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MSc (Med) Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand / Research Project Title: HIV Prevalence and Factors Associated with HIV Infection in South Africa: Analysis of the Antenatal Clinic Survey Data. Background: In sub-Saharan Africa, the HIV epidemic is commonly monitored through the sentinel surveillance of pregnant women attending antenatal clinics (ANC), which provides important indications for planning and evaluating public-health interventions. Many of such surveillance systems in South Africa reported limited information on factors associated with HIV infection, even though the survey collected information related to a woman’s participation. This is likely to compromise the development of effective preventive programmes that are more focussed. To address this, the 2005 HIV (ANC) surveillance data was used with the objective of increasing the available information on the HIV epidemic in the country and identifying the socio-demographic factors associated with HIV infection in each province. Methodology: The data from the 2005 ANC survey was analysed in depth. The chi-square test was used to test bivariate associations for categorical associations of HIV infection and other associated factors. In addition a logistic regression model was used to explore the association of sociodemographic and other variables with HIV infection in each province. Results: The HIV prevalence reported in this study was similar to earlier reports released by the Department of Health in 2005. That is the overall HIV prevalence is 30.1% (29.5-30.8%) with KwaZulu Natal having the highest (39.1%, 37.5-40.1%) and Western Cape recorded the lowest HIV prevalence of 15.9% (14.1-17.4%).

Thesis (MSc.(Med.)(Pharmacy))--University of Limpopo, 2010. / According to the World Health Organisation, there should be an essential medicines list in every functioning health care system in the world. The Department of Health of South Africa published its first Essential Drugs List for Primary Health Care in 1996 and for paediatric and hospital use in 1998. The South African Defence Force published its Military Medicine Code List (MMCL) in 2002. Since the implementation of the code list in the military service, no research study has been undertaken to determine adherence to the code list by prescribers or to determine indicators for possible non-adherence to the MMCL. The main aim of the study was to evaluate prescribing adherence to the MMCL list by doctors and nurses in the Primary Health Care military clinics in Gauteng. Further objectives were to establish indicators for non-adherence and provide suggestions to improve adherence, to determine to which drugs non-adherence was directed and to determine the average number of items prescribed per prescription. A cross-sectional, mainly quantitative, descriptive study was conducted at 14 military PHC dispensing points in Gauteng. Data were collected retrospectively from 838 prescriptions, of which 348 were written by doctors and 490 by nurses. A questionnaire was used to collect data prospectively from seven doctors and 34 nurses on their perceptions of the use of the MMCL. The prescriptions were analysed for adherence to the stipulations of the MMCL. Proportions of adherent prescriptions and items were compared between prescriber type (doctors and nurses), facility type (pharmacies and dispensaries) and facility location (Northern Region, close to 1 Military Hospital and Southern Region), using the Chi-square test. Non-adherent items were tabulated and grouped. Data from the questionnaires were analysed descriptively. Indicators for possible non-adherence and suggestions for improvement of adherence were listed and grouped. The average number of items per prescription was 3.4. Overall, 89.9% of prescriptions (n=838) and 96.4% of items (n=2832) were adherent to the MMCL. xii More prescriptions written by doctors (96,8%) were adherent, compared to nurses (84,9%; P<0.001). Only a few items were responsible for non-adherence. Nonadherent items specifically for nurses included corticoid nasal sprays, azithromycin, meloxicam and ispagula husks. Adherence of prescriptions dispensed in dispensaries (no pharmacist) (93.0%) was higher compared to pharmacies (87.0%; P<0.004). Prescriptions from facilities in the South of Gauteng (96.5%) were more adherent than those near 1 Military Hospital (North) (87.7%; P<0.001). Reasons for non-adherence included staff shortages, implementation and availability of the MMCL, absence of standard treatment guidelines (STGs) in the MMCL and delayed referrals to specialist departments. Suggestions for improvement of adherence to the MMCL included better implementation and distribution of the code list, addressing staff shortages, including Standard Treatment Guidelines (STGs) in the code list and improving the referral system from clinics to hospitals.

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Abstract Traditionally, doctors and patients are based on different cognitions and ways of thinking to communicate with each other. Doctors are often holding dominated role in the process. The knowledge of doctors is coming from the curricula that they have learned at medical school and their clinical experience, whereas the knowledge of patients is coming from their health experience and the information which was reported in the common medical magazines and journals. Because of the different cognitive modes of medicine between doctors and patients, the efficiency of doctor-patient communication is usually unsatisfied. With the popularity of medical information, the rise of consumers¡¦ consciousness, and the change of health insurance system, patients are asking better quality of medical treatment now. Thus, the quality of doctor-patient communication seems to be more important. This research was employed by case study. The doctors and outpatients of the pediatrics department were selected as the research sample. Totally, the sample included six senior doctors with three different levels of hospital and 30 outpatients. The dialogs of interrogation enquiry between these doctors and patients were collected. The analytic framework was derived from Brown and Levinson¡¦s politeness theory, Grice¡¦s conversational maxims, and Roter¡¦s analytical system of doctor-patient communication behavior. This study analyzed the politeness strategies used during doctor-patient communication, and also found the communication modes that were frequently emerging in the diagnostic processes. The research results show that the maximum politeness strategies used in pediatrics clinics is the bald on record. This reveals a kind of consensus on the importance of communication efficiency for doctors and patients. Most of patients adopt more polite strategies to communicate with doctors for medical knowledge. The results also suggest several commonly-seen dialog modes providing the further self-awareness and self-observation for doctors and patients. Indirect communication, the off-record politeness strategies are also appeared in the dialogues of doctors and patients. This study contributed toward gaining the efficiency of doctor-patient communication, thus may be helpful in the saving of medical resources. Keywords: doctor-patient communication, politeness theory, therapeutic behavior, pediatrics clinics

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Thesis (M Design)--University of South Australia, 1996