No abstract available. / Thesis (M.Med.)-University of Natal, Durban, 1981.

Since 1994, a turning point in the history of South Africa (SA), significant changes were made in the delivery of health services by the public sector, provincially and nationally. The process of change involved making important decisions about health services provision, often based on past experience but ideally requiring detailed information on health status and health services. For an example, Primary Health Care (PHC) was made freely accessible to all citizens of this country. Many studies on the impact of free PHC in the country have shown increased utilization of these services.40 In the context of HIV/AIDS and its complications and other emerging health conditions, reasons for this increased utilization may not be that simple. I17, II8. Parallel with increased utilisatIon has been uncontrollable escalation of costs in the Department of Health (DoH), often resulting in ad-hoc and ineffective measures of cost-containment.40. For these and many other reasons of critical importance to public health services management, the issue of health information generally, and epidemiological inforn1ation in particular, should be brought higher on the agenda of health management. Public health services management is about planning, organization, leading, monitoring and control of the same services.2 Any public health plan must have a scientific basis. In order to achieve rational planning of public health services in the province, adequate, up to date, accurate information must be available, as a planning tool. Health information is one of key resources and an essential element in health services management. It is a powerful tool by which to assess health needs, to measure health status of the population and most importantly, to decide how resources should be deployed.5 Trends in the health status of the population are suggested by the White Paper for transforn1ation of Health Services (White Paper), to be important indicators of the success of the Reconstruction and Development Programme (RDP), the country's programme of transformation. 37,39 It is within that context that the KwaZulu-Natal-Department of Health (KZN-DoH) resolved to establish an Epidemiology/Demographic Unit for the province, to assist management to achieve the department's objectives of providing equitable, effective, efficient and comprehensive health services. 37,89 Purpose: To develop a provincial Epidemiological-Demographic Inforn1ation System (EDIS) that will consistently inforn1 and support rational and realistic management decisions based on accurate, timely, current and comprehensive infom1ation, moving the DoH towards evidence based policy and planning. Objectives: To provide an ED IS framework to : .develop provincial health policy .assist management with health services planning and decision-making .ensure central co-ordination of health information in order to support delivery of services at all levels of the health system . . monitor implementation and evaluation of health programmes . ensure utilization of information at the point of collection, for local planning and interventlon. Methods: A rapid appraisal of the existing Health Information System (HIS) in the province was conducted from the sub-departments of the DoH and randomly selected institutions. A cross-sectional study involving retrospective review of records from selected hospitals, clinics and other sources, was conducted. The study period was the period between January 1998 to December 1998. Capacity at district and regional levels on managing health information and epidemiological information in particular, was reviewed and established through training progranmles. Results: The rapid appraisal of existing HIS in the province revealed a relatively electronically well resourced sub-department of Informatics within the KZN-DoH, with a potential to provide quality and timely data. However, a lot of data was collected from both clinics and hospitals but not analyzed nor utilized. Some critical data was captured and analyzed nationally. There was lack of clarity between the Informatics Department staff responsible for collecting and processing provincial data and top management with regards each other's needs. Demographics: The demographic composition and distribution profile of the KZN population showed features of a third world country for Blacks with the White population displaying contrasting first world characteristics. Socio-Economic Profile: The majority of the population was unemployed, poor, illiterate, economically inactive, and earning very low income. The water supply, housing and toilet facilities seemed adequate, but in the absence of data on urban/rural distinction, this finding needs to be interpreted with caution Epidemiology: All basic indicators of socio-economic status (infant, child, neonatal mortality rates) were high and this province had the second poorest of the same indicators in the country. Adult and child morbidity and mortality profiles of the province, both at clinics and district hospitals were mainly from preventable conditions. Indicators on women and maternal health were consistent with the socio-economic status of this province; and maternal mortality rate was high with causes of mortality that were mainly preventable. The issue of HIV / AIDS complications remains unquantifiable with the limited data available. HIV is a serious epidemic in KZN and this province continues to lead all the provinces in the country, a prevalence of 32 % in 1999.86 Health Services Provision: Inmmnization coverage was almost 50% below the national target and drop out rate was very high. Termlinations of Pregnancies (TOP) occurred mainly among adult, single women, and the procedure done within the first trimester and requested for social and economic reasons. Provincial clinics (mainly fixed) and hospitals provide family planning and Ante Natal Care (ANC) services to the majority of pregnant women in the province. Conclusion : KZN is a poor province with an epidemiological profile of a country in transition but predominantly preventable health conditions. The province has a potential for producing high quality health information required for management, planning and decision making. It is recommended that management redirects resources towards improving PHC services. Establishment of an Epidemiology Unit would facilitate the DoH's health services reforms, through provision of comprehensive, accurate, timely and relevant health information . / Thesis (M.Med.)-University of Natal, Durban, 2000.

Background The years 1985 to 1988 and 1997 to 2001, were periods of high morbidity and mortality due to malaria in KwaZulu-Natal, South Africa. One reason for the increased burden of disease was the emergence of drug resistant Plasmodium falciparum. The parasite was resistant initially to chloroquine and then to sulphadoxine-pyramethamine, the medication of choice for the treatment and prevention of malaria in different periods of time. The changing epidemiology of malaria in Mrica was exacerbated by policy makers not making timely and rational change to the failing malaria drug regimens to newer and effective ones. Purpose ofthe study This study was conducted to determine the impact of delayed introduction of sulphadoxine-pyramethamine (Fansidar®) and artemether-lumefantrine (Coartem®) as a first-line drugs for malaria in KwaZulu-Natal from 1985 to 1988 and 1997 to 2001 respectivel y, Study Design Observational, Analytic, Ecological Method The incidence of malaria in KwaZulu-Natal was compared during different phases of the period when chloroquine was the first line treatment. The baseline phase (1982 to 1984) was taken when chloroquine correctly should have been used and this was compared with the delayed phase (1985 to 1988), when it should have been replaced by of sulphadoxinepyramethamine. During the second period sulphadoxine-pyramethamine was the first line treatment of malaria, the baseline phase (1993 to 1996) when it correctly should have been used was compared to the delayed phase (1997 to 2001) of introduction of the alternate treatment of malaria with artemether-Iumefantrine. Ethical approval for this study was obtained from the Biomedical Research Ethics Committee, of the University of KwaZulu-Natal. Statistical Methods The relative association of malaria infection during the chloroquine baseline and change phases and the sulphadoxine-pyrametharnine baseline and change phases were compared with statistical significance at 0.05. Results The risk of malaria infection was 4.5 times (Incidence Risk Ratio = 4.5; 95% Confidence Interval: 4.1 to 5.0; P < 0.0001) higher in chloroquine change phase relative to the baseline phase. During the sulphadoxine-pyrametharnine period, the malaria risk was 3.5 times greater (Incidence Risk Ratio = 3.50; 95% Confidence Interval: 3.40- 3.60; p < 0.0001) in the change phase. In the chloroquine period, the malaria mortality risk was 9.1 times higher (95% Confidence Interval: 2.1 to 38.5; p=0.0003) and the case fatality rate was increased 1.3 times more (95% Confidence Interval: 1.0 to 1.7; p< 0.001) in the change period. The risk of death during the sulphadoxine-pyramethamine change phase was 4.8 times (95% Confidence Interval: 3.3 to 7.0; p<O.OOl) and case fatality rate of2 times (95% Confidence Interval: 1.5 to 2.7; p <0.001) relative to the baseline phase. Conclusions The dramatic change in the malaria epidemiology in Africa in recent times was exacerbated by delay in replacing first line failing antimalarial drugs. The establishment of sentinel sites for assessing drug resistance or failure and the application of World Health Organisation standards in drug resistance studies will go a long way to achieving the Roll Back Malaria target by 2010. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2007.

Compulsory community service programmes have been initiated in many countries to recruit health care professionals to provide services in rural and under-served areas. However, the success or failure of the Community Service Programme depends largely on the attitudes of the professionals, their understanding of the programme's objectives, their preparedness for working in these areas and their ability to adapt to a new and challenging experience. Aim The aim ofthis study was to assess therapist's perceptions and attitudes about the compulsory Community Service Programme in KwaZulu-Natal in 2005 and to assess whether these changed during the year. Methods An observational cross sectional study with a descriptive and analytic component was conducted on commencement and after completion of community service. The therapists completed a self-administered questionnaire before and after their community service. Results A total of 126 (89% of 142) therapists responded to the initial questionnaire, 59 (42%) completed the exit questionnaire of which 47 (33%) completed both the questionnaire at commencement and completion of community service. Despite the poor response rate, similarities in perceptions and attitudes were noted with other studies conducted nationally and internationally. At onset 50% indicated that they would work in the public sector in the future and this proportion declined to 35% by exit. Even fewer (24%) said they would work in a rural area in the future. Only 16% reported that they would stay on at the same institution the year after community service. There was also no significant association between therapists collecting a rural allowance and expressing an interest to work in a rural area in the future (p=0.78) or staying at the same institution in the years after community service (p=0.32). However, therapists working in urban areas were more likely to say they would work in a rural area in the future (p=0.018). The comparisons between the occupational catergories showed that for support and supervision, the Speech Therapy and Audiology Forum was considered significantly (p=O.OOI) supportive compared to the Physiotherapy Forum. There was no significant difference within the occupational catergories in their perceptions of support, mentoring and supervision, attitude, psychological coping, personal and professional gains, safety issues and the amount of community outreach conducted. All groups were similarly resource constrained. Language was a barrier for 50% of all community service therapists and impeded their professional functioning. Discussion Despite the challenges experienced by community service therapists the majority felt that they had made a difference in the community in which they have been placed. The obligation to work in rural and under-served areas was personally and professionally rewarding. Particular concerns centred on support, supervision, training, resources and language barriers in providing better service delivery. Recommendations To achieve its objectives in relation to compulsory community service, which is to ensure an improved provision of health services to all citizens ofthe country, the Department ofHealth should consider multiple strategies including financial incentives such as rural allowances and non-financial incentives to retain health care personnel in rural and under-served areas. A long-term strategy that addresses human resources in a comprehensive manner needs to be developed to improve staffing and quality health services in these areas. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2009.

Introduction On the 5th of December 2009, at the 40th Union World Conference on Lung Health in Cancun, Mexico, the American Thoracic Society and the Forum of International Respiratory Societies declared 2010 as the “Year of the Lung”. Asthma features amongst the “big five” of the respiratory diseases worldwide. It is estimated that South Africa has the 25th highest asthma prevalence in the world and the 5th highest case fatality rate in the world. Asthma has been reported as one of the most serious common chronic condition affecting young children. The South African media and government reports states that one in eight children in South Africa has asthma. Children spend a considerable amount of time at school. Teachers are often recognised as in loco parentis at school. Therefore, it is imperative that primary schoolteachers have some knowledge of asthma and its management to ensure that asthmatic school children can be assisted. Aim The aim of this study was to elucidate asthma knowledge and management in primary schools in Umdoni subdistrict. Methods A cross sectional study design was used. Two hundred and twenty six schoolteachers’ from 19 primary schools participated in this paperless survey. An asthma knowledge questionnaire was developed by the researcher in consultation with a paediatric asthma specialist and was fielded using the Mobile Researcher mobile application channel, provided by Clyral. The survey was conducted using cellular telephones that were used to capture teachers’ responses during face-to-face interviews with fieldworkers. The completed surveys were uploaded using general packet radio service (GPRS) to the web-based “Research Centre”. Data were exported to a Microsoft Excel spreadsheet, cleaned and then imported into SPSS 15.10 for analysis. Results This study found that although the majority of primary schoolteachers (61.5%) had above 50% correct answers in the asthma knowledge test, the vast majority (95.1%) felt asthma education was necessary for schoolteachers. The results suggest that although teachers have reasonable knowledge on certain areas regarding asthma, however there is huge gap in their knowledge on the care of a child with an acute exacerbation of asthma. The lack of medical or nursing personnel at these schools means that the initial management of the child during an asthma attack will be in the hands of school personnel. In light of this, it is important to note that 38.5% of participants scored less than 50% on an asthma knowledge test, which denoted poor or limited knowledge of asthma and its management. This study also showed that teachers’ knowledge of asthma and sports was deficient and teachers do have misconceptions about asthmatic children’s abilities. None of the schools had written material to guide the management and care of asthmatic children. Such materials would be necessary, especially in circumstances when prompt action is required in a severe acute asthma attack. Conclusion The results conclude that primary schoolteachers’ knowledge in Umdoni subdistrict is deficient especially in the knowledge of the care of a child with an acute exacerbation of asthma. Teachers in Umdoni subdistrict are in contact with and exposed to asthmatic schoolchildren on a regular basis. Teachers have to cope with asthmatic children who have diverse needs. The importance of enhancing school based asthma health promotion strategies is highlighted by the following recommendations: asthma education training for school personnel, participation and support from Departments of Health and Education and the development and implementation of sound asthma policies in schools. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

Introduction: A quantitative cross-sectional study was undertaken to assess whether parenting practices regarding alcohol use (as perceived by 16-18 year old adolescents) are determinants of alcohol use by the adolescents. Parental practices include supervision, emotional support and parenting alcohol socialization behaviours that could influence adolescents' alcohol use behaviour. Aim: The aim of the study was to investigate the influence of perceived parental practices and alcohol use behaviour among 16-18 year old adolescents in public high schools in the Emawaleni District, KwaZulu-Natal. Methods: A cross-sectional study design was used. Self-administered questionnaires provided data from 704 adolescents enrolled in public high schools Data were processed using SPSS 15.0. (SPSS Inc., Chicago, Illinois). Scale reliability analyses were conducted and frequencies on all items calculated. Chi-square tests were used to assess associations between adolescent alcohol use and demographic variables. Logistical regression analyses explored the associations between the different demographic variables, adolescents' perceptions of parental practices and alcohol use behaviours. Results: The results indicated that the most significant others that affect the adolescents' drinking behaviour are parents (51.3%) and peers (33.8%). It was revealed that peers (40.1%) and parents (12.9%) offered the first alcoholic drink to adolescents. Age of alcohol use initiation was found to be as early as 13 years. It was found that mothers who communicated the risks of drinking (84.2%), and it is also mothers (36.9%) who inform adolescents of safe drinking practices. Eighty-two percent of parents are aware of adolescents' whereabouts. Regarding peer connectedness, 86% of the adolescents who drank alcohol felt that they could depend on peers when drunk and 77% of adolescents reported that they discouraged their peers from getting drunk. The best predictors of adolescent alcohol use were: younger age, being male, race (White), religiosity, parental and peer alcohol use. Discussion: The evidence demonstrated a basic understanding of the processes by which parents influence adolescent alcohol use behaviours. Although the study showed a stronger parental protective factor than reported in other studies, the influence of the peers in the adolescents' development is also consistent with that of other studies. Recommendations: Adequate interventions for adolescents are urgently needed to improve parenting skills in order to prevent risky adolescent alcohol use behaviours. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2009.

Introduction Road traffic collisions in developing countries contribute towards the greatest burden of disabilities and fatalities globally. Concern has arisen about the high proportion of pedestrians involved in collisions in South Africa. Aim This study describes the epidemiology of motor vehicle collisions involving pedestrians in eThekwini Municipality from 2001 to 2006, aiming to identify opportunities for prevention and informing policy. Methods An analytic cross-sectional study design was used. Data was obtained from the eThekwini Transport Authority database (police accident reports), and the Nationallnjury Mortality Surveillance System (mortuary reports). Exposure variables included pedestrian and drivers' demographics and collision environment. Death and injury were the outcome variables measured. Population data was obtained from Statistics South Africa. Results Pedestrians' injuries decreased from 7 445 to 6 288 (incidence risk: 241 to 193 per 100 000) from 200 I to 2006. Annual case fatality rose from 4.9% (366 deaths in 200 I) to 6.8% (430 deaths in 2006). Child pedestrians aged 5 to 9 years had a 77% increased risk of injury relative to other children. The fatality risk ratio of male to female pedestrians was 3.8 (95% Confidence Interval: 1.7 to 9.3). Male drivers aged 30 to 34 years had a 68% increased collision risk relative to all other male drivers and eight times (Incidence risk ratio: 8.0; 95% Confidence Interval: 6.2 to 10.3) the risk of female drivers. Only 3.4% of collisions occurred on freeways but accounted for 19.6% of pedestrian fatalities. Few (1.5%) collisions involving pedestrians occurred at night in unlit conditions but constituted more than four times the number of fatalities as number of collisions in these conditions. / Thesis (MMed.)- University of KwaZulu-Natal, Durban, 2009.

No abstract available. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2010.

Background The Millennium Development Goals call for two-third and three-quarter reductions in Perinatal Mortality Rates and Maternal Mortality Ratios. The main strategy towards achieving these reductions is to increase access to skilled attendance. However, it cannot be confirmed that all health professionals are skilled in managing women in labour, nor that they are functioning in enabling environments. To measure the provision of skilled attendance, this study was undertaken in five Level 1 Hospitals in the uThungulu Health District of KwaZulu-Natal. The objectives of the study were: 1. To establish perinatal outcomes for each Level 1 Hospital in uThungulu Health District. 2. To evaluate the quality of intrapartum care provided in Level 1 Hospitals in uThungulu Health District. 3. To evaluate the obstetric knowledge of health workers attending births in Level 1 Hospitals in uThungulu Health District. 4. To evaluate the obstetric skills of health workers attending births in Level 1 Hospitals in uThungulu Health District. 5. To evaluate the environment in which births are attended in Level 1 Hospitals in uThungulu Health District. 6. Compare the quality of care, the knowledge, skills and environment with perinatal outcomes. Methods Perinatal outcomes (PNMR, FSBR, ENNDR and PCI) were calculated for each hospital; maternity case records of women who have delivered in these Level 1 Hospitals were audited to assess the quality of intrapartum care; obstetric knowledge and skills of midwives were assessed; as was the enabling environment within which midwives worked, which included a measurement of their workload. A correlation between perinatal outcomes and the quality of intrapartum care, knowledge and skills and the enabling environment was performed to determine whether variables were associated. Results The overall PNMR for five hospitals in uThungulu Health District was 31 per 1000 births. Three hospitals demonstrated PNMRs below 30 per 1000, while the other two showed rates above 45 per 1000. The combined FSBR for the five hospitals was 6 per 1000 births, the combined ENNDR was 12 per 1000 live births. The PCI in all hospitals ranged between 3 and 4. An audit of maternity case records revealed that all hospitals have a high overall mean percentage score per record. However, analysis of subsets showed good performance in recordings on the labour graph, but poor performance in the admission assessment and in the management of labour. The Kruskal-Wallis Non-Parametric Test showed a statistically significant difference in overall scores amongst hospitals (p=0.01), suggesting differences in performance in all five hospitals in terms of the quality of care provided. Overall, all hospitals scored poorly on tests of obstetric knowledge and skills. There were no statistically significant differences in the overall knowledge median scores and subsets median scores amongst hospitals (p=0.07), indicating that all five hospitals performed on a similar level in terms of obstetric knowledge. However, all hospitals performed differently in relation to obstetric skills, as there was a statistically significant difference in the overall skill median scores amongst hospitals (p=0.002). Three hospitals met the enabling environment standard. All hospitals but one scored poorly on referral, and the availability of supervision on both shifts. One hospital scored poorly on drugs and supplies. Overall no hospitals reported the presence of all the elements of the enabling environment. Three hospitals had acceptable workloads. No association could be detected between variables. However, there were trends that can be traced in different hospitals. Conclusions In South Africa, from the Demographic and Health Survey, 84% of deliveries are assisted by skilled attendant. While an attendant may be present, one cannot say that skilled attendance has been provided, as it has been shown for uThungulu Health District. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2010.

Objective To conduct an evaluation of the pilot implementation of the World Health Organization Health Promoting Hospitals initiative and its self-assessment tool in public hospitals in KwaZulu-Natal in 2004/2005 Study design This evaluation utilised a cross-sectional design that incorporated both qualitative and quantitative research methods. Main measures Throughout the Health Promoting Hospital pilot project the opinions and responses of those with a legitimate interest in the initiative were monitored. Data collection methods utilised in this evaluation included participant observation, the World Health Organisation metaevaluation questionnaire, records of workshops and feedback meetings and secondary analysis of all data collected by the six pilot hospitals during the implementation of the project in KwaZulu-Natal. Results Major constraints were found to be time, human and financial resources, lack of training and expertise and insufficient support for the project. The self-assessment tool was found to be insufficiently adapted and not all outcomes were found to be reliable and useful. Despite this, institutional staff found the Health Promoting Hospital project to be capacity building and morale boosting. Relationships between health service levels improved. All hospitals who participated recommended that other hospitals become Health Promoting Hospitals. Conclusion If the World Health Organisation Health Promoting Hospital initiative with its selfassessment tool is to be rolled out to the rest of KwaZulu-Natal province, then substantial changes have to be made to the process. Amongst these are: further adaptation of the selfassessment tool, improved methods of data collection, provision of sufficient resources and increased and sustained provincial support for the project. In addition it is imperative that outcome and impact evaluations be done. / Thesis (M.Med.)-University of KwaZulu-Natal, 2008.