Title: Case Management and Clinical Outcomes of People Living with HIV and Admitted to a State-aided District Hospital in Durban, South Africa in 2007. Introduction: A proportion of the many patients who have advanced AIDS in South Africa present for the first time requiring admission to hospital, the number of which are limited by the availability of beds. Novel ways were developed to offer subacute inpatient care at Siyaphila, a facility linked to McCord Hospital in Durban to provide expedited or immediate antiretroviral therapy (ART) (exposed) for patients with advanced disease before their discharge (ART group) . Different components of palliative care were offered for those who did not enter the inpatient ART programme or who were terminally ill (non-ART group) (non-exposed) . Aim: The aim of the study is to describe the clinical condition, inpatient case management and outcomes before discharge of people living with HIV admitted to Siyaphila in order to assist in developing appropriate protocols for inpatient care. Methods: This was an observational, analytic, cohort study using a convenience sample of all patients consecutively admitted to Siyaphila during nine months in 2006/2007. Prevalence of AIDS defining conditions at Siyaphila, time taken to progress from one stage of care to another and outcomes for the two groups before discharge were determined. Univariate and multivariate logistic regression analysis was performed on the ART group to identify risk factors for mortality before discharge. A comparison between the ART and non-ART group was also undertaken. Results: Among the cohort of 405 PLHIV enrolled at Siyaphila during the study period only 171 (42%) were initiated on ART immediately. In all patients, tuberculosis (251; 62%) was the most common opportunistic infection followed by cryptococcal meningitis (68; 17%) and Pneumocystis pneumonia (28; 7%). The mean baseline CD4 cell count was 84 celis/uL for the non-ART group and 55 celis/uL for the ART group. (p <0.01) The median time from initial admission until discharge was 13 days in the non-ART group and 18 days in the ART group. The mortality before discharge among the non-ART group was 24% compared to 6% among the ART group. (p =0.001). The median number of days before ART was initiated was 14 days. Immune reconstitution inflammatory syndrome was diagnosed in seven patients (4%) among the admissions but caused no deaths. In the multivariate analysis, the odds ratio for mortality for patients under 40 years was 0.1 (95% Confidence Interval: 0.01 - 0.9). Conclusions: Subacute care offered at Siyaphila provides an entry point into the ART programme for non-ambulatory patients who in the KwaZulu-Natal context have low ART uptake after discharge. The findings of this study should be adopted as the best clinical practice for PLHIV and AIDS admitted in the late stages of the disease. 0Nords 423) Title: Case Management and Clinical Outcomes of People Living with HIV and Admitted to a State-aided District Hospital in Durban, South Africa in 2007. Introduction: A proportion of the many patients who have advanced AIDS in South Africa present for the first time requiring admission to hospital, the number of which are limited by the availability of beds. Novel ways were developed to offer subacute inpatient care at Siyaphila, a facility linked to McCord Hospital in Durban to provide expedited or immediate antiretroviral therapy (ART) (exposed) for patients with advanced disease before their discharge (ART group) . Different components of palliative care were offered for those who did not enter the inpatient ART programme or who were terminally ill (non-ART group) (non-exposed). Aim: The aim of the study is to describe the clinical condition, inpatient case management and outcomes before discharge of people living with HIV admitted to Siyaphila in order to assist in developing appropriate protocols for inpatient care. Methods: This was an observational, analytic, cohort study using a convenience sample of all patients consecutively admitted to Siyaphila during nine months in 2006/2007. Prevalence of AIDS defining conditions at Siyaphila, time taken to progress from one stage of care to another and outcomes for the two groups before discharge were determined. Univariate and mUltivariate logistic regression analysis was performed on the ART group to identify risk factors for mortality before discharge. A comparison between the ART and non-ART group was also undertaken. Results: Among the cohort of 405 PLHIV enrolled at Siyaphila during the study period only 171 (42%) were initiated on ART immediately. In all patients, tuberculosis (251; 62%) was the most common opportunistic infection followed by cryptococcal meningitis (68; 17%) and Pneumocystis pneumonia (28; 7%). The mean baseline CD4 cell count was 84 celis/uL for the non-ART group and 55 celis/uL for the ART group. (p <0.01) The median time from initial admission until discharge was 13 days in the non-ART group and 18 days in the ART group. The mortality before discharge among the non-ART group was 24% compared to 6% among the ART group. (p =0.001). The median number of days before ART was initiated was 14 days. Immune reconstitution inflammatory syndrome was diagnosed in seven patients (4%) among the admissions but caused no deaths. In the mUltivariate analysis, the odds ratio for mortality for patients under 40 years was 0.1 (95% Confidence Interval: 0.01 - 0.9). Conclusions: Subacute care offered at Siyaphila provides an entry point into the ART programme for non-ambulatory patients who in the KwaZulu-Natal context have low ART uptake after discharge. The findings of this study should be adopted as the best clinical practice for PLHIV and AIDS admitted in the late stages of the disease. (Words 423) / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

The study sought to determine what palliative care services were provided to offenders at Medium B correctional center, which is located at Durban Management Area. It identified the perceptions of offender-patients about the services they received. The study also identified challenges that staff and offender-volunteer caregivers faced in rendering services within a correctional context in South Africa. The sample consisted of three stakeholders, namely, offender-patients who were terminally ill with AIDS at the prison hospital, staff and offender volunteer caregivers. The methods of data collection comprised of content analysis, semi-structured interviews with offender-patients and focus group discussions with staff and offender volunteer caregivers. The study revealed that efforts were made by the Department of Correctional Services to provide services to terminally ill AIDS patients. Legislation and policy frameworks were consistently being developed by the Department to meet the needs of patients and to keep abreast with international best practices. Some services were in accordance with the theoretical framework of palliative care. However, many challenges were experienced because of the contextual constraints in which the services were being rendered. Recommendations to improve the delivery of services were made by all participants in the study. The study concludes with the recommendations by the researcher and suggestions for future research. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2006.

Introduction In 1996 there were 1,847,440 pupils in 4007 primary schools in KwaZulu-Natal (KZN) who were targeted for school Health Inspection (HI). In the same year there were only 95 school health teams who were visiting schools for HI. The School Health Service (SHS) had been running on a racial basis since the Apartheid era of government, and needed to be reviewed in order to measure its effectiveness and to make it relevant to the new government and its new health policies. Purpose To review HI as a key component of School Health Services (SHS) and make recommendations to improve it's impact on the health of the school child and on health promotion in schools. Objectives To describe the structure, process, output and outcome of HI in KZN; to measure the impact of HI on the health of school children; and to calculate the SHS consultation cost and compare it with other primary health care services. Methodology A cross sectional study involving 21 schools covered by the SHS and 5 schools not covered by SHS was undertaken. The study area was KZN and the sample area was Indlovu region. All health authorities and racial groups participated in the study. Results A total of 212 children and 129 parents were interviewed. Of the children interviewed, 156 pupils (73.5%) had been involved in HI and 56 (26%) had not. The average nurse/pupil ratio was 1:49301. HI coverage was 62%. Of the 156 pupils examined, 108 were referred and 53% of them went for treatment. 93 % of parents interviewed gave a positive comment on HI and 24.8 % of them did not know their children's problems before they were informed by the SHN. Std. 5 pupils interviewed before and after HI were compared and it was found that 57% from the after-HI group went for treatment for their health problems compared to 53% before HI. Subjective feelings improved from 15% pain before HI to 0% after HI. Conclusion HI had a positive influence on encouraging pupils to seek recommended treatment and this is likely to improve their health. / Thesis (M.Med.)-University of Natal, Durban, 2000.

The Natal/KwaZulu Health Services Liaison Committee (HSLC) has been established to co-ordinate health care delivery in Natal and KwaZulu. This body has defined eight geographical Health Planning SubRegions (HPSRs) (Annexure E) of which each is a unit for planning and prioritising health service delivery in respect of its resident population. The HSLC considered that a study of inpatient catchment populations of hospitals under the control of the statutory Health Authorities would provide information which was essential to the planning processes of those authorities. The Department of Community Health was requested by the HSLC to undertake this study. A previous study, co-ordinated by the Department of Community Health (September 1987), dealt with "Outpatient Catchment Populations of Hospitals and Clinics in Natal and KwaZulu" (E DADA). No previous similar study on inpatients has been undertaken in South Africa. The expansion and improvement of basic services - particularly health care, water supply and basic education - should be perceived as essential elements in a strategy designed to enable all residents of a region to meet basic human needs and enjoy a minimum standard of living. Thus increased efforts have to be made to utilise health care resources effectively and efficiently and to plan future facilities carefully with regard to accessibility and appropriateness . This will require careful and objective management by all Authorities responsible for delivering health care to the people of Natal and KwaZulu. Accurately predicting the utilisation of hospital inpatient facilities is critical to efficient resource allocation in Health Services management. Catchment population studies and cross boundary flow characteristics provide valuable information on the utilisation of available facilities. This information is of value in the development of existing health services and the planning of additional health facilities with regard to size, situation and service type. Studies in other areas on utilisation of health service facilities, suggest that distance strongly influences hospital choice in both rural and metropolitan areas (Inquiry 1984 21(1) : 84-95) and this could explain some of the findings of this study with regard to cross boundary flow between Magisterial districts and HPSRs. For the efficient planning of resources, particularly with regard to situation and size, knowledge of the population size and demographic composition are important, as is a knowledge of the profile of disease in a community. The objectives of this study are directed to making available this information to each of the health authorities responsible for health care delivery and thus, to facilitate the management process. / Thesis (M.Med.)-University of Natal, Durban, 1988.

This commentary is essentially a report on various aspects of assessment of health needs and priorities in a peri-urban black community (mainly African) situated near Pinetown. The study was initially conducted under the auspices of the Pinetown Health Department, and the main findings are as follows (a) The geographical area of Mariannhill II Location includes what the local people call "Impola" and "Tshelimnyama", and sustains a population of 3 000 persons on some 500 hectares. (b) The origins of the population have been found, contrary to popular belief, to be 92% urban and semi-urban, and only 8% rural. (c) Demographic characteristics are those of an established stable community with a high mortality rate and high fertility (135 livebirths per 1 000 women aged 15 - 49 years per annum). The sex ratio is 99.4 males per 100 females, and there are no migratory characteristics. (d) The average number of individuals per household is 9, with a lot of overcrowding per room (not quantified). Of 1 346 adults of working age 43.68% are unemployed. (e) Morbidity and mortality studies conducted both at the level of the community and hospital revealed that children under the age of one year had the most sickness episodes, while the age groups 6.1 to 18 years had the least. (f) The disease profile is that of a typical third world developing country, with predominance of infections, accidents and physical violence. (g) Diarrhea disease constituted about 11% of the profile and was significantly associated with the water source for the household. (h) The most important cause of the 33 deaths reported over a one year period is motor vehicle accidents and physical violence (33.3%). (i) The major health resource is the local St Mary's Hospital with a 55% uptake of sickness episodes from the community. Nearly half of these ended up as in-patients. (j) 60% of children under the age of 6 years were estimated to have been fully immunized, and virtually all of it had been done by the hospital. (k) Community opinion on their problems and needs overwhelmingly pointed at water, clinic and lack of transport facilities as urgent matters. However, careful assessment of community concern pointed to the threat of removal as the most important single community problem, with implications for housing and all the other perceived problems. The majority of the people looked up to the Catholic Mission as a possible source of help to resolve the problem of availability of water. (l) As the study was initiated with a view to interventive strategies, the main findings are discussed against a background of information distilled from several literary sources, and recommendations for action are advanced. (m) Lastly, the most important problem in data collection has been that of inaccessibility of the Pinetown register of births and deaths to the Pinetown Medical Officer of Health. We regret the difficulty, but we hope to update our study when the problem has been overcome. / Thesis (M.Med.)-University of Natal, 1984.

The National Health Act (Act 61 of 2003) defined Municipal Health Services and gave full responsibility for this function to district municipalities and metropolitan municipalities. District municipalities were required, by law, to provide municipal health services which were previously rendered by local municipalities and the Provincial Department of Health. This, therefore, required the transfer of staff, assets and liabilities from local municipalities and the Provincial Department of Health to district municipalities. The purpose of the study was to identify barriers to and facilitating factors for the transfer of municipal health services from the seven local municipalities and the Provincial Department of Health to the uMgungundlovu district municipality. A cross-sectional, descriptive study design was employed. A structured questionnaire was used to collect quantitative data from local municipalities and the Provincial Department of Health on the package of environmental health services offered and the available human resources. Qualitative data was collected through in-depth interviews and focus group discussions with key role players in the provision of environmental health within the district. The key findings of the study were: There were no changes to the package of environmental health services offered by local municipalities and the Provincial Health following the definition of Municipal Health Services. The Provincial Department of Health continues to play an important role in the provision of Municipal Health Services in the district There was a lot of awareness-raising on the integration process; however planning for the integration was very poor. The lack of progress in integration has had a negative impact on service delivery and on the environmental health personnel involved. The relationship between district and local municipalities, a lack of understanding of environmental health, budget allocation, communication, lack of commitment, capacity, and lack of a champion were seen as the main barriers to the integration process. The study was able to identify possible gaps in the planning process that, if revisited could assist the district municipality in better handling the process. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2011.

No abstract available. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2012.

Catchment populations and cross-boundary flow characteristics of health facilities in Natal and KwaZulu have not previously been determined. As this information is essential to objective health service planning the present study was undertaken. Utilization. cross-boundary flow and catchment populations were determined in 1986 for each hospital and clinic in Natal and KwaZulu. All of the 61 hospitals and 178 clinics in Natal and KwaZulu which are operated by the public sector were included in the study. The ratio of clinics-to-hospitals was 2.9 1. The overall average population per hospital and clinic was 106775 and 36591 respectively. The size of the catchment populations of hospitals varied from 334972 to 272 and of clinics from 253159 to 877. Factors associated with these variations are discussed. Inter-regional cross-boundary flow of patients varied appreciably. The greatest influx of patients was experienced by the Durban sub-region where the teaching hospital is situated while the greatest influx of patients was experienced in the Port Shepstone sub-region. Attendance rates per person per annum. according to racial group, were 0.9, 2.1, 1.7 and 0.8 respectively for Blacks, Coloureds, Indians and Whites. Recommendations in respect of the distribution of health facilities and the routine collection and use of health information relevant to the management process are submitted. / Thesis (M.Med.)-University of Natal, Durban, 1987.

ABSTRACT This study focuses on the implementation strategy of free health care policy for disabled persons at hospital level in KwaZulu-Natal. Since the introduction nationally, in 2003 of free health care policy for disabled persons, no evaluation has been conducted in KwaZulu- Natal to inform health service managers and the KwaZulu-Natal Department of Health on the implementation of this policy. A provincial implementation strategy is needed for effective implementation of the policy. To date, no such provincial implementation strategy is available and the lack of an implementation strategy for this policy motivated this study. METHODS An exploratory qualitative study design was implemented to elicit information from health service providers and representatives of persons with disabilities to inform the development of an implementation strategy for the free health care policy for disabled persons at public hospitals in KwaZulu-Natal. Data was collected through interviews and focus group discussions. Data was analysed by utilising a thematic approach. RESULTS Respondents reported a variety of understandings with regard to policy context of the Free Health Care Policy for disabled persons, policy content in terms of purpose and eligibility, policy implementers and their roles in implementing the policy, and the implementation process of this policy at state hospitals of KwaZulu-Natal. CONCLUSION There is limited understanding of the Free Health Care Policy among some health service personnel and some disability groups, and this may have contributed to the erratic and poor implementation of the policy at public hospitals in KwaZulu-Natal. Factors necessary for policy implementation such as a communication strategy, guidelines for implementation, assessment of availability of resources, training of implementers, monitoring and evaluation strategy are crucial for effective implementation of any policy including the Free Health Care Policy for disabled persons. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2013.

INTRODUCTION: Providing sufficient quality nurses in resource strapped countries is a human resource management challenge which nurse managers’ experience on a daily basis. THE PURPOSE of this study was to analyse and to determine the issues which affect the the human resources management of nurse managers in selected hospitals in the eThekwini District of the Province of KwaZulu-Natal, South Africa, and to formulate draft guidelines to assist nurse managers with human resource management. METHODOLOGY: A constructionist, reflexive ethnographic approach was used. The ethnographer spent two years in the field collecting data from informants, who were nurse managers, in four (4) selected district hospitals. Data was collected using unstructured informant interviews, non-participant observation and confirmatory document analysis. Data analysis led to eliciting codes from the data, searching for semantic relationships, performing componential analyses and discovering the themes for discussion within the final ethnographic report. A nominal group process was used to develop the draft guidelines. FINDINGS: The findings showed that the human resources management around sick nurses is a complex task. The themes of nurse managers’ experiences were a “burden” of maintaining confidentiality, as well as an emotional burden. Administratively, they experience the burden of absenteeism and the burden of policy compliance. The final theme is the burden of the deaths of HIV and Tuberculosis affected/infected nurses. CONCLUSION AND RECOMMENDATIONS: Organizations should create a non-judgmental work environment where non- disclosure by employees is respected in order to promote disclosure. They should have an awareness of the emotional effect on nurse managers and provide them with support. Emphasis needs to be placed on an HIV and AIDS policy and programme, incapacity leave workplace strategies and return to work policies. It is also recommended that contingency plans be provided when the death or prolonged absence of an employee impacts the staffing of the organization; consideration to be given to piloting and refining the draft guidelines; the management of employees on prolonged sick leave be included in the Nursing Administration Curricula taught to future nurse managers; and further research be conducted to assess employee reluctance to report needle stick injuries (sharps injuries) as well as the related phenomenon of stigmatization. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2014.