Browsing by Subject "Maternal and Child Health"

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    Adherence in twice weekly therapy for childhood tuberculosis
    (1997) Naude, James te Water; Donald, Peter
    AIM: This thesis examines the adherence to therapy as part of a clinical trial to determine the effectiveness of fully intermittent therapy for childhood tuberculosis. OBJECTIVES: These were to determine 1) the effectiveness of fully twice weekly therapy in childhood pulmonary tuberculosis, 2) whether adherence rates would be affected by twice weekly dosing and 3) whether certain socio-demographic factors influenced adherence.
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    An evaluation of an education programme on neonatal care for midwives
    (1991) Greenfield, D H
    The education programme being evaluated was designed to improve the knowledge and practice of midwives working in Midwife Obstetric Units in the Southern Cape Peninsula. The programme was started at the beginning of 1987 and consisted of a number of activities including 4 two week courses in January and February 1987. In this evaluation only the knowledge and practice of the midwives were assessed. Knowledge was assessed by using a multiple choice question paper and this was done in 1987 and 1991. Practice was evaluated by means of chart review using a data collection sheet which was developed for this purpose. Specific criteria (observations, documentation, problem identification, management and overall score) were used to evaluate the records of babies transferred to hospital by the midwives. The change in practice over the periods 1983 to 1986, and 1986 to 1989 was assessed. The results showed that the knowledge of the midwives improved significantly following the two week courses at the beginning of 1987. The mean test scores of the midwives in 1991 were significantly lower than those at the end of the courses, but in real terms, only 4%. (83% compared with 87%) There was a highly significant improvement in the midwives' practice. The proportion of records with scores of less than 33% for the criteria measured, decreased significantly, while the proportion of records scoring more than 66i. increased significantly. This trend was already present in the 1983 to 1986 period, but appeared to have accelerated in the 1986 to 1989 period. The programme was able to improve and maintain the knowledge of the midwives at a significantly higher level than before the programme started. The practice of the midwives was also significantly better.
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    An exploration of disclosure and non-disclosure patterns in HIV-infected children in Cape Town, South Africa
    (2018) Shea, Robert F; Muloiwa, Rudzani
    A cross-sectional, descriptive study combining with open-ended (qualitative) interview questions with quantitative component was conducted to explore disclosure experiences of mothers and caregivers of HIV-infected children. The study was conducted with 102 parents and caregivers at a tertiary hospital in Cape Town delivering care to 303 HIV-infected paediatric patients. The study sample included 102 participants, ranging in age from 16 years to 71 years. The sample included 73 mothers (72%), six fathers (6%), 11 foster-mothers (11%), and 12 caregivers or grandmothers (12%). The median age of participants’ children was 4 (IQR 2-8) years and ranged from five months to 16 years. Only 48 (47%) were old enough for disclosure to be possible. Disclosure or disclosure delay was associated with several factors, including the child’s age or ability to understand, anxiety and guilt about being blamed for infecting the child, fear of exposing the child to stigma, discrimination and social exclusion related to the child disclosing to others, and the hope that the child would be adherent if they understood their illness and the way in which the medication could improve their health outcomes. Only 16 (33%) of 48 participants actually disclosed the child’s HIV status. The results indicate that HIV-disclosure remains a challenging, emotionally-charged experience for mothers and caregivers. The findings of this research, and similar studies, point to the value of integrating disclosure support and planning into routine care for children and adolescents, as well as their parents and caregivers.
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    An exploratory study of beliefs and understandings of health workers at Onandjokwe hospital, Namibia regarding child sexual abuse
    (2001) Meguid, Tarek
    The study presented here examines beliefs and understandings of health workers at Onandjokwe Lutheran Hospital, regarding sexual abuse of children. The introduction gives background information on the area where Onandjokwe Hospital is situated and on the magnitude of the problem of sexual abuse of children here. It also provides information on what is known about beliefs and attitudes of health workers and on facts of CSA. The literature review gives an overview of the literature on child sexual abuse. In this section an attempt is made to also look at the history of research in this area and at the specific problems of studying such a sensitive issue in cultural settings different from the setting of the researcher. This review includes literature on medical, social, anthropological, legal, cultural and political aspects of CSA. As much literature dealing with this subject in the African, Southern African and Namibian context as possible is included in this review. The chapter on methodology explains the study design and its biphasic approach combining a qualitative and a quantitative phase. The qualitative phase consists of several focus group discussions leading to the fonnulation of questions for the questionnaire used during the quantitative phase of the study. Problems and limitations are also discussed. The findings of the study are presented in two parts, one part for each of the two phases. The qualitative findings are based on three focus group discussions held with various categories of health workers. The quantitative findings are based on 186 questionnaires. They are shown mainly in tables and graphs. At the end of the chapter results are further analysed looking at specific sub-sets of respondents. Since analysis of the collected data could be very extensive and take many forms, a decision was taken to present descriptive exploratory data for the purposes of this dissertation. All answers to the main part of the questionnaire are shown in table 26 which is provided as an appendix so as to allow for further analysis if one may wish to do so. In the discussion the overall findings emerging from this study are discussed first, followed by specific aspects of the analysis. The main results of the study are that CSA is perceived to be a significant problem in the study area and that health workers do not feel competent enough to handle this problem. They clearly express the need to be trained further in this field. Although the overwhelming majority of medical doctors are from abroad and a number of other health workers have been raised abroad; the majority of health VII workers are Namibian, are nurses and have been raised in the area of the country in which the study was undertaken. The beliefs and understandings of CSA found in this study therefore reflect mainly 'local' views. The discussion then leads to the formulation of brief conclusions and recommendations. An extensive bibliography, including all the available literature on CSA in Namibia to date, and the appendices, consisting of the Ndonga and English questionnaire and a foldout list of acronyms for convenience conclude this thesis.
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    Assessing some of the associations with perinatal mortality at Kamuzu central hospital in Lilongwe, Malawi
    (2012) Mwenyekonde, Elled; Greenfield, David; Muula, Adamson S
    The study objectives were to: determine the prevalence of perinatal mortality (PNM) and causes of early neonatal deaths (ENNDs), describe socio-demographic factors of mothers with PNM and assess some of the associations with PNM at Kamuzu Central Hospital.
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    Assessment of antenatal and intrapartum referrals to Mowbray Maternity Hospital in Cape Town, South Africa
    (2017) Mohamed, Ekram; Shea, Jawaya; Greenfield, David
    Introduction: A continuous and concerning increase in the number of deliveries at Mowbray Maternity Hospital (MMH) has been noted over the years and now comprises a greater proportion of deliveries compared to deliveries conducted by midwives at midwife obstetric units (MOUs). To date there have been no studies assessing the changes in the pattern of deliveries at MMH. This study describes the antenatal and intrapartum referrals at MMH in 2005 and 2013, to identify any changes and whether or not referrals are appropriate. Method: This is a descriptive study with an analytic component involving review of a sample of hospital folders (138 for 2005 and 246 for 2013) of women who delivered at MMH from January to December 2005 and 2013. Results: The mean age of referred women was 27.259 (SD ± 6.277) years and 27.326 (SD ± 6.025) years in 2005 and 2013, respectively, with no significant statistical difference (p = 0.918). There was also no significant statistical difference (p=0.056) in the proportion of coloured, black or white women who delivered at MMH during 2005 and 2013. In 2005, a total of 27 (52.2 %) delivered women were single, 54 (39.1%) were married and two (1.4%) were divorced. In 2013, a total of 178 (72.4%) women were single, 65 (26.4%) were married and three (1.2%) were divorced, with a significant statistical difference (p < 0.001). In 2005, 75 (54.3%) women were unemployed and 46 (33.3%) were employed, whereas in 2013, 172 (69.9%) women were unemployed and 69 (28%) were employed, which shows a significant statistical difference (p < 0.001). In 2005, women mostly resided in Mitchell's Plain (32.6%), Gugulethu (28.3%) or in Khayelitsha (27.5%). In 2013, most women resided in Mitchell's plain (33.7%), Gugulethu (24.4%), Retreat 48 (19.5%) and Southern Peninsula 31 (12.6%), which represents a significant statistical difference (p= 0.001). 2 The median parity for 2005 sample was 1 (IQR: from 0 to 2), while in 2013 it was 1 (IQR: from 0 to 1). Although most women (94.2% versus 95.1%) booked at antenatal clinics in 2005 and 2013 respectively, with no significant statistical difference (p=0.697), the gestational age at first ANC differed significantly (p < 0.001) (median 24 versus 19 weeks). In 2005, the median number of ANC visits was five (IQR: from 4 to 7) visits, whereas the median was six (IQR: from 5 to 8) visits in 2013, with a significant statistical difference (p= 0.013). Over half of referred women (55.8% and 50.8%) in 2005 and 2013 respectively were delivered by normal vaginal delivery. The remainder had either a caesarean section or assisted delivery, with no significant statistical difference (p=0.139). Most women were referred from MOUs in both 2005 and 2013, at 90.6% and 85.45% respectively, with a significant statistical difference (p < 0.001). During both years virtually all pregnancies were considered high risk and the most common reason for referral was previous caesarean section (18.8% versus 19.9% respectively). For both years most pregnancy referrals experienced one, or more, antenatal risk factors, mainly previous caesarean section at 31 (12.5%), obesity at 27 (11%), prelabour rupture of membranes at 26 (10.6%) and HIV at 24 (9.8%) in 2005 and previous caesarean section accounted for 56 (11.1%), prolonged pregnancy for 51 (10.1), obesity for 50 (9.9%), HIV for 50 (9.9%) and tobacco use for 42 (8.3%) in 2013. The difference was statistically significant (p < 0.001). In 2005, the main intrapartum risk factors were fetal distress (23.6%), failure to progress and preterm labour (18% each). In 2013, fetal distress was most common (36.2%), followed by failure to progress (16.7%). The difference is statistically significant (p=0.034). Conclusion: The Cape Town Metro West health system features a functional maternity referral system. Midwives perform well in referring pregnant women who meet the criteria for high risk. There has been an increase in the number of women referred to the MMH over the study period but in this study group all referrals were found to be appropriate and were compliant with relevant obstetric management protocols. It appears there have not been large shifts in the demographics of referred women over the period reviewed. In addition, the change in the referral pathway has seen Southern Peninsula and Retreat referring to MMH but Khayelitsha no longer referring there. Furthermore, there are emerging risk factors that reflect the epidemiological changes currently being observed in the Cape Town Metro West region.
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    An assessment of the Isoniazid preventative therapy programme for children in a busy primary healthcare clinic in Nelson Mandela Bay, Eastern Cape Province
    (2015) Tucker, Faye Bronwyn; Shea, Jawaya; Amien, Feroza
    Introduction: Tuberculosis is the second leading cause of death from an infectious cause worldwide having claimed approximately 1.5 million lives in 2013. Estimates suggest that children account for about six percent of the total number of TB cases globally, however in South Africa this figure is much higher (15%). Young children are at particularly high risk of mortality and significant morbidity from TB. Despite clear evidence that Isoniazid preventative therapy (IPT) can reduce the risk of progression from TB infection to disease, IPT has been a poorly implemented component of national TB control programmes, especially in high TB-burden areas, including South Africa. This study aims to determine current practices regarding the identification and management of child contacts < 5 years in an area with an extremely high TB incidence rate where little background data exists on the topic. It will also assess the operational aspects of the TB control programme relating to the spread of TB to children. Methodology: A cross-sectional descriptive study was conducted using a retrospective review of clinic records from infectious index patients aged ≥15 years at West End clinic in the Nelson Mandela Bay health district in the Eastern Cape Province. A sample size of 246 child contacts (<5 years) was required to obtain a 95% confidence index with a 5% precision. This is based on 20% of eligible child contacts < 5years receiving IPT, as described by van Wyk, et al. (2010). 491 Index patient records were assessed in order to identify 261 child contacts < 5 years of age. Results: Contacts were generally well recorded with only 12.5% of index patient folders having no contacts documented although only 0.53 child contacts <5years were identified per index patient. A total of 261 child contacts < 5 years were identified and of these 184 (70.5%) were screened for TB. Two contacts were started on TB treatment and 108/184 (58.7%) were initiated on TB prevention therapy. For the remaining 74 (40.2%) children who were screened there was no documentation of further management. Adherence to IPT was extremely poor with only 4 (3.7%) children who started TB prevention completing the 24 week course. Female index patients were more likely to have contacts documented and to bring their contacts for screening. Contacts of index 16 patients who had previous TB were less likely to be screened and initiated on TB prevention therapy. The results of the assessment of programmatic factors relating to childhood TB control showed that patients were diagnosed and were rapidly initiated on treatment (median time of 5 days from sputum collection to commencement of treatment). It took a median of 4 days for children to be screened once the index patient had started treatment and a further 2 days (median) for child contacts < 5 years to be initiated on preventative therapy. Conclusion and recommendations: The results of this study are in keeping with those obtained in other settings with a high burden of TB. Although the documentation of contacts in this setting was relatively good, child contacts < 5 years were poorly identified and the fall-out of children at each step from identification to preventative treatment completion was still unacceptably high. Contacts of men and retreatment index patients are at particularly high risk of poor management. Recommendations are made for interventions at national and local level to improve contact management and the documentation thereof.
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    An assessment of the management of sexually transmitted diseases (STDs) in a rural district health ward of Northern Kwazulu
    (1997) McCoy, David; Karim, Salim S Abdool
    This study is an assessment of the quality of sexually transmitted disease (STD) management and control in a rural district of South Africa. A semi-structured questionnaire was administered to 5 nurses from public sector primary health care clinics, 5 doctors from the public district hospital, 5 private general practitioners, 6 traditional healers and 7 STD patients. A patient simulation exercise involving 6 nurses and 6 general practitioners was also conducted. Using routine data collection forms, the spectrum of STD syndromes and the contact tracing rate were assessed. The private sector treated nearly a third of the STDs even though they charge about ten times the price of the public sector services. In general, the clinical skills of all providers were poor. While hypothetical patient histories produced reasonable responses on STD management during the interviews, the patient simulation results showed that health service providers provided STD management that was much poorer than the questionnaires indicated. The private general practitioners did not practice syndromic STD management and often did not use laboratory tests appropriately resulting in incorrect diagnosis and inappropriate treatment for STDs. All health service providers did not counsel, promote condoms or encourage contact notification adequately. All health service providers were keen to participate in continuing medical education that better equip them to manage STDs. Any attempts at improving the quality of care in the district must therefore include private general practitioners as an important and central component of STD policy and planning. Interviews with traditional healers and patients showed the importance of using non-biomedical constructs of health and illness in developing health promotion strategies. There is an urgent need to improve STD management at district level in an attempt to meet the first milestone of ensuring that a patient presenting with an STD to a health service is correctly managed. This can be done through the design of simple quality assurance methods as demonstrated in this paper.
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    Attitudes and perceptions of males towards contraceptives services in Engela District of Ohangwena Region, Namibia
    (2019) Alagba, Alexander Adedotun; Shea, Jawaya; Akpabio, Ebong E
    Introduction In sub-Saharan Africa the unmet need for contraception for married couples is estimated to be 24%, with rural, uneducated, poor women generally experiencing a greater risk for unplanned, unwanted pregnancies compared to their urban, educated, well informed counterparts. Recommendations for addressing unmet contraceptive need are inclined to emphasise family planning programmatic efforts. The role of men in contraceptive decisions tends to receive less attention, the perception being that men are often uninvolved and unsupportive of the contraceptive needs of their female partners. This study reviewed the attitudes and perceptions of men about contraceptive services in Engela District of the Ohangwena Region, Namibia. Methods A qualitative study was conducted using Focus Group Discussions (FGD) and Key Informant Interviews (KII) with men and women aged between 18-60 years residing in the Engela district of the Ohangwena Region. Men and women were purposively selected and participated in four and two focus group discussions respectively to explore the subject. Interviews with six influential and respected key informants, including government officials and community leaders were conducted. Data generated from the interviews were transcribed, coded, and content analysis conducted. Based on the research domain, themes and subthemes were generated. Purposive sampling was done. Many people were contacted to participate as participants in the research, some declined from participating due to lack of interest, and it was only those that were keen on participating that were enlisted by the research assistants. Influential leaders, respected in the community were also selected as KII. Results The findings revealed that specific reproductive health issues are common in the community, with a high level of awareness of family planning and contraceptives among men and women, many women having access to contraceptives Yet men held negative views about women’s decision to use contraceptives without their consideration and approval by them. The results indicated that community-level information was not ideal, and should be improved. Conclusion The study showed that most of the men who participated in the study are well informed about family planning and available contraceptive options for both men and women. It also revealed the attitudes and perceptions of men to FP and contraception use of women. However, there is little male involvement in contraceptive decisions.
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    Autism Spectrum Disorder: Assessing the level of knowledge and perceived challenges to early diagnosis and intervention among general practitioners in the city of Tripoli, Libya
    (2018) Jubr, Soad; Peterson, Reneva; Shea, Jawaya
    Introduction Autism spectrum disorder (ASD) is an important global health problem. It has been shown that early diagnosis and intervention can improve the outcomes in affected children. Lack of knowledge about ASD among health care practitioners can delay the identification of children with ASD as well as early intervention. Currently, a dearth of epidemiological information exists regarding ASD in Africa. The aim of this study was to assess the knowledge of general practitioners (GPs) in Libya regarding ASD and to identify perceived challenges by GPs to early diagnosis and intervention of children with ASD in Libya. The study included the working GPs in the city of Tripoli. Methodology This cross-sectional descriptive study was conducted between 1st June 2017 to 31st August 2017 and utilized an electronic platform, the Research Electronic Data Capture (REDCap) from the University of Cape Town to collect study information. The Knowledge about Childhood Autism among Healthcare Workers (KCAHW) is validated questionnaire that explores health care worker knowledge about ASD across four domains. The KCAHW was used in combination with a more detailed questionnaire which explored challenges to early identification and interventions by GP’s in Libya. Descriptive statistics are reported in percentages and the Wilcoxon rank sum test was used to explore relationships between domain knowledge scores with age and gender as well as years of experience as a GP. Results The number of surveys returned to the REDCap application survey site was 215 which represent a response rate of 58.1%. However, the number of complete responses which could be included in data analysis was found to be only 62, indicating an overall response rate of 16.7%. The median age of the participants was 30 years old, IQR (29-33) years with a female predominance amongst participants (n= 55, 89%). The total median score from the knowledge questionnaire was 10, IQR (8- 12). No statistical differences could be found between domain knowledge scores and participants' age, gender and work practice. Participants showed good knowledge about stereotypical movements and repetitive behaviours in ASD, but 48% were not aware of comorbidities associated with ASD. The main challenges identified by GPs in the management of ASD were lack of awareness, insufficient experience, and health infrastructure in Libya as well as social stigma associated with developmental disorders. Conclusion and recommendations GPs in Libya have limited knowledge about certain aspects of ASD. A number of challenges were identified by GPs which hamper the early identification and management of ASD in Libya. There is a need to improve undergraduate medical training about ASD as well as to offer ongoing medical education to GP’s to improve recognition and management of ASD in Libya. Further research is indicated to explore the epidemiology, clinical spectrum and severity of ASD as well as intervention in Libya
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    Child safety in day care centres within the Western Cape
    (1998) Jaffer, Khadija; Bass, David
    The aim of the study is to explore aspects of child safety in registered day care centres situated in a lower socio-economic area of the Cape Town Metropole. This can be achieved by: a) describing the physical environment in day care centres b) assessing the infrastructure of day care centres to deal with potential injurjes c) reviewing injury reporting systems already in place d) highlighting the issue of child safety in the course of conducting the study.
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    Child sexual abuse in Malawi a retrospective audit of documented cases at Queen Elizabeth Central Hospital, Blantyre, in 2009
    (2012) Speth, Eva-Maria; van As, Arjan Bastiaan (Sebastian)
    Child abuse in different forms, ranging from domestic violence against children to sexual abuse, is a worldwide phenomenon with a dramatic influence on the future of the abused child. In African countries, the number of reported cases is rising which may be a result of increased awareness amongst medical staff and parents. In sub-Saharan Africa, outside South Africa, there has been limited research on child abuse, in particular on child sexual abuse, and little is known about the extent of health services offered to the victims.
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    Clients' returning for cervical screening results : a focus group study exploring the reasons why women spontaneously return for their results at the Khayelitsha Cervical Cancer Screening Project
    (2004) Honikman, Simone; Denny, Lynette
    Cervical cancer is integrally associated with the problems of poverty in the developing world. It is the most common cancer cause of death among women in these regions. In South Africa, the lifetime risk for black African women developing this cancer is 1 in 26. Rates for white women are 1 in 80. Cervical cancer is largely preventable by screening for its precursor stages. However, cervical cancer screening in low-resource settings has only rarely been initiated and sustained. There are many barriers to the establishment of mass, organised screening programmes. This study focuses on one aspect of the screening process: the clients' receiving of their screening results. For the most part, health providers in resource-poor settings rely on the clients themselves to return to the health service to receive their results and consequent arrangements for further care. Understanding those factors that impact upon clients' returning is therefore crucial to the success of the screening. The Khayelitsha Cervical Cancer Screening Project (KCCSP) was established in 1996 to evaluate alternative screening tests to cytology. In addition, the Project has evaluated alternative screening algorithms to the traditional approach of cytology, colposcopy, biopsy and treatment, specifically, a "screen and treat" approach. This approach is expected to overcome some of the many barriers to women participating in screening programmes. This study aims to investigate the phenomenon of the high spontaneous return rate in the setting of the KCCSP. Motivating and deterring factors are sought, both logistical and psychological, in the clients' personal contexts, as well as those related to their experiences of the Project. Exploratory study in the interpretive research paradigm located in a peri-urban informal settlement outside Cape Town, South Africa. Volunteer sample of women enrolled in the KCCSP returning for their first set of screening results. Four focus groups were conducted in Xhosa, facilitated by a Xhosa-speaking social worker from Khayelitsha who has experience in focus group work. Discussion guidelines were followed. The discussions were tape recorded and later transcribed before being translated into English by the facilitator. Analysis of the data draws on elements of both the grounded theory and the systems theory paradigms. The findings reveal that, for the most part, women present to the KCCSP in order to have general gynaecological problems addressed. Returning for results represents an extension of this need. Obstacles to returning include problems with access to the clinic, the need to care for dependents at home and the competing priorities of housework and generating income. Factors that promote the returning for results are the imperative to understand the cause of, and have treatment for pre-existing gynaecological symptoms which cause high levels of anxiety. Related to this, women are motivated to have confirmed or refuted the diagnosis of a fatal disease, including cancer and HIV. Certain qualities and design features of the KCCSP facilitate women returning fOr their results. These include the perceived superior quality of interpersonal communication between Project staff and clients and the efficient manner in which results are made available to clients. Other promotive or obstructive factors that playa role in cervical screening service utilisation include; client attitudes towards traditional healers, a prevalent fear of hysterectomy, concern about privacy and gossip and a suspicious attitude toward caring health workers. Women enrolled in the KCCSP have a personal health agenda with a different focus to that of the Project. Chronic gynaecological problems are frequently experienced and give rise to levels of anxiety about their being signs of serious pathology. Women have not had these fears or the symptoms adequately addressed at other health services. The need to have these issues properly managed represents a large enough motivating force to overcome many of the practical and psychological obstacles to utilisation of the KCCSP. The Project represents for women a general women's health service.
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    The clinical presentation and outcome of tuberculosis in children admitted to a paediatric intensive care unit in an area with a high incidence of pulmonary tuberculosis
    (1996) Heyns, Louis; Gie, Robert
    The purpose of this study was to measure and evaluate the clinical presentation, outcome and longterm effects of tuberculosis in children admitted to the paediatric intensive care unit at Tygerberg Hospital. A retrospective, descriptive study was conducted among 57 children admitted to the paediatric intensive care unit between January 1991 to December 1994. The sample comprised all the children with tuberculosis aged one month to twelve years who were admitted to the paediatric intensive care unit. Audit measures were taken to ensure that all the children with tuberculosis were identified. Data was collected by means of a structured working sheet and questionnaire that was sent to the clinics. Respondents completed the questionnaire in the clinics. There was an increase in the incidence of children suffering from pulmonary or disseminated tuberculosis who required admission to the PICU, although the incidence of HIV was low. None of the index cases had MDR-TB. Fifty-one percent of children were admitted to the PICU because of primary tuberculosis or complications of the disease. Of these children 69 % had respiratory failure who required ventilation. Thirty percent were admitted to the PICU for respiratory failure and were subsequently diagnosed as having tuberculosis. Tuberculosis was incidently found amongst 4 children when they were routinely examined in the PICU. Due to the difficulty in confirming the diagnosis of tuberculosis in children, a large proportion of cases go unrecognised. The chest radiographs demonstrated that hilar ( 40 % ) and paratracheal (32 % ) adenopathy was the most common findings. Bronchial compressions was present in 12 % of cases. A significantly positive Mantoux skin test was reported in 35 % of cases and 53 % had a positive Tine skin test. Gastric aspirates positive for M. tuberculosis were obtained in 42 % of cases and of cultures other than gastric aspirates, 44 % were positive. Other special investigations to confirm the diagnosis of tuberculosis included CT scan and bronchoscopies. Bronchoscopies were performed on 13 children and found to be abnormal in 12 cases. The most common finding was nodal compression of the airways. Overall the diagnosis of confirmed tuberculosis was made in 47% and of probable tuberculosis in 53 % of cases. The length of stay in the PICU was 10.2 + 22.4 days. The PICU mortality was 23%, with a total hospital mortality of 26%. The mortality for the TBM subgroup was 75 % . Although a good compliance (82 % ) was recorded by the clinics in the follow-up study, they experienced problems with the notifications. The follow-up study pointed out that communication was a problem between the referring hospital and the clinics. Thirty-one percent of the clinics made suggestions for improving the communication. The findings demonstrates that in an area with a high incidence of TB, children do develop severe disease requiring admission to the PICU. This places a considerable clinical and financial burden on the already limited health system. Early diagnosis of TB should prevent severe disease and subsequent admission to the PICU. The increasing incidence of HIV and MDR-TB will undoubtedly pose a major risk to ICU staff and the prevention of infection is of primary concern for those who may be exposed in this area. Due to this, certain recommendations regarding guidelines for admission to the PICU, investigations of patients exposed of having TB in the PICU, prevention of infection and detection of disease in staff in the PICU, the need for increase beds in the PICU and recommendations post discharge from the PICU were made.
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    Congenital syphilis : a study at Provincial Hospital Uitenhage
    (1998) Esselaar, Annette; Greenfield, David
    Aims: 1. To establish the extent of Syphilis in Pregnancy and the association of syphilis with unbooked status and perinatal deaths. 2. To determine why the diagnosis was not made in forty cases of Early Congenital Syphilis. Objectives: 1. To establish the percentage of patients with syphilis at delivery and possible association between unbooked status and positive syphilis serology. 2. To determine the Perinatal Mortality Rate and establish what percentage of perinatal death s occurred in unbooked patients and in those with positive syphilis serology. 3. To establish booking status, place of delivery, whether treated or not, serological findings, signs and symptoms of infants with Early Congenital Syphilis. Study Design: 1. A descriptive, retrospective study of deliveries in the month of March 1994. 2. A descriptive, prospective study of perinatal deaths over six-month period January to Jun e 1995. 3. A descriptive, retrospective study of Early Congenital Syphilis patients over five-year period 1990 - 1994. Setting: Maternity and paediatric wards at Provincial Hospital Uitenhage, East Cape. Patients and Methods: 1. Records were studied of 154 maternity patients delivering in March 1994 in order to ascertain booking status and serology results. 2. Data on sixty-one perinatal deaths weighing over 500 grams was examined to establish maternal booking and serological status. 3. Folders of forty patients with Early Congenital Syphilis admitted to the paediatric ward were examined. Results: 1. Syphilis in Pregnancy: i) Prevalence of syphilis at delivery was 9% for patients with titres =/> 1 :8. ii) Unbooked patients totalled 47% of deliveries (73/154). iii) Fifteen percent of deliveries had no syphilis serology tests performed and were discharged without screening (23/154). iv) No significant association was found between unbooked status and positive serology (p=0.35). 2. Perinatal Deaths: i) In instances of a perinatal death, a significant association was found between unbooked status and positive RPR serology (p=0.017). ii) Perinatal death rate due to syphilis totalled 10.8/1000 deliveries. 3. Early Congenital Syphilis: i) Eighty-five percent of cases (34/40) delivered at PHU and were mismanaged by personnel. ii) Eighteen of the thirty-four mothers had attended antenatal clinic and were untreated or inadequately treated by the time of delivery (53%). vii iii) Sixteen of the mothers had been unbooked and were discharged without screening or treatment (47%). iv) Four booked patients had negative sousveillance during the antenatal period. Conclusion: Provincial Hospital Uitenhage serves a poor community. This is reflected in the high prevalence of syphilis at delivery and the high proportion of unbooked patients. Time-consuming and inefficient methods of sero-surveillance plus separate clinics and staff for antenatal and Sexually Transmitted Diseases compounded existing problems. The standard of care anticipated at a Level 2 Referral Hospital was not delivered by Health Workers, largely due to lack of in-service training and guidelines for the management of Syphilis in Pregnancy. Recommendations: 1. In-service staff training by the Perinatal Education Programme (PEP) and adoption of protocols of management. 2. Rapid ("same-day") availability of serology results and initiation of treatment at Antenatal Clinic. 3. RPR at booking visit and repeated at delivery in all patients. 4. Monthly evaluation by Perinatal Problem Identification Programme (PPIP) and Obstetric/Paediatric meeting to monitor implementation.
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    Constructive integration : changes in uptake and outcomes of reproductive health services during the scaling up of ART and PMTCT in Thyolo District, Malawi
    (2011) Van den Akker, Thomas; Shea, Jawaya
    Background: In recent years there has been increasing debate about the impact of scaled-up ART and PMTCT programmes on the uptake and outcomes of reproductive health services, in particular the potential detrimental effects of HIV-care on the overall capacity of fragile health systems. The objective of this study was to evaluate changes in the uptake of reproductive health services as well as the main pregnancy outcomes during the scaling up of ART and PMTCT in Thyolo District, Malawi. Methods : Study design: retrospective descriptive district-wide cohort analysis for the period 2005 to 2009. Setting: Thyolo District, an area with around 600,000 inhabitants, an adult HIV-prevalence of 21% and a Total Fertility Rate of 5.7 in 2004. HIV-care including ART and PMTCT was scaled up since 2004 in Thyolo District to reach district-wide coverage in 2007. HIV-care is provided at district hospital, health centre and community health post levels. Outcomes: uptake of antenatal, intrapartum and postpartum care, family planning and treatment of sexually transmitted infections; infrastructural changes, and changes in maternal and perinatal pregnancy outcome. Data collection and analysis: data were collected from facility antenatal, intrapartum and postpartum records, as well as from MoH and MSF databases maintained for routine programme monitoring. Chisquare tests were performed comparing the baseline year (2005) with the year of study end (2009). Results: Uptake of peripartum care had improved markedly by the end of the five-year study period: the percentages of pregnant women who took up antenatal, intrapartum and postpartum care increased by 30%, 25% and 20% respectively. The number of family planning consultations increased by almost 50% and the number of women treated for sexually transmitted infections more than doubled. Interactions between HIV-care and general reproductive health care had positive effects on key health system components, including governance, health financing, human resources and drug supply. Reliable pregnancy outcome indicators for the entire observation period were difficult to obtain due to likely under-reporting of facility-based maternal and perinatal mortality. However, previously documented results from Thyolo show a reduction of facility-based severe maternal complications, including uterine rupture, between 2007 and 2009. Conclusions: Uptake of reproductive health services and facility-based maternal outcomes increased markedly during the period of HIV scale–up. This implies that the scale up of HIV-care did not inhibit, and likely increased, uptake of reproductive health services, while quality improvements in perinatal care could still be successfully implemented. The finding that ART and PMTCT care may be successfully integrated into broader reproductive health services with satisfying outcomes is a strong argument for continued scale up of ART and PMTCT in similar settings.
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    Determinants of maternal delivery at rural health facilities a study undertaken in the Mpigi District of Uganda
    (2011) Mabirizi, David; De Groot, Herman
    Mpigi District is a rural district in Uganda with high maternal morbidity and mortality. While most pregnant women in Uganda attend antenatal clinics, few ultimately deliver their babies in a health facility. Interventions have not achieved increased utilisation of maternal services. A review of maternal determinants and factors associated with health facility delivery is the focus of this study. To determine the reasons why women deliver in health facilities; to identify the maternal determinants or factors associated with health facility delivery; and to determine the socio-demographic characteristics of women who deliver in health facilities. This quantitative, descriptive, cross-sectional study of 257 women who delivered in the Mpigi District in 2008/2009 used face-to-face interviews at which a questionnaire was administered. Women delivered in health facilities because they expected a safe delivery. Ten factors were found to be significantly associated with a higher possibility of health facility delivery: eight or more years of education (P=0.002); previous health facility delivery (P<0.0001); first delivery in a health facility (P<0.0001); no history of a non-health facility delivery (P <0.0001); more than 50% of deliveries in a health facility (P=0.007); three or more antenatal care visits (P=0.031); above-average socio-economic status (P=0.016); living in a household of three or fewer individuals (P=0.028); living within 30 minutes? travel time of a health facility (P=0.007); and history of contraceptive use (P=0.046). These are the maternal determinants of health facility delivery in this rural setting. The mothers that delivered in health facilities were 15 and 29 years old (85.2%), either married or cohabiting (77.5%), had completed eight years or more of formal education (53.5%), lived within a radius of up to 30 minutes? journey from a health facility (67.2%) and lived in a household of four or more individuals (76.0%). This study shows that there are specific maternal characteristics (sociodemographic descriptors) that are associated with increased possibility of health facility delivery.
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    The effect of a training and clinical facilitation programme for registered midwives in primary maternity settings with respect to managing labour: a pragmatic cluster randomised trial
    (2015) Clow, Sheila Elizabeth; Swingler, George H; Pattinson, R C
    Background: Intrapartum complications contribute to nearly half of all avoidable maternal and perinatal deaths nationally. Inadequate understanding of the labour process by midwives, poor documentation of labour monitoring and inadequate systemlevel support may lead to wrong diagnosis, incorrect management, and the potential for missed opportunities to prevent mortality. Aim: To evaluate the effect of an intervention package of training and clinical facilitation on the quality of clinical management in labour by registered midwives in primary level public sector health facilities in rural South Africa. Methods: Research design : Pragmatic cluster randomised trial with 12 month follow-up. Setting and participants : Seventeen clusters stratified by geo-political region and size of service; 1020 labour records (60 per cluster / site; systematic random sample); and 154 registered midwives employed in the study sites during the study period. Participants were not blinded. Intervention : A package of clinical faclitation training for selected experienced midwife clinicians / managers, and an intrapartum educational update for midwives. Intervention and control sites continued receiving routine communication, all clinical guidelines and scheduled outreach activities. Main outcome measures : Primary outcome - clinical practice measuring partograph utilisation, using a modified partograph checklist, the testing of which is described in this study. Secondary outcome - midwives’ knowledge and skills, measured by written and clinical tests. Outcomes were analysed at the individual level using regression methods that allowed for clustering. The evaluator was blinded to the study allocation. Findings: The mean scores for the total partograph were not statistically significantly different between arms; the mean difference was 1.55 points out of a possible score 47 (95% CI: -1.18 to 4.28) p= 0.27. At a score of 27 the estimated absolute difference was 13.6% (95% CI : 0.16 to 0.25) p = 0.026. The total score for midwives’ knowledge and skills was 7 points (out of a possible 119) higher in the intervention arm (95% CI : 2.1 to 12.3), p=0.006. Conclusions: Although there was no difference in the quality of the overall completion of the partograph, there was a statistically significant difference in those of better quality completions in the intervention arm. Midwives’ knowledge and skills were higher in the intervention arm and those in the control arm deteriorated over time. This difference was statistically significant. Recommendations and implications for practice: This indicates a critical need to provide continuing professional education to midwives and to arrange midwifery staffing that optimises clinical practice in settings where intrapartum care is offered. In addition to regular, sustainable programmes to enhance partograph utilisation and midwife knowledge and skills, barriers to the utilisation of the partograph need to be investigated and addressed.
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    The epidemiology and diagnosis of childhood tuberculosis at a district hospital in Kwazulu-Natal, South Africa : a retrospective audit of clinical practice
    (2007) Padayachee, Samantha; Irlam, James; Patrick, Mark
    TB was declared a priority disease in South Africa ten years ago. Despite efforts to manage this illness, South Africa ranks as one of 22 high burden countries globally. TB is an important cause of childhood morbidity and mortality, but much of the emphasis of the NTP is on smear positive (adult) TB, as this is perceived to be the greater public health problem. The presence of HIV infection exacerbates both the incidence of TB, and the progress of TB from infection to the development of disease in both children and adults. The diagnosis of childhood TB has proved to be difficult and continues to challenge clinicians, despite technological advances in various spheres of medicine. Several guidelines and recommendations are available for diagnosing TB in children, including combinations of clinical criteria, special investigations, laboratory methods and score systems, but no gold standard exists.It is not clear how well the SANTCP guidelines for diagnosis of childhood TB are being implemented at Emmaus Hospital, or whether these guidelines are still appropriate within the context of high HIV prevalence. Not enough is known about the epidemiology of childhood TB in the Okhahlamba local municipal area surrounding Emmaus hospital to guide optimal management of children. Given the likely magnitude of the problem of childhood TB in this rural area and the difficulties of diagnosis, research into the epidemiology and diagnosis of childhood TB in this context is necessary.
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    An evaluation of parental knowledge of childhood asthma in a Family Practice setting
    (1995) Moosa, Sulaiman Essa Ismail; Henley, Lesley
    The purpose of this study was to measure and evaluate parental knowledge and misconceptions with regard to asthma and its treatment, to identify parental concerns with regard to the disease and its effects on their children, and to identify selected socio-demographic and medical correlates of the above. A cross-sectional survey was conducted among 54 families with a child with asthma. The sample comprised all the parents of a consecutive series of asthmatic patients between the ages of two to eighteen years attending a family practice in Mandalay on the Cape Flats. Data were collected by means of a structured questionnaire administered to 52 mothers and 48 fathers, reflecting a 95.2 per cent response rate. Respondents completed the questionnaire in their homes. A 55 item Asthma Knowledge Test was developed and validated to assess medical knowledge. Parents obtained an average score of 72%. Scores of over 70% were obtained in the sub-sections of aetiology, symptomatology, pathophysiology, precipitants and environmental control. Parents were less informed in the sub-sections of asthma prognosis, general medical knowledge and asthma therapy. Misconceptions and deficiencies in asthma knowledge which could lead to inadvertent non-compliance were identified. The following misconceptions were shared by a significant number of parents: inhaler therapy weakens the heart, regular administration of medication leads to addiction and medicines becoming ineffective, and folk remedies are effective in asthma therapy. Parental educational status was the only significant correlate with performance on the Asthma Knowledge Test. There was no significant difference in the performances of mothers and fathers. 47% of parents smoked but there was no significant difference in the scores of smokers and non-smokers. Parental concerns centred predominantly on their lack of confidence to manage acute asthma attacks, followed by concern as to whether their children will outgrow asthma. Dependence on asthma medication and its perceived harmful effect on the heart and lungs were other concerns. The findings suggest the need for systematic asthma education especially with regard to acute attack management and preventive medications. The aims of such education should be to increase asthma knowledge, develop skills, improve attitudes, and develop positive expectations toward the outcome and effectiveness of treatment. An effort should be undertaken to discourage parental smoking in asthmatic families. Attention should be given to dispel misconceptions during educational programmes. The increased information needs of parents with a lower education should be addressed by health professionals. Parents should receive adequate information during the early stages of the disease to minimise their insecurity in coping with the illness and prevent the development of misconceptions that undermine their confidence in medications and care givers.