Browsing by Subject "Public health"

Now showing 1 - 15 of 15
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    A centile chart for birth weight for an urban population of the Western Cape
    (1995) Theron, G B; Thompson, M L
    Evidence from large epidemiological studies has supported concern that being born light for gestational age (LiGA) may be detrimental. The incidence of LiGA babies is an important indicator of the health of women of reproductive age in deprived communities. In the assessment of LiGA in the Western Cape, centile charts constructed for populations in other parts of the world are generally used. These charts, however, may not be appropriate. Patients residing in the area served by the Tygerberg Hospital obstetric service, who booked early with singleton pregnancies, had their gestational age confirmed by early ultrasound and delivered between 1 March 1989 and 28 February 1990 were included in the study. The sample consisted of 3 643 patients. The mean birth weight was 2 995 g (SD 573 g) and the range 760 - 5 080 g. The distribution of birth weight at each week of gestation from 28 to 42 weeks was not normal. The 4-parameter Johnson family of densities was used to model the distribution of birth weight at each gestational age. A comparison of the distribution of birth weight in the study relative to the perinatal growth chart for international reference constructed by Dunn was also made. In addition to considering an overall chart, the sample was subdivided according to a number of characteristics (e.g. gender, firstborn and latter-born babies, smoking habit, hypertensive disorders and induction of labour) in order to explore their impact on the distribution of birth weight. Having explored the potential impact of all these factors, it was concluded that a single chart including all patients could be constructed.
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    Developing, implementing, and monitoring tailored strategies for integrated knowledge translation in five sub-Saharan African countries
    (BioMed Central, 2023-09-04) Sell, Kerstin; Jessani, Nasreen S.; Mesfin, Firaol; Rehfuess, Eva A.; Rohwer, Anke; Delobelle, Peter; Balugaba, Bonny E.; Schmidt, Bey-Marrié; Kedir, Kiya; Mpando, Talitha; Niyibizi, Jean B.; Osuret, Jimmy; Bayiga-Zziwa, Esther; Kredo, Tamara; Mbeye, Nyanyiwe M.; Pfadenhauer, Lisa M.
    Background Integrated knowledge translation (IKT) through strategic, continuous engagement with decision-makers represents an approach to bridge research, policy and practice. The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA +), comprising research institutions in Ethiopia, Malawi, Rwanda, South Africa, Uganda and Germany, developed and implemented tailored IKT strategies as part of its multifaceted research on prevention and care of non-communicable diseases and road traffic injuries. The objective of this article is to describe the CEBHA + IKT approach and report on the development, implementation and monitoring of site-specific IKT strategies. Methods We draw on findings derived from the mixed method IKT evaluation (conducted in 2020–2021), and undertook document analyses and a reflective survey among IKT implementers. Quantitative data were analysed descriptively and qualitative data were analysed using content analysis. The authors used the TIDieR checklist to report results in a structured manner. Results Preliminary IKT evaluation data (33 interviews with researchers and stakeholders from policy and practice, and 31 survey responses), 49 documents, and eight responses to the reflective survey informed this article. In each of the five African CEBHA + countries, a site-specific IKT strategy guided IKT implementation, tailored to the respective national context, engagement aims, research tasks, and individuals involved. IKT implementers undertook a variety of IKT activities at varying levels of engagement that targeted a broad range of decision-makers and other stakeholders, particularly during project planning, data interpretation, and output dissemination. Throughout the project, the IKT teams continued to tailor IKT strategies informally and modified the IKT approach by responding to ad hoc engagements and involving non-governmental organisations, universities, and communities. Challenges to using systematic, formalised IKT strategies arose in particular with respect to the demand on time and resources, leading to the modification of monitoring processes. Conclusion Tailoring of the CEBHA + IKT approach led to the inclusion of some atypical IKT partners and to greater responsiveness to unexpected opportunities for decision-maker engagement. Benefits of using systematic IKT strategies included clarity on engagement aims, balancing of existing and new strategic partnerships, and an enhanced understanding of research context, including site-specific structures for evidence-informed decision-making.
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    Do South African medical students of rural origin return to rural practice?
    (2003) de Vries, Elma; REID, Steve
    OBJECTIVES: To investigate the career choices of medical graduates of rural origin in the South African context, and to determine what proportion of rural-origin graduates are currently practising in a rural area. DESIGN: This is a retrospective descriptive study. Doctors' addresses at the time of graduation were compared with their current addresses in terms of rural/urban classification, and a questionnaire survey was done. SUBJECTS: Sample A consisted of a cohort of doctors who graduated in 1991 and 1992. Sample B consisted of the 1994-1996 graduates of two medical schools. OUTCOME MEASURES: Percentage of rural-origin graduates in rural practice. RESULTS: In sample A 14.4% were rural-origin students. When comparing addresses, it was found that 38.4% of rural-origin graduates are currently practising in rural areas, compared with 12.4% of urban-origin graduates (p < 0.001). The questionnaire data showed that 45.9% of the rural-origin respondents are in rural practice, compared with 13.3% of the urban-origin respondents (p = 0.001). In sample B, 41.61% of the rural-origin graduates are in rural practice compared with 5.08% of urban-origin graduates (p < 0.001). CONCLUSION AND RECOMMENDATIONS: The findings suggest that the South African situation is similar to that in other countries, with rural-origin medical students more likely to choose rural careers than urban-origin students. Rural-origin graduates are also more likely to choose general practice. It is recommended that the selection criteria of the medical faculties be reviewed with regard to rural origin, and that the career aspirations of applicants to medical school be taken into account in selection, particularly with regard to primary care or general practice.
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    Effects of long-term organophosphate exposures on neurological symptoms, vibration sense and tremor amongst South African farm workers
    (1998) London, Leslie; Nell, V; Thompson, M L; Myers, J E
    OBJECTIVES: This study assessed the relationship between long-term exposure to organophosphate insecticides and neurological symptoms, vibration sense, and motor tremor after control for the effect of past poisoning and acute exposure. METHODS: This cross-sectional study included 164 pesticide applicators and 83 nonspraying reference workers on deciduous fruit farms. The workers were tested on the Vibratron II, on tests of dynamic and static tremor, and for a set of neurological and "dummy" symptoms. Exposure was derived with the use of a job-exposure matrix for pesticides in agriculture. RESULTS: Compared with nonapplicators, current applicators reported significantly more dizziness, sleepiness, and headache and had a higher overall neurological symptom score. This association remained statistically significant after multiple logistic regression analyses controlling for a range of confounders and effect modifiers [odds ratio (OR) 2.25, for current applicators having high neurological score, 95% confidence interval (95% CI) 1.15-4.39]. The average lifetime intensity of organophosphate exposure was nonsignificantly associated with both neurological (OR 1.98, 95% CI 0.49-7.94) and "dummy" symptoms (OR 2.37, 95% CI 0.54-10.35). Previous pesticide poisoning was significantly associated with the neurological scores (OR 4.08, 95% CI 1.48-11.22) but not with the "dummy" symptoms. Vibration sense outcomes were associated with age and height, but not with the organophosphate exposure measures. In the multiple linear regression modeling for tremor intensity in the dominant hand, recent organophosphate exposure in the past 10 days was a significant predictor (partial correlation coefficient = 0.04), but none of the long-term organophosphate exposure measures were significant. CONCLUSIONS: Strong evidence was found for an association between symptom outcomes and past organophosphate poisoning and between symptom outcomes and current spray activity. In contrast to symptoms, there was no association between either past poisoning or current spray activity and vibration sense or tremor outcome. Long-term organophosphate exposure did not appear to predict symptoms, vibration sense, or tremor outcome.
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    Explaining and responding to the Ebola epidemic
    (2015-03-04) Benatar, Solomon
    Abstract The Ebola epidemic in West Africa is not merely a biomedical problem that can be seen in isolation and dealt with only through emergency medical rescue processes. The ethical dilemmas surfaced by this epidemic are also not confined to the usual micro-ethical problems associated with medical care and medical research. The pandemic, as one of many manifestations of failed human and social development that has brought the world to dangerous ‘tipping points’, requires deep introspection and action to address upstream causal processes.
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    Far fewer missed opportunities for immunisation in an integrated child health service
    (1993) Harrison, David; Barron, Peter; Glass, Belinda; Sonday, Shahim; van der Heyde, Yolande
    The mobile nature of the population of Kayelitsha makes it imperative that opportunities for immunisation of children are exploited at every visit to health services. Previous studies have demonstrated a high incidence of missed opportunities for immunisation at curative health services. The occurrence of undetected opportunities for immunisation are compared at two primary care institutions: one in which curative and preventive services are provided separately, and one in which these functions are integrated. Far fewer opportunities for immunisation were missed at the integrated service, underscoring the urgency of integrating child health services throughout the country.The mobile nature of the population of Kayelitsha makes it imperative that opportunities for immunisation of children are exploited at every visit to health services. Previous studies have demonstrated a high incidence of missed opportunities for immunisation at curative health services. The occurrence of undetected opportunities for immunisation are compared at two primary care institutions: one in which curative and preventive services are provided separately, and one in which these functions are integrated. Far fewer opportunities for immunisation were missed at the integrated service, underscoring the urgency of integrating child health services throughout the country.
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    Fidelity of HIV programme implementation by community health workers in rural Mopani district, South Africa: a community survey
    (BioMed Central, 2018-09-06) Naidoo, Nireshni; Railton, Jean P; Khosa, Sellina N; Matlakala, Nthabiseng; Marincowitz, Gert; McIntyre, James A; Struthers, Helen E; Igumbor, Jude; Peters, Remco P H
    Background South Africa has implemented a community health programme delivered by community health workers (CHWs) to strengthen primary healthcare services. Provision of community Human Immunodeficiency Virus (HIV) services constitutes an important component of this programme. To support effectiveness, we assessed fidelity of HIV programme implementation by CHWs from the community’s perspective in a rural South African setting. Methods A cross-sectional study was conducted targeting 900 randomly selected households in twelve wards of two sub-districts (Greater Giyani and Greater Letaba) of Mopani District (Limpopo Province, South Africa). Questionnaires were administered to the traditionally most appropriate adult member of the household. Included were questions related to the four standard components to measure implementation fidelity against local guidelines: coverage, frequency, duration and content of HIV programme implementation. Results Participants were enrolled at 534 households; in most other cases there was nobody or no adult member at home (n = 291). Reported coverage of 55% (141/253) and a frequency of 47% (66/140) were higher in Greater Giyani as compared to Greater Letaba (44%; 122/278 and 29%; 33/112, respectively, p = 0.007 for both comparisons). Coverage was not associated with the distance from the participant’s household to the facility (p = 0.93). Duration of programme delivery was reported to be high, where all CHW visits (253/253; 100%) were conducted within the last 6 months and the content delivered was adequate (242/253; 96%). Individuals reporting a CHW visit were more likely to know their HIV status than those not visited (OR = 2.0; 95% CI 1.06–3.8; p = 0.032). Among those visited by the CHW discussion of HIV was associated with knowing the HIV status (OR = 2.2; 95% CI 1.02–4.6; p = 0.044); in particular for women (OR = 2.9; 95% CI 1.5–5.4; p = 0.001). Conclusions This study demonstrates promising HIV programme implementation fidelity by CHWs in rural South Africa. Programme coverage and frequency should be improved whilst maintaining the good levels of duration and content. Resource investment, strengthening of operational structure, and research to identify other facilitators of programme implementation are warranted to improve programme effectiveness and impact.
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    General practitioners and national health insurance - Results of a national survey
    (1999) BLECHER, M; JACOBS, T; McIntyre, D
    OBJECTIVE: To determine the attitudes of South African general practitioners (GPs) to national health insurance (NHI), social health insurance (SHI) and other related health system reforms. DESIGN: A national survey using postal questionnaires and telephonic follow-up of non-responders. SETTING: GPs throughout South Africa. PARTICIPANTS: Four hundred and forty-three GPs were randomly selected from a national sampling frame of 6,781 GPs. MAIN OUTCOME MEASURES: Acceptance of NHI and GP preferences with regard to financing, provision, benefits, coverage and the role of GPs. MAIN RESULTS: A response rate of 82.1% was achieved. Sixty-two per cent of GPs approved of the introduction of some form of social or NHI in South Africa, while 24.1% disapproved. Approval rose to 81.6% if GPs were to maintain their independent status, e.g. own premises and working hours, to 75% if additional private top-up insurance was allowed, and to 79.9% if payment was by fee-for-service. Seventy per cent of GPs in the study stated that they had the capacity to treat more patients. The most important reason given for approving of NHI was to make health care more equitable and accessible to the majority of South Africans. A high proportion of GPs approved of increasing the level of interaction between GPs and district health authorities. CONCLUSIONS: Most GPs approved of some form of social or NHI system, provided that the system did not significantly threaten their professional autonomy or economic and financial situation.
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    Human microbiota research in Africa: a systematic review reveals gaps and priorities for future research
    (2021-12-15) Allali, Imane; Abotsi, Regina E; Tow, Lemese A; Thabane, Lehana; Zar, Heather J; Mulder, Nicola M; Nicol, Mark P
    Background The role of the human microbiome in health and disease is an emerging and important area of research; however, there is a concern that African populations are under-represented in human microbiome studies. We, therefore, conducted a systematic survey of African human microbiome studies to provide an overview and identify research gaps. Our secondary objectives were: (i) to determine the number of peer-reviewed publications; (ii) to identify the extent to which the researches focused on diseases identified by the World Health Organization [WHO] State of Health in the African Region Report as being the leading causes of morbidity and mortality in 2018; (iii) to describe the extent and pattern of collaborations between researchers in Africa and the rest of the world; and (iv) to identify leadership and funders of the studies. Methodology We systematically searched Medline via PubMed, Scopus, CINAHL, Academic Search Premier, Africa-Wide Information through EBSCOhost, and Web of Science from inception through to 1st April 2020. We included studies that characterized samples from African populations using next-generation sequencing approaches. Two reviewers independently conducted the literature search, title and abstract, and full-text screening, as well as data extraction. Results We included 168 studies out of 5515 records retrieved. Most studies were published in PLoS One (13%; 22/168), and samples were collected from 33 of the 54 African countries. The country where most studies were conducted was South Africa (27/168), followed by Kenya (23/168) and Uganda (18/168). 26.8% (45/168) focused on diseases of significant public health concern in Africa. Collaboration between scientists from the United States of America and Africa was most common (96/168). The first and/or last authors of 79.8% of studies were not affiliated with institutions in Africa. Major funders were the United States of America National Institutes of Health (45.2%; 76/168), Bill and Melinda Gates Foundation (17.8%; 30/168), and the European Union (11.9%; 20/168). Conclusions There are significant gaps in microbiome research in Africa, especially those focusing on diseases of public health importance. There is a need for local leadership, capacity building, intra-continental collaboration, and national government investment in microbiome research within Africa. Video Abstract
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    Is the golden hour optimally used in South Africa for children presenting with polytrauma?
    (2013) Zuidgeest, J; Jonkheijm, A; Van Dijk, M; Van As, A
    BACKGROUND: The major paediatric public health problem worldwide is injury or trauma. In 2004, 950 000 children died as a result of injury. OBJECTIVE: The aim of this study was to evaluate the logistics of medical care after paediatric polytrauma within the first hours after arrival into a trauma unit - the so-called Golden Hour. METHODS: Children presenting with polytrauma to the Trauma Unit at the Red Cross War Memorial Children's Hospital between May 2011 and August 2011 were considered for inclusion in the study. RESULTS: Fifty-five children were included in the final analysis. The median duration of stay in the Trauma Unit was 205 minutes (interquartile range 135 - 274). CONCLUSION: Several factors were identified that unnecessarily prolonged the time that patients stayed in the trauma unit following arrival in hospital for polytrauma management.
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    Modes of transmission and attack rates of group A Streptococcal infection: a protocol for a systematic review and meta-analysis
    (2021-03-31) Barth, Dylan D; Daw, Jessica; Xu, Ruomei; Enkel, Stephanie; Pickering, Janessa; McRae, Tracy; Engel, Mark E; Carapetis, Jonathan; Wyber, Rosemary; Bowen, Asha C
    Background Group A Streptococcus (Strep A) is an important cause of mortality and morbidity globally. This bacterium is responsible for a range of different infections and post-infectious sequelae. Summarising the current knowledge of Strep A transmission to humans will address gaps in the evidence and inform prevention and control strategies. The objective of this study is to evaluate the modes of transmission and attack rates of group A streptococcal infection in human populations. Methods This systematic review protocol was prepared according to the Preferred Reporting Items for Systematic reviews and Meta-analysis Protocols (PRISMA-P) 2015 Statement. Using a comprehensive search strategy to identify any transmission studies that have been published in English since 1980, full-text articles will be identified and considered for inclusion against predefined criteria. We will include all studies reporting on Strep A transmission, who have identified a mode of transmission, and who reported attack rates. Risk of bias will be appraised using an appropriate tool. Our results will be described narratively and where feasible and appropriate, a meta-analysis utilizing the random-effects model will be used to aggregate the incidence proportions (attack rates) for each mode of transmission. In addition, we will also evaluate the emm genotype variants of the M protein causing Strep A infection and the association with transmission routes and attack rates, if any, by setting, socioeconomic background and geographical regions. Discussion We anticipate that this review will contribute to elucidating Strep A modes of transmission which in turn, will serve to inform evidence-based strategies including environmental health activities to reduce the transmission of Strep A in populations at risk of severe disease. Trial registration Systematic review registration: PROSPERO ( CRD42019138472 ).
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    The Next Generation Scientist program: capacity-building for future scientific leaders in low- and middle-income countries
    (BioMed Central, 2018-10-10) Pillai, Goonaseelan; Chibale, Kelly; Constable, Edwin C; Keller, Akiko N; Gutierrez, Marcelo M; Mirza, Fareed; Sengstag, Christian; Masimirembwa, Collen; Denti, Paolo; Maartens, Gary; Ramsay, Michèle; Ogutu, Bernhards; Makonnen, Eyasu; Gordon, Richard; Ferreira, Carlos G; Goldbaum, Fernando A; Degrave, Wim M S; Spector, Jonathan; Tadmor, Brigitta; Kaiser, Hedwig J
    Background Scientific and professional development opportunities for early career scientists in low- and middle- income countries (LMICs) are limited and not consistent. There is a disproportionately low number of biomedical and clinical researchers in LMIC’s relative to their high burden of disease, a disparity that is aggravated by emigration of up to 70% of scientists from their countries of birth for education and employment elsewhere. To help address this need, a novel University-accredited, immersive fellowship program was established by a large public-academic-private network. We sought to describe the program and summarize progress and lessons learned over its first 7-years. Methods Hallmarks of the program are a structured learning curriculum and bespoke research activities tailored to the needs of each fellow. Research projects expose the scientists to state-of-the-art methodologies and leading experts in their fields while also ensuring that learnings are implementable within their home infrastructure. Fellows run seminars on drug discovery and development that reinforce themes of scientific leadership and teamwork together with practical modules on addressing healthcare challenges within their local systems. Industry mentors achieve mutual learning to better understand healthcare needs in traditionally underserved settings. We evaluated the impact of the program through an online survey of participants and by assessing research output. Results More than 140 scientists and clinicians from 25 countries participated over the 7-year period. Evaluation revealed strong evidence of knowledge and skills transfer, and beneficial self-reported impact on fellow’s research output and career trajectories. Examples of program impact included completion of post-graduate qualifications; establishment and implementation of good laboratory- and clinical- practice mechanisms; and becoming lead investigators in local programs. There was a high retention of fellows in their home countries (> 75%) and an enduring professional network among the fellows and their mentors. Conclusions Our experience demonstrates an example for how multi-sectoral partners can contribute to scientific and professional development of researchers in LMICs and supports the idea that capacity-building efforts should be tailored to the specific needs of beneficiaries to be maximally effective. Lessons learned may be applied to the design and conduct of other programs to strengthen science ecosystems in LMICs.
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    Using theory of change to design and evaluate public health interventions: a systematic review
    (2015) Breuer, Erica; Lee, Lucy; De Silva, Mary; Lund, Crick
    Background Despite the increasing popularity of the theory of change (ToC) approach, little is known about the extent to which ToC has been used in the design and evaluation of public health interventions. This review aims to determine how ToCs have been developed and used in the development and evaluation of public health interventions globally. Method s We searched for papers reporting the use of “theory of change” in the development or evaluation of public health interventions in databases of peer-reviewed journal articles such as Scopus, Pubmed, PsychInfo, grey literature databases, Google and websites of development funders. We included papers of any date, language or study design. Both abstracts and full text papers were double screened. Data were extracted and narratively and quantitatively summarised. Results A total of 62 papers were included in the review. Forty-nine (79 %) described the development of ToC, 18 (29 %) described the use of ToC in the development of the intervention and 49 (79 %) described the use of ToC in the evaluation of the intervention. Although a large number of papers were included in the review, their descriptions of the ToC development and use in intervention design and evaluation lacked detail. Conclusions The use of the ToC approach is widespread in the public health literature. Clear reporting of the ToC process and outputs is important to strengthen the body of literature on practical application of ToC in order to develop our understanding of the benefits and advantages of using ToC. We also propose a checklist for reporting on the use of ToC to ensure transparent reporting and recommend that our checklist is used and refined by authors reporting the ToC approach.
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    Using theory of change to design and evaluate public health interventions: a systematic review
    (BioMed Central, 2016-05-06) Breuer, Erica; Lee, Lucy; De Silva, Mary; Lund, Crick
    Background: Despite the increasing popularity of the theory of change (ToC) approach, little is known about the extent to which ToC has been used in the design and evaluation of public health interventions. This review aims to determine how ToCs have been developed and used in the development and evaluation of public health interventions globally. Methods: We searched for papers reporting the use of “theory of change” in the development or evaluation of public health interventions in databases of peer-reviewed journal articles such as Scopus, Pubmed, PsychInfo, grey literature databases, Google and websites of development funders. We included papers of any date, language or study design. Both abstracts and full text papers were double screened. Data were extracted and narratively and quantitatively summarised. Results: A total of 62 papers were included in the review. Forty-nine (79 %) described the development of ToC, 18 (29 %) described the use of ToC in the development of the intervention and 49 (79 %) described the use of ToC in the evaluation of the intervention. Although a large number of papers were included in the review, their descriptions of the ToC development and use in intervention design and evaluation lacked detail. Conclusions: The use of the ToC approach is widespread in the public health literature. Clear reporting of the ToC process and outputs is important to strengthen the body of literature on practical application of ToC in order to develop our understanding of the benefits and advantages of using ToC. We also propose a checklist for reporting on the use of ToC to ensure transparent reporting and recommend that our checklist is used and refined by authors reporting the ToC approach.
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    Women doctors in medical professional organisations in South Africa – a report by the Women in Medicine Workgroup
    (2003) Kane-Berman, Jocelyne; Hickman, Rosemary
    OBJECTIVES: To determine the level of representation of women doctors in medical professional organisations in South Africa historically and currently, and if not adequate, to ascertain the reasons for women's limited participation in medico-political activities. DESIGN: A descriptive study of the membership of South African medical professional organisations and their executive structures. OUTCOME MEASURES: The number and percentages of women doctors as members and at executive level in medical professional organisations compared with the number of registered women practitioners. RESULTS AND CONCLUSIONS: Women are inadequately represented at all levels in the great majority of organisations for which information was provided. In view of the rapidly increasing number of women doctors the profession and its professional bodies need to take active steps to promote the participation of women in these organisations.