A study on assessing communication challenges between clerks and deaf patients at Nelson Mandela Academic Hospital was conducted in 2010. The aim was to assess the existence of communication challenges, possible reasons and solutions to these. The literature reviewed identified a gap in the knowledge of communication between staff and deaf patients. A health systems’ study was conducted using a descriptive, cross sectional survey. The study population was made up of 33 clerks who worked at the registration and records area and deaf patients who stayed at Efata and received health services from the hospital. All clerks were interviewed and a random sample of 106 deaf patients was estimated using Epidat statistical software. Self administered questionnaires were used for data collection. Results confirmed the existence of communication challenges between the two groups. A majority of clerks were not trained in Sign Language. They used a combination of methods to communicate with deaf patients, and few clerks could use Sign Language. The patients also used a combination of methods due to the frustration of not having a common method of communication with clerks. The findings clearly showed that there are communication challenges between the two groups and Sign Language needed to be introduced to clerks in order to accommodate deaf patients. Further research may be done on all healthcare providers and to all deaf patients in the region served by Nelson Mandela Academic Hospital, and this could have a positive impact on the quality of service offered by the hospital to the deaf community.

Only in recent years have diagnostic and therapeutic advances lengthened the life expectancy for patients who have cystic fibrosis sufficiently to allow some of them to live into adulthood. Health care professionals have been focusing on survival issues and are only recently beginning to look at quality of life issues, such as sexuality, of these patients. The purpose of the study was to create a sexual profile of adults with cystic fibrosis which would describe their sexuality and sexual concerns. A questionnaire was developed and sent to all of the adult cystic fibrosis patients (19 years of age and older) in British Columbia (50 patients), all of whom attend the Shaughnessy Hospital Adult CF Clinic in Vancouver. The 62% response rate provided data for the sexual profile which indicated that 90% of the respondents were sexually active. Only a small number of subjects reported sexual difficulties in their relationships. Concerns about the impact of CF on their sexuality included: the effect of the potentially limited lifespan on their relationships, practical considerations such as fatigue and coughing during sexual activity, and poor body image. A major issue for CF males is that most of them are infertile due to CF. How and when men should be told about this issue was an important question for the CF Clinic staff. Responses indicated that men thought they should find out from either the physician in the pediatric CF clinic or the physician in the adult CF clinic. Furthermore, 100% of the men suggested that this issue be discussed with males before the age of 19 years. Limitations and recommendations of the research are discussed. A major recommendation is for physicians and other health care professionals in CF clinics to give patients the opportunity to discuss sexual issues. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

This study examines the relationships between three aspects of adjustment to hemodialysis (i.e. activity levels, mood states and severity of symptoms) and four demographic variables (i.e. age, occupation, education and length of time on dialysis). The sample consisted of 37 patients on hemodialysis. Activity levels, mood states and severity of symptoms were measured by the activity inventory, profile of mood states and symptom questionnaire, respectively. A personal history questionnaire was employed to assess the demographic variables. The data was analyzed using the Pearson Product-Moment Correlation Method with a one-tailed test of significance. Activity levels were found to be negatively correlated with age at a statistically significant level, but were not significantly correlated with occupation, education or length of time on dialysis. Total mood disturbance was not significantly correlated with any of the demographic variables. Total severity of symptoms were negatively correlated with education at a statistically significant level, but no significant correlations were discovered between this aspect of adjustment and the other demographic variables. A few supplemental findings were also deemed important. Total severity of symptoms were both negatively correlated with activity levels and positively correlated with mood states at statistically significant levels. However, mood states and activity levels were not significantly correlated. Finally, a significant positive correlation was found between education and occupational level. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

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Magister Scientiae (Physiotherapy) - MSc(Physio) / Reduced adherence levels have been demonstrated by some patients affected with Osteoarthritis. Therefore, this study aimed at exploring the barriers and facilitators regarding patient adherence towards physiotherapy rehabilitation programs in the management of osteoarthritis in Nairobi, Kenya. The objectives of the study were to determine the clinical profile of patients with osteoarthritis on physiotherapy rehabilitation programs, to explore the patient-reported barriers and facilitators towards physiotherapy rehabilitation programs and exploring physiotherapists’ perceptions of patient adherence towards physiotherapy rehabilitation programs. The study setting was at the Kenyatta National Hospital physiotherapy clinic in Nairobi, Kenya.

MPH / Department of Public Health / Post-apartheid South Africa’s healthcare system improved with many community members being able to easily access basic health care services. However, patient waiting time has remained a critical issue. Patients are well-known for arriving at healthcare facilities very early for the reason of avoiding lengthy queues. This, however, does not solve their problem. The purpose of the study was to explore factors influencing patient waiting time in Nthabiseng clinic in the Capricorn district of the Limpopo Province. The study was conducted at Nthabiseng clinic in the Capricorn District. A qualitative approach was adopted, and a sample was chosen from a targeted population through purposive sampling. Data were collected through a one-to-one semi-structured interview and analysed through the Thematic Data Analysis approach. The study found out that the Department of Health does not have a patient waiting time specific policy or legislative framework and/or a guiding document. It also showed that healthcare professionals define and calculate patient waiting time differently. Moreover, what is an acceptable waiting time to one is an unacceptable waiting time to another. The study recommended that a policy and Standard Operation Procedure be drafted to guide healthcare professionals on how to improve waiting time in their specific facilities.

One of the impacts of the rising demand for community health services, primarily used by seniors, is that hospitals are often faced with the challenge of having patients finish the acute phase of their treatment and yet are unable to discharge them due to the lack of a bed in a more appropriate community care setting. The frequency of this challenge has led to the designation of “alternative level of care” (ALC) being ascribed to patients who remain in the hospitals due to insufficient capacity downstream. The thesis focuses on a model that seeks to address patient flow through the community care network (CCN) and finding capacity allocation policies for the different facilities that resolves the ALC challenge using scenario analysis. A queuing network model with general routings and nodes’ blocking has been developed and a heuristic approximation method has been employed for solving the model. Blocking probabilities and the number of blocked patients are derived as performance metrics of the CCN. We test the accuracy of the queuing model through a simulation model and the behaviours of the system in different scenarios are investigated in the simulation model and our policy insights and conclusions are provided.

The cornerstone in the fight against HIV/AIDS is prevention followed by the access to and use of highly active antiretroviral treatment (HAART). Adherence is the greatest patient- enabled predictor of treatment outcome for the patients on HAART, as good adherence leads to a decrease in disease progression and death. There is no ‘gold standard’ in the measurement of adherence. Also, factors that influence adherence and hence the prevalence of adherence differ across different settings making it necessary to determine local adherence prevalence as well as factors that might impact on it. This was a cross sectional study which assessed the prevalence of one- week adherence to antiretroviral therapy at St Rita’s hospital through an abridged version of the questionnaire developed by the Adult Aids Clinical Trials Group in the United States. Results from the questionnaires were compared to the results from a decrease in plasma viral load to undetectable limits within six months. The study found out that the prevalence of one- week adherence by self-report was 96.8% (95% CI: 93.2 – 98.9%). Using a decrease in viral load to undetectable limits within six months of initiating treatment as a tool to assess adherence, the prevalence in this study was 96%. A combined prevalence of 94% was found for this study. These results were identical to a few results locally but it was much higher than most local studies. The explanation for this apparent higher adherence rate might be that the study site has not reached its maximum capacity for the delivery of service as it is still operating at just below the staff/patient ratio recommended by the Department of health. The study also found out that being a member of an AIDS support group was a facilitator to adherence while lack of adherence counselling and monitoring is a barrier. Based on these findings it is therefore recommended that measures should be put in place to ensure improving existing adherence counselling and monitoring, encouraging patients to belong to at least one AIDS support group, more decentralization of antiretroviral therapy roll out to the districts that are yet to roll out and providing financial assistance through improved access to disability grants for those who qualify and income generating activities for the unemployed that do not qualify for disability grant.

A research report submitted to the faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine. Johannesburg, 2017. / In South Africa, very little is known regarding the spectrum of clinical illnesses for which older patients are admitted to hospital. Within this group who are admitted, even less is known of the burden of HIV disease. This study investigated the clinical indications for acute medical admission in adults over the age of 50 years at Chris Hani Baragwanath Academic Hospital. The study also determined the prevalence of HIV infection of those with HIV, their access and adherence to treatment. Methods: This was a prospective, observational study of patients over 50 years of age who were acutely admitted to the medical wards of Chris Hani Baragwanath Academic Hospital (CHBAH) between August 2014 to March 2015. Results: A total of 200 participants 50 years and older were enrolled, 34% HIV-positive, 37% HIV-negative and 29% whose HIV status was unknown. The HIV-positive group was younger (p <0.0001), had poorer access to pension funds (p<0.0001) and higher burdens of acute infectious illness when compared to their HIV-negative counterparts (p<0.0068). HIV-negative patients had higher rates of acute cardiovascular and haematological conditions (p<0.0001) and higher rates of chronic non-communicable disease (p<0.0004), predominantly diabetes mellitus (p<0.0095) and hypertension (p<0.0024). Conclusion: In older patients hospitalised for acute illness, both infectious and non-communicable disease play a significant role however, in those with HIV, the infectious burden of disease is more prominent while non-communicable chronic disease predominated in those without HIV. / LG2018

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