The aim of the study was to identify, evaluate and compare the determinants of patient satisfaction in fee-for-service, and health maintenance organisation (HMO), medical service delivery centres. Staff at both centres, who were also patients, were surveyed to determine the congruence with patients’ quality improvement priorities. The survey was conducted using a questionnaire consisting of closed questions given to patients as they departed from the medical centres. The questionnaire was tested for convergent and divergent validity, content analysis and reliability. A rating scale was then applied to yield the scores for each determinant. The unique Patient Satisfaction Priority Index was determined using determinants that were rated low on satisfaction but high on importance. The results revealed that patients at the fee- for- service medical centre were significantly more satisfied than patients at the HMO. The priority index for patients were found to be different to that of the staff at both medical centres, proving that staff and patient priorities were incongruent. Accordingly, the recommendations were that patient satisfaction be continuously evaluated at medical service delivery centres, in order to achieve a competitive advantage, sustainability and growth in South Africa’s highly competitive private healthcare industry. Copyright / Dissertation (MBA)--University of Pretoria, 2008. / Gordon Institute of Business Science (GIBS) / unrestricted

The study examined the effectiveness of asynchronous video-otoscopy by a telehealth facilitator, for diagnosing ear disease in an underserved community at a primary health care clinic. Study I explored whether video-otoscopy images by a facilitator provided accurate asynchronous diagnosis. Onsite otoscopy was performed by an otolaryngologist on 61 adults. Video-otoscopy images were taken by the facilitator with no formal health care training, and by the otolaryngologist. Images were uploaded to secure server from which the otolaryngologist rated and made a diagnosis six weeks later. More otolaryngologist acquired images (83.6%) were graded as acceptable or better than facilitator images (75.4%). Moderate concordance was measured between asynchronous diagnosis from video-otoscopy images acquired by the otolaryngologist and facilitator (κ = 0.596). Lack of depth perception was considered a limitation of video-otoscopy images. Study II investigated asynchronous video-otoscopy recordings made by a facilitator in children at primary health care. Onsite otomicroscopy of 140 children (2-16 years) by an otologist was the gold standard. Video-otoscopy recordings were completed by a facilitator. Four and eight weeks later, an otologist and general practitioner asynchronously graded and made a diagnosis from online recordings. Video-otoscopy recording quality was acceptable or better in 87% of cases. Asynchronous diagnosis from recordings was not possible for 18% of ears. There was substantial agreement between asynchronous video-otoscopy and onsite diagnoses (κ = 0.679-0.745). Variability of asynchronous diagnosis accuracy was similar to inter- and intra-rater diagnostic variability. Study III examined the point prevalence of otitis media in the children from study II. Onsite otomicroscopy was completed by an otologist. Prevalence of otitis media was 24.8%, with OME the most prevalent (16.5%). Despite AOM prevalence of 1.7%, caregivers reported otalgia for 7.4% of children within two weeks of assessment. Caregivers did therefore not typically seek medical opinion for otalgia. Lack of medical opinion is problematic as the sample demonstrated high CSOM prevalence (6.6%). A telehealth facilitator with limited training was capable of acquiring good quality video-otoscopy measures in children and adults. Asynchronous video-otoscopy recordings may be used within a telehealth clinic in a primary health care clinic to reduce morbidity and mortality associated with CSOM. / Thesis (DPhil)--University of Pretoria, 2015. / Speech-Language Pathology and Audiology / DPhil / Unrestricted

Internationally, governments have recognised the constraints facing their citizens with regards to access to affordable, quality healthcare services. This development is evident in South Africa where the majority of the population have limited access to affordable, quality healthcare due to the healthcare inequality between the insured and uninsured. To address this lack of access to quality healthcare, medical experts recommend a focus on patient-centred primary healthcare as opposed to the current system of provider-centred healthcare. This research aims, through the development of a patient-centred framework, to assist in advising healthcare systems for the delivery for patientcentred primary healthcare. In order to develop a holistic view, all stakeholders involved in the delivery of healthcare were considered in answering the main research question. The study comprised of 43 interviews in total, of which 28 interviews were with uninsured patients who use healthcare facilities in South Africa and 15 medical expert interviews. This information was then consolidated into a framework, and further refined through the literature collected, to form a holistic service quality framework that allows for the delivery of patient-centred primary healthcare. The holistic service quality framework acts as a mechanism to ensure that the delivery of patient-centred primary healthcare has a positive impact on patient satisfaction. Patient satisfaction can be improved or increased through the levers, available to the providers, identified in the framework. This allows healthcare systems to improve the service quality of the healthcare delivered / Dissertation (MBA)--University of Pretoria, 2014. / zkgibs2015 / Gordon Institute of Business Science (GIBS) / Unrestricted

Magister Psychologiae - MPsych / An epidemiological study was conducted with the main goal of describing the occurrences of the various STTs in the Eastern Cape province as well as biographical factors such as age, gender, and geographical location influencing them. Ten primary health care (PHC) centres located throughout the province served as sentinel sites for surveillance data collection for a period of 3 months using Daily and Monthly Report Forms. The surveillance data was analysed using relative frequencies to determine STis prevalence. The main findings from the present study suggest that the most frequently encountered female syndromes were vaginal discharge and lower abdominal pains and most frequent male syndrome was Urethral discharge. Other syndromes accounted for less than 10% of the ST! cases observed at the PHC centres during the study. The study also indicate that more STI patients were seen at urban PHC centres compared to rural ones and that most of the STI patients seen at PHC centres were women. These findings are helpfol for the Health Department in the Eastern Cape Province to effectively plan for the control and prevention of all ST!s including HIV I AIDS

There is an increasing interest in ethnomedical and ethnoveterinary practices, especially as it relates to the use of medicinal plants for treating various ailments. As a result, the current trend in government health authorities is to integrate herbal medicine with primary healthcare. This arises because nearly 80% of people in the developing world, particularly those from rural communities where modern drugs are unaffordable, inaccessible or, unavailable, depend on phytomedicine for primary healthcare. Despite this, however, most medical and veterinary professionals distrust herbal medicines due to concerns of scientific evidence of efficacy and safety. Hence, there is need for their validation, before herbal medicines gain wider acceptance and use. Traditional healers and rural farmers use extracts of Peltophorum africanum (a medicinal plant wide-spread in southern Africa and other tropical regions), to treat diarrhoea, helminths and abdominal parasites, dysentery, HIV-AIDS, acute and chronic pain, anxiety and depression, infertility, and to promote well-being and resistance to diseases. To evaluate these ethnobotanical leads, dried leaves, bark and root from mature P. africanum (Fabaceae) trees were extracted with acetone, ethanol, dichloromethane and hexane. Chromatograms were made on silica gel plates. Thin layer chromatograms (TLC) were sprayed with 0.2% 2, 2-diphenyl-1-picryl hydrazyl (DPPH) for qualitative screening for antioxidants. Quantification of antioxidant activity was done in comparison with L-ascorbic acid and Trolox (6-hydroxy-2, 5, 7, 8-tetranethylchromane-2-carboxylic acid). With regard to the extracts, minimum inhibitory concentrations (MIC) were determined for Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Enterococcus faecalis. The total antibacterial activity (TAA), signifying the volume to which active compounds present in 1 g of plant material can be diluted and still inhibit bacterial growth, was also determined. In vitro anthelmintic activity was evaluated by effects of acetone extracts on the egg hatching and larval development of parasitic nematodes Haemonchus contortus and Trichostrongylus colubriformis. The eggs and larvae of the two parasites were incubated in various concentrations of the leaf, bark and root extracts for two and five days respectively. Furthermore the efficacies of the acetone extracts were tested on lambs artificially induced with H. contortus and T. colubriformis infections. Toxicity was performed in brine shrimp and MTT assay on Vero monkey kidney cells. The extracts had substantial activity against both Gram-positive and Gram-negative bacteria, with MIC values of 0.08 mg ml-1 for Staphylococcus aureus and 0.16 mg ml-1 for Pseudomonas aeruginosa ; the corresponding TAA values were 1263 and 631 ml g-1. The acetone extracts the bark, and root of P. africanum had higher antioxidant activity than L-ascorbic acid (Vitamin-C) and Trolox (6-hydroxy-2, 5, 7, 8-tetramethylchromane-2-carboxylic acid), a synthetic vitamin-E analogue, and much higher than Ginkgo biloba extract (EGb 761). The standardized extract of Ginkgo biloba (EGb 761) is widely employed for its significant benefit in neurological disorders. The respective EC50 for the P. africanum root , bark and leaf extracts, L-ascorbic acid, and EGb761 were 3.82 µg ml-1, 4.37 µg ml-1, 6.54 µg ml-1, 5.04 µg ml-1, and 40.72 µg ml-1. The extracts inhibited egg hatchability and larval development (from L1 to infective stage L3) of both H. contortus and T. colubriformis (both parasitic nematodes of ruminants) at concentrations of 0.2-1.0 mg ml-1. The plant extracts, at concentrations of 5-25 mg ml-1 completely lysed larval forms (L1) and eggs of the nematodes. In all assays, the root extracts had higher antibacterial, antioxidant and anthelmintic activity than the bark and leaf. Although the extracts were safe and non-toxic, the reduction in faecal egg and adult worm counts in lambs infected with H. contortus and T. colubriformis was not statistically significant (P=0.073). From the acetone extracts of the root, a brownish crystalline compound, bergenin was isolated. Bergenin was also assayed for toxicity with brine shrimp and Vero monkey kidney cells like the extracts, where the compound was found to be not toxic. In a disc diffusion test, the inhibitory activition of bergenin was determined for the bacteria E. coli, P. aeruginosa, Mycobacterium vaccae, and the fungi Sporobolomyces salmonicolor and Penicillium notatum. Bergenin had reasonable antimicrobial activity against S. salmonicolor, moderate activity against M. vaccae, E. coli and P. aeruginosa, but non inhibitory against P. notatum. P. africanum extracts have therefore, potential for treatment of infection-related diseases by either directly inhibiting bacterial growth or by stimulating the immune system of the host. The traditional use of P. africanum concoctions against diarrhoea, dysentery and unthriftness, may be also due to anthelmintic activity as these signs are consistent with parasitic astroenteritis. Antioxidants are also important in boosting the immunity, critical in the management of helminthosis. There is ample scientific and empirical evidence supporting the use of plantderived antioxidants in the control of human immunodeficiency virus (HIV) and neurological diseases. Synergistic activity of plant antioxidants has been proposed as a mechanism by which viral replication and immune cell killing in HIV infection can be inhibited. Antioxidants may have neuro-protective (preventing apoptosis), as well as neuro-regenerative roles. Due to the high antioxidant activity of its extracts, P. africanum has prospects in the chemotherapy of HIV and management or control of neurodegenerative diseases. Thus there is great potential of P. africanum extracts in medicine. Further isolation and bioassay characterization of bioactive compounds from P. africanum is recommended as well as refinement of in vivo tests in target livestock, or clinical trials. Better methods of plant extraction easily adaptable to rural communities for sustainable exploitation of the tree, may have to be devised especially those using the leaves instead of bark or root. / Thesis (PhD(Paraclinical Sciences))--University of Pretoria, 2007. / Paraclinical Sciences / unrestricted

Objectives. To describe the qualitative aspects of the notifiable diseases surveillance system of the Gauteng Province, South Africa; to conduct a cross-sectional survey on knowledge and practices pertaining to disease notification among private sector primary health care providers in Gauteng Province; to measure the degree of underreporting of notifiable diseases versus positive laboratory diagnoses using malaria as a cases study; and to identify the correctible short-comings in the Gauteng Health Department’s diseases surveillance system and to recommend ways of addressing these to improve the system and its performance. Design. This is an evaluation study consisting of both the qualitative aspects and quantitative descriptive components of the notifiable disease system in Gauteng Province. The study designs used for the qualitative description were literature and policy review and a semi-structured interview with communicable disease coordinators. The quantitative research comprised of a telephonic questionnaire administered to a random sample of private general practioners and secondary data analysis comparing malaria cases notified to the Gauteng Provincial Department of Health with public and private sector laboratory data and clinical surveillance data. Setting. The study setting was the Gauteng Provincial Health Department and public and private health care service providers in Gauteng Province. The study period extended from 1 January to 30 June 2006. Subjects. The subjects of the study were the Gauteng Health Department’s disease surveillance system, public and private sector health care providers including private primary health care practitioners. Outcome measures. Outcome measures for the qualitative system description were the status of selected system attributes namely usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, positive predictive value, representativeness and stability. Outcome measures for the knowledge and practice survey of private general practitioners were reporting compliance and knowledge of notifiable conditions. The primary outcome measure for the secondary data analysis was the proportion of laboratory diagnosed cases of malaria notified to the provincial health department. Results. The notifiable disease surveillance system in Gauteng is deemed useful by the public sector communicable disease coordinators but less so by the private sector general practitioners. Data quality as indicated by completeness of residential detail reporting on meningococcal notifications varied between 29% and 57% by district. Thirty seven percent of general practitioners report compliance with notifications and the mean score for knowledge on notification status of medical conditions was 56%. The sensitivity of notifications of malaria compared with laboratory notifications was 26% with relatively higher notification rates where cases occurred in children under 15 years of age. Conclusions. The notifiable disease surveillance system in Gauteng Province is relatively flexible and reasonably structured however this research suggests that there is suboptimal use of the information for local action in certain areas. Private General Practitioners self-report a low level of compliance citing time constraints and lack of motivation; knowledge of the notification status of selected medical conditions is lower than expected. The completeness and accuracy of notification data, as demonstrated in malaria notifications, is insufficient to gauge a true picture of burden of disease in the province. / Dissertation (MMed)--University of Pretoria, 2007. / School of Health Systems and Public Health (SHSPH) / Unrestricted

Masters of Commerce / The provision of health care in South Africa is undergoing major restructuring. The aim is to achieve substantial, visible and sustainable improvements to the efficiency and accessibility of primary healthcare (PHC) services for all South Africans. One of the country's most critical problems is the weak and fragmented public sector PHC system. The most critical problems contributing to this are the maldistribution of resources (financial, physical and human) between hospitals and the primary care system, and between rural and urban areas. The health sector, therefore, faces the challenge of a complete restructuring and transformation of the national health care delivery system and related institutions. Choices need to be made about which services to cut, which to streamline and where savings can be made. Ways need to be found to use ALL of South Africa's resources optimally. This process of restructuring would be facilitated by the availability of accurate information on resource utilisation in the health sector. This study estimates the difference in the cost of primary diabetes treatment at dayhospitals and a provincial hospital in the Western Cape in 1992/93. Health economics is in its infancy in South Africa and serious data limitations exist. This study is therefore a pioneering effort in many ways. An appropriate methodological framework in which to conduct the costing had to be developed. The South African health sector, health spending arid the cost of primary diabetes treatment at day-hospitals and the provincial hospital are reviewed. Theoretical perspectives of the health care market and the methodologies of cost analysis are discussed. The cost analysis method of study is chosen, and arguments are advanced for its suitability in the South African context. A simple method of calculating the direct costs to obtain the average cost is proposed for the purpose of the study. Direct costs consist of staff costs and other related costs, such as medical supplies, non-medical supplies, building operations, equipment etc. These costs are then used to calculate the average costs per diabetic patient at the day-hospitals and the provincial hospital. The average cost per diabetic patient at day-hospitals amounted to R18.76, while at the provincial hospital the cost was R59.60. https://

The epidemiology of urinary tract infection (UTI) in the population of Vännäs (8 000 inhabitants) was studied during one year. The annual incidence increased from 0.5% in the first decade of life to more than 10% in the age group 90-100 years. Male UTI comprised only 13% of the episodes, increased after middle age and contributed 4 0% by &gt; 80 years of age. At 17 PHC centres (PHCCs) a prevalence study (McPHC) of mainly uncomplicated UTI was performed. Most episodes were acutely symptomatic (lower 75%, upper 5%). Microscopy of wet-stained urinary sediment with a minimum of moderate amount of bacteria and/or 5 leukocytes per high power field (4 00 x) as breakpoint resulted in a desired high sensitivity (97%) and 86% efficacy in acutely symptomatic patients. Diagnosis of bacteriuria using Uricult dipslides yielded acceptable results with an overall efficacy of 88%. Nitrite test and Uriglox showed an unacceptable low mean sensitivity ofR56 and 69%, respectively. A positive nitrite, sediment or Uricult , when used in combination, was optimal in diagnosing UTI with a sensitivity of 98% in acutely symptomatic patients during their office visits. The average risk of drug resistance was 17% in the Vännäs study. Sensicult satisfactorily predicted drug sensitivity (93%) but not bacterial drug resistance (50%). Using Uricult with classification of bacteriuria by Gram-grouping, lactose and catalase reactions for targeting UTI therapy, according to local guidelines, resulted in a similar low risk (6 %) of prescribing drugs to which the organisms were resistagt as when using Sensicult (7%). This development of the Uricult method is simple and can be recommended for office practice in PHC. The spectrum of bacteria causing UTI and their drug resistance was more associated with the selection of patients, sex and age than with symptoms. The pattern of drug resistance was little influenced by UTI history and the mean pretherapy resistance for the seven drugs tested in McPHC was low (7%). Drug resistance was increased in failure (mean 24%) but not in early or repeated recurrence. In McPHC therapy resulted in 8% bacteriological failure and 12% early recurrence, irrespective of whether the bacteria were classified as sensitive or resistant in vitro to the drug given. Thus, in order to be of prognostic value for therapy of uncomplicated UTI, high-level breakpoints focusing more on peak urinary drug concentrations need to be studied. UTI symptoms in McPHC were eradicated in only 2/3 of the bacterio- logically cured episodes and in 1/3 of the failures at control 1-3 days posttherapy showing that symptoms are an unreliable indicator of UTI. From current literature, it seems unlikely that asymptomatic bacteriuria (ABU) plays a major role in the development of uremia due to chronic pyelonephritis. With the exception of ABU in pregnancy, therapy seems to yield no benefit. Omitting posttherapy bacteriuria controls in patients with symptoms eradicated, at least in women with uncomplicated UTI, would lead to considerable savings both for patients and the health care system. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1988, härtill 6 uppsatser.</p> / digitalisering@umu

Magister Public Health - MPH / Since the introduction in 2005 of prevention of mother-to-child transmission of HIV (PMTCT) services in Akwa Ibom State in Nigeria the PMTCT programme has faced several challenges including that of poor male participation in the PMTCT programme. To date no research has focused on the issue of male participation in PMTCT programmes in Akwa Ibom State, and there is thus a limited understanding of why so few male partners of HIVpositive pregnant women participate in the State's PMTCT programme. It is therefore important to explore the factors affecting male involvement in PMTCT programmes in Akwa Ibom State, so that strategies can be put in place to help improve the overall health of their families and themselves. The overall aim of the study was thus to explore the factors affecting male participation in the PMTCT programme at a primary health care center in West Itam, Akwa Ibom State, in Nigeria. This explorative study was conducted using a descriptive qualitative research approach. The research study approach helped to understand the perspectives of the male partners of HIV positive pregnant women who received the PMTCT intervention, as well as key informants in the Primary Health Care (PHC) facility where these PMTCT services are offered. The study population consisted of all males living within the catchment area of the West Itam PHC, Akwa Ibom State, Nigeria. In the research study, 11 men were purposively sampled: five of whom were the partners of HIV-positive women who had attended, or were currently attending the PMTCT services at the West Itam PHC with their partner. The other six interviewees were local male community members – who would be eligible to potentially accompany their partner to PMTCT services at the facility. The data was collected through individual, in-depth interviews with the male partners and community members using a semi-structured interview guide. One focus group discussion (FGD) was conducted with key personnel working in the West Itam PHC using a semistructured interview guide. All interviews and the FGD were tape-recorded and transcribed. Thematic analysis was used to analyse the data. Ethical approval was first obtained from the UWC Research Ethics Committee and the Ethics Committee of the Akwa Ibom State Ministry of Health before proceeding with the study. From this study, it is suggested that most of the respondents knew that PMTCT services are offered at the PHC West Itam. They knew their partner's next antenatal appointment, but only very few accompany their pregnant partners to the antenatal clinic. The striking reason being a lack of time/being busy. The key means of support of the partners' antenatal visits was giving their pregnant partners money for transport, and money for food/snacks (at the clinic). Inter-spousal communication was found to be good, and there appeared to be a perception by the men that antenatal clinic (ANC)/PMTCT is not only for women, with most of the men agreeing that it is useful for men to participate in PMTCT. The barriers to male participation in the PMTCT programme that were elicited in this study include lack of belief about HIV/AIDS and lack of awareness about PMTCT and the perception of PMTCT as a "women's affair". Another barrier to male participation in the PMTCT programme was the men being busy with their jobs/lack of time, and fear. Facility-based barriers include delays/time wasting at the clinic, and the nurses, who were identified as having an unaccommodating attitude towards the clients. Finally, the fact that the nurses and counsellors at the PHC West Itam were all female was a problem for men. It is recommended that there is need for advocacy and education to raise awareness about HIV/AIDS, and encourage male participation in PMTCT. It is also important to encourage the disclosure of HIV status by the women to their male partners. Furthermore, a separate male counselling unit needs to be created, as well as ensuring the employment of male nurses and counsellors. Additionally, the female nurses at the facility need to be trained/re-trained on proper attitude and confidentiality, and efforts must be made to avoid delays at the clinic.

Although the importance of early identification and intervention of infants at risk for communication delays and disorders have been advocated and emphasized in literature, case finding and service delivery in rural areas in South Africa appears to be problematic. The implementation of early communication intervention (ECI) within public service delivery has been proposed in the past. The primary health care (PHC) package had to be considered as a possible vehicle to be utilized for the implementation of ECI functions in rural communities. Against this background the existing identification methods and referral systems, utilized in Ditsobotla sub-district, were described in the current study to determine the limitations in case finding, and the feasibility of the implementation of ECI functions in collaboration with other PHC programmes. A descriptive dominant-less-dominant model provided the design to describe the identification process and teamwork in Ditsobotla sub-district. Data triangulation was utilized to improve reliability and validity of results which entailed a rating scale, face-to-face interviews with PHC personnel (participants in Group 1) and face-to-face interviews with PHC programme managers (participants in group 2). The results indicated that the capacity of facilities and human resources to support the implementation of ECI functions vary within the sub-district. Therefore an incremental implementation of ECI functions is feasible in collaboration with the existing PHC package. The current identification methods and referral systems are limited and a great need for collaboration exists. ECI functions need to be implemented formally within the PHC package and guidelines for such an implementation are provided. Furthermore the identification process to be introduced needs to form part of the incremental implementation of ECI functions. The implications are discussed in terms of ECI service delivery in rural South Africa. The proposed process of incremental implementation of ECI functions in rural areas, i.e. Ditsobotla sub-district, within the PHC package is provided. The need to develop identification methods, referral systems and guidelines for the implementation of ECI in PHC are emphasized. Future practice-based research is recommended in order to improve ECI service delivery in rural areas in South Africa. Copyright / Dissertation (MCommunication Pathology)--University of Pretoria, 2009. / Speech-Language Pathology and Audiology / Unrestricted