Browsing by Author "Irlam, James"

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    Career plans of final-year medical students in South Africa
    (2010) de Vries, Elmien; Irlam, James
    There is strong international evidence that students of rural origin, and those who intend to practise rural medicine, are more likely to practise in rural settings after graduation.2 The purpose of this study was to survey final-year medical students about their career plans and the influences on those plans, to ascertain implications for the future training of doctors in South Africa.
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    Developing indicators for Monitoring and evaluation of the implementation of the Primary Health Care Approach in Health Sciences at the University of Cape Town using a DELPHI method
    (2021) Datay, Mohammed Ishaaq; Singh, Shajila; Irlam, James
    Background The University of Cape Town Faculty of Health Sciences (UCT FHS) adopted the Primary Health Care (PHC) approach as its lead theme for teaching, research, and clinical service in1994 Aim To develop indicators to monitor and evaluate the implementation of the PHC approach in Health Sciences Education . Method A Delphi study, conducted over two rounds, presented indicators of Social Accountability from the Training for Health Equity Network (THEnet), as well as indicators derived from the principles of the PHC approach in the UCT FHS, to a national multidisciplinary panel. An electronic questionnaire was used to score each indicator according to relevance, feasibility/measurability, and its application to undergraduate and postgraduate curricula. Qualitative feedback on the proposed indicators was also elicited. Results Round 1: Of the 59 Social Accountability indicators presented to the panel, the 20 highest ranked indicators were selected for Round 2. Qualitative feedback challenged the link between social accountability and PHC, resulting in an additional 19 PHC-specific indicators being presented in Round 2. Round 2: The indicators which scored >85% and made the final list were: PHC: Continuity of care (94%); Holistic understanding of health care (88%); Respecting human rights (88%); Providing accessible care to all (88%); and Promoting health through health education (88%). THEnet: Safety of learners (88%); Education reflects communities' needs (86%); Teaching embodies social accountability (86%); Teaching is appropriate to learners' needs (86%) Conclusion These PHC and THEnet indicators can be used to assess the implementation of PHC in Health Sciences Education. The specific indicators identified reflect priorities relevant to the local context. One limitation is that some key priority indicators did not make the final list.
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    Education for sustainable healthcare: opportunities and barriers in undergraduate health professions education in South Africa
    (2025) Irlam, James; Rother, Andrea; Reid Stephen, Bruno
    The escalating global crisis of climate change and environmental degradation is having severe public health impacts. One key response requires faculties of health sciences globally to review how they prepare their health professional graduates to address the changing needs of the communities they serve. Health professions education has generally not kept pace with changing societal needs, and current curricula are often too fragmented and static to prepare graduates as effective climate health leaders and agents of change. Education for sustainable healthcare (ESH) is a field in health professions education focused on the interdependence of human health and planetary ecosystems, and on making healthcare systems more environmentally sustainable. ESH incorporates the principles of planetary health, which recognises that informed stewardship of earth's natural systems is essential for human health and well-being. ESH also includes education about environmentally sustainable healthcare, which is high-quality healthcare that is less polluting and wasteful of natural resources than conventional healthcare. There is, however, little evidence about ESH from low- and middle-income countries, which are generally most impacted by climate and environmental breakdown. The aim of this thesis was to identify the opportunities and barriers to ESH in undergraduate health professions education in South Africa, illustrated by a case study at the University of Cape Town Faculty of Health Sciences (UCT FHS). A mixed methods study of three sequential phases addressed four objectives. Phase 1 was a national survey of key educators to assess the status of ESH-related teaching and learning activities in undergraduate health professions education in South Africa. Phase 2 recruited a national Delphi panel of educators for the second objective of appraising the ESH learning objectives, activities, and assessments proposed by the International Association for Health Professions Education (AMEE) Consensus in 2021. The Delphi panel also helped achieve the third objective, to assess perceptions of educators about the opportunities and barriers to ESH in South Africa. The third phase was a Planetary Health Report Card (PHRC) assessment of the UCT FHS, by interviewing key educators and completing standardised scorecards. This phase addressed the fourth objective, to assess perceptions of educators about the opportunities and barriers to ESH in the UCT FHS. The thesis is structured into seven chapters. Chapter 1 provides the rationale, aim, objectives, design, and structure of the thesis. Chapter 2 reviews the literature on the health impacts of climate change, and the contribution of ESH towards social and environmental accountability in health professions education. It presents the conceptual framework of the thesis for evaluating environmental accountability in health professions education institutions, derived from the Conceptualisation, Production, and Usability (CPU) model for socially accountable medical schools. Chapter 3 describes the national audit survey in Phase 1, which found that ESH curriculum development is emerging in South Africa and is enabled by strong institutional leadership and by staff and student involvement. Chapter 4 analyses the findings of the national Delphi panel in Phase 2. It reached consensus on a set of learning objectives, activities, and assessments for health professions education in South Africa and identified enablers of ESH curricular development, among them faculty leaders, capable educators, and multidisciplinary collaboration. Chapter 5 presents the baseline findings of the PHRC assessment of the curricula, research, community engagement, student leadership, and campus sustainability of the UCT FHS. The PHRC identified curriculum overload, “siloed” learning, limited educator capacity, and health system challenges as key barriers, and recommended longitudinal integration of ESH across all curricula. Chapter 6 presents the discussion of the overall findings of the study. It proposes a framework for guiding ESH curricular development, which integrates recommendations in six focus areas for faculty leaders and educators within three domains of the CPU model. The key barriers and enablers of ESH identified by this study, and examples of opportunities in the UCT FHS, are also discussed. Chapter 7 concludes with the contribution of the study to knowledge about ESH and the implications for future research. The thesis has helped to build the evidence about ESH from a LMIC perspective. It has identified barriers and opportunities within South African undergraduate health professions education, and has proposed learning objectives, activities, and assessments for the South African context. A PHRC assessed opportunities for ESH integration in the UCT FHS, a first in the global South. The thesis proposes an integrated ESH curricular development framework within a social accountability model for HPE institutions, with potential applicability to low- and middle-income countries.
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    The epidemiology and diagnosis of childhood tuberculosis at a district hospital in Kwazulu-Natal, South Africa : a retrospective audit of clinical practice
    (2007) Padayachee, Samantha; Irlam, James; Patrick, Mark
    TB was declared a priority disease in South Africa ten years ago. Despite efforts to manage this illness, South Africa ranks as one of 22 high burden countries globally. TB is an important cause of childhood morbidity and mortality, but much of the emphasis of the NTP is on smear positive (adult) TB, as this is perceived to be the greater public health problem. The presence of HIV infection exacerbates both the incidence of TB, and the progress of TB from infection to the development of disease in both children and adults. The diagnosis of childhood TB has proved to be difficult and continues to challenge clinicians, despite technological advances in various spheres of medicine. Several guidelines and recommendations are available for diagnosing TB in children, including combinations of clinical criteria, special investigations, laboratory methods and score systems, but no gold standard exists.It is not clear how well the SANTCP guidelines for diagnosis of childhood TB are being implemented at Emmaus Hospital, or whether these guidelines are still appropriate within the context of high HIV prevalence. Not enough is known about the epidemiology of childhood TB in the Okhahlamba local municipal area surrounding Emmaus hospital to guide optimal management of children. Given the likely magnitude of the problem of childhood TB in this rural area and the difficulties of diagnosis, research into the epidemiology and diagnosis of childhood TB in this context is necessary.
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    Health sciences undergraduate education at University of Cape Town: a story of transformation
    (Health & Medical Publishing Group, 2012) Hartman, Nadia; Kathard, Harsha; Perez, Gonda; Reid, Steve; Irlam, James; Gunston, Geney D; Janse van Rensburg, Vicki; Burch, Vanessa; Duncan, Madeleine; Hellenberg, Derek; Van Rooyen, Ian; Smouse, Mantoa; Sikakane, Cynthia N; Badenhorst, Elmi; Ige, B
    Undergraduate education and training in the Faculty of Health Sciences at the University of Cape Town has become socially responsive. A story of transformation that is consonant with wider societal developments since the 1994 democratic elections, outlining the changes in undergraduate curricula across the faculty, is presented.
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    A household survey of maternal and child health in the Mount Frere Health District, Eastern Cape
    (1998) Irlam, James; McCoy, David
    A cross-sectional household survey of maternal and child health was conducted in the Mount Frere health district of the Eastern Cape in August / September 1997. The aim was to describe key aspects of maternal and child health to inform the planning activities of the District Health Management Team (DHMT). A participatory process was followed, in order to develop research capacity within the district, and to facilitate interaction between health workers and the community. Methods: Structured questionnaires were used by local research trainees to gather data from each household on: • household demographics; • deaths in household since April 1994; • household access to water and sanitation; • children under five years; • children aged 5 to 15 years; • deliveries in the past 12 months; • knowledge of prevention and transmission of HIV/AIDS. Focus group discussions around the key findings were conducted with community members and clinic nurses to provide a qualitative component. Results: A high proportion of children under the age of 16, high household density, high unemployment, migrant labour, and absent mothers, are some of the defining demographic characteristics which affect the status of maternal and child health in the district. Access to health services is constrained by distance, lack of transport, and poor roads. Registration of births and deaths is poor, and the crude birth and death rates were found to be significantly higher than the " official" provincial rates. Tuberculosis, diarrhoea, trauma and homicide are notable features of the overall mortality profile, although the majority of deaths were classified "ill-defined / unknown". Diarrhoea and pneumonia accounted for half of all infant deaths. Eight out of ten deaths due to diarrhoea in under-fives occurred at home, but knowledge and use of oral rehydration solution is poor. Access to clean drinking water and sanitation is a major concern, with almost three quarters of homes using unprotected sources, a third more than 30 minutes' walk from the nearest source, and a half having no toilet. Areas of the district with particularly poor environmental health indicators were identified. Immunisation coverage among children 1-4 years is poor. Coverage for all vaccines except BCG falls well short of the national target of 90%, and fewer than 1 in 3 children was fully immunised with valid doses at the age of one year. Long intervals between doses and a high "dropout" rate between subsequent doses was observed. The road to health card (RTHC) could be produced for just over a half of under-five children. The proportion of home deliveries is high (45%), and traditional birth attendants (TBAs) therefore play an important role in this community. Nine out of ten mothers had attended antenatal clinic at least once, but almost half reported receiving no tetanus toxoid and no WR test for syphilis during their antenatal visits. More than a half of all mothers was using no family planning method at the time of the survey. Almost all 15-49 year-olds had heard about HIV/AIDS, but one in five did not know how HIV is transmitted, and a third did not know how it could be prevented. Recommendations: A detailed set of recommendations with action points for the DHMT was developed in a district workshop around the following key issues: 1. Improving access to health care, including road access, mobile clinic coverage, and waiting facilities for expectant mothers. 2. Promoting health in the community, by means of integration of health promotion into all health programmes, and more involvement of communities. 3. Improving the quality of care in the existing health facilities and services, including minimising missed opportunities for immunisation, and promoting home-made oral rehydration (sugar-salt) solution. 4. Improving the district health information system, especially the registration of vital events, and the provision of feedback to district health managers. 5. Identifying areas of further research, including the reasons for home deliveries, management of diarrhoea at home, and the use of traditional healers. Conclusion: The participatory research process that was used has helped to build research capacity in the district, to provide a deeper insight into community health problems, to highlight the value of health workers listening to the people they serve, to further collaboration between the disciplines, and to develop specific action plans. This is a process that should be followed in all research conducted in health districts.
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    Nutrition counseling in adults infected with the Human Immunodeficiency Virus : a systematic review of randomised controlled trials
    (2006) Koech, Joyce; Irlam, James
    [Background] HIV-infected individuals may be at nutritional risk at any point in the course of their illness. Nutrition counselling has been found to be an important intervention for maintaining and improving nutritional status in HIV infection. The evidence for the magnitude of benefit has not previously been systematically reviewed. [Objectives] To assess the effectiveness of nutritional counselling in improving dietary intake and nutritional status in HIV-infected adults. [Methods] Eligible studies were identified from comprehensive searches of electronic databases and conference proceedings for all randomised controlled trials (RCTs) of nutrition counselling compared with either no nutrition counselling, oral supplements, or with nutrition counselling plus oral supplements. Two reviewers independently assessed the eligibility of the studies and their methodological quality, and extracted data on participants, interventions and outcomes. A meta-analysis of data on nutritional status and dietary intake was performed. Results Three studies with a total of 238 participants were included in the review. All three studies compared nutrition counselling with nutrition counselling plus oral supplements. Data were available from all three studies for changes from baseline in weight, lean body mass and body fat. ln one study the changes in both groups were significant, but the differences between groups did not reach statistical significance. Energy intake data were available from 2 studies, and both showed a significant increase from baseline in both groups.
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    A review of University of the Witwatersrand medical students' community-based health promotion service learning projects in South Africa
    (2013) Mothoagae, Gaolatlhe; Irlam, James; Prozesky, Detlef; Hlungwani, Tintswalo
    The purpose of this study was to review past SL projects that have been implemented by GEMP 1 and 2 students, in order to inform the future planning and conduct of the SL programme in the faculty. A document review of all available Power Point presentations for projects implemented from 2006 - 2011 was undertaken employing content analysis. Of approximately 286 projects completed, 183 documents were available for review.
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    A systematic review of existing national priorities for child health research in sub-Saharan Africa
    (BioMed Central Ltd, 2005) Swingler, George; Irlam, James; Macharia, William; Tietche, Felix; Meremikwu, Martin
    BACKGROUND:We systematically reviewed existing national child health research priorities in Sub-Saharan Africa, and the processes used to determine them. METHODS: Collaborators from a purposive sample of 20 WHO-AFRO Region countries, assisted by key informants from a range of governmental, non-governmental, research and funding organisations and universities, identified and located potentially eligible prioritisation documents. Included documents were those published between 1990 and 2002 from national or nationally accredited institutions describing national health research priorities for child health, alone or as part of a broader report in which children were a clearly identifiable group. Laboratory, clinical, public health and policy research were included. Two reviewers independently assessed eligibility for inclusion and extracted data. RESULTS: Eight of 33 potentially eligible reports were included. Five reports focused on limited areas of child health. The remaining three included child-specific categories in reports of general research priorities, with two such child-specific categories limited to reproductive health. In a secondary analysis of Essential National Health Research reports that included children, though not necessarily as an identifiable group, the reporting of priorities varied markedly in format and numbers of priorities listed, despite a standard recommended approach. Comparison and synthesis of reported priorities was not possible. CONCLUSION: Few systematically developed national research priorities for child health exist in sub-Saharan Africa. Children's interests may be distorted in prioritisation processes that combine all age groups. Future development of priorities requires a common reporting framework and specific consideration of childhood priorities.