The study aimed to describe the health seeking behaviours and experiences of homeless people in South Central Durban. Homelessness is a broad and complex term that affects many people in South Africa. Homelessness inevitably causes serious health problems, conditions that are closely associated with poverty. Health problems experienced by homeless people are numerous and multifaceted. Homelessness is a complex issue that not only damages both physical and mental health, but also contributes to the spread of disease to the non-homeless (National Health Care for the Homeless Council, 2008:1). Drawing on interviews with homeless participants and healthcare workers, this study depicted the experiences, and the observed, felt and perceived needs of homeless people in accessing healthcare. The study reveals why, when and where homeless people access healthcare and the factors facilitating and hindering their access to healthcare. The researcher primarily used a qualitative methodology with a small quantitative component. The qualitative component comprised one on one in-depth interview. The quantitative component comprised a record review showing frequency distribution of health problems experienced by homeless people presenting at the Kathleen Voysey clinic. The findings highlight the unique lived experiences which include health problems, basic needs, accommodation, safety and security, community networks, access to pensions and grants. Findings show that homeless people are accessing healthcare facilities however there are mixed responses as to the service that they have received. A number of recommendations were suggested by both homeless participants and healthcare workers for policy makers, healthcare services, and homeless people and for future research regarding the care of homeless people. / Thesis (MMed.)-Universityof KwaZulu-Natal, Durban, 2009.

Introduction Hospital boards are vital structures that represent the needs and aspirations, of the community that hospitals serve. Aim This study aims to determine whether district-level hospital boards in KwaZulu-Natal (KZN) are equipped to support hospital management in the effective and efficient delivery of hospital services. Methods A quantitative, descriptive and cross-sectional health systems research study has been used. Thirty-two (32) of the thirty five (35) district hospitals in KZN participated in the study. Nineteen (19) chairpersons of hospital boards (CHB) and twenty-four (24) chief executive officers (CEO’s) were telephonically interviewed using a structured but open-ended questionnaire. Ordinary board members at eleven district hospitals were interviewed over a period of four (4) months using an interview schedule. Minutes of fifty-eight (58) board meetings were scrutinised to establish what items were discussed at board meetings and how matters were dealt with. Hospitals were excluded from the study after five (5) failed attempts to involve them in the study. Results Hospital boards in KwaZulu-Natal (KZN) are interim structures. The role and responsibilities of hospital board members are unclear and their supervision is inadequate. Their commitment and ability to function is limited and they are not representative of the community that they serve. There is a lack of clarity as to the real purpose of hospital boards. Training, orientation and induction of new members are weak. There was little evidence about how boards provide feedback to the community and health users. Conclusion Hospital boards will function adequately once legislative regulations have been passed, clear policies finalised and appointed board members are adequately trained and capacitated. Recommendation The KZN Department of Health should promulgate legislation that will govern hospital boards, appoint permanent hospital boards, develop policies and training manuals and capacitate board members on an on-going basis. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2009.

Information Technology (IT) is revolutionizing every sphere of human interaction. IT has changed the way individuals communicate. In the healthcare system, information technologies are considered the key to addressing challenges to healthcare delivery such as shortages of healthcare professionals, and networking. Therefore, healthcare providers need to possess information technology skills, knowledge, and resources to communicate and manage information effectively and efficiently and also to be able to perform their duties adequately in such an information technology age. Nurses, the largest group of healthcare providers who spend the most time with patients, are also frontline healthcare managers and need to have access to IT and should be computer literate in order to perform their duties quickly and adequately. In South Africa, the health system has been slow in integrating IT into healthcare delivery, particularly in rural and remote areas where such services are most needed. A "digital divide" exists, by which access to computers and the internet remain a privilege, and many nurses are unable to use a computer even after completing the computer literacy courses. This study aims to investigate the challenges faced by professional nurses to access and use information technology in healthcare facilities after being trained. Data was collected through focus group discussions conducted with professional nurses from two regional and four district hospitals. Participants who had received computer training offered by the Department of Health were selected to ensure that issues beyond a lack of training could be explored. Focus group discussions were recorded and transcribed verbatim. Content analysis was used to identify themes from the transcriptions. Results show that professional nurses had little access to information technology. Reasons given were a lack of hardware and appropriate software, insufficient training and lack of support, irrelevance of the computer courses, and negative attitudes towards computers. Despite previous computer training, the professional nurses interviewed felt they lacked the skills to use computers confidently in their daily activities. The quality of the training was perceived as inadequate and irrelevant with a lack of ongoing support to cement new skills and build confidence. The provision of training workshops for nurses is not sufficient to ensure that IT will be used for healthcare delivery. On-going support an motivation, among others, are needed to encourage nurses to use IT efficiently. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2010.

The SA National Department of Health made maternal deaths notifiable in 1997. It also commissioned a National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) to confidentially investigate all maternal deaths, to write the "Saving Mothers Report" and to make recommendations based on the findings of the study. The Department of Health in 2003 commissioned an evaluation of the extent to which the 10 recommendations contained in the first "Saving Mother's Report" had been implemented. This rapid appraisal was carried out by Centre for Health and Social Studies (CHESS), University of Natal. A report 'The Progress with the Implementation of the Key Recommendations of the 1998 "Saving Mothers Report" on the Confidential Enquiry into Maternal Deaths in South Africa - A Rapid Appraisal," was published in 2003. The data collected on Recommendation 5 on the use of the obstetric partogram in 46 selected provincial hospitals in all the 9 provinces was only partially analysed in this report. This study reports on a secondary analysis of the 942 questionnaires that were completed on the use and application of the partogram in hospitals in South Africa. In the rapid appraisal experienced field workers evaluated the use of the partogram using a 36-point checklist. Provincial and national averages for each of these variables were calculated and hospitals were evaluated into how they performed according to these averages using Lot Quality Assurance Sampling methodologies. Using national and provincial averages, the hospitals in each province are compared with one another provincially and nationally. In addition, the application and use of partograms in areas and levels of hospitals are described. An attempt is made to show if there is relation between the number of deliveries and the recording of the partogram. The main findings were that, of all the provinces KwaZulu-Natal had the lowest number variables below the national average from the 36 variables used as a checklist. Eastern Cape and Limpopo had the highest number of variables below the national average. The hospital with the highest number below the national average is in the Eastern Cape. In the recording of the chart rural and level one hospitals are low in comparison with urban and level three hospitals. There was no relation in the recording of the chart and the number of deliveries. / Thesis (M.PH.)-University of KwaZulu-Natal, 2004.

No abstract available. / Thesis (M.Med.)-University of KwaZulu-Natal, 2004.

The introduction outlines the reasons for the priority of maternal and child health emphasizing the relatively simple resources required. The aims of such programmes must be identified and the results measured so that services can be monitored and evaluated. Categories of measurement are defined and indicators of maternal child health identified within these categories. A chapter is devoted to an outline of the principal non-medical determinants based on material from the Inter-American Investigation of Childhood Mortality. The significance of the principal indicators viz. the perinatal mortality rate, the infant mortality rate, the maternal mortality rate and growth and development data are compared. Chapter lV presents a report of a questionnaire study into local indices viz. Stillbirth rates, Caesarean Section rates and Maternal Mortality rates. The uptake of certain clinic services was also determined. Differences between groups and possible reasons for these are discussed. The final chapter points out the need for accurate birth and death registration and a reliable health information system and suggests methods for achieving this. Recommendations are made for upgrading the collection of data and for improving maternal and child health by research and peripheralization of services. / Thesis (M.Med.)-University of Natal, Durban, 1981.

PURPOSE. Domestic violence has a significant prevalence in the world, and certainly in South Africa, yet Emergency Care Practitioner (ECP) training and practice does not have any particular focus on domestic violence intervention. The absence of any clear response protocol to domestic violence in a Health Professions Council of South Africa (HPCSA) regulated profession, suggests the reliance on health practitioner discretion in this regard. This is problematic as the profession is male dominated and focused on tertiary levels of care. ECP's may be positioned to screen for abuse early, yet there is no evidence of success or failure in this endeavour. This study aimed to ascertain what the prevailing ECP knowledge, attitudes and beliefs around domestic violence in the Western Cape are, so that any factors preventing or nurturing early identification and appropriate treatment of domestic violence may be mitigated or supported respectively. METHODS. Health Professions Council of South Africa (HPCSA) registered ECP's in the Provincial Government- Western Cape (PGWC)- Emergency Medical Service (EMS) Metropole region voluntarily completed a questionnaire. MAJOR RESULTS. Only 49% of respondents could correctly define domestic violence. ECP qualification was associated with domestic violence definition in that Basic ECP's were more likely to incorrectly define domestic violence than the advanced ECP's. Eighty-one percent of respondents recognized less than thirty domestic violence calls in the preceding six months. The majority of ECP's (89%) experienced no special handling of domestic violence victims. No significant association could be found (Chi-Square: p = 0.2298) between qualification and knowledge of domestic violence laws. An ECP's qualification is no predictor of his/her legal knowledge about abuse. Qualification could also not be positively associated with the referral of victims, although the majority of practitioners of all qualifications (78%), had only sometimes referred victims or not at all. The majority of respondents expressed inadequate assessment and management of domestic violence patients. The majority also indicated that their ECP training was inadequate in preparing them for domestic violence intervention. CONCLUSIONS DRAWN. The attitudes and beliefs of Emergency Care Practitioners elicited from this study suggest a poor level of understanding of the extent and nature of domestic violence. There is a probable low detection rate amongst the majority of ECP's. There exists harbouring of myths that may confound the implementation of a pre-hospital protocol for domestic violence management. There is an inadequacy of current ECP practice with respect to domestic violence crisis intervention with regards screening, management and referral. The EMS response to domestic violence should be congruent with an appropriate health sector response and should include universal screening (asking about domestic violence routinely); comprehensive physical and psychological care for those patients who disclose abuse; a safety assessment and safety plan; the documentation of past and present incidents of abuse; the provision of information about patients rights and the domestic violence act; and referral to appropriate resources. The ECP curriculum should emphasise the particular nature and treatment of domestic violence. The study supports the need for the introduction of a comprehensive ECP protocol, in training and in practice. This information should prove useful to all who attempt to design educational programmes and clinical strategies to address this public health issue. / Thesis (M.PH.)-University of KwaZulu-Natal, 2006.

The uThukela District in the province of Kwazulu-Natal, Republic of South Africa, has been involved in improving Primary Health Care (PHC) in the district through evaluation surveys carried out at regular intervals during the past six years. World Vision's uThukela District Child Survival Project (TDCSP) began in November 16, 1999. This has been made possible by a Child Survival Grants Program from the Unites States Agency for International Development (USAID). In all previous surveys a 30-cluster sampling methodology was used to select individuals from the survey population. This time however, the Lot Quality Assurance Sampling (LQAS) methodology was used. The recent re-organization of the District into municipalities enabled each municipality to function as one Supervision Area (SA) or Lot. Even with a small sample size (in this case 24 per SA), poor health service performance could be identified so that resources are appropriately distributed. Furthermore, people from the community such as Community Health Workers (CHW) were involved in all phases of the study, including the manual analysis of the results, upon being trained appropriate. However, it is questionable as to how accurate and reliable such a manual analysis was. In this dissertation, the manual results of the study were evaluated by doing an electronic analysis. In addition, a more refined analysis of the data has been produced (e.g. population-weighted coverage, graphs and stratified analyses in some cases). From the comparisons made, it was concluded that the manual analysis was very similar to the electronic analysis and that differences obtained were not statistically significant. In addition, due to each municipality varying in population size, it was queried as to whether population-weighted results would produce a marked difference from the un-weighted, manual results. Again, the differences produced were in most cases not statistically significant. This concluded that the manual analysis carried out by the TDCSP team was accurate and that it is appropriate to use such results in determining individual municipality performance and overall District performance so that responsive action can then be taken immediately, without necessarily having to wait for electronic results. / Thesis (M.P.H.)-University of KwaZulu-Natal, 2005.

Background: There is global concern about the impact of lifestyle related diseases which have been on a steady increase in recent years. Poor nutrition, reduced physical activity and cigarette smoking have been documented as the main lifestyle behaviors that result in an increase in prevalence of the three most common occurring chronic diseases of lifestyle namely: diabetes, hypertension and cardiac diseases. Healthcare workers are frontline personnel and are seen as role models by their family, friends and the community they serve. It is therefore important that positive healthy lifestyle behaviors are practiced and encouraged by healthcare workers themselves. Objectives: To develop an initial descriptive profile of hospital employees with regards to their general knowledge, attitudes and practices about healthy lifestyles and to make appropriate recommendations to the hospital management on how the workplace can support the adoption of healthy lifestyles. Methods: The study was conducted at one health institution using the permanently employed staff as the study population. An exploratory descriptive study design was used in context of the precede-proceed planning framework. Self-administered questionnaires and consent forms were distributed in English and isiZulu. Collection boxes were placed in all wards and departments. Data was captured using the SPSS version 13 statistical package. Results: The response rate was 42%. Respondents were classified into the administrative, general staff and health professional categories. There was a significant difference (p=0.03) between the staff body mass index and their weight perception. Knowledge and attitude had mean indices of greater than 70% and the practice indices were lower for all three categories at less than 45%. A significant difference was found between certain staff categories in the knowledge and attitude indices but no significant difference existed in their practices. Conclusion: All categories of staff possessed adequate knowledge and attitudes but this is not transferred into positive health promoting practices. The possibility of workplace health promoting interventions was well supported by staff especially with regards to healthier meal choices at the staff dining room and an onsite gym facility. The main limitations of the study were the non-standardized data collection tool, and the poor response rate, which make the generalization of the study findings difficult. / Thesis (M.PH.)-University of KwaZulu-Natal, 2008.

The purpose of health service research is to produce knowledge that will contribute to the improvement in the delivery of health care and it is in this spirit that this study of the quality of paediatric care at King Edward VIII Hospital was undertaken. The main method utilized was an evaluation of aspects of the process of care of selected conditions, as measured against a predefined set of standards. This was accomplished by a retrospective review of patient records. Assessments were also made of the utilization of the Department's services, manpower and equipment. The surveys conducted involved the Outpatient's Department, the General and the Neonatal Wards of the Paediatric Department of the King Edward VIII Hospital, Durban. The Hospital Administration's routine and computerized data were also analyzed. Among the findings was that the routinely collected data is inadequate,providing only limited information for management purposes. The assertion that the utilization of the Department is high was confirmed, as was the claim that some resources are inadequate to cope with increasing demand. Many factors contribute to this, including high bed occupancy, high patient to doctor ratios, and several factors outside of direct hospital control (primary care services). The general clinical care of patients is high, but particular aspects were found to be in need of attention; for example, the metabolic and fluid management of the ill young patient and medical records in general. Immediate and long-term recommendations pertaining to the Paediatric Department and the Administration are presented.