An audit of Couples attending the Infertility Unit at Inkosi Albert Luthuli Central Hospital (IALCH), Durban Objectives To determine the patient profile, causes of infertility and the success rates of medical and surgical treatment of infertility thus emphasizing the need for assisted reproductive treatment Methods Data was obtained retrospectively from the medical records of 281 couples that presented to Inkosi Albert Luthuli Central Hospital Infertility Unit between January 2004 and December 2006. Information was recorded on a structured proforma and data analysed using SPSS version 15.0 Results The causes of infertility were anovulation (32.7%), tubal factor (30.3%), male factor (11.7%), endometriosis (7.8%), uterine factor (4.3%) and unexplained infertility in 7.1% of cases. Couples with both male and female factors contributed to 6.1% of infertility cases. Twenty two percent of patients with severe male factor and tubal infertility could not be offered any treatment because of the unavailability of assisted reproductive technology (ART). The pregnancy rate was 24.3% after medical treatment and 14.3% after surgery. When both modalities were employed, the pregnancy rate was 26%. The overall pregnancy rate was 16% with 84% of couples requiring further treatment. Conclusion Anovulation and tubal factors were the major causes of infertility. This audit illustrates that the majority of couples (84%) require gonadotrophins and / or assisted reproductive services to achieve conception. A dedicated infertility unit should provide a full range of services including ART. A significant proportion of couples are denied this health service in the public sector in KwaZulu Natal. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

South Africa has the highest Tuberculosis (TB) incidence in the world. In 2006 it was estimated that in South Africa, with only 0.7% of the world population; some 28% of HIV positive adults had TB. To treat one patient with ordinary TB costs the Health Department approximately R310 and a patient with multi-drug TB (MDR-TB) more than R2000. TB has added to the burden of a country which is struggling to cope with the HIV/AIDS pandemic. TB is one of the national health priorities of the Department of Health (DoH). KwaMsane Clinic is located at Mtubatuba, in the UMkhanyakude district. The uMkhanyakude district has the highest prevalence of HIV and the highest number of cases of TB in South Africa. The UMkhanyakude district stretches from the Umfolozi River, which is south of Mtubatuba, to the Mozambique and Swaziland borders. The clinic is a Primary Health Care centre and is open 24 hours a day. UMkhanyakude has a population estimated at 614,046. According to the DoH National Tuberculosis Management Guidelines (2009), the greatest challenge that the TB programme faces are inadequate financial and human resources for TB control, resulting in poor case detection, increasing numbers of multi-drug resistance TB, extensively dry-resistance TB and poor quality data collection and data analysis. The study set out to identify the challenges that KwaMsane clinic faces in terms of TB management. It was found that the problem facing KwaMsane clinic’s effectiveness was largely due to two factors. The first is the delay in patient diagnosis and the second is the negative nurse/patient ratio which affects the workload and compromises levels of service delivery. The population was sufficiently small, but statistically adequate and all 31 employees were surveyed. Of these, 61% or 19 of the employees agreed that there is a delay in patient diagnosis. The recommendations for KwaMsane clinic include more effective recruiting of staff; attracting and retaining qualified and experienced health personnel; equipment and resources need to be more available; and the clinic management should ensure that they have enough personnel to cope with high number of patients More research is needed on issues such as recruiting attracting and retaining qualified and experienced health personnel; provision of skills training for clinic management and other health personnel to improve service delivery; management of information systems at primary health care clinics for record keeping and data analysis; and integrating TB and HIV/AIDS management. / Thesis (MBA)-University of KwaZulu-Natal, Durban, 2011.

Catchment populations and cross-boundary flow characteristics of health facilities in Natal and KwaZulu have not previously been determined. As this information is essential to objective health service planning the present study was undertaken. Utilization. cross-boundary flow and catchment populations were determined in 1986 for each hospital and clinic in Natal and KwaZulu. All of the 61 hospitals and 178 clinics in Natal and KwaZulu which are operated by the public sector were included in the study. The ratio of clinics-to-hospitals was 2.9 1. The overall average population per hospital and clinic was 106775 and 36591 respectively. The size of the catchment populations of hospitals varied from 334972 to 272 and of clinics from 253159 to 877. Factors associated with these variations are discussed. Inter-regional cross-boundary flow of patients varied appreciably. The greatest influx of patients was experienced by the Durban sub-region where the teaching hospital is situated while the greatest influx of patients was experienced in the Port Shepstone sub-region. Attendance rates per person per annum. according to racial group, were 0.9, 2.1, 1.7 and 0.8 respectively for Blacks, Coloureds, Indians and Whites. Recommendations in respect of the distribution of health facilities and the routine collection and use of health information relevant to the management process are submitted. / Thesis (M.Med.)-University of Natal, Durban, 1987.

This study was intended to determine the architectural characteristics of a built environment that makes a positive contribution to the effective treatment of addictions and associated mental illnesses. Buildings affect people both physically and psychologically: Architects and interior designers create retail spaces that increase sales, restaurants that stimulate appetite and offices that maximise productivity. But do they design mental health-care facilities that improve treatment and recovery? Surely, given the nature of its function, this building typology is the most deserving of attention with regard to the subject of ‘environmental psychology’. On the contrary however, mental health-care has a history of inadequacy when it comes to the buildings that have been constructed to facilitate it: During the middle of the twentieth century – particularly in Great Britain and the United States of America – state ‘mental asylums’ housed hundreds of people in oppressive, inhumane buildings, remote from their communities. Derelict asylums bear testimony to the ‘de-institutionalism’ movement that followed, favouring out-patient care in the community context. On the other hand however, homeless, destitute addicts and mentally ill individuals tell of the shortcomings of community-based care. Current medical insights have now led to a new concept of ‘balanced-care’, which calls for the integration of in-patient and out-patient treatment. This new approach provides an opportunity for architects to re-define the mental healthcare facility – to humanise the institution and create treatment environments that contribute positively to recovery. The purpose of this study was therefore to establish a sound understanding of the unique needs of this particular user group, to interpret the implications of these needs with regard to the design of the treatment environment, and to assess the appropriateness of existing facilities in terms of these findings. The research was carried out by way of consultation with local mental health-care professionals, a review of existing literature on the subject, and relevant precedent and case studies. The outcome was a set of principles and criteria to inform the design of a new addiction and mental health clinic in Durban. / Thesis (M.Arch.)-University of KwaZulu-Natal, Durban, 2011.