OpenUCT :: Browsing by Author "Jacobs, Marian"

Browsing by Author "Jacobs, Marian"

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Open Access
Childhood sexual abuse : the Red Cross War Memorial Children's Hospital experience, 1986-1988
(1990) McKerrow, Neil Hugh; Lachman, Peter Irwin; Jacobs, Marian
This retrospective descriptive study reviews sexually abused children who presented to the Child Abuse Team at the Red Cross War Memorial Children's Hospital (RCWMCH) between 1 January 1986 and 31 June 1988. During this period 365 children were referred to the Child Abuse Team, of whom 357 were entered into this study. 297 of these were cases of confirmed sexual abuse. There were 48 male children and 123 children under 6 years of age. Most children were victims of a single episode of sexual abuse with only 13, 7% presenting following repeated abuse. More serious forms of sexual abuse, rape or sodomy, were common, accounting for 60% of the cases. Over 70% of the children had physical signs to substantiate their claims of having been sexually abused. Sexually transmitted disease was a common finding, being present in 15,6 % at presentation. All children were accompanied to hospital by an adult, usually a parent. 60% of the children presented directly to RCWMCH. A delay between abuse and presentation was common, only 42% of the children presenting within 48 hours of having been abused. Physical problems frequently required management. Very few children received more than crisis intervention for their emotional state and only 20% needed any form of intervention to ensure their safety. Only 1% of cases involved a female abuser. In general, the age of the abuser was older than previously reported with 18, 6% being under 20 years of age. The relationship between abused and abuser was similar to that described in the literature, as was the reaction of the family against the abuser. 27,4% were prosecuted and of those that appeared in court 7 4, 5% were convicted. Further comparison of the following sub-groups of abused children are presented: male and female, young and old, intrafamilial and extrafamilial abuse, a single episode of abuse and repeated abuse.
Open Access
Healing Inequality: targeting health care for children
(Children's Institute, 2005-12) Shung King, Maylene; McIntyre, Di; Jacobs, Marian
Open Access
Health and health care of the preschool child in Hout Bay
(1987) Delport, S V; Jacobs, Marian
At present not enough is known about the health of preschool children in the poorer communities of Cape Town. This study, was undertaken to assess the health and health care of preschool children in one such community: that of the Hout Bay harbour township. A clinic and community-based surveillance programme was devised to make this assessment. Data were obtained by monitoring the records at the Community Health Centre in the township. A study sample of 214 children from the community was also selected by random stratified cluster sampling. This sample was assessed by means of a questionnaire and a full physical examination. Analysis of data was performed on the IBM main-frame computer. A large number of medical problems were identified on screening the community sample. Most of these problems were minor ones and could be managed appropriately at the Health Centre. On the basis of the referral patterns and the small number of newly diagnosed functionally important health problems, the provision of health care in-the area was considered to be adequate. The high immunisation rate in the preschool children and the excellent attendance figures at the child health clinics indicates that the services provided are well utilised by the population. Dental caries was found to be a major health problem in the area. A strong case for the introduction of a dental health educational programme and for the fluoridisation of drinking water can made on the basis of these findings. An ongoing health screening programme would be beneficial. It could be accomplished by utilising appropriately trained nursing personnel.
Open Access
Health of street children in Cape Town, May-November 1989
(1990) Gebers, Paul Eric; Jacobs, Marian
This cross-sectional study looks at the health profiles of street children both in institutions and on the street between May and November 1989. The former group had a clinical examination, with blood and urine investigations done where possible; the latter group were only interviewed. 159 street children were interviewed of whom 47 were interviewed on the street. 73 children had clinical examinations; 64 of these had blood and urine investigations. The age range was 8 years to 19.8 years. 18.2% were females and 28.3% were black. 59,6% of those interviewed on the street had not been in an institution or shelter for street children. 27, 2% of the total group had been on the street for more 3 years. 3 7, 1 % perceived colds and chest complaints as their main physical health problem. This was confirmed by the fact that 69,2% had a history of respiratory problems. 44,7% said that they would go to a hospital if they injured themselves or were ill; however, 36,5% said they would not use or get any medication for problems such as a headache or a bad cold. 37·, 7% of children used a hospital while they were on street but 59, 7% had not used any facility while on the street. Most street children (72,8%) washed themselves at least occasionally and 61% washed their clothes. 47,2% had suffered trauma significant enough to seek hospital attention. 56% had skin problems (including lice and scabies) while on the street. 15,7% complained of visual problems and 10,7% complained of reduced hearing. Dental problems appeared to be of major concern with 37,7% complaining of either toothache or dental caries (23,3% had obvious caries on examination). 73,4% admitted to solvent abuse, 49,9% had never taken alcohol and 12,7% had never smoked. 43% had tried dagga, 10,8% white pipe (mixture of dagga and "Mandrax" which is smoked) and only 7,6% "Mandrax" alone. 10, 9% of boys and 10, 0% of girls indicated that they had been sexually exploited. Of the 67 examined 32,8% were below 90% of expected height for age, 44,8% were below 80% of expected weight for age and 8,6% had a circumference of head below 95% of standard. There is a 9,4% Hepatitis Bs ag carrier rate. No HIV (human immunodeficiency virus) antibodies were detected in 64 sera tested. On the basis of these results, the following are recommended: 1) Improving accessibility of health care resources. 2) Improving the availability of health care resources. 3)· Initiating contacts with street children by employing field health workers. 4) Drawing up a health care policy for street children institutions and field care workers. 5) Limit venereal disease management to single dose treatment where possible. 6) Further studies need to be undertaken in the following areas: - solvent abuse - utilisation of health care resources utilisation institutions of street children shelters and Further breakdown of habits, physical problems and results of examinations are presented.
Open Access
An investigation of antenatal screening and management of syphilis in two districts in the North West Province
(2005) Chueu, Mmaphoko Patricia; Jacobs, Marian
Syphilis is a common sexually transmitted disease in South Africa and infection acquired during pregnancy is associated with an increased rate of miscarriage, stillbirth, preterm labour, intra uterine growth restriction (IUGR), neonatal death and congenital syphilis in the newborn. This study was undertaken in the Potchefstroom and Wolmaranstad Districts of the North West Province and was aimed at contributing to reducing perinatal mortality and morbidity within these districts. The objectives of this study were: + To determine the prevalence of syphilis amongst women attending antenatal and/or delivery care in the two selected districts. + To evaluate the effectiveness of antenatal screening and management of syphilis + To determine the perception of consumers (antenatal attendees) concerning screening for syphilis at antenatal clinics. + To determine the perception and understanding of health workers concerning the provision of antenatal syphilis screening and treatment. + To analyse any inadequacies revealed in the antenatal screening and management of syphilis in the two districts + To make recommendations for guidelines arising from the results of the research in order to improve syphilis screening in service delivery.
Open Access
Referral patterns to the Red Cross War Memorial Children's Hospital
(1989) Lachman, Peter Irwin; Jacobs, Marian
This prospective descriptive study describes the referral patterns to the Red Cross War Memorial Children's Hospital. The study was conducted from 1st July to 31st December 1987 and entailed the collection of all referral letters presented (9288) to the hospital and the analysis of a sample of these letters (4702). The results indicated: * The patients are similar in terms of age and sex to those attending the Outpatients Department except that relatively fewer referred patients are Black. * The private sector, i.e. general practitioners, is the largest referral agency followed by Day Hospitals. * Most patients were ref erred to the Outpatients Department without an appointment. * Of the specialist clinics, the surgical clinics, i.e. Ophthalmology and Ear, Nose and Throat Clinics, were utilised the most. * The majority of patients (84,90%) were not admitted. * The contact made by the hospital with referral agents was poor (only in 30,30%). * The quality of information in referral letters was generally poor and did not contribute to patient care. Recommendations are made to the hospital and relevant health authorities.
Open Access
A study of the knowledge and problem solving ability of the family planning nurse in Mdantsane
(1998) Mathai, Mary; Jewkes, Rachel; Jacobs, Marian
Women's control over their fertility is vital for both their health and that of their children. Although family planning methods are available at most health facilities in the country, the service does not enable many Black South African women to control their fertility successfully. This inadequacy of the present service is demonstrated, by a high rate of teenage pregnancy and abortion. Based on anecdotal reports, one of the barriers to effective use of contraceptive methods seemed to be the competence and abilities of the providers. This qualitative study was done in clinics in a peri-urban township to explore the knowledge and problem-solving abilities of the nurses providing family planning services. The aim was to use the information so gained to improve family planning services in the area by preparing a set of guidelines for the management of specific clinical problems and making recommendations to service organisers. The study tape-recorded 18 actual nurse-patient interactions to get an idea of the clinical problems faced by the nurses. A consensus panel was used to derive a set of "ideal" answers to the clinical scenarios the nurses faced in the consultations and the nurses' and panels' responses were compared. A focus group discussion with the nurses was then conducted and their opinions and reasons for the differences explored. The results revealed a general malaise affecting the services in this area. There were significant differences in the nurses and panels' handling of the problems especially in the areas of counselling and advice. In addition, the nurses were found to be inappropriate providers of family planning as their scope of practice prevented them from examining patients. They were also unable to rule out pregnancy because there were no pregnancy test kits available in the clinics. The focus group discussions indicated that many of the nurses knew how to handle the problems and what advice to give. They claimed that work and time pressures prevented them from doing this. They also alleged that patients were the problem and never told the truth. Poor communication skills and attitudes towards patients were other barriers identified. Nurses spoke to their patients like children and were often rude. In addition, nurses counselled patients infrequently on the use of methods and the side effects to be expected. Patients were offered a choice of method rarely and health education when given, focused on morality and did not mention issues like safe sex and HIV/ AIDS. The manual of guidelines will only address the problem solving of the nurses. The study therefore concludes by making recommendations to the Directorate of Maternal, Child and Women' s Health to carefully evaluate the use of enrolled nurses as providers with full consideration given to the quality of care that can be provided by them. The resources available and the practices related to supervision and in-service training also need to be reviewed and prioritised. A recommendation is also made to the Provincial Human Resources Directorate to develop policies for improving staff attitudes towards service users and disciplinary procedures for staff who are rude to service users. Recommendations are also made to supervisors to review the present training course and introduce the problem-solving approach and respect for patient autonomy into it. The supervision is also recommended to be facilitative and on-site and the providers must be involved in the solving of problems. The emphasis of the service must change from patient turnover to effective contraceptive use to enable women in this area to have any meaningful control over their fertility.
Open Access
Submission on the Committee of Inquiry's Report: Comprehensive Social Security for Children
(Children's Institute, 2002-06) Guthrie, Teresa; Jacobs, Marian; Shung King, Maylene; Giese, Sonja; Proudlock, Paual; Berry, Lizette
Comment made to the Department of Social Development on the Report of the Committee of Inquiry into a Comprehensive Social Security System for South Africa, June 2002.
Open Access
Survey of medical, dental and nursing services in centres for intellectually and physically disabled children in Cape Town and its environs
(1992) Westwood, Anthony Thomas Read; Jacobs, Marian
This study describes the present medical, dental and nursing services in and used by centres for intellectually and physically impaired children in Cape Town and its environs. The information was gained by means of a structured questionnaire. Thirty three of the 34 centres with a total of 3480 children are included. Twelve are Special Care Centres, 15 Training Centres and 6 are Special Schools. The number of children enrolled ranges from 9 to 400. At the time of the study 9 of the centres were for white children, 17 for coloured children, 5 for black children and 2 were multiracial. Nine of the 11 Special Care Centres were not government supported while only 6 of the other centres were mainly funded from non-government sources. Nurses employed at the centres had worked an average of 8 years at their centres, 23,5% of them having worked with disabled children prior to taking up their present posts. Of the Special Care Centres, only the two residential ones had a nurse on the staff. All the Special Schools had at least one nurse. 57,5% of the centres have a doctor or doctors visiting the centre. Two of the others have regular medical care for the children arranged with local health centres. All the Special Schools are visited while 25% of the Special Care Centres and 33% of the Training Centres receive medical visits. The number of doctors visiting a centre varies from 1 to 7. The doctors come from a variety of services both private and public. Most of the doctors do not receive remuneration for their services. Of the 1 7 centres who have no doctors visiting, the majority depend on parents to take their children to a medical facility if there are problems related to the child's disability. For 7 of them, there is no other option. A similar pattern exists for medical problems unrelated to the child's disability. Six centres make use of medical facilities as a first option in these circumstances. For emergencies only 1 centre can count on a doctor to come to the centre. Ten centres may be able to get a doctor to come. The General Hospitals are the most common facility used in an emergency. Dentists visit 4 of the centres. Twelve of the remaining 29 centres arrange regular dental visits for the children. Eleven of the 13 Special Care Centres do not have regular visits to a dentist arranged. Fifteen centres receive visits from Community Nurses and these are local authority nurses in the main. Their functions are limited in all but one case to contraception, immunisation, Heaf testing or genetic services. There are 10 centres which receive visits from neither doctor, dentist nor nurse (7 Special Care Centres, 3 Training Centres). 32% of the interviewees were satisfied with the services received. The most common improvement sought was to have a doctor visit the centre. Of those with a doctor visiting, 28% wanted the doctors to deal with intercurrent problems as well as the child's disability. The need for paramedical services was also expressed. Further detail is presented and the implications of the findings discussed.

Browsing by Author "Jacobs, Marian"

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