Browsing by Author "Michaels, Desireé"

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    An exploratory study of the key determinants of self-referral by women in labour to Chris Hani Baragwanath Hospital in the Johannesburg Metro District, South Africa
    (2017) Kula, Nonkqubela Carvie; Shea, Jawaya; Michaels, Desireé; Buchmann, Eckhart
    Introduction: At Chris Hani Baragwanath Hospital (CHBH) in Johannesburg overcrowding remains a concern as women who have low-risk pregnancies continue to bypass community-based obstetric facilities to deliver at the tertiary hospital. A significant number of self-referred pregnant women had no obstetric risk factors qualifying them for delivery at CHBH Maternity Unit. The primary concern at CHBH was that the management of low-risk maternity patients in high-risk a setting interfered with the care of patients requiring specialist care. Study Objectives: To determine the socio-demographic characteristics of the women who selfrefer to CHBH; to explore the reasons why low-risk patients present at CHB Maternity Hospital in labour, and to determine obstetric risk factors amongst self- referred pregnant women. Methods: A descriptive, cross-sectional study was conducted focusing on self-referred pregnant women who delivered at CHBH and were in the post-natal ward during the study period (26 October 2013 to 03 November 2013). A structured questionnaire was administered by the researcher to each study participant to establish variables of the key determinants of self-referral. The data were analyzed using SPSS version 18 and all tests for statistical significance between appropriate and inappropriate self-referral were carried out at a p=0.05 level of significance with a 95% confidence interval. Results: The total number of deliveries for the study period 26 October 2013 to 3 November 2013 was 514 of which 112 were self-referrals. Only 108 women consented to participate in the study and were subsequently interviewed. The results indicated that of the pregnant women who self-referred to CHBH for delivery (N=108), 58.33% travelled more than 5km, 14,81% were teenagers, 81.48% were single, only 1.85% had no formal education, while 72.22% were unemployed. The results further showed that 47.22% of the women had a history of obstetric risk factors and were appropriate for delivery at CHBH, while the majority (52.78%) were low-risk pregnancies and should have delivered at local MOUs. Analysis of the results showed that age (p=0.042), transport mode (p=0.030), transport cost (p=0.001), transport ownership (p=0.041), distance (p=0.032) and waiting times (p=0.025) had statistically significant influence on self-referral. 22.22% were of the high-risk age-groups (<20 years and >35 years), 2,78% had previous surgery, and 12.04% had medical conditions for which they were on treatment. Conclusion: This study showed that the referral system for maternity care within the Johannesburg Metro Health District is not fully functional. Most of selfreferrals were inappropriate for CHBH. The age of the pregnant woman, transport, distance and waiting times at the service point are key determinants of self-referral.
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    Open Access
    Paediatric antiretroviral HIV treatment : measurement and correlates of adherence in a resource-poor setting
    (2008) Michaels, Desireé; London, Leslie; Eley, Brian
    [Objectives] There is a paucity of data regarding paediatric adherence in resource-limited settings (RLS) especially among the very young age groups (<7yrs). The study investigated the rates of adherence, the identification of the adherence measurement, amongst four, which best correlates with viral load suppression; as well as correlates of adherence amongst a cohort of children younger than 7 years on antiretroviral HIV treatment. Design: A Prospective cohort study with 6 months follow-up [ Methods ] Measures of adherence used: caregiver self-report (CSR), medicine measure/pill count, pharmacy refill and clinic attendance. Child, caregiver, socio-economic and health service characteristics were assessed for impact on adherence. Bivariate and multivariate analyses were used to determine agreement between measures and viral load outcome and to determine correlates of adherence. [ Results ] Mean age of children enrolled into the study was 27.08 months with a cohort mean adherence rate of 85% and mean viral load suppression of 74% at 6 months. Biological mothers were the majority primary caregivers (85%) and the majority (76%) of caregivers were unemployed with 60% receiving some form of social welfare grant. Results showed that caregiver selfreported adherence (CSR) was significantly correlated with viral load at 6 months (p=0.004). Correlations were found between clinic visits and pharmacy refill (highest values 0.35; p=0.000) and between medicine measure and clinic visits (highest value -0.21; p=0.04) but none of these measures were significantly correlated with viral load. Sensitivity and specificity analysis for CGSR showed that >95% adherence ensured a good viral load outcome. Four factors were significantly associated with adherence in bivariate analyses. These were: access to social welfare grants (OR=2.7; p=0.05); being counselled for initiation of ARV treatment by a counsellor vs. a doctor or nurse (OR 3.2, p=0.03); having another person in the household other than the index child infected with HIV (OR = 0.34, p=0.05) and caregiver depression (OR=0.07, p=0.01). However, in multivariate analyses certain other child, caregiver, socio-economic and health system characteristics as well as the abovementioned variables emerged as significant. [ Conclusion ] Key findings indicate that adherence rates are relatively high in this cohort and CGSR is valid in a resource-poor setting but medicine measure was problematic as a paediatric HAART adherence measure. Certain child, caregiver, socio-economic and health system characteristics have a significant impact on adherence.