Health Studies / (D. Litt. et Phil. (Health Studies))

Dissertation submitted in partial compliance with the requirements of the Master's Degree in Technology: Homoeopathy, Durban University of Technology, 2010. / In collaboration with Lifeline, Durban University of Technology (DUT) established its first satellite homoeopathic community clinic; Ukuba Nesibindi Homoeopathic Clinic (UNHC). UNHC provides a free homoeopathic primary healthcare service on the third floor of the LifeLine building in Warwick junction, Durban, an area which is classified as being disadvantaged with high crime rates, prostitution, violence, small, informal business and low cost housing. The clinic is run by 4th and 5th year homoeopathic students under the supervision of a qualified homoeopathic practitioner and funded totally by the Department of Homoeopathy – DUT. The purpose of this retrospective clinical audit of UNHC was to determine a patient demographic and disease prevalence profile, as well as identify and describe the major medicines prescribed. Methodology The study used a retrospective, explanatory, and descriptive design method by means of a clinical audit, to determine a patient demographic and disease prevalence profile, as well as identify and describe the various homoeopathic treatment modalities. All the patient files from June 2004 – June 2008 were included for analysis and the data collection spreadsheet (Appendix D) was compiled respectively. IV The data collection form was divided into patient demographics, information on number of consultations and follow-ups, clinical diagnoses, urine dipstick analysis, patient referral information and medicines prescribed. The researcher captured the data, which was analysed and various means of descriptive statistics applied using Excel from Microsoft Office® 2007. Results UNHC opened in 2004 and initially only operated two afternoons per week; in order to cope with the demand for this service which grew rapidly in 2006 an additional consultation afternoon was added. A total number of 862 patients were seen between June 2004 and June 2008, 497 being new patients and 365 being follow up patients. On average 56% of patients came back for more than one follow up consultation during the study period. The majority of patients who attended UNHC during the study period were African females between 40 and 64 years of age who were unemployed and single. Of the 5 most prevalent systemic disorders encountered at UNHC infectious disorders were the most frequent along with cardiovascular, dermatological, psychological and musculoskeletal disorders. Conclusion The significant increase in patient numbers at UNHC and the relatively high percentage of patients who returned for more than one follow up consultation are positive trends and suggestive of UNHC’s success in providing homoeopathic primary healthcare as well as the positive impact it has had on the surrounding community. With additional funding UNHC can improve service provision further; dedicated translators as well as various equipment to facilitate administration will streamline the consultation process significantly and allow for more patients to be seen. Expansion of the scope of diagnostic services provided such as pregnancy and glucose testing will reduce the need for referral for such basic services. V Future studies should formally measure patient benefit in response to treatment in the form of a patient benefit survey; qualitative measures of patient satisfaction with the service provided by UNHC are also warranted.

Thesis (MBA)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: This study set out to identify the key success factors of Public Private Partnerships (PPPs) in the healthcare sector to be considered by Netcare when exploring possible PPP opportunities. Public Private Partnerships (PPP) presents a means of mobilising private funds for delivering of public services whilst government manages the relationship via a negotiated PPP agreement to ascertain the quality of services rendered. A literature study was performed in order to conceptualize the potential of the application of PPP in the healthcare industry and the factors impacting on the success thereof. PPPs around the world did not develop in unison nor are they uniform in nature. It is this variation in development that led to the formation of a wide variety of different PPP models that define these partnerships. The different PPP models currently applied by Netcare in the UK are similar in their basic characteristics to some of the models described in literature. One of the biggest challenges facing the healthcare industry in South Africa is the unequal split between public and private healthcare sectors. This is not only in terms of number of people serviced but also includes allocation of the available resources. Very limited information is available on application of PPP in the healthcare sector. The private hospital groups primarily involved in PPP in the healthcare industry in SA are Netcare and Medi-Clinic. Netcare has successfully positioned itself not only as the biggest private hospital group in South Africa, but also as the leader in PPP involvement in the healthcare sector in South Africa. The PPP projects undertaken, though still very early days, have been very successful, but do not yield very high returns. The rationale to Netcare for partaking in these extends beyond financial returns. It is mainly strategic in terms of its position in the local market and its potential involvement in the anticipated NHS (National Health System). It is essential that Netcare maintains credibility and goodwill and continues to demonstrate its commitment to address the healthcare industry needs of all in SA. Responding to the limited growth opportunities presented by the local market, Netcare expanded its operations to include international contracts, in particular in the UK, with negotiations under way for contracts in Portugal. The experienced gained through the PPPs in the UK, the country regarded as the leader in PPPs in the healthcare sector, is invaluable to their future participation in PPPs. Governments all over the world want to improve healthcare service delivery and curb healthcare inflation. This presents opportunities to Netcare that could arguably be in the form of a PPP. The ability to evaluate the key success factors that will impact on these PPPs is therefore of great importance to Netcare. The study showed that the actual process involved in forming a PPP depends on various key factors that impact on the outcome thereof. The role of government is essential and it includes the creation of the infrastructure and the legal environment for PPP, to demonstrating competence in managing PPPs, providing the political support and achieving investor confidence. An extensive list of key success factors was identified, but applying these factors to two possible PPP opportunities revealed their shortcomings. It was concluded that the list of factors cannot be applied as the ultimate checklist to pre-determine the outcome of a PPP. This is because various factors will only be revealed in the later stages of the PPP project life. It was also concluded that PPP participation by the company is a priority strategic decision. The strengths and weaknesses of the company relative to the opportunities and threats presented then needs to be evaluated. The list of key success factors provides an important guideline in terms of considering the specific opportunities and threats associated with PPPs. These factors should be considered during the various stages of the project development. / AFRIKAANSE OPSOMMING: Die doelwat van die studie is die identifisering van die faktore wat die sukses van Staat Privaat Vennootskappe (SPV) binne die gesondheidsorg industrie sal bepaal, en wat deur Netcare in ag geneem moet word wanneer sodanige vennootskappe oorweeg word. Hierdie vennootskappe bied 'n geleentheid vir die mobilisering van privaat fondse vir publieke dienslewering terwyl die regering deur middel van die onderhandelde PPP ooreenkoms die verhouding bestuur en die kwaliteit van dienslewering monitor. Die literatuurstudie het ondermeer die potensiaal van sodanige vennootskappe in die gesondheidsorg industrie, sowel as die faktore wat die suksesvolle uitkoms daarvan bepaal, ondersoek. Verskeie SPV modelle en tipes vennootskappe bestaan weens die uiteenlopende ontwikkeling van SPVs in die onderskeie lande. Die modelle tans toegepas deur Netcare in Engeland reflekteer die eienskappe van modelle beskryf in literatuur. Een van die gesondheidsorg indrustrie in Suid Afrika (SA) se grootste uitdagings is die oneweredige verdeling tussen publieke en privaat gesondheidsorg, beide in terme van populasie verteenwoordiging en aanwending van die beskikbare hulpbronne. Inligting aangaande die aanwending van SPV in die gesondheidsorg industrie is baie beperk. In die Suid Afrikaanse konteks is Netcare en Medi-Clinic die dominante rolspelers in SPVs in die industrie. Netcare is tans nie net die grootste privaat hospitaalgroep in SA nie, maar ook die leier op SPV betrokkenheid in die gesondheidsorgsektor in SA. Hoewel die huidige SPV's relatief onlangs tot stand gekom het, is daar reeds heelwat sukses behaal. Die opbrengs gerealiseer is egter nie fenominaal nie. Die motivering vir Netcare se betrokkenheid in hierdie vennootskappe strek egter verder as bloot die finansiële opbrengste. Gegewe die potensiële nasionale gesondheidstelsel en die posisionering in die plaaslike mark, is dit noodsaaklik vir Netcare om gesien te word as toegewyd aan 'n oplossing vir die gesondheidsorg uitdaging in Suid Afrika. Netcare se internasionale uitbreiding kan deels toegeskryf word aan die beperkte groei geleenthede in SA. Hulle internasionale kontrakte sluit in Engeland met onderhandeling in Portugal tans onderweg. Die ondervinding opgedoen met die SPV's in Engeland is van onskatbare waarde gegewe Engeland se posisie as leier op die gebied van SPV in die gesondheidsorg industrie. Verskeie lande poog tans om hulle gesondheidsorg dienslewering te verbeter en mediese inflasie te beperk. Dit skep potensiële SPV geleenthede vir Netcare. Die vermoë om die kritiese sukses faktore wat die uitkoms van hierdie SPVs sal bepaal, te kan evalueer, is dus van kardinale belang vir Netcare. Dit blyk uit die studie dat die proses van die ontwikkeling van SPV deur verskeie faktore beinvloed word. Die regering van 'n land speel 'n belangrike rol in die daarstelling van die infrastruktuur, die regsaspektelike omgewing, hulle bevoegdheid in terme van die bestuur van SPV, hulle vermoë om politiese ondersteuning te verleen en hulle vermoë om beleggers se vertrou te wen. 'n Omvattende lys van faktore wat impakteer op die sukses van SPV is identifiseer. Tydens die toepassing daarvan op twee voorbeelde het dit duidelik geblyk dat die lys nie as allesomvattend beskou kan word en aangewend kan word om vooraf die uitkoms van 'n SPV te voorspel nie. Verskeie faktore wat krities is in die sukses van SPV kan eers bepaal word tydens later stadiums van die SPV. Daar is ook tot die slotsom gekom dat die firma strategie die primêre oorweging tydens die evaluering van SPV behoort te wees. Die sterk en swak punte van die firma relatief tot die geleentheide en bedreigings wat die SPV inhou moet evalueer word. Die lys van faktore krities tot die sukses van SPV dien as 'n belangrike riglyn vir die oorwerging van geleenthede en bedreigings geassosieerd met SPV. Hierdie faktore behoort tydens die verskeie stadia van SPV projek ontwikkeling in ag geneem te word.

Introduction: Trauma is the main cause of death in working-age adults in the UK. Multiple organ failure (MOF) is associated with a high proportion of late trauma deaths, and MOF survivors have poor long-term outcomes. Early prediction of patients at risk of MOF would assist treatment decisions and allow targeted interventions. Methods: A cohort of major trauma patients requiring intensive care unit (ICU) treatment at the John Radcliffe Hospital was identified. Data were obtained from the two national databases of the Trauma Audit Research Network and the Intensive Care National Audit and Research Centre, and from a local ICU database with hourly data recording. Literature review and questionnaire analysis of trauma clinicians identified candidate predictors of MOF, grouped into patient, injury, physiological, laboratory and management variables. MOF scoring systems were reviewed to determine the most appropriate for use in trauma patients. Prediction models of post-trauma MOF were developed using logistic regression at a range of times from 0 to 48 hours after injury. Models were internally validated using bootstrapping. Results: 517 adult trauma patients were identified from 2003-2011. Overall mortality was 14.9%, with 491 patients surviving more than 48 hours, and therefore being at risk of MOF development. For these 491 patients, MOF incidence depended on the definition, and ranged from 23% (Denver score) to 58% (SOFA score). MOF was associated with mortality, time to ICU admission, and length of ICU and hospital stay. MOF could be predicted with an accuracy of up to 81.3% at 2 hours post-injury, and 84.2% at 12 hours post-injury using small numbers of clinical variables. Age, head injury, abdominal injury, maximum heart rate and the need for vasopressors were strong predictors of all definitions of MOF. Conclusions: Post-trauma MOF can be predicted early after injury using combinations of clinical variables. Further validation of the identified variables on external populations would allow development of a clinical score to assist clinicians in trauma management.

No description available.

No description available.

Submitted in partial compliance with the requirements of the Master’s Degree in Technology: Homeopathy, Durban University of Technology, Durban, South Africa, 2016. / Introduction The Durban University of Technology (DUT) homoeopathic satellite clinic in Redhill was established in 2005. It was started by private homoeopathic practitioners who wanted to provide healthcare services to members of the community. This satellite clinic is very distinct from other DUT homoeopathic satellite clinics as it occupies space in an eThekwini Municipality public health care clinic. The homoeopathic clinic offers free homoeopathic treatment to the local community, as it is a training facility for 5th year homoeopathy students of the DUT. Students consult at this clinic under the direct supervision of a qualified homoeopathic clinician. This descriptive and retrospective study aimed to determine the patient demographics, the disease prevalence, the forms of homoeopathic treatment modalities utilised and to assess the financial implications of operating the clinic. Data was collected by conducting an audit of new and follow up appointments at the Redhill clinic over a five year period from 2010 to 2014. Methodology This descriptive and investigative clinical audit was conducted retrospectively at the Redhill Clinic. A data collection sheet was completed for each patient file which included demographic data such as race, age and gender, the year of the consultation, the date of each visit, the number of visits, the diagnoses and treatment protocols, materials used, prices of medicines and the cost of the clinician. The researcher captured the relevant data of each patient file at the DUT premises under the direct supervision of the supervisor. Each patient file was examined individually. Any patient file that was found to have missing information was not included on the data collection sheet or entered into the Microsoft Excel® spread sheet. The results were then analysed by using various forms of descriptive statistics such as pivot tables, pivot charts, pie charts and bar-charts. Results The Redhill Clinic was open once a week from 2010 to 2012 thereafter it was open every second week until September 2014 due to unavailability of rooms. A total number of 841 patient files which met the inclusion criteria were investigated. There were a total number of 1573 visits over a five year period. The majority of patients who attended the Redhill clinic during the study period were Africans, females and between the age group 21 – 30 years old. The five most prevalent conditions that were seen at the Redhill clinic were respiratory, musculoskeletal, infections, dermatological and gastro-intestinal conditions. The operational expenditure of a homoeopathic satellite clinic included the cost of medicines and materials used. The total cost was calculated to be less than R130 000 over a five year period. Conclusion The patient numbers decreased from 2010 to 2014. The number of follow up visits increased from 2010 to 2012. The number of patient visits has been consistent with more than 50 new and follow up visits each year. This suggests that there has been patient satisfaction with homoeopathic treatment over the years. The homoeopathic satellite clinic is unique as it is enclosed within the Redhill municipality clinic where allopathic doctors also practice medicine. This setting is advantageous because the nursing sisters at the clinic often refer patients to the homoeopathic satellite clinic on a weekly basis and students are able to refer their patients to the municipal clinic as appropriate. Patients were treated with homoeopathic remedies, herbal tinctures and creams and tissue salts. The low operational expenditure of the homoeopathic satellite clinic shows that it is very cost effective and inexpensive to maintain such a clinic. The results that were obtained from this study imply that the inclusion of homoeopathic satellite clinics in disadvantaged communities such as Redhill is beneficial and viable. The practice of homoeopathy is viable especially because of the current challenges that the health system of South Africa is exposed to. One of the significant concerns is that there is a shortage of health care workers in the public health care system. This study did not aim to investigate the possibility of incorporating homoeopathy into public health care at present but results can serve as a model for the inclusion of homoeopathy into other public health care facilities. The disease profile and treatment protocols that were obtained from this study can be used in planning the establishment of other homoeopathic satellite clinics in the future. / M

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Complications of chronic conditions pose serious consequenses for the patient and financial implications for the health authorities, in the form of serious procedures, adaptions of medication, hospitalisation or rehabilitation. The goal of the study was to investigate the management of patients with diabetes mellitus type 2 on primary health care level. The objective of the study: • a retrospective investigation into the holistic management of patients with diabetes mellitus type 2 by CNPs. The research design was descriptive, non-experimental with a quantitative approach. The population included 896 files of patients diagnosed with diabetes mellitus type 2 over a period of 6 months at 4 clinics in the George Subdistrict. The sample consisted of 180 files, namely 20% of the population. The researcher gathered the data personally by means of a structured check list. Ethical approval was obtained by Stellenbosch University and above mentioned health authorities. Reliability and validity was ensured by means of a pilot study, as well as inputs from a statistician, experts in the fields of primary health care and a research panel. Descriptive statistics were used for data-analysis. Variables were presented in the form of tables, graphs and frequencies. Statistica Version 9 software were used and relations between the various variables were analysed by means of ANOVA (“Analysis of Variance”). By means of systematic probability sampling every second file that adhered to the inclusion criteria was drawn, until 20% saturation was reached at each clinic. Thereafter every second file was drawn from the rest of the appropriate files, until the sample was sufficient or until there were no more suitable files left over. The results of this study provide evidence that the holistic approach was not constantly applied by CNPs in patients with diabetes mellitus type 2. Drug treatment was renewed by a doctor every six months, but no attention was given to the diabetes mellitus in between the doctor's visits. Health information was given. It varied between 100% to 81%. Complications were not addressed appropriately though. In clinic A for example 6% (n=5) recorded on the condition of the patients' feet, while in clinic B 4% (n=2) addressed this issue. At clinic C nothing was recorded on this aspect, while at clinic D 13% (n=2) recorded on this. Respiratory and cardio-vascular systems often fail in patients with diabetes mellitus type 2. At clinic A CNPs enquired only in 18% (n=16) of cases about these systems, at clinic B 22% (n=11), at clinic C 27% (n=7) and at clinic D 6% (n=1). This study has the potential to stimulate further research, especially regarding the reasons why CNPs do not manage chronic patients holistically. / AFRIKAANSE OPSOMMING: Komplikasies van kroniese toestande het gevolge vir die pasiënt en koste-implikasies vir die gesondheidsdienste, byvoorbeeld ernstige ingrepe, medikasieaanpassings, hospitalisasie of rehabilitasie. Die doel van die studie was om te bepaal hoe KVPs pasiënte met diabetes mellitus tipe 2 op primêre gesondheidsorgvlak hanteer. Die doelwit van die studie: • retrospektiewe waarneming na die holistiese hantering van pasiënte met diabetes mellitus tipe 2 deur KVPs. Die navorsingsontwerp was beskrywend, nie-eksperimenteel, met ‘n kwantitatiewe benadering. Die populasie was 896 lêers van pasiënte wat oor ses maande met diabetes mellitus tipe 2 gediagnoseer was by vier klinieke in die George Subdistrik. Die steekproef was 180 lêers, naamlik 20% van die populasie. Die navorser het persoonlik data ingesamel met ‘n gestruktureerde kontrolelys. Etiese goedkeuring is verleen deur die Universiteit van Stellenbosch en bogenoemde gesondheidsowerhede. Betroubaarheid en geldigheid is verkry deur ‘n loodstudie en deur insette van 'n statistikus, primêre gesondheidsorg eksperts, asook 'n navorserspaneel. Beskrywende statistieke is aangewend vir data-analise. Veranderlikes is voorgestel in die vorm van tabelle, grafieke en frekwensies. Statistica Version 9 sagteware is gebruik en verhoudings tussen veranderlikes is geanaliseer deur van ANOVA (“analysis of variance”). Deur middel van sistematiese waarskynlikheidsteekproefbepaling is elke 2de lêer wat aan die insluitingskriteria voldoen het getrek, tot 20% saturasie by elke kliniek bereik is. Verder is elke 2de lêer uit die oorblywende lêers getrek, totdat die hoeveelheid genoeg was, of totdat daar nie meer geskikte lêers was nie. Resultate van hierdie studie bewys dat pasiënte met diabetes mellitus tipe 2, nie holisties hanteer was deur KVPs nie. Medikasie was meestal elke 6 maande deur 'n dokter hernu, sonder enige aandag aan die diabetes mellitus tipe 2 gedurende die tussen-in periodes. Gesondheidsvoorligting was goed. Dit het gewissel van 100% tot 81%. Komplikasies was egter onvoldoende aangespreek. In kliniek A het byvoorbeeld 6% (n=5) oor die toestand van die pasiënte se voete gerekordeer, terwyl in kliniek B 4% (n=2) hiervan melding gemaak het. By kliniek C was daar niks hieroor aangeteken nie, terwyl by kliniek D 13% (n=2) hieroor gerekordeer het. Respiratoriese en kardiovaskulêre sisteme versaak dikwels by pasiënte met diabetes mellitus tipe 2. By kliniek A het KVPs slegs by 18% (n=16) navraag gedoen oor hierdie sisteme, by kliniek B 22% (n=11), by kliniek C 27% (n=7) en by kliniek D 6% (n=1). Hierdie studie behoort verdere navorsing te stimuleer, veral oor die redes hoekom die KVPs nie kroniese pasiënte holisties hanteer nie.

Thesis (MDF)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The role of health foreign assistance in explaining health outcomes remains an unending debate. The study assessed the relationship between foreign health aid and three selected health indicators of interest: infant mortality rate, under-five mortality rate and life expectancy, with control variables such as government expenditure on health and general medical clinics and public health services in Namibia. The data used was from 1990 to 2013 although there was some missing data. It was found that all health indicators improve with an increase in foreign health aid except that it is more impactful (statistically significant) in the case of infant mortality rate. The regression analysis shows that a one percent increase in heath aid will result in a 0.03 decrease in infant mortality rate but this is statistically insignificant. A one percent increase in health aid will result in a 0.01 decline in under-five mortality. A one percent increase in health aid will result in 0.53 increase in life expectancy. The Granger causality test revealed a uni-causal relationship among most variables. An increase in government expenditure to health is accompanied by a decline in all indicators. Overall, based on correlation coefficients, aid is linearly related to health outcomes in Namibia. The study gives a tentative conclusion that foreign health aid slightly improves health outcomes in Namibia.

The central theme or 'red-thread' that I consider in this thesis is the concept of risk as it is perceived by and affects the two sides of the medical encounter -in this instance ethnic Pakistanis and Health Professionals- in Britain. Each side very often perceives risk quite distinctively, relating to the balance between the spiritual and temporal realms. This is particularly germane in matters to do with possible congenital defects within the prenatal realm for the ethnic Pakistani, and predominantly Muslim, side of this encounter. Thus one of the factors considered in this thesis is how senses of Islam impact upon the two sides. By ethnic Pakistanis Islam is seen as central to all life decisions, whilst Health Professionals view Islam with some considerable trepidation, little understanding it or its centrality to the former's decision-making processes. This is particularly significant with regard to attitudes to health and health care. In the initial stages of the project I had thought first cousin marriage (FCM), seen by ethnic Pakistanis as desirable and by Health Professionals as putting ethnic Pakistanis at-risk to be central to the argument, but concluded that concerns around FCM were a 'red herring', merely a trope for the tensions between the two sides -at once both British and at-risk from audit culture. Although no longer central, FCM remains a viable touchstone in consideration of the two sides' perceptions of genetic risk. In this thesis the medical encounter between ethnic Pakistanis and Health Professionals is performed within the realm of the so called New Genetics. Here the respective understandings of the New Genetics are informed by the enculturation processes that shape the two sides' world view. Furthermore, I will agree with Lord Robert Winston's and others' concern that any attempt to eradicate an adaptive genetic mutation, in this instance, thalassaemia, from the gene pool is not only undesirable in the short term, but also that such eradications may have an adverse, and far reaching, effect on whole population groups in the future. The main thrust of my argument is that audit culture not only compounds risk for both sides, but also perpetuates institutional racism within the National Health Service (NHS), by promulgating what I have called the language myth. That is to say that much institutional racism is the unwanted by-product of the NHS's attempts to become more patient centred and its continuing efforts to develop systems of best practice. This professionalisation process within the NHS can be seen to impact most strongly in relation to communication -particularly the claimed language barrier between the two sides. This 'barrier' has worrying policy implications for any meaningful communication between the two sides, notably relating to obtaining informed consent from ethnic Pakistani patients -with a resultant increase in risk for the two sides and clear economic consequences for the NHS.