Encouraging older adults to become more active and maintain that activity is critical to the promotion of their health and well-being, social networks and independence. Leadership behaviour and quality of instruction is important in influencing engagement of older adults in exercise classes. Instructors' attitudes could influence older adults' uptake and adherence to classes, but little is known about the relationship between attitudes and characteristics of instructors and their delivery in relation to uptake and adherence of older adults to exercise classes. Methods: Underpinned by the Theory of Planned Behaviour and using a mixed methods approach this thesis uses three studies to:1) Survey 731 United Kingdom exercise instructors with Level 3 older adults exercise qualification to investigate instructors' characteristics and attitudes towards older-adults' participation in exercise. 2) Interview 19 instructors to further explore instructors' attitudes, experiences and beliefs in relation to their exercise classes for older adults and how their attitudes, experiences and beliefs are influenced by their training and characteristics.3) Follow up a cohort of 16 instructors and 193 of their class participants over 6 months to explore what characteristics of exercise instructors, the group and class participants influence adherence and also whether instructors influence uptake and adherence to home exercise. Results and Conclusion: The first study establishes that there is a relationship between instructors' training, experience, characteristics and their attitudes. The second study supports these findings and demonstrates how instructors' think that these factors and others not only influence how they deliver and promote their classes but also influence older adults' uptake and adherence to exercise classes. The final study enables us to look at the relationship between instructor variables and the participant within the exercise class setting. Class participants' mental well-being, education and housing were key factors related to their attendance. Having attended the class for more than six months at baseline was an important factor related to adherence. Individual factors such as participants' attitudes, beliefs about group cohesion and instructor variables such as personality traits and experience emerged in the final models both in relation to participant attendance and adherence. There are a series of complex interactions between the instructor, participant, the group and others which influences beliefs and attitudes. It is clear that the instructor can influence participants and they have an important role to play in creating an atmosphere and environment of which participants want to be a part of.

The primary objective of this study was to examine the association between the theory of planned behavior (TBP) and adherence to a multidisciplinary pain center (MPC) treatment program for chronic pain. While the results of several studies have provided support for the efficacy of MPC treatment in chronic pain, the problems of adherence and attrition are important. TPB is a cognitive/social model of behavior that has been used to predict a variety of behaviors, although it has never been used to predict adherence to a multidisciplinary chronic pain treatment program. It was predicted that Adherence would be predicted by Intentions and that Intentions would be predicted by 1) Perceived Social Norms, 2) Perceived Behavioral Control, 3) Attitudes Toward New Behavior (completing the treatment program), and 4) Attitude Toward Current Behavior (maintaining current treatment and coping strategies). It was found that the total Intentions scores did not predict the total Adherence scores. However, Intentions was predicted by 1) Perceived Behavioral Control, 2) Attitudes Toward New Behavior (completing the treatment program), and 3) Attitude Toward Current Behavior (maintaining current treatment and coping strategies). The finding that Perceived Social Norms did not predict Intentions was consistent with results of previous studies with the TBP. The secondary objective was to examine the extent to which MPC treatment affects patients' attitudes towards behaviors that are associated with successful pain management. The majority of the patients (82%) developed a more favorable attitude toward the program and their average report of the importance of the program was 6.78 on a 10-point scale. The majority of patients (74%) reported experiencing a greater decrease in pain than expected, and the average amount of pain decrease was 5.39 on a 10-point scale.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-04-12T11:19:21Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO BIBLIOTECA FINAL.pdf: 1034947 bytes, checksum: 6c77b35b40ea74a6e55e7866ffb69296 (MD5) / Made available in DSpace on 2016-04-12T11:19:22Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO BIBLIOTECA FINAL.pdf: 1034947 bytes, checksum: 6c77b35b40ea74a6e55e7866ffb69296 (MD5) Previous issue date: 2015-11-14 / FACEPE / Introdução: A baixa aderência as DAEs (drogas antiepilépticas) reduz a efetividade do tratamento medicamentoso e também aumenta o risco de estado de mal epiléptico, traumatismos, internações hospitalares, alterações psíquicas e sociais associadas às crises epilépticas não controladas. Métodos: Esta dissertação é dividida em apresentação e quatro capítulos. No segundo capítulo, realizamos uma abrangente revisão da literatura dos últimos 30 anos, dividida em duas partes: Aspectos gerais da aderência ao tratamento e Aderência ao tratamento em epilepsia. O terceiro capítulo, intitulado: Metodologia, esteve dedicado ao detalhamento do método empregado em um estudo de corte transversal e descritivo, que foi realizado no ambulatório de Neurologia do Hospital das Clínicas, com atenção à epilepsia, em 249 pacientes, maiores de 18 anos, em uso de DAE há pelo menos 1 ano, entre o período de outubro a dezembro de 2013, em Recife, Pernambuco. Avaliaram-se nessa amostra os seguintes desfechos: o grau de aderência ao tratamento através do MS (MoriskyScale) e do BMQ-regime (The BriefMedicationQuestionnaire- regime), a incidência de reações adversas das DAEs, através da versão portuguesa-brasileira do LAEP (Liverpool Adverse Events Profile); e se houve associação do MS e BMQ regime com as variáveis demográficas, socioeconômicas e clínico-farmacológicas. Os dados dos pacientes foram plotados no Excel 2007 e analisados pelo programa STATA 12.0. As variáveis categóricas foram descritas utilizando distribuição de frequência e as quantitativas a média com suas variações. Para verificar a associação entre o MS e o BMQ regime utilizou-se, para as variáveis categóricas, o teste do chi-quadrado de Pearson e para as quantitativas o teste de Mann-Whitney, e se adotou p <0,05 como significância presente. O grau de associação foi estimado pelo OddsRatio; e a correlação de Spearmann foi utilizada entre o BMQ regime e MS e versão portuguesa-brasileira do LAEP. O teste de concordância com o índice Kappa foi utilizado entre o MS e o BMQ regime. Para eliminar fatores de confusão foi utilizado um modelo de regressão logística com variável de entrada com p <0,2. Resultados: O quarto capítulo, afeito aos resultados, foi composto por um artigo original, cujo título é: Avaliação do grau de aderência medicamentosa em pacientes com epilepsia, onde se pode observar que: 51,8% dos pacientes eram mulheres (129/249) com a média de idade (36,73±13,9) anos; tempo de epilepsia foi (21,8±14,6) anos; foram pouco aderentes à terapia 77,1%(192/249) pelo MS e 67% (144/200) pelo BMQ regime; a concordância entre o MS e o BMQ foi de 22,5%; o BMQ regime apresentou 72,9% de sensibilidade, quando adotado o MS como padrão-ouro; e que se encontrou associação das variáveis: gênero masculino (p= 0,078) com o MS, renda individual (p= 0,007) e > 1 DAE (p= 0,028) com o BMQ; e tempo de epilepsia < 20 anos [p= 0,02 (MS) e p= 0,004 (BMQ regime)] e LAEP >45 [p= 0,006 (MS) e p= 0,025 (BMQ regime)] com ambos.Conclusões: no quinto capítulo, Considerações Finais, apontamos que um elevado percentual de pacientes não foram aderentes ao tratamento; não houve boa concordância entre o MS e o BMQ regime na identificação de indivíduos não aderentes, porém o BMQ regime apresentou elevada capacidade de identificar não aderência entre os participantes; pacientes com tempo de epilepsia < 20 anos, sexo masculino, LAEP > 45 e em politerapia foram associados à má aderência e renda individual > 1 salário mínimo à boa aderência; e que os fatores inerentes à terapêutica que contribuem para má aderência são plenamente modificáveis quando há um esforço conjunto do médico e do paciente. / Introduction: The low adherence to AEDs (antiepileptic drugs) reduces the effectiveness of treatment and also increases the risk of status epilepticus, injuries, hospitalizations, psychological and social changes associated with seizures uncontrolled. Methods: This master´s thesis is divided into four chapters and presentation. In the second chapter, we conducted a comprehensive literature review of the last 30 years, divided into two parts: General aspects of treatment compliance and Adherence to treatment in epilepsy. The third chapter, entitled: Methodology, was dedicated to detailing the method used in a cross-sectional descriptive cohort study, which was conducted at the Neurological diseases center, with attention to epilepsy, in 249 patients, 18 years, AED in use for at least 1 year between the period October to December 2013 at the Hospital das Clínicas, Recife, Pernambuco. The following outcomes it was evaluated in this sample: the degree of adherence to treatment through MS (Morisky Scale) and the BMQ-regime (The Brief Medication Questionnaire- regime), the incidence of adverse reactions of AEDs by Portuguese-Brazilian version the LAEP (Liverpool Adverse Events Profile); and if there was an association of MS and BMQ regime with demographic, socioeconomic and clinical and pharmacological parameters. Patient data were plotted in Excel 2007 and analyzed using STATA 12.0. Categorical variables were described using frequency distribution and quantitative average with its variations. The association between the MS and the BMQ regimen and the categorical variables was verified using Pearson's chi-square test and the quantitative variables using the Mann-Whitney test, adopted p <0.05 as significance. The degree of association was estimated by odds ratio; and the Spearman correlation was used between the BMQ regime and MS and Portuguese-Brazilian version of LAEP. The concordance test with the Kappa index was used between the MS and the BMQ regime.To eliminate confounding factors we used a logistic regression model with variable inclusion with p <0.2. Results: The fourth chapter, accustomed to the results, was composed of an original article, entitled: Evaluation of drug adherence degree in patients with epilepsy, where you can observe that: 51.8% of patients were women (129/249 ) with mean age (36.73 ± 13.9) years; time of epilepsy was (21.8 ± 14.6) years; were less adherent to therapy 77.1% (192/249) for MS and 67% (144/200) at BMQ regime; the concordance between the MS and the BMQ was 22.5%; the BMQ regime showed 72.9% sensitivity, when adopted MS as the gold standard; and there was association of variables: male gender (p = 0.078) with MS, individual income (p = 0.007) and> 1 DAE (p = 0.028) with the BMQ; and time of epilepsy<20 years [p = 0.02 (MS) and p = 0.004 (BMQ regime)] and LAEP > 45 [p = 0.006 (MS) and p = 0.025 (BMQ regime)] with both.Conclusions: in the fifth chapter, Final Considerations, pointed out that a high percentage of patients were not adherent; there wasn´t good concordance between the MS and the BMQ regime in identify nonadherent individuals, but BMQ regime showed ability to identify low adhesion between the participants; patients with time of epilepsy <20 years, male, LAEP> 45 and polytherapy were associated with poor compliance and individual income> 1 minimum wage with good adherence ; and that the inherent therapeutic factors that contribute to poor adherence are fully modifiable when there is a joint effort of the doctor and the patient.

Malaria is a threat to United States military personnel operating in endemic areas, from which there have been hundreds of cases reported over the past decade. Each of these cases might have been avoided with proper adherence to malaria chemoprophylaxis medications. Military operations may detract from the strict 100% adherence required of these preventive medications. However, the reasons for non-adherence in military populations are not well understood. This behavior was investigated using a cross sectional study design on a convenience sample of U.S. Army Ranger volunteers (n=150) located at three military instillations. Theoretical support was based on components of the Health Belief Model, the Theory of Reasoned Action/Theory of Planned Behavior, and the Social Cognitive Theory. Data on knowledge, attitudes, and practices, as well as multiple environmental domains was collected using an original yet unvalidated questionnaire. The data was analyzed using bivariate Pearson correlations, binary logistic regression, and moderated logistic regressions employing a 0.05 criterion of statistical significance. Power analyses predicted 96-98% power for this analysis. Multiple significant medium strength Pearson correlation coefficients were identified relative to the two dependent variables Take medications as directed and Intend to take the medications as directed the next time. Binary logistic regression analyses identified multiple variables that may predict behavioral intentions to adhere to these preventive medications, as a proxy for behavioral change. Moderated logistic regression analyses identified Command Support for adherence to these medications as a potential significant moderator that interacts with independent variables within three domains of the survey questionnaire. The findings indicate that there may be potential significant beneficial effects, which may improve this behavior in this population of Rangers through 1) promoting affirmative interpersonal communications that emphasize adherence to these medications, 2) including malaria chemoprophylaxis medications in the mission planning process, and 3) military command support, in the form of including the importance of proper adherence to these medications in the unit safety briefings.

Trata-se de um estudo descritivo transversal de abordagem quantitativa, realizado entre 75 portadores de hipertensão arterial (HA) seguidos no ambulatório de um hospital-escola de nível terciário, no interior paulista, realizado no período de setembro de 2008 a abril de 2009, tendo por objetivo avaliar a adesão ao tratamento. Para a coleta de dados foram utilizados três instrumentos: um relativo a dados sociodemográficos, da doença e do tratamento; o Teste de Morisky e Green (TMG) para avaliar a adesão ao tratamento medicamentoso e o Instrumento de Avaliar Atitudes Frente à Tomada de Remédios (IAAFTR). Os testes estatísticos foram realizados por meio do software Statistica 8.0, e os resultados foram considerados significativos quando o nível de significância foi (p <0,05). Os sujeitos possuíam idade média de 61,5 ±10,36 anos, 52,0% eram do sexo feminino, 85,3% brancos, 70,7% casados, 48,0% aposentados e 24,0% do lar, 65,3% possuíam ensino fundamental incompleto, média de 3,08 ±1,99 filho, 94,7% residiam com outros membros da família, 81,3% informaram renda familiar entre um e três salários mínimos; 48,0% apresentaram valores de pressão arterial (PA) maiores que 140X90mmHg, 48,0% eram obesos, 80,6% dos homens e 94,9% das mulheres apresentaram circunferência da cintura com valores alterados. A média do tempo de diagnóstico da hipertensão arterial sistêmica (HAS) foi de 15,57 ±9,61 anos. As principais comorbidades identificadas foram: diabetes mellitus (54,3%) e dislipidemia (46,6%). A média dos medicamentos utilizados foi de 5,1 comprimidos/dia, sendo os mais comumente utilizados os hipoglicemiantes (58,7%) e os antiagregantes plaquetários (54,8%). A média de medicamentos usados para o tratamento da HA foi de 3 comprimidos/dia, sendo que os diuréticos foram os mais usados (84,0%). Quando avaliados pelo TMG, 21 (28,0%) apresentaram adesão ao tratamento; pela utilização do IAAFTR 37 (49,3%) mostraram atitudes positivas frente à tomada dos medicamentos. Entre aqueles que apresentaram adesão pelo TMG, 16 (76,2%) também apresentaram atitudes positivas quando avaliados pelo IAAFTR. A prevalência de controle da PA foi maior para os que tiveram adesão (66,7%) e para aqueles com atitudes positivas (64,9%). Houve significância estatística para o sexo e atitude frente à tomada dos medicamentos em relação ao controle da PA. Os valores de PA foram menores para os que tiveram adesão pelo TMG e que apresentaram atitudes positivas quanto à tomada dos medicamentos (p <0,05). Em relação aos fatores de risco para a HAS, 64,0% não praticavam exercício físico; 9,3% eram fumantes; 17,3% faziam uso de bebida alcoólica e 54,7% diziam ser estressados; 96,0% citaram antecedentes familiares para doenças cardiovasculares. Diante deste contexto permanece um desafio quanto à necessidade de revisão das medidas educativas instituídas no sentido de possibilitar alternativas que possam melhorar, na prática, a adesão dos portadores de HA ao tratamento medicamentoso, o controle da PA e a mudança nos fatores de risco para a HAS. / It is a cross-section descriptive study of quantitative approach, carried out with 75 hypertensive outpatients of tertiary level, in upstate São Paulo, carried out from September 2008 to April 2009, aiming to evaluate adherence to the treatment. Three questionnaires were used to collect the data: one about socio-demographic data regarding the disease and the treatment; the Morisky-Green Test, to assess the adherence to the drug-based treatment and the Questionnaire to Evaluate Attitudes Towards Taking Medicines. The statistical tests were applied by means of the software Statistica 8.0, and the results were considered significant whenever the significance level was (p<0.05). The subjects average age was 61.5 ±10.36 years, 52.0% were women, 85.3% Caucasians, 70.7% married, 48.0% retired and 24.0% housewives, 65.3% did not finish primary education, they had on average 3.08 ±1.99 children, 94.7% lived with other family members, 81.3% stated that their familly income was between one and three minimum wages; 48.0% had blood pressure readings above 140X90 mmHg, 48.0% were overweight, 80.6% of the men and 94.9% of the women had unhealthily large waist circumferences. Average hypertension diagnosis time (HT) was 15.57 ±9.61 years. The most important comorbities identifed were: diabetes mellitus (54.3%) e dyslipidemia (46.6%). The average of the medications used was 5.1 pills/day, and the most commonly used drugs were hypoglycemiants (58.7%) and platelet antiaggregant (54.8%). The average of the medications used for the treatment of HT was 3 pills/day, and the diuretics were the most used ones (84.0%). When evaluated with the Morisky-Green test, 21 (28.0%) showed adherence to the treatment, by means of the Questionnaire to Evaluate Attitudes Towards Taking Medicines, 37 (49.3%) showed positive attitudes towards the taking the medicines. Those that showed adherence through the Morisky-Green test also showed positive attitudes when evaluated by means of the Questionnaire to Evaluate Attitudes Towards Taking Medicines. The prevalence of control of the blood pressure was higher for those who had adherence (66.7%) and for those with positive attitudes (64.9%). Gender and attitude towards taking medicines had statistical significance to the control of blood pressure. Blood pressure readings were lower in hypertensives that had adherence according to the Morisky- Green test and that had positive attitudes toward taking the medicines (p<0.05). Regarding the risk factors for HT, 64.0% did not practice physical exercise; 9.3% were smokers; 17.3% drank alcoholic drinks and 54.7% reported being stressed; 96% cited family antecedents of cardiovascular disease. In face of this context, there remains the challenge of reviewing the current educative measures to enable alternatives that may improve, in practice, the adherence of hypertensives to the drug-based treatment, the control of blood pressure and the change in the risk factors for HT.

Adherence is a complex concept, with multiple definitions, over 200 possible predictors, and inconsistent measurement. This has had a detrimental impact on producing interventions to promote treatment adherence. Promoting and maintaining treatment adherence can decrease the likelihood of poor health outcomes and decrease healthcare costs for patients. This study created a conceptual model that was utilized in a secondary analysis to determine if patient factors (Income, Depression, Perceived Threat of Illness Severity, Social Support, and Treatment Beliefs) in the model predict adherence to Transcutaneous Electrical Nerve Stimulation (TENS) when used for pain control post-Total Knee Replacement (TKR). The sample included 97 patients who were randomized to TENS treatment. A higher level of Perceived Threat of Illness Severity, measured with the Pain Catastrophizing Scale, was significantly related to a Moderate level of Adherence (60-79%) versus Non-Adherence (0-59%) (OR= .260, 95% CI= .073-.992, p= .037). The other patient factors of income, depression, social support and treatment beliefs did not significantly predict adherence. This finding is clinically important, as clinicians can assess how patients are interpreting or perceiving actual (or potential) threats of illness severity, then provide education and support to help patients adhere to treatment. The effect of Daily Pain [measured with an 11-point Numeric Rating Scale (0-10)] on Daily Adherence was also investigated in this study. Daily Pain and Daily Adherence did not show a significant association in this sample. This could be attributed to the fact that Daily Adherence was maintained consistently around 70% throughout the 2-week period.

Given the pathophysiology associated with the Human Immunodeficiency Virus (HIV) and the reported predilection for frontal circuitries and deep white matter, one might expect that executive dysfunction forms part of the neurocognitive profile of people living with HIV. However, such deficits have mainly been reported for adults living with HIV. Adolescence is a period where significant growth and refinement of executive functioning occurs and therefore specific research focused on HIV-positive adolescents is needed. Adolescence is also a developmental period where poor adherence to Antiretroviral Therapy (ART) persists despite marked increases in the national roll out of ART in South Africa, which has significantly decreased HIV-related morbidity and mortality rates. Poor adherence is not only a threat to the efficacy of ART but is also linked to the emergence of drug-resistant HIV strains and identified as a key contributor in the persistence of some cognitive impairments among people living with HIV. Studies show that executive dysfunction can undermine adherence to ART particularly in adolescents, whose frontal lobes are still developing. The first aim of this study was to compare the executive function profile of a group of HIV positive adolescents with that of a matched HIV negative control group. Using P. Anderson's (2002) model, executive functions were considered along the four subdomains: attentional control, processing speed, cognitive flexibility and goal setting. A second aim of the study was to investigate the relationship between executive function and levels of adherence to ART amongst the HIV positive adolescents in the sample. This cross sectional, between-groups study used a comprehensive neuropsychology test battery which was sorted into composite domains to investigate differences in executive functioning between the two study groups of adolescents aged between 14 to 16 (n = 22 in each group) using t-tests. Correlation coefficients were further computed to establish association between adherence and executive functioning. Apart from processing speed (p = 0.42, after the removal of outliers), there were no significant between-group differences in executive functioning outcomes that emerged between the HIV-positive and HIV-negative groups. The neuropsychological test scores for both groups were largely in the borderline range. Correlations between adherence and executive functioning outcomes did not yield any significant associations for each of the executive function domains. The lack of significant between-group differences may be explained by the mitigating effects of ART in the CNS in the HIV-positive group. However, consideration should be given to social factors as these may be important mediators of cognition and may therefore confound neuropsychological performance outcomes for both groups. Although the findings in the current study did not conclusively provide evidence for the role of executive functions in adherence, given the noted limitations, further studies with larger samples should confirm such outcomes.

MPH / Department of Public Health / South African HIV epidemic remains the largest in the world with an estimated 7.7 million people living with HIV in 2018. It accounts for a third of all new HIV infections in southern Africa. In 2018, there were 240,000 new HIV infections and about 71,000 South Africans died from AIDS-related illnesses. To meet the 90 90 90 targets by the end of 2020, patients are subject to uncompromising and long-term commitments of taking at least 95% of their treatment as prescribed. Evidence shows that patients are not adhering to treatment regardless of the systems that the government has initiated. The purpose of this study was to identify factors contributing to non-adherence levels to antiretroviral therapy amongst adults living with HIV and AIDS in Makhado Municipality. A quantitative, descriptive approach was adopted. Data was collected using a questionnaire with closed ended questions. The targeted population was made up of males and females between the ages of 18 to 59. Validity and reliability were ensured in the study. Pretesting was done in Kulani Gateway clinic and 10 respondents were selected. A sample of 225 respondents was selected from the targeted population using convenience sampling. Data analysis was done using statistical package for social sciences (SPSS) version 25.0.The analysed data were presented in tables/percentages and charts. The findings revealed that most respondents(80%) who have been on treatment for less than six months adhere more to treatment than respondents who have been on treatment for more than 24 months (57%). The studies also revealed that about 57.9% of respondents forget to take treatment when they have taken alcohol and 42.1% took their treatment even when they have taken alcohol. Side effects were identified as barriers to adherence. The study indicated most respondents (73.3%) experienced side effects especially in the first few months of commencing treatment. and about 26.7% did not report any side effects. In conclusion, Non-adherence to ART poses a major challenge in most regions of the world and in all stages of HIV infection. When patients adhere to treatment the virus will suppress, quality of life will improve and patients will also prevent cross infections. The study revealed factors contributing to nonadherence to ART that includes alcohol intake and side effects. The study also indicates a strong association between waiting times as a factor to improve on adherence. Therefore the study recommends that an intervention to address alcohol intake and side effects should be carried in Makhado Local Municipality. / NRF

This research presents a proposal for the assessment of technology to manage antiretroviral treatment. The system called Cell-Life has been successfully tested at a pilot site in Gugulethu, Cape Town from September 2002 till date and offers a cost-effective solution for adherence monitoring, side effect management, effective home based care and reducing pill count dependence at the clinic. With the aid of the Cell-Life SIM card menu (please see Appendix A, page 63) on a cell-phone the therapeutic counsellor is equipped with a live-link to the clinic or doctor while visiting patients. The menu allows entering data about the patient's drug adherence, side effects and symptoms, scheduling visits to the clinic and alert messages. The data is sent using short message service (SMS) and stored in a database, which can be accessed via the Internet by a doctor who will receive a complete report on the patient's status quo. The main benefits of the system lie in creating a communication link between the clinic/doctor and the therapeutic counsellor at minimal cost. Another benefit is the collection of reliable data relating to drug adherence and the minimising of human error through preset menu options on the phone. The pilot study has shown that management of anti-retroviral therapy is possible in resource-constraint urban settings. But for a provincial or national rollout of the Cell-Life system, the challenge is the lack of the required infrastructure, technology, personnel and logistics for effective operation of the Cell-Life systems specifically in the rural areas of South Africa. This research investigated the availability of the Cell-Life requirements in the Western Cape. The findings showed that the Cell-Life systems could be implemented in the health regions investigated across the Western Cape. It was also shown that an in depth needs assessment study is required before implementing the Cell-Life system in any community.

Background: The aim of surgical antibiotic prophylaxis (SAP) is to prevent surgical site infection (SSI) by administering an appropriate antimicrobial agent perioperatively. However, SAP may be associated with adverse effects and incurs added costs. The primary objective of this prospective study is to establish whether clinicians are adhering to existing perioperative antibiotic prophylaxis guidelines in terms of indication, dosage and timing of SAP. Secondary objectives are to determine the proportion of patients receiving inappropriate antibiotics; and to evaluate correct practice concerning re-dosing and duration of SAP. Methods: A cross-sectional prospective audit of the anaesthetic records and prescription charts of surgical patients was conducted at Groote Schuur Hospital, a tertiary level teaching hospital in Cape Town, South Africa, over a period of one week. Data were collected by anaesthetists – blinded to the study objectives – and the investigators; then captured on Excel spread sheets and compared to existing SAP guidelines. Descriptive statistics and binary logistic regression were used for analysis. Results: Of the 192 patients consented, 180 questionnaires were completed for data analysis. The median age of participants was 44.5 years (IQR: 31.5-58), with a preponderance of females (58.7%). SAP was administered in 149 cases (82.8%) and withheld in 31 (17.2%). This was appropriate in 91.9% (137/149) and 77.4% (24/31) respectively. Twelve patients (6.7%) received inappropriate antibiotics and in seven (3.9%) it was inappropriately withheld. Of the 156 patients who should have received SAP, choice of drug was correct in 121 (77.6%), dosage in 110 (70.5%) and timing in 87 (55.8%). Absolute compliance was achieved in 44.4% (80/180). Errors were mostly related to timing, re-dosing and duration of SAP. Conclusion: Anaesthetists and surgeons at Groote Schuur Hospital demonstrate variable adherence to surgical antibiotic prophylaxis guidelines. Interventions aimed at improving compliance are warranted.