Browsing by Subject "developing country"

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    Open Access
    Clinicians' knowledge, attitudes and behaviours towards evidence-based practice using clinical presentations of dizziness and vertigo as an exemplar
    (2022) Clarke, Richard Matthew; Rogers, Christine
    Evidence-based practice (EBP) is an approach to clinical decision-making that incorporates well-researched and established scientific knowledge with other sources of knowledge such as practitioner experience, patient preferences, and clinical context. Use of EBP aims to provide standardised care, which is rooted in the best available evidence. Among the most important and arguably clinically relevant outcomes of EBP are Clinical Practice Guidelines (CPG), which cover a variety of topics in medicine and associated professions. CPG exist for vestibular conditions, which are prevalent in the general and medical populations. Nevertheless, there is some suggestion that EBP regarding dizziness is sub-optimal in wealthy countries, and little is known about CPG use in LMIC, particularly across the professions that would be expected to use them. However, despite the availability and proliferation of evidence in the health sciences, research has shown that uptake and utilisation of EBP is poor even in the Global North. In low- and middle-income countries (LMIC) such as South Africa where resources are scarce, previous research has suggested that additional challenges exist which are specific to the developing context. There is, however, little research on translation of EBP into clinical practice. Thus, this study sought to investigate the knowledge, attitudes, and practices towards evidence-based practice of a specific subset of South African clinicians (audiologists, otorhinolaryngologists, and physiotherapists) in South Africa, using assessment and management of dizzy patients as an exemplar. Mixed methodology achieved the study's aims. Phase one employed a two-part questionnaire. Fifty-four participants, comprising 37 audiologists, five Ear, nose and throat surgeons (ENTs), and nine physiotherapists were surveyed to identify their orientation towards EBP using the Evidence-Based Practice Profile Questionnaire (EBP2Q). Independent samples t-tests and one-way ANOVAs were used to analyse the EBP2Q data. Three cases of common vestibular pathologies (Ménière's disease, vestibular migraine, and persistent postural perceptual dizziness) based on the CPG, were developed by the researcher and a Delphi panel of experts. Survey participants answered questions regarding implementation of CPGs in each case. Cases were scored according to matches with the CPGs. Phase two adopted a qualitative, descriptive approach and comprised four mini focus groups with a total of 10 participants representing the three professions surveyed. The focus groups aimed to explore participants' self-perceived barriers and facilitators to the use of EBP in general as well as in the context of dizzy patients. The most clinically relevant result was that the case questionnaire analysis revealed that approximately half of participants were able to identify Meniere's disease and vestibular migraine, whereas only one quarter of participants could identify the case of functional dizziness. Focus groups revealed barriers to the use of EBP such as lack of access to research and lack of time to research. Furthermore, participants recognised that the complexity of dizzy patients had led to sub-optimal assessment and management of such patients. Quantitative results of the current study suggested that participants with additional exposure to research through postgraduate training had higher scores on the EBP2Q in four out of five domains and the total questionnaire score than those with undergraduate training only. These results were consistent with previous research from wealthy countries which suggested that increased exposure through postgraduate training and working at academic facilities results in better orientation towards EBP. However, mean domain scores amongst participants in studies from wealthy countries appear to be higher than those from the sample on the current South African study, although it is difficult to tell whether the difference is statistically significant. Additionally, there was no apparent influence of years' experience on orientation towards EBP, contradicting what has been found in previous research. Outcomes of the study suggest that while healthcare practitioners have good attitudes towards EBP, it is more effectively implemented by clinicians with postgraduate training. Further, ease of access and exposure to research is the greatest facilitator to use of research and EBP by clinicians. Despite that, barriers to uptake and utilisation of EBP such as lack of access to research, lack of contextually relevant research, and low confidence at appraising literature were described. In addition, barriers common to the Global North and Global South were recognised such as lack of time to conduct literature searches and overburdening of clinical staff. Finally, a gap was noted in the knowledge of practitioners managing dizzy patients, specifically regarding patients with functional dizziness. Thus, this study highlights the need for use and application of EBP to the management of dizzy patients. Additional training of audiologists, ENTs and physiotherapists may be required regarding effective, multidisciplinary management of dizzy patients.
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    A critical review of South Africa’s Carbon Tax Policy Paper: recommendations for the implementation of an Offset Mechanism
    (2013-12) Newham, Melissa; Conradie, Beatrice
    The South African government has emphasised the need for ‘developing country’ solutions to climate change that simultaneously pursue GHG reductions and socioeconomic development. To encourage the transition to a low-carbon economy the National Treasury has proposed a carbon tax and offset mechanism to be introduced in 2015. The practical delivery of the offset scheme remains uncertain. This paper investigates which features and governance structure would be desirable for such a mechanism in South Africa. Primary research is conducted into the South African voluntary carbon registry; Credible Carbon. The questions asked by this paper are: Should firms be allowed to offset emissions? What is the ideal way to implement offsets in South Africa? This paper concludes that Credible Carbon provides a good model for carbon trading that can be scaled up to meet demand under the new regulations. However, government needs to ensure that projects continue to deliver acceptable social benefits and that carbon auditors are well-trained and accountable.
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    Locally manufactured wheelchairs in Tanzania – are users satisfied?
    (2016-12) Amosun, Seyi; Ndosi, Aston; Buchanan, Helen
    Background: The government of Tanzania created opportunity for the production of wheelchairs that would be appropriate to the local needs and environment. Objectives: The study assessed the extent to which the wheelchairs met the activity and participation needs of the users, as well as the users’ level of satisfaction with the provision, repair and maintenance of these wheelchairs. Methods: A descriptive cross-sectional analytical design was utilized to collect data through the administration of a questionnaire among 75 adult wheelchair users. Results: Participants had used wheelchairs for an average period of 9.3 years. Most participants (61%) had sustained spinal cord injuries, and used three-wheeler chairs (76%). More than 90% reported that their wheelchairs positively influenced their activity and participation needs, and 85% were satisfied with their ability to carry out daily activities. Participants expressed satisfaction with the durability of the wheelchairs (89%), and the professional services received (71%), but not with follow-up services (77%). There was difference in satisfaction with features of 3-wheeler and 4-wheeler rigid chairs (p=0.030). Conclusion: The wheelchairs positively impacted participants’ activity and participation needs. Participants were satisfied with the features of the wheelchairs but not with follow-up services. The concerns of dissatisfied users should be addressed.