Browsing by Subject "Decision making"

Now showing 1 - 4 of 4
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    A proposed prioritization system for the management of invasive alien plants in South Africa
    (2003) Robertson, M P; Villet, M H; Fairbanks, D H K; Henderson, L; Higgins, S I; Hoffmann, J H; Le Maitre, D C; Palmer, A R; Riggs, I; Shackleton, C M; Zimmermann, H G
    Every country has weed species whose presence conflicts in some way with human management objectives and needs. Resources for research and control are limited, so priority should be given to species that are the biggest problem. The prioritization system described in this article was designed to assess objectively research and control priorities of invasive alien plants at a national scale in South Africa. The evaluation consists of seventeen criteria, grouped into five modules, that assess invasiveness, spatial characteristics, potential impact, potential for control, and conflicts of interest for each plant species under consideration. Total prioritization scores, calculated from criterion and module scores, were used to assess a species' priority. Prioritization scores were calculated by combining independent assessments provided by several experts, thus increasing the reliability of the rankings. The total confidence score, a separate index, indicates the reliability and availability of data used to make an assessment. Candidate species for evaluation were identified and assessed by several experts using the prioritization system. The final ranking was made by combining two separate indices, the total prioritization score and the total confidence score. This approach integrates the plant's perceived priority with an index of data reliability. Of the 61 species assessed, those with the highest ranks (Lantana camara, Chromolaena odorata and Opuntia ficus-indica) had high prioritization and high confidence scores, and are thus of most concern. Those species with the lowest ranks, for example, Harrisia martinii, Opuntia spinulifera and Opuntia exaltata, had low prioritization scores and high confidence scores, and thus are of least concern. Our approach to ranking weeds offers several advantages over existing systems because it is designed for multiple assessors based on the Delphi decision-making technique, the criteria contribute equally to the total score, and the system can accommodate incomplete data on a species. Although the choice of criteria may be criticized and the system has certain limitations, it appears to have delivered credible results.
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    A qualitative analysis of factors influencing HPV vaccine uptake in Soweto, South Africa among adolescents and their caregivers
    (Public Library of Science, 2013) Katz, Ingrid T; Nkala, Busisiwe; Dietrich, Janan; Wallace, Melissa; Bekker, Linda-Gail; Pollenz, Kathryn; Bogart, Laura M; Wright, Alexi A; Tsai, Alexander C; Bangsberg, David R
    BACKGROUND: In South Africa, the prevalence of oncogenic Human Papillomavirus (HPV) may be as high as 64%, and cervical cancer is the leading cause of cancer-related death among women. The development of efficacious prophylactic vaccines has provided an opportunity for primary prevention. Given the importance of psycho-social forces in vaccine uptake, we sought to elucidate factors influencing HPV vaccination among a sample of low-income South African adolescents receiving the vaccine for the first time in Soweto. METHODS: The HPV vaccine was introduced to adolescents in low-income townships throughout South Africa as part of a nationwide trial to understand adolescent involvement in future vaccine research targeting human immunodeficiency virus (HIV). We performed in-depth semi-structured interviews with purposively-sampled adolescents and their care providers to understand what forces shaped HPV vaccine uptake. Interviews were recorded, transcribed, translated, and examined using thematic analysis. RESULTS: Of 224 adolescents recruited, 201 initiated the vaccine; 192 (95.5%) received a second immunization; and 164 (81.6%) completed three doses. In our qualitative study of 39 adolescent-caregiver dyads, we found that factors driving vaccine uptake reflected a socio-cultural backdrop of high HIV endemnicity, sexual violence, poverty, and an abundance of female-headed households. Adolescents exercised a high level of autonomy and often initiated decision-making. Healthcare providers and peers provided support and guidance that was absent at home. The impact of the HIV epidemic on decision-making was substantial, leading participants to mistakenly conflate HPV and HIV. CONCLUSIONS: In a setting of perceived rampant sexual violence and epidemic levels of HIV, adolescents and caregivers sought to decrease harm by seeking a vaccine targeting a sexually transmitted infection (STI). Despite careful consenting, there was confusion regarding the vaccine's target. Future interventions promoting STI vaccines will need to provide substantial information for participants, particularly adolescents who may exercise a significant level of autonomy in decision-making.
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    A socio-ecological approach for identifying and contextualising spatial ecosystem-based adaptation priorities at the sub-national level
    (Public Library of Science, 2016) Bourne, Amanda; Holness, Stephen; Holden, Petra; Scorgie, Sarshen; Donatti, Camila I; Midgley, Guy
    Climate change adds an additional layer of complexity to existing sustainable development and biodiversity conservation challenges. The impacts of global climate change are felt locally, and thus local governance structures will increasingly be responsible for preparedness and local responses. Ecosystem-based adaptation (EbA) options are gaining prominence as relevant climate change solutions. Local government officials seldom have an appropriate understanding of the role of ecosystem functioning in sustainable development goals, or access to relevant climate information. Thus the use of ecosystems in helping people adapt to climate change is limited partially by the lack of information on where ecosystems have the highest potential to do so. To begin overcoming this barrier, Conservation South Africa in partnership with local government developed a socio-ecological approach for identifying spatial EbA priorities at the sub-national level. Using GIS-based multi-criteria analysis and vegetation distribution models, the authors have spatially integrated relevant ecological and social information at a scale appropriate to inform local level political, administrative, and operational decision makers. This is the first systematic approach of which we are aware that highlights spatial priority areas for EbA implementation. Nodes of socio-ecological vulnerability are identified, and the inclusion of areas that provide ecosystem services and ecological resilience to future climate change is innovative. The purpose of this paper is to present and demonstrate a methodology for combining complex information into user-friendly spatial products for local level decision making on EbA. The authors focus on illustrating the kinds of products that can be generated from combining information in the suggested ways, and do not discuss the nuance of climate models nor present specific technical details of the model outputs here. Two representative case studies from rural South Africa demonstrate the replicability of this approach in rural and peri-urban areas of other developing and least developed countries around the world.
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    Testing effectiveness of the revised Cape Town modified early warning and SBAR systems: a pilot pragmatic parallel group randomised controlled trial
    (2019-12-30) Kyriacos, Una; Burger, Debora; Jordan, Sue
    Abstract Background Nurses’ recognition of clinical deterioration is crucial for patient survival. Evidence for the effectiveness of modified early warning scores (MEWS) is derived from large observation studies in developed countries. Methods We tested the effectiveness of the paper-based Cape Town (CT) MEWS vital signs observation chart and situation-background-assessment-recommendation (SBAR) communication guide. Outcomes were: proportion of appropriate responses to deterioration, differences in recording of clinical parameters and serious adverse events (SAEs) in intervention and control trial arms. Public teaching hospitals for adult patients in Cape Town were randomised to implementation of the CT MEWS/SBAR guide or usual care (observation chart without track-and-trigger information) for 31 days on general medical and surgical wards. Nurses in intervention wards received training, as they had no prior knowledge of early warning systems. Identification and reporting of patient deterioration in intervention and control wards were compared. In the intervention arm, 24 day-shift and 23 night-shift nurses received training. Clinical records were reviewed retrospectively at trial end. Only records of patients who had given signed consent were reviewed. Results We recruited two of six CT general hospitals. We consented 363 patients and analysed 292 (80.4%) patient records (n = 150, 51.4% intervention, n = 142, 48.6% control arm). Assistance was summoned for fewer patients with abnormal vital signs in the intervention arm (2/45, 4.4% versus (vs) 11/81, 13.6%, OR 0.29 (0.06–1.39)), particularly low systolic blood pressure. There was a significant difference in recording between trial arms for parameters listed on the MEWS chart but omitted from the standard observations chart: oxygen saturation, level of consciousness, pallor/cyanosis, pain, sweating, wound oozing, pedal pulses, glucose concentration, haemoglobin concentration, and “looks unwell”. SBAR was used twice. There was no statistically significant difference in SAEs (5/150, 3.3% vs 3/143, 2.1% P = 0.72, OR 1.61 (0.38–6.86)). Conclusions The revised CT MEWS observations chart improved recording of certain parameters, but did not improve nurses’ ability to identify early signs of clinical deterioration and to summon assistance. Recruitment of only two hospitals and exclusion of patients too ill to consent limits generalisation of results. Further work is needed on educational preparation for the CT MEWS/SBAR and its impact on nurses’ reporting behaviour. Trial registration Pan African Clinical Trials Registry, PACTR201406000838118. Registered on 2 June 2014, www.pactr.org.