Thesis (MSD (EAP))--University of Pretoria, 2003. / Includes bibliographical references.

Background and objectives of the study: Although it is known that good glycaemic control improves microvascular outcomes in diabetic patients, no local study has yet been undertaken to investigate the potential factors that influence poor or good blood glucose control. This research focused on the evaluation of blood glucose control as assessed by glycosylated haemoglobin (HbA1c) levels in diabetic patients. In addition, certain determinants which contributed toward poor control at Kalafong Hospital were studied in a cohort of adults with diabetes mellitus for the year 2008. The aim of studying these determinants was to identify patients with a high risk of disease morbidity and barriers that prevent these patients from meeting their goals of improved health outcomes. The specific objectives were to estimate HbA1c control of patients seen at the diabetic clinic at Kalafong Hospital Pretoria in 2008 and to assess any existing association between patient demographic characteristics and diabetes characteristics with HbA1c. Methods: The study was a retrospective cohort study. All diabetic patients aged 18 years and above, who had been registered in the 2008 dataset and who had come for at least one visit to the diabetic clinic and had at least one HbA1C measurement, were included in the study. Patients who did not meet the above criteria were excluded from the study. A total of 942 patients seen in 2008 were selected, 801 patients met these inclusion criteria. The outcome variable HbA1c was obtained by computing the mean of the two HbA1c values collected for each participant for the year 2008, and used as a continuous dependent variable in multivariate linear regression. For descriptive purposes, HbA1c values were categorised into good control (<7%), poor control (> or = 7&< or =10%) and very poor control (>10%). Data analysis was performed using Stata version 10. Statistical significance was established at a threshold of 95% (p < 0.05). Results: More than half of participants in the study were females (60.8%/39.2%). The mean age of participants in the study was 56 years (sd 14.1). With regard to race, the proportion of blacks was more than three quarters of the sample (93.1%/2.4%/2.4%). Our results showed that HbA1c level decreased with increasing age, (p = 0.016). These results also showed that for every 1 mmol/l increase in total cholesterol, there was a 0.178% increase in HbA1c, (p = 0.019; 95% confidence interval (CI): 0.030 - 0.327), suggesting that higher cholesterol was associated with poorer HbA1c control. In addition, for every 1 mmol/l increase in capillary glucose, the HbA1c increased by 0.276%, (p = 0.000; CI: 0.230 - 0.322) while for every one unit increase in BMI, the HbA1c reduced by 0.032%, (p = 0.017; CI: -0.057 to -0.006). Conclusion: These results suggest that patients with higher total cholesterol and patients with higher capillary glucose level are more likely to exhibit poorer HbA1c control, whereas, older patients and patients with a higher BMI are more likely to have better HbA1c control. / Dissertation (MSc)--University of Pretoria, 2011. / Clinical Epidemiology / unrestricted

This research focuses on the psychosocial factors that affect adherence to highly active antiretroviral therapy (HAART) amongst HIV/AIDS patients at Kalafong Hospital. Even though the development of such regimens has helped turn HIV infection in the United States into a relatively manageable, though still serious chronic disease, compliance remains one of the major challenges in managing medication for those patients living with HIV/AIDS. This is particularly relevant given the high adherence rate (95%) required to obtain a successful long-lasting effect. In South Africa non-compliance to HAART is an under-explored phenomenon. Consequently, an understanding of factors influencing compliance is still incomplete. A qualitative study that investigates non-adherence to medication in HIV/AIDS patients was undertaken at Kalafong Hospital. This study aimed to understand patients’ psychosocial difficulties resulting in non-adherence. The study was approached in terms of the health belief model (HBM), which addresses individual characteristics pertaining to change, the transtheoretical change model (TTM) and the motivational interviewing model (MI), which address both individual and social contexts pertaining to change. The findings are designed for use by healthcare professionals as a proactive compliance enhancement tool. Participants were recruited through referrals by the medical staff to the researcher. The criteria included that participants had relapsed due to non-compliance with drug therapy. Participants that were currently experiencing difficulties with adherence were also included in the study. Males and females aged between 20 and 40 were included in the study. Fifteen participants between the ages of 20 and 40 participated in the study (13 females and two males). The data were collected by means of semi-structured interviews and follow-up unstructured questions. The interviews were audio recorded and field notes were taken. Data were analysed qualitatively. Sixteen themes emerged and were further classified into two categories: individual and social context. The themes were then compared and integrated with the literature. The study concludes that psychosocial factors such as support from family, friends and healthcare workers was found to be of utmost importance in encouraging adherence. Medication can only prolong a patient’s life if the psychosocial context in which the patient is embedded is considered in the treatment plan. / Dissertation (MA)--University of Pretoria, 2008. / Psychology / unrestricted