Introduction: This study aimed to explore private General Practitioners' perceptions of Managed Health Care CMHC) for health service delivery in the Republic of South Africa (RSA). The specific objectives were to review perceptions regarding issues in MHC including ethics of care, quality of care, design ofMHC programmes and regulation and monitoring ofMHC. The study also reviewed demographic profile of respondents and associations between demographic profile and perceptions. A literature survey indicates that MHC was introduced in a Western context as a means ofregulating cost of healthcare. Models ofMHC generally involve a need to obtain authorization and a restriction of services available. There are ongoing debates about MBC and in particular the potential conflict between managing healthcare provision using business and profit principles and the principles of other stakeholders in health care. Providers, such as General Practitioners, are concerned that their autonomy and their ability to offer best possible care for their patients may be compromised. Patients feel that their ability to access optimal care is not a primary consideration in a model of MBe. The popularity ofMBC in the United States of America is declining and MBC companies have been making financial losses on the Stock Market. MBC has been introduced in South Africa and there has not been any recent assessment of healthcare provider perceptions of the model. This study aimed to address this gap in literature. Methods: The study design was mixed with quantitative and qualitative components. The study population was all private General Practitioners in RSA as this population would have most experience of MBC. The data collection tool was designed by the researcher and comprised closed-ended questions and one open-ended question around perceptions of MBe. Demographic data, and other data relating to experience of MBC, was collected on a separate questionnaire. Questionnaires were posted to a representative sample of private General Practitioners; this constituted 30% of all active private General Practitioners. Results and discussion: The response rate was poor at 13.6%. Respondents generally had negative perceptions of MHe. They cited problems with ethics ofMBC, quality of service and felt that it affected their ability to act independently. They felt that MHC should be monitored by an independent regulatory body and that there should be more teaching around differing models of healthcare. There were no significant associations between gender, place of work, experience oftvtHC and perceptions. However, there was a significant correlation between doctors employed by Iv1HC companies and perceptions. A major limitation of this study was the predominant use of quantitative methodology. A qualitative methodology, using focus group discussion, may have highlighted major issues and following initial qualitative methods a quantitative tool could have been developed. The low response rate is of concern. Respondents may be biased and may have only responded if they felt strongly about the subject. However, respondents did raise some important issues, especially with regards to ethics which must be explored further. There should be ongoing research into differing models of healthcare provision (for example private-public partnerships). Medical school curricula should include training around models of healthcare. Consideration should be given to monitoring MBC using an independent monitoring authority. / Thesis (M.Med)-University of KwaZulu-Natal, Durban, 2008.

Introduction: Erectile dysfunction, the persistent inability to achieve and maintain an erection sufficient to permit satisfactory sexual performance, is a common problem. Aim: To determine the prevalence of erectile dysfunction among men attending a primary health care clinic in Kwazulu-Natal and to determine the association between erectile dysfunction and age, smoking, economic status and co-morbid conditions. Method: An analytic, quantitative, cross-sectional study was conducted on a group of men attending the Primary Health Care clinic at Addington Hospital. The information was obtained using a structured questionnaire (IIEF15) which had already being validated. The questionnaire was self administered at the time of attending the clinic. Statistical analyses using Pearson Chi square, Mann Whitney and Kruskal-Wallis tests determined the statistical significance of the results. Results: A total of 1300 randomly selected men participated in the study of which 803 were eligible for analysis. The overall prevalence rate for erectile dysfunction was 64.9% (621) with 14.6% (117) having mild erectile dysfunction, 19.9% (160) moderate erectile dysfunction and 30.4% (244) severe erectile dysfunction. There was a strong association between erectile dysfunction and age, economic status and co-morbid conditions. (p<0.01) Discussion: The prevalence of erectile dysfunction in the urban primary health clinic was high. The results indicate that the condition is a common problem and that primary care physicians need to become aware of the condition. The awareness will result in improved assessment and offer of appropriate treatment that will only enhance the quality of life of patients. Furthermore, the strong association of erectile dysfunction with co-morbid conditions will serve as a predictor for undiagnosed medical conditions which would have otherwise not being detected. Conclusion: The prevalence of erectile dysfunction in a primary health centre was high and there is a statistically significant association with co-morbid conditions. Further epidemiological studies in the general population focussing on the incidence of erectile dysfunction are recommended. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2009.

Much work has been done in urban areas to implement national guidelines in the treatment of asthma. There is however a dearth of studies done in rural and semi-rural areas. For this reason this study on the profile and management of patients presenting with asthma at a community hospital was undertaken in Estcourt. The study involved interviewing patients presenting with asthma at an outpatient clinic. The questionnaire and patient records were used. The questionnaire was designed by the author to detect precipitating factors leading to exacerbation of asthma and to assess whether national guidelines were been followed by doctors treating these patients. A hundred patients were interviewed. Eighty seven percent of these patients' treatments were not in keeping with national guidelines. In only 11 % of these patients had a doctor used a peak flow meter in the assessment of the patient. Three percent of patients had an understanding of their disease because of relatives who were medical workers. Patients complained that their illness was not explained to them and-they were not shown methods of coping with an acute attack. In many cases patients and health workers did not appreciate the seriousness of an attack. This is demonstrated by the study which showed seventy four percent of participants did not receive prophylactic treatment such as inhaled steroids or sodium chromoglycate although all were chronic sufferers of asthma. Of the thirty one patients admitted in 1997, twenty five had presented to outpatients in 1997 in the same month of their admission. This proves that the seriousness of their condition was not detected by the health workers attending to them. Recommendations are made in keeping with national guidelines to improve services in the Estcourt area in order to reduce morbidity and mortality in patients suffering from asthma and to increase patient satisfaction. / Thesis (M.Fam.Med.)-University of Natal, Durban, 1997.

Background and Objectives The improved uptake of antenatal Opt-out testing has been documented internationally. In South Africa little is known about the efficiency and die acceptability of Opt-out testing. This study compared VCT with Opt-out testing by measuring the efficiency (defined as uptake of testing, number of women identified as HIV positive and consultation duration of the testing approach) and the acceptability to patients and staff. Methodology We conducted a prospective, quasi-experimental equivalent time-samples clinical trial in which we enrolled a consecutive sample of women who presented at die McCord Hospital antenatal clinic from June to August 2006. The study consisted of 2 phases. During the 6 week intervention period women were offered HIV testing with the Opt-out mediod. During die 6 week control period women were offered midwife-provided VCT. Efficiency was measured in each phase, with 150 participants in the VCT arm and 150 in die Opt-out arm. Participants also completed a survey questionnaire. In depth interviews were conducted with 9 purposefully selected participants from each arm. Two focus group discussions were held with staff. The staff focus group findings were followed-up and validated by conducting in-depdi interviews with die staff members who participated in die focus groups 18 mondis later. Results The uptake of HIV testing during the VCT period was 134/150(89.3%) compared to 147/150(98.0%) in die Opt-out period (p<0.001). The percentage of women identified as being HIV positive during the VCT period was 7.33% (11/150) vs. 12.6% (19/150) during the Opt-out period (p=0.133). Time was saved as a decrease in the duration of midwife consultations from 34 min (VCT) to 26 min (Opt-out) was found with p<0.001. Qualitative analysis revealed Opt-out testing to be an acceptable way of testing. Patients found Opt-out emotionally less distressing than VCT (p<0.05). Staff reported that Opt-out decreased the burden on human resources (only one person needed to facilitate the group and shorter consultations) while it identified more women infected with HIV. Conclusion Opt-out testing is significantly more efficient and acceptable than VCT. Opt-out testing should include a group pre-test information session, adequate and ongoing post-test counselling, to be effective and acceptable. / Thesis (M. Med.)-University of KwaZulu-Natal, Durban, 2008.

This study identifies the alcohol intaKe patterns of 274 white patients attending an Urban General Practice. The average consumption rate was 6.5 drinKs per person per weeK (d/p/w). 40X of the surveyed group did not consume any alcohol. The drinkers averaged 11 dIp/wo 72X of the males drank and 501: of the females dranK. 4.31: of the population surveyed were drinking more than 28 dIp/wo Marital status made no real difference to consumption rates but unemployment (16 d/p/w) and being a manual labourer (11.7 d/p/w) did. People who had lost either their occupation (11.7 d/p/w) or a close family member (9.3 d/p/w) in the preceeding year had higher than average (6,5 d/p/w) consumption levels and these were increased further if they had identified an alcohol abuser in their family. This study also identifies the useful supportive services available to this particular community and its health care worKers with a brief discussion of the type of service prOVided and method of access to the service. The appendix contains a list of the services with the relevant address. telephone number and where possible the name of a contact person. / Thesis (M.Prax.Med.)-University of Natal, Durban, 1986.

No abstract available. / Thesis (M.Fam.Med)-University of Natal, Durban, 1994.

Objectives: To assess the role of ambulatory blood pressure monitoring in the diagnosis of hypertension in general practice. Background: Hypertension is usually diagnosed by casual office blood pressure readings. However, ambulatory blood pressure monitoring has shown that a significant proportion of patients diagnosed as hypertension in fact do not have hypertension. Method: Sixty four Indian patients diagnosed as having mild to moderate hypertension by casual measurements were subjected to a twenty four hour ambulatory blood pressure monitoring. A blood pressure load of >35% was classified as true hypertension and < 35% as white coat hypertension. White coat hypertensives were compared to the hypertensive group with respect to various demographic characteristics, and to correlate ambulatory blood pressure monitoring and casual blood pressure readings. Results: A prevalence of 23.44% white coat hypertension was found. In addition, the demographic profile of such patients show a preponderance of non-obese females (73.33%), the majority of whom are on concomitant medication (60%). A poor correlation was found between the casual office blood pressure readings and the twenty four hour ambulatory blood pressure readings in the white coat hypertensives as compared to the hypertensive group. Conclusion: White coat hypertension is common in patients diagnosed as having mild to moderate hypertension by casual blood pressure readings. There are no reliable clinical indicators to identify patients with white coat hypertension. Ambulatory blood pressure monitoring has been shown to be a useful method for differentiating white coat hypertensives from true hypertensives. / Thesis (M.Med)-University of Natal, 1997.

A study was conducted at a Durban high school which has a mixture of socioeconomic classes and races. All grade 10 pupils present on the day of the study were asked to complete a questionnaire under examination-like conditions. The aim was to determine the prevalence of dagga smoking as well as the pupils' knowledge of the effects and health risks of dagga smoking and the prevalence of associated features such as alcohol use, cigarette smoking and sexual activity. Dagga smoking was found to occur commonly (22.9%) and to be mainly a white male group activity. There was a strong association with cigarette smoking and alcohol abuse and a general lack of knowledge concerning the adverse health effects of dagga smoking. Peer pressure and relief of stress were cited as the commonest reasons for dagga smoking. More information and life skills training is required for this group of students as well as further research into substance abuse related topics in general. / Thesis (M.Med.)-University of Natal, Durban, 1997.

Thesis (MFamMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background: The number of adults affected by diabetes mellitus in developing countries, such as South Africa, is projected to grow by 170%, from 84 to 228 million people between 1995 and 2025 .This high and increasing prevalence of diabetes worldwide, and the economic burden of diabetes on developing countries like South Africa emphasizes the importance of ensuring good glycemic control so as to slow down the rate of disease progression and prevent complications. The district health care facilities are the foundation of the health care system of South Africa. The current practice is that diabetics have a point of care random blood glucose (RBG) done on the morning of their clinic appointment and this is used as a form of assessment of glycemic control during the consultation. For further clinical decision making a HbA1c is done once a year as a benchmark of glycemic control. The practical clinical question that arises is whether the assumptions underlying local clinical decision making using the RBG are valid and to what extent RBG can be used to guide clinical management. Aim and Objectives: The aim of this study was to assess the strength of the correlation between RBG and HbA1c and to make recommendations for the interpretation of RBG results in adult patients with Type 2 Diabetes taken at Karl Bremer District Hospital out-patient department. The objectives were: To determine glycaemic control in the study population and compare differences between age, sex and racial groups , and determine the RBG cut-off with the best sensitivity and specificity for predicting poor glycaemic control (HbA1c>7.0% ) as well as the predictive value, likelihood ratio and pre/post-test odds and probability at this cut off. Methods: A retrospective analysis of existing hospital data and the HbA1c tests requested from the NHLS by Karl Bremer Hospital over the 2011 year period. The data was analysed by means of a receiver operating characteristic (ROC) curve analysis to determine the value of RBG with the best combination of sensitivity and specificity to predict poor control of diabetes. A p-value of < 0.05 was assumed to represent statistical significance and 95% confidence intervals were used to describe the estimation of unknown parameters. HbA1c level of < = 7% was taken as representing good control and > 7% poor control. Results: Data was obtained on 349 diabetic patients of whom 203 (58.2%) were female and 146 (41.8%) male. This study population had a mean age of 54.7 years, mean RBG of 13.0mmol/l and mean HBA1c of 9.4%. The total number of black patients was 79 (23%), coloured patients 147 (42%) and white patients 122 (35) % and their mean RBG were 15.4 mmol/l, 12.8 mmol/l and 11.9 mol/l respectively. There was a statistically significant correlation between increasing RBG and increasing HbA1c (p< 0.01). The best value obtained on the ROC curve was an RBG of 9.8 mmol/l, which had a sensitivity of 77% and a specificity of 75%, positive predictive value of 0.88, positive likelihood ratio 3.08 and post-test probability of 88.2% for predicting an HbA1c above 7%. Conclusion: It was concluded that a moderate correlation exists between RBG and HbA1c in this population of diabetic patients. .The best RBG for determining poor control, defined as a HbA1c>7.0%, was found to be 9.8mmol/l and this RBG had a sensitivity of 77% , specificity of 75% and positive predictive value of 88%. Significant differences were found in pre- and post -test probability for different racial groups. Point of care testing using this level of RBG for clinical decision making will inappropriately categorise 23% of patients in this population and therefore introducing point of care testing for HbA1c is recommended.

Purpose To evaluate the impact of Laduma, a health education intervention, on the knowledge, attitudes, beliefs and practices regarding sexually transmitted infections among secondary school learners in KwaZulu-Natal. Objectives The objectives of the study were to determine knowledge, attitudes, beliefs, perceptions and practices of secondary school learners regarding sexually transmitted infections at baseline and post-exposure to Laduma; assess intended behaviour change regarding sexually transmitted infections and condom use as well as the awareness of skills to achieve such behaviour; assess learners' perceived vulnerability to sexually transmitted infections; assess comprehension, acceptability and appeal of the photonovella among learners and to assess whether learners can identify with the characters and situations in the photo-novella. Design This was an experimental study design. Setting Nineteen randomly selected secondary schools in the Midlands district of KwaZulu-Natal. Subjects Grade 11 learners, n = 1168, from randomly selected schools that were further randomised into intervention and control groups. Outcome Measures The learners had to complete three sets of questionnaires that elicited information about their biographical profile, knowledge, attitudes, beliefs, perceptions and practices regarding sexually transmitted infections, intention to change their behaviour with regard to sexually transmitted infections and condom use, as well as their skills to achieve such behaviour, their perceived vulnerability to sexually transmitted infections and their perceptions of Laduma. All of these outcomes were assessed at baseline (Tl), following the learners' exposure to Laduma (T2, three weeks after the baseline), as well as six weeks later (T3) in the case of the intervention group. With respect to the control group they had to answer the baseline questionnaire on all three occasions. Results The mean age of the respondents was 16.8 years with almost two thirds of the learners being between the ages of 15 - 18 years. Seventy percent were primarily Zulu speaking. Learners reported feeling personally scared of getting a sexually transmitted infection with 17.8% responding that they thought they could get a sexually transmitted infection in the next two years. There was a significant gender difference between male and female learners in their topics of communication to friends, parents and partners regarding HIV/AIDS, condom use, having sex or not having sex (p < 0.01). Although learners had adequate knowledge about the spread of sexually transmitted infections at baseline, the mean scores for the spread for the group exposed to Laduma differed significantly from the mean scores of the control group, both immediately after the intervention (p < 0.01) and six weeks thereafter (p < 0.001). Learners in the intervention group responded more positively towards condom use at time 2 (T2) than the control group and maintained this change six weeks later. Sexual activity and condom use at time 3 (T3) was not influenced by the intervention but was significantly predicted by past sexual activity (p< 0.001) and past condom use (p < 0.001) respectively. At time 3 (T3) significantly more learners in the intervention group intended to have sex with a condom (65.1 %) compared to the control group (52.3%, p < 0.05). Overall learners had a positive response to Laduma and appreciated it as a health education intervention. Conclusion and Recommendation The findings of this study provided important information about adolescent sexuality on a range of outcomes related to knowledge, attitudes and sexual behaviour. The findings also provided information on learners' gender differences about what they communicate and to whom, as well as their sexual behaviour. After a single reading of Laduma learners showed an increase in knowledge about the spread of sexually transmitted infections, a change in their attitude to condom use as well as an increased intention to practice safer sex. Laduma did not influence communication about sexually transmitted infections, sexual behaviour nor condom use. These are complex behaviours and indicate that interventions focussing on preventive sexual behaviour need to move beyond awareness and information dissemination towards being more intensive and skills focussed. Such interventions need to address the gaps between knowledge and practice and be facilitated in a context that supports such implementation. The specific recommendations made from the findings of this study therefore include, the development of a systematic health promotion programme that addresses the issues related to personal vulnerability, knowledge related to treatment of and protection against sexually transmitted infections as well as skills that promote safer sexual choice. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2005.