Browsing by Subject "Public Health Medicine"

Now showing 1 - 5 of 5
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    Open Access
    An evaluation of the clinical audit of diabetes management at community health centres in the metro district of the Western Cape Province
    (2011) Govender, Indira; Ehrlich, Rodney
    This study aimed to evaluate the long-term trend in quality improvement and determine whether there had been an increase in the performance of diabetic clinical processes.
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    Open Access
    An evaluation of the role of an Intermediate Care facility in the continuum of care in Western Cape, South Africa
    (2015) Mabunda, Sikhumbuzo Advisor; London, Leslie; Pienaar, David
    BACKGROUND: A comprehensive Primary Health Care approach includes clear referral and continuity of care pathways. South Africa lacks data that describe Intermediate Care (IC) services and its role in the health system. This study aimed to describe the model of service provision at an IC facility and the role it plays in the continuity of care in Cape Town. METHODS: Sixty-eight patients (65% Response Rate) were recruited in a prospective cohort design over a one-month period in mid-2011. Patient data were collected from a clinical record review and an interviewer-administered questionnaire, administered at a median interval between admission and interview of 11 days to assess primary and second ary diagnosis, knowledge of and previous use of Home Based Care (HBC) services, reason for admission, demographics and information on referring institution. A telephonic interviewer-administered questionnaire to patients or their family members post-discharge recorded their vital status, use of HBC post-discharge and their level of satisfaction with care received at the IC facility. A Cox regression model was run to identify predictors of survival and the effect of a Care-plan on survival. Seventy staff members (82%) were recruited in a cross-sectional study using a self-administered questionnaire to describe demographics, level of education and skills in relation to what they did for patients and what they thought patients needed. RESULTS: Of the 68 participants, 38 % and 24% were referred from a secondary and tertiary hospital, respectively, and 78% were resident of a higher income community. Stroke (35%) was the most common single reason for admission at acute hospital. The three most common reasons reported by patients why care was better at the IC facility than the referring institution was the caring and friendly staff, the presence of physiotherapy and the wound care. Even though a large proportion of the IC inpatients had been admitted in a health facility on the year preceding the study, only 13 patients (21%) had used a Community Health Worker (CHW) ever before and only 25% (n=15) of the discharged patients had a confirmed CHW visit post-discharge. The presence of a Care-plan was significantly associated with a 62% lower risk of death (Hazard Ratio: 0.380; CI 0.149-0.972). Notably, 46% of staff members reported performing roles that were outside their scope of practice and there was a mismatch between what staff reported doing and their actual tasks. In addition, of the 57 patients that could be traced on follow-up 21(37%) had died. CONCLUSION: Patients and family understood this service as a caring environment that is primarily responsible for rehabilitation services. Furthermore, a Care-plan which extends beyond admission could have a significant impact on reducing mortality. IC services should therefore be recognised as an integral part of the health system and it should be accessed by all who need it.
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    Open Access
    Expanded programme for immunisation: Review of the Western Cape Department of health public private partnership
    (2021) Werner, Jesse; Cleary, Susan; Boulle, Andrew
    Background: The demand for healthcare services has been steadily increasing over the years whilst the health system is subjected to increasing resource limitations. The private sector has therefore, in various ways, including Public Private Partnerships, been viewed as a means to address these resource limitations. The Western Cape Department of Health has undertaken to expand the Expanded Programme for Immunisation as a Public Private Partnership. The programme aims to improve population health outcomes through increased vaccination coverage and service access. Benefits and challenges of such partnerships have been identified in various contexts. However, there is a significant research gap pertaining to public partnerships with for-profit entities, particularly in Sub-Saharan Africa. Objectives: The study sought firstly to describe the socio-demographic characteristics of clients who utilised the Expanded Programme for Immunisation public private partnership services in the 2016/17 financial year. Secondly, to compare the socio-demographic characteristics of those using the Expanded Programme for Immunisation public private partnership services to those using the Expanded Programme for Immunisation services in Western Cape public sector facilities. Thirdly to describe the proportion of Expanded Programme for Immunisation public private partnership clients who have utilised public sector facilities for healthcare in the Western Cape. Finally, to describe the provincial health staff experiences of the service. Methods: A descriptive quantitative cross sectional study and 12 semi- structured interviews were undertaken to fulfill the objectives of the study. The study population was clients who utilised the Western Cape Department of Health Expanded Programme for Immunisation services from April 2016 to March 2017 in the Western Cape Province. Convenience sampling of public private partnership clients was conducted which enabled the descriptive analysis whilst a random sample of public sector immunisation clients enabled the socio-economic status comparison to the public private partnership clients. Socio-economic status was analysed by reviewing the annual head of household income of clients estimated by client postal code. Western Cape Government staff were selected for interviews to gain insights into provinical staff experiences of the partnership. This was conducted by snowball sampling methods. Univariate analysis was conducted on data submitted by 80 private partners and thematic coding was used to analyse the staff interviews. Results: The proportion of provincial Expanded Programme for Immunisation client visits attributable to the public private partnerships was approximately 12% in 2016/17. The 80 participating private partners provided almost 60, 000 vaccinations to 23,695 clients in the period of a year. The public private partnership appears to be accessed by users who are of similar socioeconomic status to the Expanded Programme for Immunisation clients accessing public sector facilities. Additionally, the small proportion (12.2%) of public private partnership clients having access to medical insurance further supports the findings of the similar socioeconomic profile of the two groups. 42.7% of public private partnership clients were found to have visited public sector facilities therefore suggesting that in the absence of the public private partnership they might otherwise have utilised the public sector to attain the service. Notwithstanding concerns around management and governance, the initiative is generally appreciated and supported by government stakeholders. Conclusions and recommendations: The Western Cape Department of Health Expanded Programme for Immunisation public private partnerships operate at a scale that accounts for a meaningful proportion of the immunisation coverage and is utilised by clients of similar socioeconomic status when compared to Expanded Programme for Immunisation clients accessing public sector facilities. The small proportion of public private partnership clients having access to medical insurance suggests public private partnership clients might otherwise have utilised the public sector in the absence of the partnership. Overall, the public private partnership has been appreciated by the Western Cape Department of Health staff and affords clients a degree of financial risk protection. Future research areas include an economic evaluation, a benefits incidence analysis and the describing barriers to uptake of the service from the perspective of stakeholders external to the Western Cape Department of Health.
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    Missed opportunities for immunisation in health facilities in the Western Cape metro
    (2016) Jacob, Nisha Anne Sunny; Coetzee, David
    Background: Childhood immunisations are a cost effective public health intervention for prevention of infectious diseases. Immunisation coverage, however, is still sub-optimal which may result in disease outbreaks. Immunisation at every contact with a health facility is a strategy developed by the World Health Organization (WHO) in order to improve immunisation coverage. Objectives: The aim of this study was to estimate the prevalence of missed opportunities for immunisation at different levels of healthcare in the Western Cape and assess factors associated with missed opportunities. Methods: The study included a health-facility based cross-sectional exit survey of caregivers with children up to 5 years of age, followed by a qualitative exploration of staff attitudes towards immunisation. Results: The prevalence of missed opportunities for immunisation was 4.6%; 81.3% of caregivers brought Road-To-Health- Booklets (RTHB's) to consultations. Overall, 56.0% of health workers requested to see the RTHB's during consultations. Children attending primary level facilities were significantly more likely to have their RTHB's requested than children attending a tertiary level facility. Lack of training, resources and heavy workloads were the main challenges reported at secondary/tertiary level facilities.
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    Using proxy markers from routine diagnostic PCR testing to assess the disease severity of new SARS-CoV-2 variants
    (2023) Hussey, Hannah; Davies, Mary-Ann
    Background With the emergence of new SARS-CoV-2 variants, understanding the clinical implications of these variants in our South African setting is critical. The Delta variant (B.1.617.2) has been associated with more severe disease, but most of this data is from high income countries. And while the Omicron variant (B.1.1.529, sub-lineages BA.1 and BA.2) has been associated with a reduced risk of severe disease, it is uncertain whether this is caused by a decrease in variant virulence or by higher levels of population immunity. Methods We used a novel proxy marker, RNA-dependent RNA polymerase (RdRp) target delay in the Seegene AllplexTM 2019-nCoV polymerase chain reaction assay, to identify suspected Delta variant infection in routine laboratory data. All cases diagnosed on this assay in the public sector in the Western Cape, South Africa, from 1 April to 31 July 2021 (for analysis of clinical severity of Delta vs previously circulating [mainly Beta] variant analysis) and from 1 November to 14 December 2021 (for analysis of clinical severity of Omicron vs Delta variant analysis), were included in the dataset provided by the Western Cape Provincial Health Data Centre (PHDC). We calculated odds/hazard ratios for the association between the proxy marker and death/hospitalization, adjusted for socio-demographic factors, comorbidities, prior diagnosed infection and vaccination status. Results For the analysis of the clinical severity of Delta vs previously circulating (mainly Beta) variants, we included 11,355 cases with 700 deaths. RdRp target delay (RTD - i.e., suspected Delta infection) was associated with higher mortality (adjusted odds ratio [aOR] 1.45; 95% confidence interval [CI]: 1.13-1.86), compared to presumptive Beta infection (absence of RTD). Prior diagnosed infection during the previous COVID-19 7 wave, which was driven by the Beta variant, was protective (aOR 0.32; 95%CI: 0.11-0.92) as was vaccination (aOR [95%CI] 0.15 [0.03-0.62] for complete vaccination [≥28 days post a single dose of Ad26.COV2.S or ≥14 days post second BNT162b2 dose]). For the Omicron (BA.1/BA.2) vs Delta variant analysis, we included 150 cases with RTD and 1486 cases without RTD. Cases without RTD (i.e., suspected Omicron cases) had a lower hazard of admission (adjusted hazard ratio [aHR], 0.56; 95% CI 0.34-0.91). Complete vaccination was protective against admission, with an aHR of 0.45 (95% CI, 0.26-0.77). Conclusion RdRp target delay, a proxy for infection with the Delta variant, is associated with an increased risk of mortality amongst those with laboratory-diagnosed COVID-19 in our setting. Omicron has resulted in a lower risk of hospital admission compared with contemporaneous Delta infection, when using the proxy marker of RTD. Under-ascertainment of reinfections with an immune escape variant remains a challenge to accurately assessing variant virulence. This study also resulted in two publications, that could be disseminated, initially on MedRxiv, and shared with policy makers in the Department of Health and other scientific colleagues in time to influence the pandemic response.