Masters of Public Health - see Magister Public Health / Background: Malaria is the leading cause of death of Uganda's children under 5 years of age and the number-one cause of illness in adults in Uganda. The success of malaria treatment strategies is closely linked to the behavior of patients and caretakers of young children. In the case of malaria this includes accessing appropriate treatment for suspected malaria in time. In Bungokho Sub County, in spite of the efforts by district health workers and the Ministry of Health to implement the malaria control, prevention and treatment strategies, pregnant women and caretakers of children under 5 years of age continue to present late for treatment in the health units resulting in possible avoidable death or disability. Aim and objectives: The aim of this study was to explore the factors that lead to late presentation of children and pregnant women with malaria for treatment at health units. This was done by exploring the perceptions of caregivers of children under five years and pregnant women on the community knowledge and understanding of the symptoms and treatment of malaria; and describing perceptions of caregivers and pregnant women on health care provision at the health units and alternative treatment for malaria. Methods :The study was conducted in Bungokho Health sub-district, in Mbale district, Eastern Uganda over a two month period in 2009. It was a descriptive exploratory study using qualitative research methods. Four focus groups were carried out, two with caregivers of children under 5 years and two with pregnant women, with each focus group consisting of eight participants. Two caregivers and two pregnant women were identified from the focus groups for further indepth interviews. Four in-depth interviews were conducted with health unit staff from Bungokho HCVI. Notes were taken and observations made during the focus groups and interviews. The proceedings were audio-taped and recordings used to expand and clarify notes. Thematic content analysis was used to analyze the data and identify recurrent themes from the focus group discussions and  interviews of the reasons for late presentation for malaria treatment. Results: All caregivers were women, a significant majority of whom were peasants who had not gone beyond the primary education. Caregivers were aware of the general symptoms of malaria but associated more serious or dangerous symptoms with other causes including witchcraft. Pregnant women, on the other hand, seemed to have sound knowledge of both the general and dangerous symptoms of malaria and were likely to attend the health units timeously for reatment. Religious beliefs and practices, particularly belief in the healing ability of prayers prevented early reporting of malaria cases to health units leading to late presentation. Alternative treatment of malaria from traditional herbalists was also sought by the communities particularly when the intensity of malaria was at its peak during the rainy season. Poverty in the community seemed to play a big role in shaping community preference for treatment sources, as well as early presentation to the health units. It was found that the anticipated cost of laboratory tests and sundries at the health units deterred caregivers from taking children under five to health units. There was therefore a strong reliance (and preference for) community medicine distributor's (CMDs) because of free services and easy access. Lack of support from spouses (in particular husbands) coupled with the rude behavior of health workers towards caregivers and pregnant women discouraged visits to health units. The long waiting time and intermittent drug stock-outs also created a negative perception of service at the health units. Conclusions and recommendations: There is need for further sensitization of communities on the need to seek prompt treatment for children under five years of age at the health units (that is, within 24 hours of the onset of fever). Training and supervision of CMDs should be strengthened to ensure consistent supply of drugs, correct dosage of anti-malarial medication and improvements in the referrals to the health units. In order to improve service delivery at the health units, there is need to review and strengthen human resource management of the health units, including staffing requirements and management practices, such as support and supervision, patient care standards and client feedback mechanisms. It is also important that there are adequate stocks of anti-malarial drugs  and laboratory supplies at health units. / South Africa

Magister Pharmaceuticae - MPharm / South Africa is faced with a high number of people living with HIV/AIDS, and subsequently a great need to access quality medicines for improving patient therapeutic outcomes. Antiretroviral drugs (ARVs) require rigid, efficient and effective management, due to their valuable efficacy in prolonging the survival of HIV/AIDS patients, and the limited possibility of substitution. Managing their flow is vital to ensure an uninterrupted supply. Problematic inventory management was experienced by some healthcare facilities in South Africa where in recent years it resulted in stock outs and stock losses through thefts. These factors present obstacles to the availability of quality medicines, which ultimately leads to treatment failure and deterioration of the health status of patients. The aim of this study was to characterise the inventory management practices and medicine store maintenance of ARVs in community health centres (CHCs) in the Cape Metropole, Western Cape, in order to identify specific problems associated with ARV stock management. The study used a descriptive, cross-sectional study design to examine ARV records and to highlight associated discrepancies between recorded iii quantities on logistics tools used and physical counts, to assess the store maintenance, to measure the supply rate and identify factors contributing to poor stock management. The sample comprised 15 CHCs under the Western Cape Provincial Government (WCPG) accredited to provide ARV treatment. A checklist developed by Management Sciences for Health was adapted and was used to gather quantitative information (e.g. physical stock count). Some qualitative data was collected from responsible personnel for ARV drug management at each site. 86.7% of CHCs utilised a logistics tool (either manual or electronic) to manage ARVs. The average number of adult ARV drugs with a logistics tool available in all CHCs was 82.7% of which 21.9% met the criteria for accuracy. Only 32.9% of all logistics tools had records that were up to date. The average percentage of total variation between stock records and physical counts for the ARV drugs assessed was 51.6%. No historical data on stock outs and monthly usage (monthly consumption) could be retrieved in any of the CHCs, although there were no actual stock outs on the day of the fieldwork. The order fill rate was 91.9%. Since ordering is done more often that it should, stock availability did not appear to be problematic. Standard appropriate physical dimensions were not met by 20% of the CHCs and only 66.7% of the CHCs had appropriate labeling of the shelves in the dispensary and in the storeroom. This study demonstrated poor inventory management with respect to the general quality of record keeping, space allocation and general organisation of the medicine storeroom. Making timely entries and recording issues on logistics tools are recommended to keep up to date inventory records and management information system. Frequent monitoring of stock status is suggested, to avoid discrepancies and to keep it to adequate levels iv which will minimise multiple ordering. Regular supervision by the district pharmacist is needed to identify training and other needs. A study on general cost and delivery costs associated with poor record keeping should be carried out.

The aim of the thesis is through the selected analysis analyze the functioning and financing of health centre.

Magister Scientiae Dentium - MSc(Dent) / Oral epithelial dysplasia (OED) is a growth anomaly which occurs as a result of atypical, abnormal proliferation and a change in the architecture and cytological features of cells of epithelial origin, which ultimately results in the formation of a lesion with disturbed differentiation and maturation The purpose of this study was to describe the OED cases diagnosed at Tygerberg Oral health centre in a 7-year period between 2012 and 2019. The patients’ medical records from Tygerberg Oral Health Centre and National Health Laboratory Service (NHLS) were reviewed. All diagnosed cases of OED were identified and the data retrieved for further assessment and comparison. The individual medical records and follow up data were assessed. Seventy cases of OED were diagnosed in the period assessed. Of those 70 cases, the median age was 58 and the interquartile range was from 48 – 62. Thirty-six of the diagnosed patients were female and thirty-four were males. The majority of lesions diagnosed with OED were found on the tongue, floor of the mouth (FOM) and buccal mucosa. Majority of the lesions were found in non-smokers and non-alcohol consumers. These two categories both presented with mild cases of OED. From the results, it was derived that OED has no intra-oral location predilection. Moreover, OED is not directly associated with smoking.

This thesis explores the role and functionality of the Hamilton Urban Core Community Health Centre (HUCCHC) within the context of advocacy and activism to understand how this institution can contribute a pathway for social change in public health. This qualitative case study uses an interpretive lens to analyze primary health care at the HUCCHC, and how it is being used to improve the social determinants of health (SDH). The study investigated participants’ understandings of how the HUCCHC demonstrates that a community health centre can be a catalyst for social change. Moreover, this research project asked what sorts of conditions or circumstances are necessary to foster an environment conducive for community organizing for social change. This study employed field observation and interview techniques to gather data. Findings suggest that building equitable relationships based on dignity and respect, and community engagement were the foundational aspects necessary to provide the conditions conducive for community organizing. However, the outcomes from these relations put the HUCCHC at risk of becoming marginalized. Findings further suggest that equitable relationships and community engagement also provided a foundation for social action. The HUCCHC demonstrated that it is a catalyst for social change by embracing a primary health care model that also fosters a social action approach to health care. / Thesis / Master of Social Work (MSW)

Thesis (M.Med. (Family Medicine)) -- University of Limpopo, 2017 / Objectives: To assess adherence to Isoniazide Prevention Therapy (IPT) among HIV positive patients in Rethabile Community Health Centre in the Capricorn District of the Limpopo Province. Methods: A cross-sectional study with qualitative and quantitative data collection methods was conducted among HIV positive patients in Rethabile Community Health Centre from January 2013 to December 2013. Consecutive sampling was used to select 90 participants. Adherence was assessed using patient self-rated adherence to IPT, and confirmed by urine tests for isoniazid metabolites. Data was collected using an interviewer administered questionnaire. Information was also obtained from health care works regarding the perception about reason for non- adherence to IPT. Data was analysed using STATA software and thematic analysis. Results: Self-rated adherence to IPT among the participant was 80% where as urine test was positive for Isoniazid metabolites in 73%. While 84% of participants reported that transportation was the main reason for non adherence, 70% also reported distance from the health care as their main reasons for non-adherence to IPT. However, health care providers reported that many patients do not adhere to treatment due to: Lack of money for transport, missed clinic appointment due to rain and fear of losing jobs, use of traditional medicine, wrong belief about IPT, medicine side effects and alcohol consumption. Conclusion: Self – rate adherence to IPT was suboptimal and appears over – estimated among study participants. Interventions to improve adherence to IPT must ensure easy access to healthcare facilities, address wrong perceptions and promote healthy social behaviours

I bakgrunden presenteras sjuksköterskans och distriktssköterskans ansvarsområde, att arbetet ska utgå från ett etiskt och holistiskt förhållningssätt och främja hälsa genom exempelvis rådgivning. Forskning beskrev att arbetet med telefonrådgivning upplevdes stimulerande samtidigt som det var svårt att vara både grindvakt och vårdare. Som en hjälp i det arbetet kunde beslutsstöd användas, det sågs som ett skyddsnät som kompletterade sjuksköterskans erfarenheter. Det sågs även som ett kvalitétshöjande instrument samt att rädslan för att ta fel beslut och anmälas minskade. Syftet med studien var att beskriva sjuksköterskors och distriktssköterskors erfarenheter av att arbeta med telefonrådgivning utifrån det webbaserade rådgivningsstödet på vårdcentral. För att få fram beskrivningarna användes halvstrukturerade intervjuer som analyserades genom kvalitativ innehållsanalys med induktiv ansats. I resultatet beskrevs det att stödet skapade trygghet då det var en källa till kunskap, ett stöd vid behov, ett bra hjälpmedel och gav bekräftelse. Stödet sågs som otillräckligt och svårarbetat då det var svårnavigerat, tidskrävande, språket satte gränser, det kunde inte ersätta den kliniska blicken och stämde inte med verkligheten. Slutligen beskrevs det att den egna erfarenheten styr hur stödet används. Erfarenheterna var övervägande positiva, men omvårdnadsfokus minskade då dyrbar tid användes till att hantera rådgivningsstödet. / In the background we present the responsibilities of nurses and district nurses, namely that the duties will begin with an ethical and holistic point of view, and to promote health through for example giving advice. Research described that working with telephone counselling was perceived as stimulating, though hard being both a gatekeeper and a caretaker. One kind of help in that task could be decision support, it was seen as a safety net and a complement to the experience of the nurse. It was also seen as an instrument to improve quality, as well as reducing the fear of making the wrong decisions and being reported. The purpose of the study was to describe the experience of nurses and district nurses to work with telephone counselling using the web-based counselling support in health centres. To get the descriptions half structured interviews were used, which were analyzed by qualitative content analysis with an inductive approach. It was described in the result that the support created a sense of assurance, because it was a source of knowledge, a support when needed, a good aid, and gave confirmation. The support was also seen as insufficient and not user-friendly, since it was hard to navigate, time consuming, had a language barrier, it could not replace the clinical “eye”, and did not correspond with reality. Lastly it was said that the experience of each individual was a key in how the support was used. Most had positive experiences, but focus from taking care of patients was lost due to valuable time being used for handling the counselling support.

Background: The purpose of this research was to examine how the Three Bridges Community Health Centre conceptualizes and addresses the issue of accessibility for gay men. This research explored the intersection and disjuncture of how accessibility for gay men is understood and practiced from multiple perspectives (staff and clients). It revealed perceived and real barriers and opportunities for gay men in accessing health services, and provides insight into the mechanisms Three Bridges Community Health Centre employs to provide comprehensive health care to a local population that is not easily identifiable. Methods: Case study is the central defining methodological feature of this research. This study applies both inductive and deductive approaches. The data are qualitative, derived from 14 semi-structured interviews, document analysis (25 documents with a total of 398 pages) and participant observation (approximately 33 hours). Analysis and interpretation of the data were accomplished through the various procedures and techniques associated with qualitative data analysis, including the use of a qualitative software package - NUD*IST 4.0. Results: The study revealed twelve main factors that facilitate (and obstruct) accessibility for gay men. They were developing a mission of accessibility for vulnerable populations; assessing gay men's health issues, barriers and needs; utilization of the clinic; delivery of appropriate programs and services; available providers with appropriate knowledge, attitudes and behaviour; cultural accessibility (e.g., gay-friendly environment, multiple languages); geographic accessibility (location); physical accessibility (architecture); financial accessibility (affordability); functional accessibility (convenience); awareness (marketing & publicity of services and location); and partners in accessibility (e.g., community, health authorities, government). Each section of this chapter details how Three Bridges addresses each of these elements (the strengths), the challenges (e.g., time, money and personnel) in addressing these issues, as well as suggestions for improving accessibility. These factors would also be relevant for any primary care setting about to embark upon an examination of how (well) it addresses access for gay men, and other vulnerable populations. Conclusions: Partnerships with community-based agencies and recruitment of queer staff are critical in creating cultural accessibility for queer people. Many of the challenges raised by staff need to be addressed at a policy, region-wide level. Cultural accessibility for queer people also needs to be addressed by other healthcare settings.

Darbo tikslas. Ištirti Kauno ir Marijampolės visuomenės sveikatos centrų ir jų filialų darbuotojų poreikius, susijusius su profesine veikla, bei jų sąsajas su bendru pasitenkinimu darbu ir įvertinti profesinio tobulėjimo bei kvalifikacijos kėlimo galimybes. Tyrimo metodika. Atlikta anoniminė anketinė Kauno visuomenės sveikatos centro ir Marijampolės Visuomenės sveikatos centro bei jų filialų darbuotojų apklausa. Išdalinta 251 anketa, užpildytas anketas grąžino 176 respondentai (atsako dažnis 70,1 proc.). Duomenys apdoroti ir analizuojami naudojant statistinių duomenų analizės paketą SPSS for Windows 12.0. Hipotezės apie dviejų požymių nepriklausomumą buvo tikrinamos naudojant Chi kvadrato kriterijų. Mažų grupių palyginimui naudotas Fisher tikslusis kriterijus. Hipotezė apie dviejų proporcijų lygybę buvo tikrinama naudojant Z kriterijų. Rodiklių skirtumai laikyti statistiškai reikšmingi, kai p<0,05. Rezultatai. Įvertinus Kauno visuomenės sveikatos centro ir Marijampolės visuomenės sveikatos centro bei jų filialų darbuotojų poreikius ir motyvaciją darbe, paaiškėjo, kad dominuojantis poreikis yra tinkamas darbo užmokestis (73,3 proc.) bei saugumo ir socialiniai poreikiai. Darbuotojai blogiausiai vertina savo karjeros perspektyvas, daugiau nei pusė respondentų yra nepatenkinti savo gaunamu darbo užmokesčiu. Svarbiausios skatinimo ir motyvacijos darbui priemonės yra darbo užmokestis, socialinės garantijos ir tinkamos darbo sąlygos. Didžiajai daugumai (82,9 proc.) respondentų... [toliau žr. visą tekstą] / Aim of the study. To investigate the needs of employees of the Public Health Centres of Kaunas and Marijampolė and their branches, related with occupational activities, and relations with the general satisfaction with occupation, and to evaluate opportunities of professional training and improvement of their professional skills. Methods. Anonymous questionnaire survey of the employees of Kaunas Public Health Centre and Marijampolė Public Health Centre and their branches was performed. There were 251 questionnaires delivered, and 176 questionnaires were returned by respondents (the response rate – 70.1 per cent). Data was processed and analyzed using the statistical package SPSS for Windows 12.0. Associations between the variables were tested by the application of Chi-square test. Fisher criteria were used for comparison of two small groups. The hypothesis about the equality of two proportions was checked by using Z criteria. The differences between variables were considered statistically significant, when p<0.05. Results. It was estimated that the dominant needs were an adequate salary (73.3 per cent), safety and social needs when assessing the needs and motivation at work in the Public Health Centre of Kaunas and in the Public Health Centre of Marijampolė. As the worst aspects employees evaluated their career opportunities, more than a half of respondents were not satisfied with their salary. Salary, social security and proper working conditions were considered as the main... [to full text]

Background: The purpose of this research was to examine how the Three Bridges Community Health Centre conceptualizes and addresses the issue of accessibility for gay men. This research explored the intersection and disjuncture of how accessibility for gay men is understood and practiced from multiple perspectives (staff and clients). It revealed perceived and real barriers and opportunities for gay men in accessing health services, and provides insight into the mechanisms Three Bridges Community Health Centre employs to provide comprehensive health care to a local population that is not easily identifiable. Methods: Case study is the central defining methodological feature of this research. This study applies both inductive and deductive approaches. The data are qualitative, derived from 14 semi-structured interviews, document analysis (25 documents with a total of 398 pages) and participant observation (approximately 33 hours). Analysis and interpretation of the data were accomplished through the various procedures and techniques associated with qualitative data analysis, including the use of a qualitative software package - NUD*IST 4.0. Results: The study revealed twelve main factors that facilitate (and obstruct) accessibility for gay men. They were developing a mission of accessibility for vulnerable populations; assessing gay men's health issues, barriers and needs; utilization of the clinic; delivery of appropriate programs and services; available providers with appropriate knowledge, attitudes and behaviour; cultural accessibility (e.g., gay-friendly environment, multiple languages); geographic accessibility (location); physical accessibility (architecture); financial accessibility (affordability); functional accessibility (convenience); awareness (marketing & publicity of services and location); and partners in accessibility (e.g., community, health authorities, government). Each section of this chapter details how Three Bridges addresses each of these elements (the strengths), the challenges (e.g., time, money and personnel) in addressing these issues, as well as suggestions for improving accessibility. These factors would also be relevant for any primary care setting about to embark upon an examination of how (well) it addresses access for gay men, and other vulnerable populations. Conclusions: Partnerships with community-based agencies and recruitment of queer staff are critical in creating cultural accessibility for queer people. Many of the challenges raised by staff need to be addressed at a policy, region-wide level. Cultural accessibility for queer people also needs to be addressed by other healthcare settings. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate