Stroke is the third leading cause of death and a major cause of disability in most societies. Individuals with physical disabilities are at risk of secondary complications due to the impact of the disability, which may be exacerbated by poor lifestyle choices. Although disabled persons desire to engage in wellnessenhancing activities, limited programmes based on their health promotion needs&rsquo / assessment have been developed. The aim of the present study is to determine the health promotion needs of stroke patients accessing selected Community Health Centres in the Metropole region of the Western Cape. A cross-sectional survey, utilizing a self-administered questionnaire and in depth interviews with a purposively selected sample was used to collect the data. The quantitative data was analysed using Microsoft Excel &reg / . Means, standard deviations and percentages were calculated for descriptive purposes and the chi-square test was used to test for associations between socio-demographic and health-related variables. Audiotape interviews were transcribed verbatim, the emerging ideas were reduced to topics, categories and themes and finally interpreted. In order to qualify for between-method triangulation used in the study, complementary strengths were identified by comparing textual qualitative data with numerical quantitative results and vice versa. The quantitative analysis revealed that the participants were engaging in health risk behaviours such as physical inactivity, substance usage, non-compliance to medication use and inappropriate diet modification. Lack of financial resources, facilities and access to information predisposed them to involvement in risky health behaviours. In-depth interviews supported the quantitative findings and revealed that numerous participants&rsquo / suffered from depression and frustration as a result of having a stroke. The necessary ethical considerations were upheld. The outcome of the study could contribute to the need to develop, encourage and promote wellness-enhancing behaviours and activities to improve the participants&rsquo / health status and ultimate quality of life.

The research explored the new health care service vehicle of South African with special reference to health service providers in Western Cape Department of health for the period 1995-2001. A study was made of the District Health System and the shift of emphasis from tertiary and secondary level of health care to the more cost effective Primary Health Care Service rendered at District level.

Dissertation submitted in compliance with the requirements for the Masters Degree in Technology: Nursing, Durban University of Technology, 2016. / Introduction Although the South African Government adopted a primary health care approach to health care service provision in order to ensure equitable access to and utilization of health care services to all communities, the country continues to face challenges regarding access and utilisation of health care services especially in the rural communities. Antenatal care which is mostly provided at primary health care level is regarded as the cornerstone for the success of the maternal and child health care programme. Therefore, poor access to and under-utilisation of health care services could potentially influence the success of this programme and pregnancy outcomes. Aim of the study The aim of the study was to determine whether pregnant women from KwaMkhizwana rural community had access to and were utilising antenatal care services. Methodology A qualitative, exploratory, descriptive and contextual study was conducted guided by Thaddeus and Maine’s three delays model. Purposive sampling of the pregnant women and all categories of nurses who were employed in the three health care facilities in the area was done. Data was collected in two phases through in-depth semi-structured interviews with both the pregnant women and the nurses respectively between February and March 2016. The sample size was guided by data saturation. All data were analysed using the Tesch’s method of data analysis. Study findings Six major themes and several sub-themes emerged from the interviews with both Phase 1 and Phase 2 participants. The major themes included: 1) access to health care and emergency services, 2) availability of human and material resources, 3) social and cultural beliefs, 4) past pregnancy experiences, 5) communication and transparency regarding health care service delivery and 6) quality of antenatal care services. Summary of the findings The pregnant women encountered several challenges which led to delays in seeking, reaching and receiving antenatal care. Most of the pregnant women participants related limited access to health care, with under-utilisation of antenatal services. They were unhappy about the antenatal care services they received in the three available health care facilities in the area, which made these facilities to be inaccessible and underutilised. The nurse participants recognised the challenges facing the pregnant women regarding the access and utilisation of antenatal care services, together with the challenges faced by the nurses while working in the three available health care facilities in the area. Recommendations The recommendations that were made included: to consider building a centrally located fixed primary health care clinic that would ensure equal access to health care services, strengthening the implementation of policies regarding the referral system and ambulance services, ensuring sustainable availability of human and material resources, developing strategies to ensure that the antenatal care services are delivered in line with the South African Department of Health policies and guidelines and strengthening community education. A further study on provision of antenatal care services in the area is also recommended. / M

Submitted in Fulfillment of the requirements for the Master’s Degree in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Aim The aim of the study was to examine students’ perspectives regarding their learning in a community based undergraduate nursing programme at the Durban University of Technology in South Africa. Methodology A quantitative descriptive design was used to examine student nurses’ perspectives regarding their experiences in community-based education (CBE), with specific reference to perceived academic gains, local and global gains, intrapersonal gains and interpersonal gains. Hours spent by students outside their CBE schedule as well as most preferred clinical practice Participants included 203 undergraduate nursing students drawn from the 2010, 2011 and 2012 cohorts. A stratified random sampling technique was used. A modified 4-point Likert scale version of a questionnaire designed by Ibrahim (2010), which also comprised of open-ended questions for supportive qualitative information, was used to collect data. Analysis was done accomplished using SPSS Version 22 for the quantitative data and identification of themes for the supportive qualitative information. Results The study results revealed that students had benefited from CBE in all the four domains under study. Participants rated the impact of CBE on academic gains lowest ( ̅x = 3.09, SD = .38) with perceived impact of CBE on local and global gains rated highest ( ̅x = 3.33, SD = .38). The personal gains subscale was the second highly rated subscale with a mean of 3.27 (SD = .43), followed by the intrapersonal gains domain ( ̅x = 3.15, SD .48). No significant differences were found between groups on all the variables of interest. Furthermore, the results revealed that participants spent a varying number of hours outside of scheduled CBE placement. The majority of the participants spent 200 hours to 399 hours (n= 119) = 58.6% in the first semester and (n = 120) = 59% in the second semester. The majority (72%) of the participants indicated that their preferred clinical practice environment was Primary Health Care. / M

Dissertation submitted in the partial fulfillment for the requirements of the Degree of Master in Public Management, Durban University of Technology, Durban, South Africa, 2015. / The challenges facing the South African public health systems, especially public clinics seem to be increasing. These Primary Health Centres are having to deliver service under difficult circumstances thereby making the “offering” of the service being perceived as poor. The way in which these centres operate is mainly hampered by infrastucture and resource allocation which is seen as sufficient to render appropriate service to the “black communities”. To the eyes of an outsider, this particular service is seen as ideal, yet the people for whom it is meant, do not fully benefit from it. Prior to 1994, South Africans were faced with poor health facilities; with the democratic elections, they thought the delivery of essential services was going to change for the better. In the White Paper for Transformation of the Health System in South Africa, one of the objectives states that various implementation strategies were to be designed to meet the basic needs of all people, given the limited resources available, but this does not seem to be the case. Research has shown a huge discrepancy in the delivery of service between rural and urban areas. Some of the findings are that one nurse will attend to a huge number of patients without any assistance, either from the doctor or other nurses. The literature review contained in this research indicates that there is still a gap between how the service delivery should be made available to the public and how it is currently administered or managed. This research, which is driven by a passion and love for good public service delivery assesses the perceived quality of service in the public clinics of Sobantu and Scottsville. Interviews were conducted within employees of both the clinics and the patients being served by these two clinics to assess the perceived quality of service received in these clinics / An electronic copy of the Thesis is currently unavailable.

The physical, psychological and social development of school children has been neglected - partly because they were seen as healthy "survivors" of the ravages of childhood illnesses, and partly because of the way in which health services are organized (such as the traditional under-five maternal and child health (MCH) services and the curative PHC clinic services). From the age of five years children undergo rapid and profound bio-psycho-social development, to emerge in adolescence as the next generation of leaders and workers. Securing their future growth and development is vital for any society to be economically and socially productive. A substantial body of national and intemational literature has recognised the detrimental impact of helminthic infections and micronutrient deficiencies on the physical and psychological health and development of school children; which requires appropriate nutritional interventions. Concern has been expressed that these adverse biological, physical and social deprivations have a cumulative impact on several dimensions of children's growth. Most important, apart from stunting physical growth, is the inhibition of educational development of school children. Recent evidence strongly suggests a powerful interaction between physical and psychosocial growth and development of children. Inhibition of either component of a child's well-being has adverse implications. Conversely, investments in the physical and psychological development of children are likely to generate substantial health and educational benefits and are a worthy investment to secure a healthy future generation. In summary, there are a number of reasons for, and benefits of, investing in school-based health and nutrition interventions. They are likely to improve learning at school and enhance educational outcomes; create new opportunities to meet unfulfilled needs; redress inequity; build on investments in early child development and promote and protect youth and adolescent development. Health and nutrition interventions such as school feeding programmes, micronutrient supplementation and deworming aim to improve primary outcomes of macro and micro-nutrient deficiencies, parasitic and cognitive status; as well as secondary outcomes of developing integrated comprehensive school health policies and programmes. This rationale served as the conceptual framework for this study. This theoretical framework views improvements of the health, nutritional, cognitive and scholastic development status of school children as the primary focus of policies, strategies and programmes in the health and education sector. This focus constitutes the central core of this thesis. Optimum social development requires investments in both the health and educational development of school children, so as to maximise the synergies inherent in each sector and to operationalise national and international strategies and programmes. As part of the larger RCT study a comprehensive nutritional, health and psychological profile of rural school children was established through a community-based cross-sectional study. Eleven schools were randomly selected from the Vulamehlo Magisterial District in southern KwaZulu-Natal (KZN). Within each school, all Standard 1 pupils, aged between 8 - 10 years, were selected giving a final study sample of 579 children. Some of the observed prevalence's were stunting (7.3%), wasting (0.7%), anaemia (16.5%) (as measured by haemoglobin below 12 g/dl), vitamin A deficiency (34.7%) (as measured by serum retinol below 20 ug/dl) and serum ferritin below 12ng/ml (28.1%). This study established that micronutrient deficiency, parasitic infestations and stunting remain significant public health problems among school-aged children in South Africa. Combining micronutrient supplementation and deworming are likely to produce significant health and educational gains. To determine the impact of single and combined interventions (anthelminthic treatment and micronutrient supplements) on nutritional status and scholastic and cognitive performance of school children, a double-blind randomised placebo controlled trial was undertaken among 579 children 8-10 years of age. There was a significant treatment effect of vitamin A on serum retinol (P<0.01), and the suggestion of an additive effect between vitamin A fortification and deworming. Vitamin A and iron fortification also produced a significant treatment effect on transferrin saturation (P<0.05). Among the dewormed group, anthelminthic treatment produced a significant decrease in the prevalence of helminthic infections (P<0.02), but with no significant between-group treatment effect (P>0.40). Scholastic and cognitive scores and anthropometric indicators were no different among the treated or the untreated children. Fortified biscuits improved micronutrient status among rural primary school children; vitamin A combined with deworming had a greater impact on micronutrient status than vitamin A fortification on its own; while anthelminthic treatment produced a significant reduction in the overall prevalence of parasite infection. The prevalence's of Ascaris lumbricoides, Trichuris trichiura and Schistosoma haematobium declined significantly sixteen weeks post-treatment. The levels of both prevalence and intensity in the untreated group remained constant. The cure rates over the first two weeks of the study were 94.4% for Ascaris lumbricoides, 40% for Trichuris trichiura, and 72.2% for Schistosoma haematobium. The benefits of targeted school-based treatment in reducing the prevalence and intensity of infection supports the South African government's focus of using school-based interventions as part of an integrated parasite control programme. These strategies and programmes were found to be consistent with the recommendations of WHO and UNICEF. The nutritional transition facing developing and middle-income countries also has important implications for preventive strategies to control chronic degenerative diseases (Popkin B, 1994; WHO 1998; Monyeki KO, 1999). This descriptive study, comparing BMI data of school children over three time periods, found a rising prevalence of overweight and obesity among South African school children. Obesity as a public health problem requires to be addressed from a population or community perspective for its prevention and management. Environmental risk factors such as exposure to atmospheric pollution remain significant hazards for children. Lead poisoning is a significant, preventable risk factor affecting cognitive and scholastic development among children. The prevalence of elevated blood lead (PbB) levels in rural and semi-urban areas of KwaZulu-Natal (KZN) as well as the risk factors for elevation of PbB among children in informal settlements were examined. This study investigated over 1200 rural and urban children in two age groups: 3-5 and 8-10 years old. Average PbB level in peri-urban Besters, an informal settlement in the Durban metropolitan region, was 10 ug/dl with 5% of the children showing PbB level of greater than 25 ug/dl. By comparison, average PbB value in Vulamehlo, a rural area located 90-120 km from Durban, was 3.8 ug/dl and 2% of the children's PbB levels were greater than 10 ug/dl. Since the cognitive and scholastic performance of school children was a primary outcome measure in this study, it was important to explore other factors that influenced this variable. The performance scores of all four tests in the battery, among the cohort of a thousand rural and urban children, were in the lower range. The educational deficit identified in this test battery clearly indicates the impact of the inferior "Bantu" educational system that African children have experienced in South Africa. Aspects of the School Health Services that were investigated in this descriptive study included the services provided and their distribution; assessment of health inspection; health education and referral processes undertaken by the School Health Teams; perceptions of managers, providers and recipients of the service; as well as the costs of the provision of the service in KwaZulu-Natal. In KwaZulu-Natal, there were School Health Teams In all the 8 health and education regions in the province. In total, there were 95 teams in the province, consisting of nearly 300 staff members. The School Health Teams were involved in a wide range of activities - 74% of all teams were involved in health inspection and 80% were involved in health education. The total annual cost of delivering School Health Services in the province in 1995 was estimated to be approximately R8 750 000. Given the rise of HIV and AIDS in the province, School Health Services need to play a central role not only in prevention, but also in assisting with the acceptance of HIV-positive children within schools. It is recommended that the current and future draft SHS policy guidelines be approved by the relevant authorities for immediate implementation. Districts should consider developing "Health Promoting Schools", with School Health Teams being a central resource. This thesis has explored several aspects of the epidemiological profile of school children in rural and urban settings in KwaZulu-Natal. It has established that school children are exposed to a range of risk factors ranging from nutritional deficits, parasitic infections, atmospheric lead poisoning and a rising prevalence of overweight. All of these risk factors may compromise their physical, psychological and social development. A number of health interventions have been identified, which have the potential to address these problems. Such investments are essential to secure the health of future generations. / Thesis (M.D.)-University of Natal, Durban, 2001.

The research explored the new health care service vehicle of South African with special reference to health service providers in Western Cape Department of health for the period 1995-2001. A study was made of the District Health System and the shift of emphasis from tertiary and secondary level of health care to the more cost effective Primary Health Care Service rendered at District level.

Stroke is the third leading cause of death and a major cause of disability in most societies. Individuals with physical disabilities are at risk of secondary complications due to the impact of the disability, which may be exacerbated by poor lifestyle choices. Although disabled persons desire to engage in wellnessenhancing activities, limited programmes based on their health promotion needs&rsquo / assessment have been developed. The aim of the present study is to determine the health promotion needs of stroke patients accessing selected Community Health Centres in the Metropole region of the Western Cape. A cross-sectional survey, utilizing a self-administered questionnaire and in depth interviews with a purposively selected sample was used to collect the data. The quantitative data was analysed using Microsoft Excel &reg / . Means, standard deviations and percentages were calculated for descriptive purposes and the chi-square test was used to test for associations between socio-demographic and health-related variables. Audiotape interviews were transcribed verbatim, the emerging ideas were reduced to topics, categories and themes and finally interpreted. In order to qualify for between-method triangulation used in the study, complementary strengths were identified by comparing textual qualitative data with numerical quantitative results and vice versa. The quantitative analysis revealed that the participants were engaging in health risk behaviours such as physical inactivity, substance usage, non-compliance to medication use and inappropriate diet modification. Lack of financial resources, facilities and access to information predisposed them to involvement in risky health behaviours. In-depth interviews supported the quantitative findings and revealed that numerous participants&rsquo / suffered from depression and frustration as a result of having a stroke. The necessary ethical considerations were upheld. The outcome of the study could contribute to the need to develop, encourage and promote wellness-enhancing behaviours and activities to improve the participants&rsquo / health status and ultimate quality of life.

Assignment (MPA)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: Primary Health Care (PHC) approach is currently receiving tremendous attention worldwide as a mechanism to ensure effective and efficient public health services. The concept has evolved from the Alma Ata conference (1978). Since then many countries began to reorient their health services to achieve the goals of availability, accessibility and affordability of health care for all citizens and a number of management issues came to the forefront. Therefore, the provision of comprehensive PHC services is the key aspect to improving health services. A district health system has been identified as an ideal model for comprehensive PHC services to all the citizens in South Africa. Public health services in the Cape Metropolitan Area are characterised by functional fragmentation. Two public authorities render Primary Health Care services, namely the: Provincial Administration of the Western Cape through CHSO, and the Municipal Health Department. The fragmented nature of the public health services, which result in poor coordination of service delivery between the two health authorities, compromises the quality of service delivery. Historically, PHC services in the Cape Metropolitan Area - and indeed in the whole South Africa - have developed in a skewed manner. This work is an attempt at conceptualising the implications and consequences of this skewed health development. South Africa is presently undergoing fundamental reform, which has brought the PHC into disarray of fundamental change. Since the South African health care system is a highly complex institution, attempts have been made to critically analyse those aspects and features of inequality, inaccessibility, and inequity. Among these is the historical and present development of Cape Metropolitan Area health care and the structural features it assumed with the passing of time, trends and characteristics. In order to examine the theory in practice, the evolvement of PHC in the Cape Metropolitan Area will be analysed. The analysis highlights how different political formations have affected the development of PHC services and points out obstacles and limitations throughout the process, which had to be dealt with. Transformation of the existing health services, based on the principles of PHC, requires the redressing the imbalances of the past. Therefore, the integration of the two health authorities into one entity would best achieve the principles of district health system and will ensure comprehensive PRe. / AFRIKAANSE OPSOMMING: Die Primêre Gesondheidsorg benadering geniet tans wereldwyd erkenning as 'n meganisme om doeltreffende openbare gesondheidsdienslewering te versker. Die konsep, wat ontwikkel en gegroei het uit die Alma Ata-konferensie van 1978, is reeds deur verskeie regerings ge-implementeer ten einde die doelwitte van beskikbaarheid, toeganklikheid en bekostigbaarheid van gesondheidsorg vir alle landsburgers te verseker. Die voorsiening van omvattende Primêre Gesondheidsorgdienste word erken as 'n noodsaaklike middelom gesondheidsorg te verbeter. Die Distrikgesondheid-stelsel is geidentifiseer as 'n ideale model vir die implementering van omvattende Primêre Gesondheidsorgdienste in Suid Afrika. Publieke Gesondheidsdienste in die Kaapse Metropolitaanse-gebied word gekenmerk deur die feit dat dit funksioneel gefragmenteer is. Twee publieke owerhede, te wete die Provinsiale Administrasie van die Wes Kaap en die Kaapse Stadsraad lewer Primêre Gesondheidsorgdienste, wat aanleiding gee tot swak koordinering met die gevolg dat dienslewering daaronder ly. Primêre Gesondheidsdienste in die Kaapse Metropolitaansegebied, soos in die res van Suid Afrika, het op 'n onlogiese, skewe manier ontwikkel Hierdie werk is 'n poging om die gevolge en implikasies van die onlogiese, skewe gesondheids-ontwikkeling te konseptualiseer. Daar is gepoog om die uiters gekompliseerde gesondheidsdiens-stelsel in Suid Afrika krities te analiseer met spesifieke verwysing na die kenmenrke van ongelykheid, ontoeganklikheid en onbillikheid. Dit sluit die historiese en huidige ontwikkeling van gesondheidsorg in die Kaapse Metropolitaanse gebied en die strukturele kenmerke in wat deur die loop van jare as gevolg van verskeie invloede en neigings sigbar geraak het. Die ontwikkeling van Primêre Gesondheidsorg in die Kaapse Metropolitaanse-gebied word ge-analiseer ten einde bogenoemde teorie in die praktyk te bevestig. Die analise beklemtoon die invloed van verskillende politieke rolspelers op ,die ontwikkeling van Primêre Gesondheidsorgdienste en bevestig die struikelblokke en beperkings wat deurentyd opgeduik het. Transformasie van gesondheidsdienste soos dit tans daaruit sien, gegrond op die beginsels van Primêre Gesondheidsorg, vereis dat die ongelykhede van die verlede aangespreek word. Die integrasie van die twee gesondheidsdiensowerhede sal die beginsels van die Gesondheidsdistrik-stelsel verwesenlik, wat daartoe sal aanleiding gee dat omvattende Primêre Gesondheidsorg 'n werklikheid word.

This study explores environmental understanding among the health care practitioners serving a rural community in the Eastern Cape Province in South Africa. During the preliminary phases of the research, the decision was made to adopt a participatory approach to the inquiry as far as was possible. Semi-structured interviews, participant observation and focus group discussions were the techniques chosen to focus the participants' thinking about: the meaning of environment, environmental issues and problems which impact on health, and, environmental education in practice. Comparisons between the recently transformed health education idea proposed by the World Health Organization (WHO), known as "health promotion", and a popular environmental education model are made. It is argued that many of the obstacles to effective health education described by the participants in the study can be overcome by using environmental educationlhealth promotion approaches. The findings show that the health practitioners studied relate to a wide range of environmental issues with varying levels of engagement. They are influenced by changing values, their feelings about indigenous knowledge, and their notions about how people should respond to the environment. An urgent need for more and better communication among the different levels of health practitioners is identified. Finally, it is recommended that health care practitioners be supported with opportunities for professional development which can lead to a confident, seIfreflective approach to health education.