OpenUCT :: Browsing by Author "Ras, Tasleem"

Browsing by Author "Ras, Tasleem"

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Open Access
A clinical audit on the quality of care and the outcome of patients with pregnancy induced hypertension within a primary-secondary care pathway: the Wesfleur-New Somerset Hospital Axis, Cape Town, South Africa.
(2020) Sobamowo, Theophilus Oluwadayo; Ras, Tasleem; Ugoagwu Abiola Abimbola
Background: Pregnancy Induced Hypertension (PIH) and its complications contribute to a significant burden of disease both in developed and developing countries of the world. Unfortunately, PIH has no cure, the delivery of the baby and the placenta is required. Early detection of pregnancy induced hypertension and close monitoring remains the key to achieving a favourable outcome. This study aimed to determine the quality of care given to women diagnosed with Pregnancy Induced Hypertension (PIH) within a care pathway spanning peri-urban primary and urban secondary level facilities. Methods: This was a retrospective clinical audit of medical records of patients diagnosed with PIH. It was conducted in the Wesfleur -New Somerset Hospital drainage area, using a locally validated data extraction tool, based on the South African Maternal Care Guidelines. The data were analyzed using descriptive methods to report on the frequencies and proportions of the variables, and analyzed to report on statistical significance of correlations. Results: The prevalence rate of pregnancy induced hypertension in this study was 12%. The overall pregnancy induced hypertension complication prevalence in the study for mothers was 7.7%, and that of babies was 30.7%. Facilities generally performed well according to the audit indicators detailing structures and processes that should be followed, as outlined by the standard guidelines used. Two process indicators were correlated with adverse outcomes: 66.1% of patients were appropriately referred, resulting in statistically better foetal outcomes (p = 0.059); and those who booked early in the pregnancy had less PIH-induced complications than those who booked late (p = 0.012) Conclusion: This study followed a standardized audit methodology and found that the quality of care in this peri-urban area is of a good standard and identified areas for quality improvement and further enquiry to ensure continual improvement in maternal and fetal outcomes.
Open Access
A descriptive study of suspected perinatal asphyxia at Mitchells Plain District Hospital. A case series
(2021) Stofberg, Johannes Petrus Jordaan; Spittal, Graeme W; Hinkel, T; Ras, Tasleem
Background: South Africa aims to end all preventable deaths of children under the age of five as part of their commitment to the Sustainable Development Goals. More than half of these mortalities occur in the neonatal period with perinatal asphyxia as one of the leading causes. This study investigated and identified the characteristics of perinatal asphyxia and its contributing factors at a district hospital in Cape Town. Methods: A retrospective descriptive case series was performed and included all suspected cases of perinatal asphyxia referred from Mitchells Plain District Hospital (MPH)) to a specialised centre in the years 2016-2018. A data collection tool was used to extract information. Data was processed with SPSS to produce descriptive statistics and to investigate associations between variables using the Chi-square tests. Results: The study included 29 cases of suspected perinatal asphyxia. Ten (34.5%) had abnormal amplitude Electroencephalograms (aEEG's) indicative of Hypoxic Ischaemic Encephalopathy (HIE) and four (13.8%) demised before day seven of life. Non-operative deliveries (p=0.005), lack of a doctor at the time of delivery (p=0.004) and neonatal chest compressions (p=0.044) were associated with abnormal aEEG's. Babies with Thompson score of equal to or more than 12 (p=0.006), neonatal seizures (p=0.036) and delayed arrival at referral hospital (p=0.005) were associated with abnormal aEEG findings. Mortality was associated with Thompson score ≥12 (p=0.007) and the need for neonatal intubation at delivery (p=0.016). Conclusions: Significant reversable factors were identified in the peri-and postpartum periods. More capacitated staff would have the greatest impact on outcomes. The profile of HIE is exceedingly complex and challenges the resources and services of district level of care. Therefore, these factors should be targeted for future development and investment to improve outcomes from district hospitals.
Open Access
Analysing the technique of blood pressure measurement in primary care: a single pilot study
(2023) Etonu, Joseph Benedict; Ras, Tasleem
Background: Accurate blood pressure (BP) measurement is essential for the diagnosis and management of hypertension. However, BP measurement technique is often suboptimal in primary healthcare facilities, potentially leading to misdiagnosis and inappropriate management. Objective: To assess the quality of BP measurement technique in a primary healthcare facility in the Western Cape, South Africa, and to identify factors that may affect the accuracy of BP recordings. Methods: A cross-sectional study was conducted using a questionnaire and clinical point of care audit to assess the knowledge, attitude, and skills of healthcare workers involved in BP measurement. Digital BP machines were also audited for calibration and cuff size appropriateness. BP measurements were observed for 102 patients to audit the technique of BP measurement and compared to measurements obtained by the research team using a pre- validated, standardised technique. Results: Knowledge of BP measurement was adequate (>60% on knowledge quiz) amongst 72% of doctors, and inadequate (<60% on knowledge quiz) amongst 81% of nurses. We found widespread use of improper BP cuff sizes and non-calibrated digital BP machines. The use of digital BP machines produced significantly higher systolic BP readings than manual readings (145 vs 141.1; p=0.031), with non-significant differences in diastolic and mean arterial pressures. Conclusion: This study successfully piloted a novel method of assessing BP measurement technique, and identified several factors that could influence measurement outcomes, potentially impacting on clinical care. Recommendations for further research and targeted staff training are suggested.
Open Access
An audit of geriatric stroke rehabilitation services at a post-acute hospital (Booth Memorial) in urban Cape Town, South Africa
(2009) Ras, Tasleem; Isaacs, Abdul Aziz; Schweitzer, Beverley
Booth Memorial Hospital (BMH), situated at the foot of Table Mountain in urban Cape Town, South Africa, is an NGO-run hospital in a Public- Private Partnership with the Western Cape Department of Health. The essential service being offered is sub-acute health care, with state hospitals referring patients needing terminal, rehabilitation or convalescent care for a variety of illnesses. Post-acute stroke rehabilitation forms an integral part of the general service being offered by BMH. This dovetails with the state-run rehabilitation hospital in the sense that younger patients able to undergo intense rehabilitation are sent to the state-run hospital, while BMH generally cares for those patients who may not be able to withstand the rigours of an intense rehabilitation program. In our setting, this means that most of the patients seen at BMH for post-stroke rehabilitation are elderly. The elderly patient who has suffered a stroke is vulnerable in many respects. The most obvious vulnerability refers to the physical, emotional and psychological derangements that follow strokes in this age group. In addition, due to rampant poverty prevalent in the community we serve, social and economic factors place this group of patients at an even greater disadvantage. It is an imperative for social survival and an acceptable quality of life that this group of patients retain as much of their independence and empowerment after the stroke as is possible. The current situation of overflowing old-age homes, increasing prevalence of elder abuse and neglect, and the deficiency of community structures to care for the elderly compel health care providers to ensure that a post-stroke rehabilitation service operates with maximal efficiency, given the paucity of resources endemic in our health system. The above factors provided an impetus for this study. A need arose to assess the quality of the stroke rehabilitation services at BMH, as the starting point to what is hoped will be a continuous Quality Improvement Cycle. An additional factor compelling the examination of the quality of service being offered is that the Geriatric population is underserved in the present health system, competing for scarce resources with other vulnerable groups such as children, Cancer patients, and people living with HIV/AIDS. By focussing on a service that is almost exclusively aimed at the elderly, we hope to be able to advocate for greater resource allocation to this age group, given that receiving good health care is essential to the quality of life of the ageing population. This assessment of the current services looked at the Structure, Process of care and Clinical Outcomes of stroke rehabilitation services being given to patients over the age of 65 years. The findings were evaluated against internationally accepted norms of post-acute stroke care, and are presented in this study.
Open Access
Barriers and facilitators to health care access for children in a low-income are in Cape Town
(2023) Profitt, Luke; Ras, Tasleem
Background In Cape Town the under-5 mortality rate has plateaued to 20 per 1000 live births. The southern subdistrict has the largest paediatric population in Metro West and accounts for 31% of deaths in Metro West. Across the metropole 60% of child deaths are out of hospital. We investigated barriers to accessing health care for children in the False Bay Hospital drainage area. Methods Quantitative and qualitative methods were used: community survey (n=62), qualitative interviews (n=11) with caregivers of children who presented critically ill or deceased (January 2017 - Dec 2020) and a modified nominal group meeting of community based and clinical services managers to identify and achieve consensus on solutions. Results Community members (74%) experienced barriers in accessing care and only 60% knew the correct emergency contact numbers. Knowledge of basic home care for common conditions was limited. Interview themes showed barriers of affordability, acceptability, access, as well as household and facility factors. The nominal group technique suggested that improvement in community-based services, transport access and lengthening service hours would alleviate some of the challenges in accessing care. Conclusions The barriers to accessing care seem insurmountable to those who encounter them, yet solutions and community assets do exist. The optimal utilization of services and community assets have the potential to improve access to care with resultant decreased out-of-hospital deaths and improvement of the under-5 mortality rate. A well-coordinated Community Orientated Primary Care (COPC) program with intersectoral collaboration and government commitment needs to be implemented.
Open Access
Clinical Profile Of Patients Who Died Of Covid-19 Infection At A Field Hospital In Cape Town
(2023) Karki, Abhaya; Ras, Tasleem
Background: In May 2020, Cape Town was designated as the COVID-19 outbreak's epicenter in South Africa. As the infection spread so did admissions in hospitals and mortality among the infected. Field hospitals were established to take the burden off the hospitals, however, the mortality rate in these facilities has not been described yet. This study describes the clinical profile and characteristics of patients who died in this field hospital. Methods: This was a single-center, retrospective cross-sectional study involving secondary dataset and folder review of patients who died in Cape Town International Convention Center (CTICC), Hospital of Hope during its commission from June 2020 to August 2020. Results: During its period of operation the CTICC had 1502 admissions and 83 deaths giving a mortality rate of 5.53%. Among the patients who died, 55% were female and 77% were older than 60 years. Most patients (75%) had more than two comorbidities. Of these patients 71% had hypertension and 45% had diabetes. As per the CTICC admission category, 77% were category three patients who were either terminally ill or referred to as not for further escalation. Blood results showed that 77.14% of patients had high D-dimer and 97.7% had high CRP. Conclusions: The CTICC field hospital was the first intermediate care facility in South Africa born out of a time of need. The mortality rate at this field hospital was 5.53%. Further studies should explore the benefits of palliative care on patients who were admitted as not for escalation.
Open Access
Early identification and elective inpatient management of high-risk people living with diabetes diagnosed with COVID-19 decreases morbidity and mortality: a quasi-experimental study
(2022) Aronson, Tatum; Ras, Tasleem; Dave, Joel A
Introduction: The Diabetes-COVID-19 relationship is complex, resulting in increased morbidity and mortality. In response to this enhanced vulnerability of people living with diabetes (PLWD) to COVID-19 morbidity and mortality, the Western Cape Department of Health established a telemedicine team (the VECTOR team) that fast tracked at-risk PLWD diagnosed with COVID-19 into the Hospital of Hope (HOH), a temporary intermediate health care facility (ICHF) established as a field hospital to cater for the anticipated overburdening of the acute hospitals in the Cape Metro. This study evaluated the effects of implementing a telemedicine mediated rapid admission process and applying a tertiary hospital practice guideline (the High Risk Diabetes-COVID-19 protocol - HRDCp) for treating high risk PLWD who were electively admitted to a field hospital. Aim: To assess the impact of early admission and application of a clinical practice guideline (HRDCp) developed for use at a specialised tertiary facility for the inpatient care of PLWD who were diagnosed with COVID-19, on clinical outcomes in a generalist run, intermediate healthcare facility. Methods: Using a retrospective quasi-experimental study design applied to the clinical dataset for the HOH, patients admitted prior to the implementation of the clinical protocol (control group) were compared to those admitted via the telemedicine team, who received care using the clinical protocol (experimental group). A total of 183 patients were included in this study. Using secondary data from the hospital clinical dataset, baseline characteristics, inpatient clinical course and clinical outcomes were compared between these two groups. Findings: The key findings showed that the experimental and control groups were similar at baseline for age, gender, renal function and co-morbidity. Glucose control on admission was better in the experimental than in the control group [HbA1C 8.1 vs 9.3% (p=0.013); HGT 10.2 vs 10.7 g/dL (p=0.039)].The experimental group needed less oxygen (p< 0.001), less antibiotics (p< 0.001), and less steroids (p=0.003), while the control group had a higher incidence of acute kidney injury during admission (p=0.046). The median inpatient glucose control was better in the experimental group (8.3 vs 10.0; p=0.006). The two groups had statistically similar clinical outcomes for discharge home (94% vs 89%), escalation in care (2% vs 3%) and inpatient death (4% vs 8%). Ethical considerations: Ethics approval was obtained from the Human Research Council University of Cape Town. (HREC 502/2020) Conclusions: This study demonstrated a novel approach that foregrounds risk of adverse outcomes as criteria for elective admission. Aggressive management had comparably good outcomes versus the usual practice of waiting for severe disease to arise and subsequent emergency admission. While showing noninferiority to usual care in terms of clinical outcomes, it is suggested that significant savings were made in terms of financial costs and emotional distress.
Open Access
Evaluating the implementation of a paediatric allergy-training programme in urban primary care centres in Cape Town, South Africa
(2022) Ortel, Randall Shane; Levin, Michael; Ras, Tasleem
Background: Approximately a third of South Africans have suffered from some allergic disease during their life, with the highest burden of morbidity occurring in childhood. Despite the incidence and prevalence of allergic diseases steadily increasing worldwide in the past few years, it has not yet been met with an increased capacity to treat these conditions. Inappropriate management in primary care, for instance, impacts patient quality of life and leads to increased health care costs, compounded by limited relevant learning opportunities for primary care practitioners (PCP). Studies in a South African context have demonstrated that inadequate management of allergic disorders in children results in unscheduled hospital visits, preventable admissions and a heavy reliance on tertiary allergy services. To address this, the Allergy Foundation of South Africa (AFSA) and Red Cross Children's hospital Allergy unit designed a hybrid in-service training programme in paediatric allergies for PCP's. The training consists of online modules, face-to-face seminars, in reach and outreach support. The aim of this study was to evaluate the implementation of this paediatric allergy training programme. Methods: A cross-sectional observational descriptive design with an analytical component was used. The study population were all staff members who registered for the training programme, with voluntary recruitment into the survey arm of the study. As this is programme-level data, exclusion criteria were not applied. Descriptive data were collected from registration and attendance registers, and survey data in the form of an online self-administered questionnaire which explored three domains: accessibility; relevance to practice and acceptability. Results: Three hundred and forty staff members registered for the training programme, and 89 participated in the survey by completing the self-administered questionnaire. Of the staff enrolled in the training programme, 215 were doctors, 66 were nurses, 2 were facility managers, and 2 were pharmacists. Job categories of 55 staff who registered could not be determined. The throughput rate for the online component was 35.3% (120/340), and for the practical's, it was 49.2% (59/120), with an overall throughput rate of 17.4% (59/340). Medical officers were more likely to complete the training programme (online component: OR 5.4, (95% CI) 1.54 – 21.3, p = 0.011; practical component: OR 4.37, (95% CI) 1.33 – 15.5, p = 0.18) when compared to the nurses in this study. Having easy access to the training programme (OR 2.42; 95% CI 1.48 – 4.39; p= 0.001), senior or mentor support (OR 1.54; 95% CI 1.05 – 2.29, p= 0.035), having enough allocated time to complete the programme (OR 5.34; 95% CI 2.88 – 11.8, p 0.9) for the training of this nature requiring regular coursework was not associated with the completion of the training programme. The roll-out of the training programme was significantly impacted by the COVID-19 pandemic, which prevented any further training from March 2020. Conclusions: This study showed that significant contextually relevant factors impact the implementation of innovations aimed at improving clinical quality in primary care. Developing a deep understanding of these barriers is essential in implementing sustainable quality improvement projects. The study achieved its key outcomes of describing the implementation of the training programme, measuring the accessibility, relevance to practice, the overall acceptability domains of the programme and identifying factors that were enablers or barriers to its implementation.
Open Access
Incidence and Prevalence Of Renal Dysfunction In Antiretroviral Therapy (ART) Naïve Patients Starting A Tenofovir (TDF) Based ART Regimen In Mitchell's Plain Community Health Centre (CHC) ARV Clinic
(2021) Fayanju, Olanrewaju Philips; Hellenberg, Derek; Ras, Tasleem
Background: Tenofovir disoproxil fumarate (TDF) has high antiretrovirus (ARV) activity and available in fixed dose combination (FDC). However, it has been found to cause renal dysfunction. Objectives: To document the prevalence, incidence, pattern of occurence and associated factors of nephrotoxicity in patients initiated on TDF based ART regimen in Mitchell's Plain CHC ARV Clinic and make recommendations. Methodology: The study was conducted by reviewing retrospective records of all ARV naïve HIV positive adults initiated on TDF based ARV regimen from January 2016 to June 2016. The creatinine clearance (CrCl) was calculated from follow up parameters till June 2018. Results: 87 patients were included in the study and 56% were female. The mean age was 34 years. Majority, 83%, had normal renal function at ART initiation. Older age [OR = 1.11; 95% CI (1.03–1.19), p =0.005], was associated with an increased probability of non-normal renal function at baseline. The incidence of CrCl < 90ml/min were 1.5% at 1 month post ARV initiation, 3.3% at 4 months, 6.1% at 12 months and 2.8% at 24 months while the prevalence were 10.5%,11.5%, 20.4% and 16.7% respectively. Older age and male gender were independently associated with prevalence of renal impairment. Conclusion: Renal dysfunction in patients initiated on TDF based regimen in this study varied and were relatively small when compared to the prevalence of renal dysfunction at initiation. Majority of the decline in CrCl were transient and patients were found to have recovered after further follow up. It is recommended that the frequency of renal function monitoring in patients on TDF regimen be done within programmatic guidelines based on patients' risk factors and potential poor outcomes.
Open Access
Postgraduate Training Experiences Among International Registrars, at a Health Sciences Faculty, in South Africa
(2023) Baheir, Baheir; Ras, Tasleem
Background: The lived experiences of International Registrars (IRs) at a health sciences faculties in South Africa (SA) has not been documented, given the high numbers of IRs choosing SA as the destination of choice for medical specialization. This study addresses the question: what are the experiences of IRs pursuing medical specialization in SA?. The findings may help future IRs make informed decisions when choosing their study destination. It could also assist supervisors and program managers to anticipate some of the challenges that IRs face. Methods: A qualitative design using interpretive phenomenology approach was employed. using semistructured face-to-face interviews, data was collected directly from IRs, and checked for accuracy using a focus group discussion. Results: 2 major themes were developed: Negative experiences were subdivided into 4 subsections: registration and administrative barriers, structural and policy related-challenges, challenges related to teaching, supervision and clinical training, and finally challenges related to life outside university. The second theme documented positive experiences. Conclusion: We described several important issues affecting externally funded IRs arriving for postgraduate training at the study site. Some recommendations are made for practical implementation and future research.
Open Access
Quality and extent of adherence on internal medicine discharge letters in a regional hospital in South Africa to prescribed guidelines. A retrospective audit
(2019) Nya, Anthony; Ras, Tasleem; Cupido, Clint
Background: Hospital discharge letters are an essential part of good patient record keeping that ensures transmission of the healthcare information of a patient from the hospital of admission to the primary care practitioner. These letters were traditionally handwritten, but the medical ward in Victoria hospital Wynberg in adapting to current progress in clinical record keeping has transited from paper to the use of electronic discharge letters. Objectives: To audit the structure and contents of the electronic discharge summaries and find out to what extent they meet universally accepted criteria. Methodology: A retrospective clinical record audit of 60 patient records was conducted, spanning a period of 12 months (January-December) of 2018. Sequential sampling was used to select five folders from each months’ discharge records, making a total study sample of 60 patient records. A checklist of prescribed criteria was developed and used to collect data which was analysed descriptively. Ethical approval was obtained from University of Cape Towns’(UCT) Human Research Ethics Committee (HREC) and the Western Cape Government Provincial Research Committee. Electronic discharge letters compiled in the period 1 January- 31 December 2018 with corresponding folders found properly indexed in the medical records department were included in the sample, while discharge letters where the folders could not be found were excluded, as were the folders of patients who died during the hospital admission. Results: Nearly all clinical records contained biodata (100%), contact details (93%) and clinical details (93%). Only two-thirds of the folders contained information on other diagnoses(67%) and investigations matched clinical issues 63%.). The least compliant category was medication changes(53%), with just under half the folders containing this information. Conclusion: This study found that clinical records met 67% of the standards that define clinical and medico-legal compliance in the internal medicine ward in Victoria Hospital Wynberg. Several areas for future intervention were identified. A useful audit tool was also developed for ongoing quality improvement cycle.
Open Access
Tackling the First COVID-19 Wave at the Cape Town Hospital of Hope: Why Was It Such a Positive Experience for Staff?
(Multidisciplinary Digital Publishing Institute, 2023-03-29) Reid, Steve; Nana, Mitan; Abrahams, Theo; Hussey, Nadia; Okun-Netter, Ronit; Ras, Tasleem; von Pressentin, Klaus
Background: In contrast to alarming reports of exhaustion and burnout amongst healthcare workers in the first wave of the COVID-19 pandemic, we noticed surprisingly positive staff experiences of working in a COVID-19 field hospital in South Africa. The 862-bed “Hospital of Hope” was established at the Cape Town International Convention Centre specifically to cope with the effects of the first wave of the COVID-19 pandemic in Cape Town. Methods: We aimed to systematically describe and assess the effects on staff and the local health system. A cross-sectional descriptive study design was employed using mixed methods including record reviews and interviews with key informants. Results: Quantitative results confirmed high job satisfaction and low staff infection rates. The emerging themes from the qualitative data are grouped around a “bull’s eye” of the common purpose of person-centeredness, from both patient and staff perspectives, and include staff safety and support, rapid communication, continuous learning and adaptability, underpinned by excellent teamwork. The explanations for the positive feedback included good disaster planning, adequate resources, and an extraordinary responsiveness to the need. Conclusions: The “Hospital of Hope” staff experience produced valuable lessons for designing and managing routine health services outside of a disaster. The adaptability and responsiveness of the facility and its staff were largely a product of the unprecedented nature of the pandemic, but such approaches could benefit routine health services enormously, as individual hospitals and health facilities realize their place in a system that is “more than the sum of its parts”.
Open Access
The contraceptive knowledge, attitudes and practice among women seeking induced abortion in Mitchell's Plain District Hospital, women's health clinic, Western Cape, South Africa
(2020) Sobamowo, Samuel Oluwafemi; Ras, Tasleem
Background: There is an increased awareness among women of child bearing age on the forms of contraceptives in South Africa. Despite this, there has been a steady rise in the number of induced abortions conducted in the country. The aim and objectives of this study was to understand the contraceptive choices of the women requesting termination of pregnancy as well as their knowledge, attitude and practice toward contraceptives in one of the District Hospitals in Western Cape, South Africa. Methods: This was a cross sectional descriptive study which was conducted in Mitchell's Plain District Hospital, among women seeking induced abortion. Women aged 18 years and older seeking elective Termination of Pregnancy were included in the study. Convenience sampling method was used to select the participants women attending the clinic and who were willing to participate. Researcher-administered questionnaires were used as a data collection tool, and the data analyzed using SPSS version 25. Correlation between socio-demographic factors and contraceptive uptake was made using chi-square and Fisher's tests. Results: Most of the participants were between the ages of 26-39 years, single, unemployed and did not have matric education. There was an acceptable knowledge on contraceptives in terms of types, sources and side effects. However, there was low uptake of contraceptives (17%) prior to falling pregnant. The most common barriers to contraceptives use were side effects, no time to visit the clinic and low level of education. Conclusion: Findings from this study showed that awareness and knowledge of contraceptives does not necessarily translate to practice. In the future, it would be worthwhile to conduct a qualitative in-depth study on decision-making and behavior of all women around contraceptives.

Browsing by Author "Ras, Tasleem"

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