Thesis (MPH)--University of Limpopo, 2009. / Background Primary Health Care is a basic mechanism that brings healthcare as close as possible to the people. In South Africa, it is seen as a cost effective means of improving the health of the population. It is provided free of charge by the government. This service should be accessible to the population so as to meet the millennium health goals. Aims The aims and objectives of the study were: • To investigate whether Primary Health Care services were accessible to the communities of Tshwane Region. • To determine the utilization of the health care services in the three Community Health Care centres of Tshwane Region. Methodology Data were collected at the three Community Health Care centres of Tshwane Region using self-administered questionnaires. A document review of the Community Health Care centres records was conducted to investigate the utilization trends of services. Descriptive statistics were used. The analysis was based on the information that was elicited from the questionnaires that the people who utilize the Community Health Care centres of Tshwane Region provided. The extracted data emanating from the records from the three centres were also used. Results The study demonstrated that in terms of distance, the Community Health Care centres of Tshwane Region are accessible as most participants lived within 5km. They traveled 30 minutes or less to the clinic. The taxi and walking was the most common form used to access the clinic. The services were utilized with the Tuberculosis clinic being the most visited. Generally, people were satisfied with the service and their health needs are met. Conclusion The Community Health Care centres of Tshwane Region are accessible and utilized effectively. Key words: Primary Health Care, accessibility, utilization.

Primary Health Care (PHC) plays a vital role in decentralization of health care services. PHC is designed to ensure health care coverage at the community level through the involvement of the community in improving their healthy living. PHC offers treatment and care in continuum that is supported by a facility-linked home- based care system and a referral system. While PHC is global, its operation and functioning in the area of community health provisioning varies across communities. The main objective of this study is to find out whether PHC is effective or not in Roma Valley, Lesotho. The study was carried out in Roma Valley, in the Maseru district of Lesotho. The population for this study includes the nurses under the department of PHC, village health workers, Chiefs and out-patients from four different villages. Out of this, a sample of thirty individuals was selected. The data for this study was collected through qualitative research technique, particularly oral interviews and written records or secondary data sources. The analysis revealed that nurses and village health workers respond to the social needs and health problems of the community and community members are also involved in improving their health status. Village health workers face many challenges in their engagement in this system such as not being given incentives for what they do and often uncooperative disposition of some community members including their leaders. It was also found that they operate under a lot of stress due to lack of resources.

Abstract Introduction The study aimed to assess and improve the quality of care for congestive cardiac failure in a public sector, primary health care setting, in Cape Town. There is currently no literature available on the quality of care for the management of congestive cardiac failure in primary health care in South Africa. Methods A disease register was constructed by identifying patients prescribed Furosemide and checking the medical records. Altogether 95 patients with CCF were identified. The study followed the usual steps for a quality improvement cycle: Formation of an audit team; agreeing on criteria based on current CCF guidelines; collection of data from medical records to measure the criteria; analysis and feedback of results to the staff; critical reflection, planning and implementing change; re-audit of the medical records. Results There was a mean age of 63.4 years, 21% were male and 75% were females. The results of the initial audit revealed suboptimal management of patients diagnosed with CCF: 53% had an aetiological diagnosis recorded in the clinical notes, 24% had a documented functional capacity, 12% of patients had documented precipitating/exacerbating factors, 58% had fluid status documented, and 37% had documentation of their cardiac rate and rhythm. The intervention consisted of feedback on the audit results and critical reflection with the relevant staff members. The doctors were provided with a printed protocol to refer to for the management of CCF. Clinicians were resistant to change and to taking on new tasks in relation to the management of patients with CCF and decided to only focus on improving the clinical assessment of patients. The results of the re-audit after 5-months in 40 patients demonstrated improvement in the clinical assessment criteria: 95% of the patients had an aetiological diagnosis recorded in the notes, 50% had a documented functional capacity, 42% had documented precipitating/exacerbating factors documented, 72% had their fluid status documented, and 85% of patients had their cardiac rate and rhythm documented. None of the five assessment criteria were met at baseline but post-intervention three of the five met the target set and all showed substantial improvement. There was no improvement noted in any of the other criteria, which were not specifically focused on in the plan to improve clinical practice. Conclusion The current quality of care for CCF in primary health care is poor and needs to be improved. The quality improvement cycle led to substantial improvement in the clinical assessment of patients with CCF. Recommendations are made regarding future criteria, which could be included in local audit tools.

Includes bibliographical references. / Objective: A waiting time survey (WTS), conducted in 2007 at 94% of clinics in Cape Town, measured length of patient waiting times (WT) for services and provided recommendations to shorten waiting times. Whether subsequent implementation of these recommendations occurred was unknown, hence a study was conducted to assess the impact of the previous waiting time survey recommendations on stimulating efforts to reduce waiting times and whether waiting times had reduced. Methods: A cross-sectional analytical study design assessed the perceptions of 92% of clinic managers in Cape Town, regarding the 2007 survey, while a before and after study design assessed changes in waiting time between 2007 and 2011, using a random sample of 22 clinics. Results: The overall median waiting time of all clinics in the sample decreased by 21 minutes in 2011 (95% CI 11.77-30.23), a 28% decrease from 2007. This reduction was manifest at individual clinic level as well, with 55% of clinics reducing their median waiting time by at least 15 minutes. No specific factors, including whether recommendations to reduce waiting times were implemented, were associated with decreases in waiting times. Implementation of recommendations to reduce waiting times was 2.67 times (95% CI 1.33-5.40) more likely amongst those who received written recommendations and 2.3 times ) 95% CI 1.28-4.19) more likely amongst managers with 5 or more years' experience. Conclusion: The decrease in waiting times in primary care urban clinics subsequent to a waiting time survey, demonstrates the utility of waiting times surveys, although no specific factors associated with the decrease in waiting time were identified.

Bibliography: leaves 89-94. / Starting oral contraceptives immediately, under direct observation, increase OC initiation rates and may increase effective use and continuation However, if adverse bleeding pattern occur, then such an approach may paradoxically decrease continuation rates. The purpose of this study is comapare 90-day bleeding patterns following immediate ("Quickstart) versus conventional OC initiation.

Includes bibliographical references. / Metabolites of DDT (1, 1, 1-trichloro-2,2-bis(p-chlorophenyl)ethane), used in many developing countries including South Africa for the control of malaria vectors, have been shown to be endocrine disruptors in vitro and in vivo. The study hypothesis was that male vector control workers highly exposed to DDT in the past should demonstrate clinically significant exposure-related anti-androgenic and/or estrogenic effects reflected in abnormalities in hormone levels, semen, sexual function and fertility. A cross-sectional study of 60 workers from 3 camps situated near Malaria Control Center (MMC) in Tzaneen was performed.

Bibliography: p. 171-172. / South Africa's HIV epidemic has increased rapidly over the last 10 years, and developing effective strategies to curb it is a priority. The presence of other sexually transmitted infections (STIs) facilitates the sexual transmission of HIV, and the control of STIs has been shown to be an effective way of reducing HIV incidence. One component of the process of STI control is partner notification: a process whereby the sexual partners of patients who have been diagnosed with an STI are informed of their exposure to infection and of the importance of obtaining effective treatment. Partner notification is one of the two strategies to reach and treat asymptomatic and unrecognised STIs, which are highly prevalent in South Africa. Unfortunately, current partner notification strategies are not very effective, and there is a need to improve their effectiveness. This thesis investigates strategies to improve partner notification in South Africa. This aim is achieved through three separate studies. The first is a systematic review of published and unpublished randomized controlled trials (RCTs) conducted around the world, comparing the effects various partner notification strategies, in an attempt to uncover evidence of effective strategies. The review uses methods advocated by the Cochrane Collaboration. Eleven RCTs were found, including 8014 participants, only two of which were conducted in developing countries. The review found moderately strong evidence that either provider referral alone, or the choice between patient and provider referral, or contract referral, when compared with patient referral, improved partner notification. This evidence is of limited value in South Africa, where public health services have not been able to implement provider or contract referral due to the prohibitive staffing costs involved. The review also found that verbal, nurse-given health education together with intense patient-centred counselling by lay workers, when compared with standard care results in small increases in the rate of partners treated. The review concludes that there is a need for evaluations of patient education interventions (including audiovisual presentations), of interventions combining provider training and patient education, and for evaluations to be conducted in developing countries. Further, there is a need to measure potential harmful effects, such as domestic violence, to ensure that partner notification does more good than harm.

Includes bibliographical references (p. 196-245). / A multicenter hospital-based case-control study with incidence density sampling was conducted between November 2001 and February 2003 to assess the impact of social and dietary habits, and the consumption of dietary and medicinal wild plants on the risk of developing oesophageal cancer (OC) among residents of the Eastern Cape Province of South Africa. The study was conducted on 670 incident cases (98/% response rate) and 1188 controls (96/% response rate) attending either of the three major referral hospitals in the Province, i.e Umtata General, Frere and Cecilia Makiwane Hospitals.

Bibliography: leaves 51-59. / The objective of this study was to evaluate maté consumption as a risk factor for oesophageal cancer and to further evaluate the role of quantity and temperature in order to assess whether the effect is related to the carcinogenicity of the plant or the high temperature at which maté is consumed. In addition the effect of diet, alcohol drinking and tobacco smoking on oesophageal cancer risk was assessed.

Bibliography: p. 113-118. / The private sector in South Africa has a keen interest in ensuring that all employees are fully educated on issues related to HIV/AIDS (especially transmission mechanisms) to avoid losing a large proportion of the workforce and incurring a subsequent drop in productivity. In 1977, Woolworths, a South African retail company, implemented an HIV peer education programme for its employees. The broad aim of the programme is to reduce the HIV infection rate among staff by providing educational material on safe sexual practices, discussing various issues connected to HIV such as sexuality and modes of transmission and by providing free condoms to staff. The objective of this study is to provide a thorough and realistic evaluation of the Woolworths HIV/AIDS peer education programme. A formal evaluation is required to understand the current position of the programme and to determine its future direction.