Background: Effective collaboration between health professionals can reduce medical errors and assist in interpretation of health information resulting in improved patient care. The International Classification of Functioning, Disability and Health (ICF) has been suggested as a potential framework to help health professionals develop a common language for better collaboration and to provide more holistic care. In the main, Rwandan district hospitals still utilise the hierarchical medical model of health. Aim: The aim of the study was to determine whether training on interprofessional practice, using the ICF framework, resulted in improved knowledge, attitudes and behaviour(as determined by improved recording of interprofessional assessment and management in patient records) in randomly selected Rwandan District Hospitals. Methodology: This study was composed of two phases. Phase I: Preparation. The intervention programme was developed based on a literature review and input from an international panel of experts. A feasibility study in which self-designed instruments and the training programme were tested was undertaken in one district hospital. Phase II: A Cluster Randomised Control Trial. Four district hospitals were randomly allocated to receive a day’s training in interprofessional practice using the ICF (experimental hospitals) or a short talk on the topic (control hospital). Participants included medical doctors, nurses, physiotherapists, social workers, nutritionists, and mental health nurses/clinical psychologists. Using self-designed and validated measures, pre- and postmeasurements of knowledge and attitudes towards Interprofessional Practice (IPP) were performed at baseline and after training and audit of patients’ records after discharge was performed at baseline and at two, four and six months. The independent t-test and Mann-Whitney U test were used to establish if the two sets of groups were equivalent before and after training at baseline and at two, four and six months. Repeated measures ANOVA and the post-hoc Tukey test were used to compare the audit scores at each time point. The Kruskal Wallis test was used to compare rankings of the scores of attitudes of different professions before and after the intervention. Ethical approval was obtained from the Human Research Ethics Committee of the University of Cape Town and the Rwandan National Ethics Committee.

Master of Public Health - MPH / Background: The largest focus areas for the department of health is ensuring access to quality healthcare. The district health system (DHS) model remains the vehicle used by the district managers to deliver on the health department’s goals, objectives and priority focus areas. Strengthening the district health system platform is therefore important to the department to improve access and quality of care to the clients serviced in the province. The district hospitals play a fundamental role since they support primary health care (PHC) and serve as the entry point to more specialised care. The efficient management of beds in the district hospitals is the key in ensuring access to care and preventing bed blocking. Bed Utilisation Rate (BUR) and Average Length of Stay (ALOS) are indicators used to measure the efficiency of hospital beds. This study provides a description of the trends in bed utilisation within the inpatient wards of eight district hospitals in the Cape Town metro district in the 2016-2017 financial period. Methodology: To analyse and compare wards a quantitative approach was used. Inpatient ward activity reports for eight district hospitals were accessed from the department of health’s routine data collection repository. A total of fifty-five wards were compared across small and large hospitals for BUR and ALOS during the financial year period 1 April 2016 to 31 March 2017. Data entry was done in MS EXCEL and analyses were done using STATA 11.0.

Thesis (M. Sc.)--University of Hong Kong, 1998. / Includes bibliographical references.

Magister Artium - MA / Staff members of a district hospital experience various challenges in managing psychotic patients in the emergency department. Psychosis can result from the use of illicit drugs. Persons presenting in a psychotic state due to use of illicit substances are common at emergency departments of district hospitals. In terms of the South African legislation, mental health services are accessible at general district hospitals with the 72-hour observation period being mandatory. Emergency departments are the first area where behaviourally disturbed and psychotic persons are assessed and managed in terms of the Mental Health Care Act of South Africa (Act No. 17 of 2002). Emergency staff members render a 24-hour service to all public users requiring emergency services, and should have the skills, training and resources necessary to manage any public user presenting for emergency services. A large proportion of the patients presenting with psychosis at the hospital where the study was done, were reported as using illicit substances. This study sought to discover and understand: What are the challenges experienced by staff members in managing substance-induced psychotic patients in the emergency department of a district hospital? In an attempt to answer the research question, the aim of this study was to explore and describe the challenges experienced by emergency department staff members in managing substance-induced psychotic patients in a district hospital in the Western Cape. An explorative and descriptive research design was used, grounded in the qualitative research approach. Ten staff members managing or assisting with managing substance-induced psychotic patients in the emergency department were purposefully sampled. This sample comprised doctors, nurses, and other support staff members, such as security guards, porters and general workers. An interview schedule guided the face-toface semi-structured interviews as the method of data collection. The digitally recorded data from these interviews were transcribed verbatim, and analysed into six themes as well as sub-themes. Data were analysed according to Tesch, as cited in Creswell (2009). Measures to ensure trustworthiness were adhered to, such as neutrality, consistency, truth value, and applicability. Ethical considerations were closely followed, such as obtaining permission from the Senate Higher Degrees of the University of the Western Cape and the Provincial Health Ethics Committee, participants’ gave voluntary written consent to partake in the study, aware of the right to withdraw at any time, and of their anonymity and confidentiality being maintained through the use of pseudo names. The findings of the study were that the emergency department was inappropriate for the managing of acutely psychotic or behaviourally disturbed patients such as these, particularly if these staff members were not adequately trained, and where there were staff shortages. Though there was recognition of these patients’ rights to obtain medical care, fear and resentment accompanied by stress on the part of staff presented throughout the themes. The study yielded recommendations such as the need for training and debriefing of staff members and support by hospital management, as well as services such as groupwork and supportive services to patients and family. Recommendations were also made for a review of staffing, infrastructure, facilities and legislation. These recommendations are considered important to assist in the planning, and implementation of healthcare services to mental healthcare users, with specific reference to substance-induced psychotic patients.

Interior design has a social responsibility. To facilitate the way in which buildings change, thereby allowing the user to retain interest and awareness of buildings. The sensitivity of built fabric with historical value combined with the symbolic nature of institutional buildings justify the need to reinterpret architecture in order to retain its value to future generations. It is the aim of this dissertation to investigate the interior designer’s role in altering built fabric by reinterpreting the existing design language. A new perspective should evolve from a well informed understanding of the elements present on site and provide a new strategy by reacting to it. The selected project is a Human Anatomy Centre at the Tshwane District hospital that should provide both the academic and non-academic user with the opportunity to reinterpret their understanding of the human body. / Dissertation (MInt(Prof))--University of Pretoria, 2011. / Architecture / unrestricted

Magister Curationis - MCur / Background: Psychiatric observation units are the units where 72-hour psychiatric observations are conducted in the district and in some of the regional hospitals. These hospitals were selected under the Mental Health Care Act No. 17 of 2002 (MHCA 2002) to admit patients suspected to be mentally ill, ascertain the cause of symptoms, exclude medical illness as a cause of the symptoms, treat and rehabilitate these patients; and at times transfer the patients to tertiary psychiatric hospitals. These units are often overcrowded as only about 30% of patients are transferred to the tertiary psychiatric hospitals. These units are fraught with challenges such as shortage of crucial facilities like seclusion rooms, specialised staff, resources and minimal budget is allocated to these units. Nursing staff in these units are faced with a number of challenges such as shortage of staff, patient overflow, prolonged patient stay, psychologically disturbed patients who can be agitated and violent, and are working long hours. Therefore, Compassion Satisfaction may be affected and these nurses are prone to Compassion Fatigue, which can lead to low Professional Quality of Life. Aim & objectives: The aim was to investigate Professional Quality of Life among nurses working in psychiatric observation units in Metropole District Health Services in the Western Cape Metropole. The objectives were to measure Compassion Satisfaction, to measure levels of Burnout and determine levels of Secondary Traumatic Stress among nurses working in psychiatric observation units in the Metropole District Health Services. Method: A quantitative research approach using a descriptive design was used to determine the Professional Quality of Life of nurses working in psychiatric observation units in the Metropole District Health Services. A self-administered survey using a structured questionnaire, the Professional Quality of Life version 5 (ProQoL 5) was used to collect data from an all-inclusive sample of 175 nurses, yielding a response rate of 93% (n=163). Data was analysed using the Statistical Package of Social Services (SPSS) version 24. Findings: The findings of this study showed that respondents experienced moderate Compassion Satisfaction, moderate Burnout and high Secondary Traumatic Stress. Advanced psychiatric nurse practitioners and registered nurses reported lower Compassion Satisfaction, higher Burnout and higher Secondary Traumatic Stress than enrolled nurses and enrolled nursing assistants. Recommendations: Qualitative research studies need to be conducted on nurses working in psychiatric observation units in order to understand experiences and factors affecting Professional Quality of Life among nurses. Qualitative research studies need to be conducted in order to understand factors affecting Professional Quality of Life of advanced psychiatric nurse practitioners and general registered nurses in psychiatric observations units.

Magister Public Health - MPH / In the context of human resource crisis in African countries, the World Health Organization has proposed task-shifting as an approach to meet the ever-increasing need for HIV/AIDS care and treatment services. Rwanda started the process of task shifting towards nurse-based care in ART services in June 2010. After one year of implementation, a need to determine whether task shifting program has been implemented as intended and if it achieved its primary goal of increasing accessibility of people living with HIV to ARV therapy and improving nurse capacity in HIV patient care was imperative.A multi-method program evaluation study design, combining cross sectional, retrospective review and retrospective cohort sub-studies were used to evaluate the implementation,maintenance processes and outcomes of task shifting in 13 Health Centres (HCs) located in the catchment area of Kibagabaga District Hospital, in Rwanda. The study population consisted of HCs providing task shifted care (n=13), nurses working in the ART services of the 13 HCs(n=36), and more than 9,000 patients enrolled in ART care in the 13 HCs since 2006. All 13 HCs and 36 nurses were included in the evaluation. Routine data on patients enrolled in the pre-task shifting period (n=6 876) were compared with the post task shifting period (n=2 159), with a specific focus on data in the 20-months periods prior to and after task shifting. A cohort of patients 15 years and older, initiated onto ART specifically by nurses from June to December 2010 was sampled (n=170) and data extracted from patients medical files.Data collection was guided by a set of selected indicators. Three different data collection tools were used to extract data related to planning, overall programmatic data and individual data from respectively, the program action plans/reports, HIV central databases and patients medical files. Descriptive analysis was performed using frequencies, means and standard deviations (SD). The paired and un-paired t-tests were used to compare means, and chi-square test was used to compare categorical variables. To compare and to test statistical difference between two repeated measurements on a single sample but with non-normally distributed data, Wilcoxon signed rank test was used. To judge if current task shifted care is better, similar or worse than non-task shifted care, comparisons were made of program outputs and outcomes from the central database prior to and after the period of task shifting, and also with the cohort of nurse initiated patients.Results showed that 61% of nurses working in the ART program were fully trained and certificated to provide ART. Seven out of 13 HCs met the target of a minimum of 2 nurses trained in ART service delivery. Supervision and mentorship systems for the 13 HCs were well organized on paper, although no evidence documenting visits by mentors from the local district hospital to clinics was found. In term of accessibility, the mean number of patients newly initiated on ART per month in the HCs increased significantly, from 77.8/month (SD=22.7) to 93.9/month (SD=20.9) (t test (df=38), p=0.025). A small minority of patients was enrolled in late stages of HIV, with only 15% of the patient cohort having CD4 counts of less than 100 cell /μL at initiation on ART. The baseline median CD4 cell count was 267.5 cells /μL in the cohort as a whole. With respect to quality of care, only 8.8% of patients in the cohort had respected all appointments over a mean follow up period of 17.2 months; and although follow up CD4 counts had been performed on the majority of patients (80%), it was done after a mean of 8.5 months(SD=2.7) on ART, and only a quarter (24.7%) had been tested by 6 months (as stipulated by guidelines). From central ART program data, a small but significant increase of patients on 2nd line drugs was observed after implementation of task shifting (from 1.98% to 3.00%, 2=13.26,p<0.001), although the meaning of this shift is not entirely clear.The median weight gain was 1 kg and median CD4 increase was 89.5 cells /μL in the cohort after 6 months of receiving task shifted care and treatment. These increases were statistically significant for both male and female patients (Wilcoxon signed rank test, p<0.001). With regard to loss to follow up, only three of the 170 patients in the cohort followed up by nurses had been lost to follow-up after a mean of 17.2 months on treatment. The routine data showed a decrease of patients lost to follow up, from 7.0% in the pre-task shifting period to 2.5% in the post-task shifting period. In general, the mortality rate was slightly lower in the post-task shifting period than in the pre-task shifting (5.5% vs 6.9% respectively), although this was not statistically significant (2=2.4, df=1, p=0.1209).This study indicates that, after over one year of implementation of task shifting, task shifting enabled the transfer of required capacity to a relatively high number of nurses. In an already well established programme, task shifting achieved moderate improvements in uptake (access) to ART, significant reductions in loss to follow up, and good clinical outcomes. However,evaluation of process quality highlighted some concerns with respect to adherence to testing guidelines on the part of providers and follow up visits on the part of patients. Improvements in processes of monitoring and follow up are imperative for optimal mid-term and long-term task shifting in the ART program.

Magister Public Health - MPH / Background: Every year, about 20 million infants are born with low birth weight globally, putting a heavy burden on health care and social systems, especially in developing countries as they are often understaffed and/or lack optimally functional equipment. In 1978, Dr E. Rey proposed the Kangaroo Mother Care (KMC) programme which was further developed by coworkers at one of the largest obstetric facilities in Santa Fe de Bogotá, Colombia. KMC was introduced as an alternative to the expensive and seldom used traditional methods to care for low birth weight infants. KMC is currently not practised at Tsumeb district hospital despite many infants born with low weight in the district. Aim: The aim of the study was to explore perceptions regarding the implementation of Kangaroo Mother Care in the maternity ward of Tsumeb district hospital. Study design: This was a qualitative exploratory study. Study population and sampling: The study population are doctors and nurses working in Tsumeb district, the Chief Medical Officer (CMO) as well as the health programme administrators in the family health division of the Ministry of Health and Social Services (MOHSS), Oshikoto region. Purposive sampling was used to select participants. Results: Perceptions were grouped into three main themes namely the parent-related, health worker-related and baby-related. Parent-related perceptions include self-trust, increased competency, less frustration, and active involvement of parents in baby care, which are similar to the literature and regarded as benefits of KMC. Health worker-related perceptions included both reduced workload and an increased workload. Baby-related perceptions are reduced morbidity, increased bonding and improved care. The study also revealed the barriers to KMC implementation as well as factors that can make KMC implementation a success. Conclusions: Three broad themes emerged from the study, parent-related, health worker-related and baby-related. Most of the health workers’ perceptions are similar to the benefits of KMC found in the literature but, some health workers have negative perceptions regarding KMC.

Master of Public Health - MPH / Background: Severe acute malnutrition contributes disproportionately to child mortality rates despite availability of the WHO protocol, “Ten Steps”, to guide hospital management. Auditing morbidity and mortality rates of malnourished children at hospitals is useful to measure the effectiveness of hospital-based management compared to standards advocated by the WHO protocol. The study aimed to assess the adequacy of clinical management practices for severely malnourished children admitted to three district hospitals in the Western Cape as compared to the WHO guidelines. Objectives: To describe prognostic indicators on admission such as clinical severity of malnutrition and co-morbidities such as HIV, TB, diarrhoea and pneumonia. To assess the management practices of severe malnutrition against the key principles of management during the stabilisation phase as outlined by the WHO guidelines. To describe the number of severely malnourished children who were treated for or died due to preventable complications (hypothermia, hypoglycaemia, dehydration, over-hydration, infection, electrolyte imbalance). Methodology: A retrospective, descriptive study based on a folder review of medical records of 83 severely malnourished children admitted to the Stellenbosch, Helderberg and Eersteriver hospitals from September 2009 to June 2011 was done. viii Structured data collection was undertaken to capture data to allow assessment of the clinician’s management practices, and the adequacy thereof in implementing the first six steps of the WHO protocol guidelines. Results The predominant co-morbidities in the sample were diarrhoea in 51% ofcases and pneumonia in 33%. Thirteen percent were HIV infected, 28% of the sample had TB. Clinical signs were poorly documented by clinicians. The highest percentage of adequate management practices was for treatment of infections with 90% of patients receiving antibiotics. The second best management practice was for treatment of electrolyte and micronutrient deficiency. Hypoglycaemia and hypothermia were poorly managed as children developed these complications in the hospitals and yet these complications were still left untreated. Nineteen percent of the sample needed transfer to a specialist hospital. Conclusion The study concludes that overall management practices for children admitted with severe acute malnutrition to three district hospitals in the Western Cape was poor and often did not adhere to the WHO guidelines. Doctors showed poor understanding of the need for accurate assessment and monitoring in order to reduce the mortality risk of these patients.

<p>This study assessed the knowledge, attitudes and practices about MC as an HIV prevention intervention among adult males presenting for HIV Voluntary Counselling and Testing (VCT) services at Onandjokwe District Hospital in northern Namibia. A high level of knowledge of MC, particularly its potential to reduce the risk of HIV infection, STIs and enhance penile hygiene exists among VCT attendees in Onandjokwe District Hospital. MC will most likely to be accepted in this study area, especially when it is implemented to reduce the risk of HIV infection. The study recommends a comprehensive education and information program targeting males and their partners and a training for traditional and medical circumcisers to ensure a high quality of MC services.</p>