Browsing by Subject "Community Health"

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    A detailed study of persons admitted to the spinal unit of conradie hospital, Pinelands, Cape, during 1985.
    (1988) KETTLES_AN; Klopper, Jack
    Part I of this study has highlighted certain aspects pertaining to the patients admitted to the Spinal Cord Unit at the Conradie Hospital, Pinelands, with Spinal Cord Injury (s.c.i.). The main points of interest are as follows: 0 The majority of victims of s.c.i. in this series are young men, mainly Black or Coloured, with a low educational and poor employment status, with little in the way of pension or sick leave benefits. 0 Post injury employment opportunities are very limited, as are vocational training facilities. 0 The main causes of injury are examined, and while Motor Vehicle Accidents, Falls and Gunshot wounds are commonly described in the literature as causes of s.c.i., what is unique at the Conradie Hospital is the high percentage of stab wounds (29,6%) causing spinal cord lesions. 0 The method of injury in patients coming from Cape Town is compared and contrasted with the methods of injury in other areas. 0 The levels of the cord lesions and the clinical sequelae are analysed, and while Tetraplegia and Paraplegia are well described in all series on spinal cord injuries, this series is unique in the large number of Brown-Sequard type lesions (36, or 12,7% of all patients) that exist, associated with the large number of stab wounds.
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    Acceptability to general practitioners of national health insurance and capitation as a reimbursement mechanism
    (1999) Blecher, Mark Stephen; Bachmann, Max; McIntyre, Di
    Objective: The objectives of the study were to determine General Practitioners' attitudes to National Health Insurance (NHI) and to capitation as a mechanism of reimbursement. The study also aimed to explore determinants of these attitudes. Design: The methodology utilised a cross-sectional survey using telephone interviews and four focus group discussions. Setting: The study area was the Cape Peninsula area in the Western Cape Province of South Africa. Participants: 174 general practitioners (GPs) were randomly sampled from a total population of 874 GPs in the Cape Peninsula area. Main outcome measures: The main outcome measures were GPs' acceptance of NHI and of capitation as a method of reimbursement. Main results: Sixty three percent of GPs (63,3%) approved of NHI. More than 81 % approved of NHI if GPs were to maintain their independent status, for example their own premises and working hours. Eighty two percent (82,3%) said NHI would be a more equitable system of health care than the system that existed at that time, 88% approved of the fact that NHI would make care by GPs more accessible and 73% said they had the capacity to treat more patients. However, 61,3% of GPs disapproved of capitation as a form of reimbursement. The most common conditions cited by GPs for support of NHI were retention of professional autonomy, fee for service reimbursement and adequate levels of reimbursement. Conclusions: Most GPs in the Cape Peninsula were amenable to some form of NHI. However, approval of NHI is to some extent conditional to details of the NHI system, such as payment mechanisms, workload, income and effects on professional autonomy. The implications of GPs' preferences concerning the reimbursement mechanism for the feasibility of implementing a NHI in South Africa requires serious consideration by policy makers. While this research demonstrates broad ideological and conceptual support for some form of NHI or SHI, further research is required to provide more detailed quantitative information on the trade-offs that GPs would be prepared to make for them to support the introduction of a new socially based insurance system. A national survey of medical practitioners is recommended.
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    Aspects of medical waste disposal in the Cape Peninsula
    (1996) Tolosana, Sandra; Ehrlich, Rodney I; Brown, Alec C
    Hazardous waste management practices at ten medical institutions in Cape Town were studied and tests undertaken to determine concentrations of specific chemicals and radioactivity in liquid effluent outflows, as well as emissions from incinerators. To investigate the sewage outflow for Chemical Oxygen Demand (COD), N, pH and heavy metals, a continuous sampler was installed at two hospitals and a Medical School. Samples were analysed by atomic absorption spectrometry for As, Hg, Cd, Co, Cr, Cu, Mn, Ni, Pb, Zn and Fe. Mercury levels ranged from l-70μg l⁻¹, exceeding the Environmental Target Quality of 0.04μg l⁻¹, and the South African General Effluent Standard of 20μg l⁻¹ . All other heavy metals were below General Effluent Standard Limits. In addition, a sludge sample from the Athlone Wastewater Plant was tested for Hg, realising 6mg kg⁻¹ on a dry weight basis, which was within Department of Health (DOH) Guidelines of 10 mg kg⁻¹. Samples of incinerator bottom ash analysed for heavy metal content gave Hg concentrations of 1.1-4.0mg kg⁻¹, and Zn concentrations of 5.1-11.0g kg⁻¹. Incinerator ash was also analysed for radio-activity and substantial levels of ¹²⁵I (332-650 bq kg⁻¹ ), and Ga⁶⁷ (9186bq kg⁻¹) recorded, which exceeded the South African limits of 200bq kg⁻¹. In Cape Town, hospital incinerators are old, burn large amounts of plastics and produce toxic emissions. They are all situated in residential or inner-city areas, and even though there is legislation dealing with emissions and chemical waste, these laws are not being enforced. Based on the above results, an investigation was carried out to assess attitudes to and knowledge of hazardous waste in the ten institutions. One thousand questionnaires were administered to staff, and the data from the 80% response rate statistically analysed. Results suggest that there is an urgent need for an holistic approach to toxic waste management, encompassing enforceable legislation coupled with on-going educational programmes and strong support from top management and all levels of staff.
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    Assessing financial management capacity for district health system development : a case study of the Mount Frere District
    (1998) Morar, Reno Lance; McIntyre, Di
    The specific objective of this report is the assessment and analysis of the current financial management capacity at the district level in Mount Frere. It will specifically address the assessment and analysis of financial management capacity in the Mount Frere district, Region E in the EC Province, Department of Health.
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    An assessment of the extent of environmental mercury contamination in the vicinity of Thor Chemicals, Cato Ridge, Kwa Zulu-Natal, South Africa and the subsequent health risk communities consuming fish in the area are exposed to
    (1999) Oosthuizen, Jacques De Villiers; Ehrlich, Rodney I
    Environmental mercury pollution of the Valley of a Thousand Hills area of KwaZulu-Natal, South Africa, in particular the river system below the Thor Chemicals mercury recycling plant, has been a topic of heated debate for a number of years. Thor Chemicals was established as a mercury recycling plant in the mid-1980' s and it processed mercury waste imported from various countries. A number of factory workers were subsequently exposed to high levels of mercury vapour causing the death of a worker. Upon investigation it was found that in addition to the occupational exposures of workers, mercury waste had been discharged into the river systems of the Valley of a Thousand Hills. During the 1998 South African Parliamentary session, questions were raised regarding the lack of adequate monitoring and research directed at quantifying human health risks in the region. A number of Government departments were accused of apathy and incompetence in adequately addressing the issue. Fish forms an important part of the diet of the local community living in the Valley of a Thousand Hills. Children, in particular, are frequently observed fishing in the rivers, thus placing these individuals at risk should the fish be contaminated with mercury. The aims of this study were: to determine the extent of environmental mercury pollution of the river system downstream from the Thor Chemicals plant, and to quantify the human health risk associated with fish consumption in the region. Samples of streambed sediment, algae, cattle hair, fish and human hair, were obtained from the study area as well as from a control area upstream from the Thor Chemicals plant. These were analysed to determine the concentration of mercury in each sample. Mercury levels in the study group were compared to mercury levels in the control areas.
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    The chemoprophylaxis of meningococcal disease in the Cape Town City Council area : an evaluation of programme efficacy
    (1994) Girdler-Brown, Brendan Vaughan; Coetzee, Nicol; Coetzee, Gerrit
    This dissertation reports the findings of a study which was carried out in the Cape Town City Council area, in order to establish whether the offering of rifampicin to household contacts, of patients with meningococcal disease, resulted in protection of those contacts against developing the disease during a 32 week follow up period. The study took the form of a retrospective follow up of 3 350 household contacts of 412 cases notified over a 4-year period (mid 1988-mid 1992). It was found that the offering of rifampicin to the household contacts resulted in an odds ratio of not developing meningococcal disease over the 32-week follow up period of 14, 17 (SD = 12, 34). Although there was a tendency for contacts who were not offered rifampicin to have been younger, and of male gender, when compared to those who were offered prophylaxis, these demographic differences were not statistically significant at the 0,05 level. Furthermore, three out of the four male second cases, all in the younger age group, were in fact offered prophylaxis. It seems desirable that prophylaxis should be given as soon as possible. It is concluded, therefore, that the offering of rifampicin to household contacts of patients with meningococcal disease, living under the prevailing social circumstances in the Western Cape, has protective benefit for those contacts. It is likely that the chemoprophylaxis programme prevented up to 88 cases of meningococcal disease over the study period of four years, as well as preventing 8 deaths from this disease, in the CCC population.
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    The epidemiology of asthma and wheeze in primary school children in Mitchell's Plain, Cape Town, with special reference to the role of environmental tobacco smoke
    (1999) Ehrlich, Rodney; Myers, Jonny; Burney, Peter
    This study was undertaken in the light of the increasing importance of childhood asthma worldwide, an apparently large burden of asthma morbidity disease in Cape Town, high local smoking rates and a lack of epidemiologic information on childhood asthma in South Africa. Two detailed literature reviews were undertaken. The first covered epidemiologic aspects of asthma and allergy in South Africa, as inferred from allergen and atopy studies, clinical series, and studies of prevalence and mortality. The second addressed the international literature on whether environmental tobacco smoke is associated with asthma, wheeze or bronchial hyperresponsiveness in general and asthmatic populations of children. This thesis is based on a self-administered questionnaire survey of the parents of 1 955 sub-8 pupils (90% response rate), aged 7 to 9 years, in Mitchell's Plain, a large, working class area of Cape Town Five empirical questions were asked: 1) is the prevalence of asthma and wheezing in primary school children? (2) What is the reliability (across two questionnaires) of questions about wheezing and asthma? 3) What are the household risk factors for wheezing and asthma; in particular, to what extent is household environmental tobacco smoke (ETS) a risk factor for asthma/wheeze? 4) Among children with asthma/wheeze, is there an association between ETS exposure and bronchial hyper-responsiveness (BHR), and 5) To what extent is asthma underrecognised and undertreated?
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    An evaluation of the provision and performance of acute care hospitals in the non-metropolitan regions of the Western Cape Province
    (2003) Onwuchekwa, Uchechukwu Foster; London, Leslie
    Health Departments across South Africa face increasing financing constraints comparable to other developing countries and reported internationally. During the 1997/98 financial year, the Department of Health (DOH), Provincial Administration of the Western Cape (PAWC) faced huge cuts in its financial resource allocation from the National Department as policy shifted to wards addressing past inequity between the provinces. In the Western Cape Province, 200 regional hospital beds have already been closed with a further 500 beds located in academic health centres earmarked for closure. Hospitals in the province consume over 73% of the health care budge at PAWC and faced with budget cuts, research teams were approached to evaluate the supply of acute care hospital beds focusing on efficiency and equity in order to guide rational policy decisions to achieve savings from hospitals.
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    The health hazards of chemical use in agriculture
    (1996) London, Leslie
    Despite playing an important role in crop protection and increasing food production, chemicals used in agriculture may have a range of unanticipated effects on human health. Such effects may range from overt and acute poisonings to gradual-onset chronic morbidity. In South Africa, data on such morbidity are sparse, and subject to much underreporting as one of the included papers illustrates. The dearth of such data has much to do with the marginalised living and working conditions in agriculture and the lack of attention to occupational and environmental health on farms in the country. We have little sense of the extent of hazardous exposures in agriculture, nor of their health impacts on rural populations. Even less so, have methods for the control of poisoning by pesticides been investigated amongst farm workers in South Africa. A public health response to this problem should aim at all levels of prevention (primary, secondary and tertiary), by characterising the extent and distribution of the problems caused by pesticides, identifying risk factors and groups at highest risk for poisoning, as well as testing intervention strategies and technologies. The set of papers presented below attempts to do that by linking a series of investigations into different aspects of agrichemical hazards in South Africa, with a focus on the Western Cape. The first paper examined various aspects of potential exposure to agrichemicals on farms in the Stellenbosch region, taking into account both environmental and occupational routes of exposure. The second paper describes the profile of agrichemical poisoning in the province from 1987 to 1991, identifying high risk groups and characterising the completeness and nature of reported poisonings. The third paper developed from the author's growing realisation of the need to contextualise problems related to agrichemical exposures and effects within the overall legislative and public health framework in South Africa. This paper therefore identifies the key public health issues that need addressing with regard to pesticide safety. Finally, the last two papers address aspects related to workplace interventions for the prevention of agrichemical poisoning. One paper deals with the evaluation of a field kit (for validity and repeatability) for monitoring workers exposed to organophosphate and carbamate insecticides, while the last paper elaborates guidelines for the use of cholinesterase testing in the primary and secondary prevention of organophosphate and carbamate poisoning. In this series, therefore, the papers attempt to address the problem of agrichemical hazards within a public health framework, tracing the problem from potential exposure to acute outcomes, through reviewing the legislative and occupational health environments, through to technologies and policy guidelines related to workplace intervention. In doing so, the papers use the term "agrichemical" to refer to all chemicals used in agriculture for pest and weed control. This supersedes the term "pesticide" which has ambiguous meanings in the technical environment. Readers are therefore advised to understand the term "agrichemical" to include the generic aspects of chemical usage on crops in agriculture. The research on which these papers was based was spawned by the involvement of the author in a larger research project investigating long-term neurobehavioural effects of organophosphate exposure on deciduous fruit farm workers over the period 1991 - 1994. This latter piece of research is not referred to here as it was the basis for another degree at the University of Cape Town.
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    An historical demographic investigation into mortality in three historical birth cohorts born between 1837 and 1900 in Mamre, with special reference to life expectancy
    (1990) Katzenellenbogen, Judy Masha; Yach, Derek
    This thesis reports on an historical prospective study of three Mamre decadal birth cohorts (1837-1846, 1870-1879, and 1900-1909) constructed retrospectively through existing parish records of the Moravian Mission at Mamre in the Western Cape region of South Africa. Nominative data collection techniques were used to gather information needed to determine the infant mortality rates, quinquennial mortality rates and life expectancies of the three cohorts. Issues related to the quality of data – non-registration and follow-up - were investigated. Birth registration was best for the 1837-46 cohort for males and females, with the 1900-1909 registration being next best. Overall, male registration coverage was substantially better than that for females. Infant death registration was best for males in these 2 cohorts, but were poor for females. Based on these data, the infant mortality rates for the cohorts born in 1837-1846, 1870-1879 and 1900-1909 - 196, 182 and 128 per 1000 respectively for males and 160, 172 and 97 per 1000 respectively for females - appeared to be underestimates. There is some evidence of a downward trend for the infant mortality rates with time for males, but this was not statistically significant. Quinquennial mortality rates for the 3 cohorts did not differ statistically, and are similar to the 1935-37 national 'coloured' figures. The life expectancies also did not differ significantly between cohorts. The life expectancies at birth (range 34- 40 years for males and 32-45 years for females) were probably overestimates due to biased IMR's. The life expectancies at age 1 (range 41-44 for males and 37-49 for females) were more representative figures. Life expectancies at age 20 were fairly stable over time (37-45 years) except for females in the 1900-1909 cohort whose life expectancies were substantially higher than earlier figures. All mortality indices investigated in this study consistently showed a lighter burden of mortality in historical Mamre compared to 'coloureds' in the Cape Colony at the turn of the century. This is probably associated with the better housing, environmental, social, economic and educational conditions at the Mamre mission relative to the rest of the Colony in the century after the emancipation of slaves.
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    A liquid consumption survey of individuals in greater Cape Town
    (1986) Bourne, Lesley Thelma; Watermeyer, G S; Klopper, J
    There is no published data for the per capita consumption of water of individuals in South Africa. A daily rounded volume of 2 litres per person is usually taken as a working estimate from world wide data. As part of ongoing epidemiological studies into potential health effects of changes in the water supply to greater Town, water consumption patterns were ascertained. As health effects are often spatially ascribed to the place of residence of a person, it was necessary to ascertain how much water was drunk at home as well as away from home. Water consumed was divided into three classes: (i) water consumed from the tap, (ii) commercial beverages and (iii) water bound in food. A review of methods of conducting dietary surveys indicated that a 24-hour recall would be the most appropriate method. Two surveys on total dietary intake utilizing a 24-hour recall were carried out (n = 2 000 persons for each survey), one in winter and the ether in summer. The design of the survey involved a cluster sample of households that were representative of the socio-economic and demographic structure of greater Cape Town. Three pretested types questionnaires were administered by trained interviewers: (i) a placement questionnaire to describe the household composition, (ii) a recall questionnaire for individual adults and children and (iii) a recall questionnaire for babies. Particular attention was paid to the accurate ascertainment of the volumes of food and drink consumed as well as their preparation to facilitate accurate analysis. The water content of each food item was calculated by a computer program that utilized computerized food composition tables. The water consumption data was analyzed by sex, age, population group, income and the season of the year. Detailed graphs and tables are provided. Results were also standardized to the population of greater Cape Town. It was found that the difference in consumption between the White and "Coloured" population groups was greater than the difference between those people of high and low-income groups. The mean total water intake for Whites was 2.19 litres per day, while for "Coloureds" it was 1.26 litres per day. There is no obvious bias to account for this difference. The figures for protein consumed by the two groups, which was used as a control, are consistent with values reported in the literature. Summer consumption was higher than that during winter. The ratio of tap water consumed at home to total liquid consumed was approximately 0.5.
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    The long-term respiratory health effects of the herbicide, paraquat, among Western Cape workers
    (1996) Dalvie, Mohamed Aqiel; White, Neil; Myers, Jonny
    Objective: Paraquat is a commonly used herbicide worldwide and is a well-documented cause of pulmonary fibrosis in studies of laboratory animals and in humans following high dose exposure (usually accidental or as parasuicide). The respiratory effects of long-term, low dose paraquat exposure have not been fully evaluated. We set out to evaluate the possible effects of paraquat spraying among deciduous fruit farm workers in the Western Cape, South Africa. Methods: A cross-sectional study of 126 workers was performed. Administered questionnaires generated information on exposure, respiratory symptoms and confounding variables. Spirometry and gas transfer were measured and chest radiographs performed. Oxygen desaturation on exercise testing was by oximetry during a modified stage one exercise test. Results: No association was found between long-term paraquat exposure and reported symptoms, spirometry (FVC, FEVl, FEVl/FVC) and gas transfer (TLco and Kco) or chest radiography. Multivariate analysis showed a significant relationship between measures of long-term paraquat exposure and arterial oxygen desaturation during exercise (p < 0.05). Conclusion: Previous studies have also not shown a significant relationship between measures of paraquat exposure and standard tests of lung function. Arterial oxygen desaturation during exercise represents a more sensitive test. Our findings indicate that working with paraquat under usual field conditions for a long period is associated with abnormal exercise physiology in a dose dependant fashion.
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    Nurses and their work in tuberculosis control in the Western Cape : too close for comfort
    (1998) Van der Walt, Hester Maria; Swartz, Leslie; Cooper, Diane
    The setting for the research is the urban areas of Cape Town, South Africa where the notification rate of tuberculosis is the highest in the world. Despite the availability of modern drugs, the cure rate is low and approximately 40% of diagnosed patients do not adhere to treatment. This has serious implications for the spread of multiple drug-resistant tuberculosis. The relationship between the patient and health care providers is one of the main determinants of compliance to medical treatment. The main aim of the thesis is to develop an understanding of how nurses experience their work with patients who have pulmonary tuberculosis. The research explores how nurses interact with patients, how nurses perceive their relationship with patients and the processes and organisational arrangements which contribute to the patterns of nurse-patient interaction. The interpretive research design was largely informed by an ethnographic approach. The iterative research process led to several sub-studies; the analysis of each sub-study led to a further cycle of data collection. Data collection techniques include participant observation of nurse-patient interaction and depth interviews with nurses and key informants. An exploration of opportunities to change the prevailing work patterns yielded data on nurses' responses to change. The data were captured as field notes or audio taped and analysed thematically by using qualitative methods and by the application of psychodynamic theory. The research identifies task orientation and patient-centredness as the main patterns of nurse-patient interaction. Task orientation was found to be the dominant work pattern. Its origins are traced to the colonial history and to the influence of Taylorist labour practices. Task orientated work patterns are maintained because of complex mechanisms which operate at both intrapersonal and interpersonal levels. It is argued that the history of racial politics and racial identity has influenced the ways in which nurses manage the degree of distance between themselves and patients. The findings suggest that the closer the nurses identify with patients in terms of ethnic background, the more the nurses may feel the need to distance themselves from the patients. The notion of tuberculosis as a stigmatised disease, the concept of compliance, and the implementation of control measures such as directly observed therapy are critically examined. An exploration of the illness experiences of nurses who become infected with tuberculosis, provides an opportunity to explore how nurses perceive the role of the caregiver when they are in the unfamiliar position of being patients. The findings have implications for public health interventions aimed at transforming nurse-patient interaction. It is recommended that change management processes explicitly acknowledge the consequences of decades of apartheid policies and practices on the behaviour of health professionals and the users of health services. In the years to come change agents will need to address the emotional pain of the past, as well as the more well-known sources of organisational resistance to change.
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    A nutritional and socio-economic study of Philippi farm children and their mothers during November 1986
    (1987) Whittaker, Stuart; Klopper, J M L
    A community based survey to determine the nutritional status using anthropometric methods, of children and mothers and to assess certain socio-economic factors was carried out during November and December 1986 in Philippi, a predominantly vegetable farming area. Twenty-one (43%) of the 49 vegetable farms which were included in the study were selected by stratified random sampling. All children in the 0-6 year age group and their parents on the selected farms were included in the sample which consisted of 129 children and 212 parents. Questionnaires were administered and subjects' weights and heights were measured. It was found that 47% of children were below the National Centre for Health Statistics 5th percentile weight for age and 58% were under the 5th percentile height for age. There were 47 child deaths out of 279 births over a six-year period, thirty-four of which had occurred in the first year of life. Twenty eight percent of children had a birth weight of less than 2.5 kg. The number of cases of tuberculosis (10%) and severe diarrhoea (31%) contracted within the first year of life is unacceptably high. Twenty four percent of mothers were malnourished in terms of body mass index and fifty five percent of mothers were illiterate. Fifty nine percent of mothers were regular farm workers who worked for an average of 10.2 hours per day and a wage of R0.44 per hour. Grossly inadequate facilities existed for the care of children while the mothers worked. The average amount spent on food was insufficient to maintain normal nutrition. Although 91.5% of mothers breast fed their children and fed for a mean duration of 13.4 months, breast feeding was not exclusive. Supplementary feeding was introduced on average at 3 months of age. The long working hours of working mothers made it difficult for them to breast feed their children satisfactorily. Acceptance of the family planning services was high and immunisation cover was good. These statistics reflect the effects of extreme poverty and neglect of a community which is totally reliant on its employers for its livelihood. The parents poor educational level, coupled with their meagre financial and other physical resources gives them and their children little opportunity to improve their station in life and leaves them open to the scrounge of malnutrition and disease. Similarly, the dearth of educational and other child care facilities will ensure that this disastrous trend continues. A multidisciplinary approach, including active community involvement of both farmers and workers, to the many physical and social problems is urgently needed if the unacceptable human suffering is to be stopped.
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    The prognosis of tuberculosis in adults infected with Human Immunodeficiency Virus (HIV-1)
    (1999) Badri, Motasim Hassan Yousof; Maartens, Gary; Ehrlich, Rodney
    Objectives: The primary objective of this study was to assess whether active tuberculosis (TB) accelerates the course of HIV-1 infection by measuring progression to AIDS and mortality in HIV-infected patients. Secondary objectives were to evaluate whether TB should be considered an AIDS-defining illness in an area with a high prevalence of TB, and to assess the risk factors for developing TB in HIV-1 infected patients. Setting: New Somerset and Groote Schuur Hospital adult HIV clinics, Department of Medicine, Faculty of Health Sciences, University of Cape Town. Design: Prospective patient cohort study with five years of follow-up. Sample: Adult HIV-infected patients presenting to the two HIV clinics between 1992 and 1996. Methods: The TB case definition was a positive culture or a compatible clinical picture combined with a positive smear or a histologic diagnosis. TB patients were treated with 6-month short course regimens. The Kaplan-Meier method was used to estimate the overall survival times of tuberculosis and non-tuberculosis patients. The generalized log rank test was used to compare the survival curves of these two groups. The Cox proportional hazards regression method was used to determine the risk of death associated with tuberculosis while adjusting for potential confounding variables (i.e. age, CD4+ count, history of an AIDS-defining illness, use of co-trimoxazole prophylaxis, and antiretroviral therapy, etc.). The Kaplan-Meier method was used to evaluate the prognosis of HIV-infected patients with TB vs the prognosis of HIV-infected with other HIV ( or AIDS, as defined by the WHO or the CDC staging systems) related diseases at baseline. The generalized log rank test was used to compare the survival curves of the TB group vs the other groups. Predictors of active TB in HIV-infected patients were assessed using univariate and multivariate logistic regression models.
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    Public/community engagement in health research with men who have sex with men in sub-Saharan Africa: challenges and opportunities
    (2016) Molyneux, Sassy; Sariola, Salla; Allman, Dan; Dijkstra, Maartje; Gichuru, Evans; Graham, Susan; Kamuya, Dorcas; Gakii, Gloria; Kayemba, Brian; Kombo, Bernadette; Maleche, Allan; Mbwambo, Jessie; Marsh, Vicki; Micheni, Murugi; Mumba, Noni; Parker, Michael; Shio, Jasmine; Yah, Clarence; van der Elst, Elise; Sanders, Eduard
    Abstract Background Community engagement, incorporating elements of the broader concepts of public and stakeholder engagement, is increasingly promoted globally, including for health research conducted in developing countries. In sub-Saharan Africa, community engagement needs and challenges are arguably intensified for studies involving gay, bisexual and other men who have sex with men, where male same-sex sexual interactions are often highly stigmatised and even illegal. This paper contextualises, describes and interprets the discussions and outcomes of an international meeting held at the Kenya Medical Research Institute-Wellcome Trust in Kilifi, Kenya, in November 2013, to critically examine the experiences with community engagement for studies involving men who have sex with men. Discussion We discuss the ethically charged nature of the language used for men who have sex with men, and of working with ‘representatives’ of these communities, as well as the complementarity and tensions between a broadly public health approach to community engagement, and a more rights based approach. We highlight the importance of researchers carefully considering which communities to engage with, and the goals, activities, and indicators of success and potential challenges for each. We suggest that, given the unintended harms that can emerge from community engagement (including through labelling, breaches in confidentiality, increased visibility and stigma, and threats to safety), representatives of same-sex populations should be consulted from the earliest possible stage, and that engagement activities should be continuously revised in response to unfolding realities. Engagement should also include less vocal and visible men who have sex with men, and members of other communities with influence on the research, and on research participants and their families and friends. Broader ethics support, advice and research into studies involving men who have sex with men is needed to ensure that ethical challenges – including but not limited to those related to community engagement – are identified and addressed. Summary Underlying challenges and dilemmas linked to stigma and discrimination of men who have sex with men in Africa raise special responsibilities for researchers. Community engagement is an important way of identifying responses to these challenges and responsibilities but itself presents important ethical challenges.
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    Restructuring academic health services in the Western Cape : a critical evaluation with emphasis on a range of financial models developed to assist the process
    (1997) De Beer, Zach
    Various financial models were developed in the process of planning for the restructuring of academic health services in the Western Cape. In an attempt to inform and assist this process, these models are described, critically analysed and in certain cases further developed. Since most of these models are dynamic and have been developed within computer spreadsheet applications, the relevant files are included here on computer disk and form an integral part of this submission. The background to restructuring is first explored, the models are examined, and then the implications for policy, resource allocation and academic health services are discussed.
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    The role of the professional nurse in providing continuity of care for geriatric patients at Groote Schuur Hospital
    (1982) Dick, Judy; Watermeyer, G S; Meiring, P de V; Jacka, Ethnee
    Due to the fragmented structure of the health organisation in South Africa, there is often difficulty in assuring good co-ordination between in-patient and domiciliary health facilities. This results in the discharge of patients from hospital with poor prospects for the continuity of health care in the community. At Groote Schuur Hospital, approximately 44% of the hospital beds in the white section of the Hospital are occupied by patients in the age group of sixty-five years and over. This group of patients must be regarded as particularly vulnerable with regard to the transition of the care in a hospital to their own home for some of the following reasons: - * The nature of the disease - The chronic and recurrent nature of the degenerative diseases of old age often results in varying degrees of disability. in the aged patient. Many geriatric patients suffer from several unrelated clinical conditions, and thus there is a need to coordinate the many health services required. * Social circumstances - The aged population frequently live alone or with a frail relative, often in poor economic circumstances. * Re-admission rate - The geriatric re-admission rate following discharge is high. As the first principle of geriatric care is to restore independence, and to help patients live away from the hospital environment, the provision of extended care facilities for vulnerable patients is of utmost importance. A structured interview was used to assess the need for extended care facilities of 172 white patients over the age of 60 years who were discharged from Groote Schuur Hospital during March to May of 1981. An attempt was made to evaluate how effectively these needs were being met in the community following discharge. It was found that 34% of the patients interviewed were not getting the nursing care and support in the community which they needed to facilitate rehabilitation. The most vulnerable patients as regards aftercare were: - * The aged * The chronically ill * Patients who live alone or without social support * Patients whose illness leads to temporary or permanent disability * Patients hospitalised for prolonged periods. It was found that the patients interviewed were given insufficient preparation, while still in hospital, for the problems they would be faced with on discharge. No systematic policy exists to ensure that health care staff give adequate information to the patient on discharge from hospital. The ward sister was found to play a vital role in making the preparations for a patient's transfer from hospital to home. A questionnaire was designed to assess the Groote Schuur ward sisters' attitudes towards the importance of discharge planning. An analysis of the ward sisters' response indicated that great variation existed in the attitudes towards the importance of this task. An investigation into the existing community services for geriatric patients was undertaken. An attempt was made to assess the limitations and gaps which exist in the provision of services for the aged. Finally, the role of the recently established Department of Community Liaison at Groote Schuur Hospital was investigated. It was evident that the Community Liaison nurse had proved to be an invaluable member of the health team of a large, specialist hospital such as Groote Schuur. The activities of the Community Liaison nurse led to improved continuity of care for patients needing extended care facilities in the community.
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    Open Access
    The impact of chest radiography on the diagnosis, clinical management and outcome of acute lower respiratory infections in children
    (1999) Swingler, George Henry; Hussey, Gregory; Zwarenstein, Merrick
    Background. When available, chest radiography is widely used in acute lower respiratory infections in children. Its impact on clinical outcome is unknown. Methods. A randomised controlled trial was performed of 522 children aged 2 to 59 months who met the World Health Organisation case definition for pneumonia. The main outcome was time to recovery, measured in a subset of 398 participants who offered a telephone number. Subsidiary outcomes included diagnosis, elements of clinical management and subsequent use of health facilities. Findings. There was a marginal improvement in time to recovery, which was not clinically significant. The median time to recovery was seven days in both groups, 95% CI 6-8 days and 6-9 days in the radiograph and control groups respectively (p=0.50, log rank test). The hazard ratio for recovery was 1.08 (95% CI 0.85 to 1.34). This lack of effect was not modified by clinicians' experience and no sub-groups of children were identified in whom the radiograph had an effect. Pneumonia was diagnosed more often in the radiograph group (14.4% vs. 8.8%, p=0.03) and bronchiolitis less often ( 44% vs. 56%, p=0.005). Antibiotic usage was higher in the radiograph group (60.8% vs. 52.2%, p=0,05). There were no differences in subsequent health facility usage. Interpretation. Despite a net change in diagnosis and an increase in antibiotic usage, chest radiography did not affect clinical outcome in outpatient children with acute lower respiratory infection. This lack of effect was independent of clinicians' experience. There were no clinically identifiable sub-groups of children within the World Health Organisation case definition of pneumonia who benefited from radiography. It is concluded that routine use of chest radiography is not beneficial in ambulatory children over two months of age with acute lower respiratory infection.