSSION:Although well intentioned, the added legal protections in the National Health Act may have the unintended consequence of reducing participation rates in school-based adolescent sexual and reproductive health research, thereby excluding the most at-risk students. The Act may also compromise adolescents' right to dignity and privacy, especially considering the personal nature of research on sex and sexuality. Devolved, discretionary decision-making, which empowers local human research ethics committees to permit a wider range of protective measures, including passive consent, independent adolescent consent or community consultation ought to be considered. The continued and direct involvement of young people in their sexual and reproductive health and well-being is an important principle to uphold.SUMMARY:This paper calls for a re-examination of section 71's ethical guidelines relating to informed consent in the National Health Act, No 61, 2003 in South Africa in order to better serve the interests of South African adolescents in sexual and reproductive health research.
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    A descriptive study of the attitudes of doctors, working at clinics and day hospitals in the Cape Metropole to patients with HIV/AIDS
    (1998) Fransman, Desireé Christine; Hussey, Gregory D; Henley, Lesley
    HIV/AIDS is a fairly new condition. Despite a large amount of published literature regarding its clinical aspects, there is a paucity of South African research and information relating to the attitudes and feelings of the physicians who diagnose, care for and make decisions with regard to these patients, especially children. Several studies suggest that health care workers who provide clinical care for Persons with HIV/AIDS (PWA's) may have an intolerant attitude towards them. As the number of children with HIV/AIDS increases, the burden of care will shift to health care workers at primary level care. It was therefore decided to assess the attitudes of doctors at primary level care facilities in Cape Town, towards paediatric patients with HIV/AIDS. The results of this study are crucial given the increasing exposure of doctors at this level to HIV/AIDS patients and understanding their response to its management. The objectives of the study were to: assess whether doctors' knowledge of the patient's HIV positive status affects their attitudes and management of the patient; assess doctors' perceived competency with regard to the management of paediatric AIDS; determine doctors' opinions with regard to HIV testing, the utilisation of diagnostic investigations and treatment; determine doctors' main concerns with regard to the management of paediatric patients with HIV/AIDS. A descriptive, cross-sectional survey was conducted amongst all doctors working at the clinics and day hospitals in Cape Town during the period February to April 1997. Seventy-eight doctors (51 % response rate) working in the clinics and day hospitals in Cape Town each completed an anonymous self-administered questionnaire. Doctors in this survey generally displayed a positive, humanistic attitude towards children with HIV/AIDS. In the majority of cases the knowledge of the child 's HIV positive status did not impact negatively on their management of the child. Interestingly, 86% of respondents felt that they would always/mostly take extra care in applying universal precautions when they know that the child is HIV positive. There is a lack of confidence in their counselling and clinical competency in the management of children with HIV/AIDS. The main source of information with regard to paediatric HIV/AIDS is journals (69%), followed by in-service training (53%) and colleagues (49%). In contrast, the preferred sources of information were in-service training (68%) and organised discussion groups/workshops (65%). Most were in favour of routine HIV testing of pregnant women and informed consent for HIV testing. However, not everyone agreed that pre-HIV test counselling was necessary in the case of children. Confidentiality of positive test results was not favoured in the majority of cases (65%) and disclosure even without the consent of the patient/carer was supported. Priority concerns relating to the management of paediatric HIV/AIDS, were lack of support in the community for parents and children, lack of policy and management guidelines and the lack of resources in the health services to cope with the burden of care. This study identifies the need for specific training in HIV/AIDS for medical doctors at primary level care facilities. The foundation of this training must begin with medical students during their clinical years but training and support should continue through in-service training. Training strategies, which address the clinical and psychological challenges presented by this disease, should be employed. In addition, clinical guidelines, which are relevant to South Africa and evidence-based, should be adopted nationally. Resources should be available to support these guidelines. It is further recommended that policies be underpinned by appropriate legislation which protects the rights of patients and health care workers in order to minimise the effects of individual attitudes and biases with regard to the treatment of PWAs.
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    An evaluation of parental knowledge of childhood asthma in a Family Practice setting
    (1995) Moosa, Sulaiman Essa Ismail; Henley, Lesley
    The purpose of this study was to measure and evaluate parental knowledge and misconceptions with regard to asthma and its treatment, to identify parental concerns with regard to the disease and its effects on their children, and to identify selected socio-demographic and medical correlates of the above. A cross-sectional survey was conducted among 54 families with a child with asthma. The sample comprised all the parents of a consecutive series of asthmatic patients between the ages of two to eighteen years attending a family practice in Mandalay on the Cape Flats. Data were collected by means of a structured questionnaire administered to 52 mothers and 48 fathers, reflecting a 95.2 per cent response rate. Respondents completed the questionnaire in their homes. A 55 item Asthma Knowledge Test was developed and validated to assess medical knowledge. Parents obtained an average score of 72%. Scores of over 70% were obtained in the sub-sections of aetiology, symptomatology, pathophysiology, precipitants and environmental control. Parents were less informed in the sub-sections of asthma prognosis, general medical knowledge and asthma therapy. Misconceptions and deficiencies in asthma knowledge which could lead to inadvertent non-compliance were identified. The following misconceptions were shared by a significant number of parents: inhaler therapy weakens the heart, regular administration of medication leads to addiction and medicines becoming ineffective, and folk remedies are effective in asthma therapy. Parental educational status was the only significant correlate with performance on the Asthma Knowledge Test. There was no significant difference in the performances of mothers and fathers. 47% of parents smoked but there was no significant difference in the scores of smokers and non-smokers. Parental concerns centred predominantly on their lack of confidence to manage acute asthma attacks, followed by concern as to whether their children will outgrow asthma. Dependence on asthma medication and its perceived harmful effect on the heart and lungs were other concerns. The findings suggest the need for systematic asthma education especially with regard to acute attack management and preventive medications. The aims of such education should be to increase asthma knowledge, develop skills, improve attitudes, and develop positive expectations toward the outcome and effectiveness of treatment. An effort should be undertaken to discourage parental smoking in asthmatic families. Attention should be given to dispel misconceptions during educational programmes. The increased information needs of parents with a lower education should be addressed by health professionals. Parents should receive adequate information during the early stages of the disease to minimise their insecurity in coping with the illness and prevent the development of misconceptions that undermine their confidence in medications and care givers.
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    Reporting of ethical requirements in published physiotherapy research
    (2004) Frank, Denise M; Henley, Lesley