Introduction A well-functioning primary health care system depends on all three levels of healthcare, that is, the primary, secondary and tertiary levels of care. District hospitals have a major role to play in the development of a strong referral system. This study was undertaken to evaluate whether the primary health care clinics in Area 3 possess all the key essential components for a strong referral system. Area 3 comprises 3 districts in northern KwaZulu-Natal, i.e. the Umkhanyakude, Uthungulu and Zululand districts. Aim The aim of the study was to evaluate referral support systems between fixed clinics and district hospitals in the three districts of Area 3 in KwaZulu-Natal province. Methods A descriptive study was undertaken in 58 randomly selected clinics in Area 3. Data was collected between July and August 2007, on availability of: communication technology, transport for patients being referred to the district hospital, and guidelines. Referral letters were reviewed to determine if they contained adequate information. Professional nurses were interviewed to determine the training they had attended. Results A third (34%) of clinic nurses on duty had been trained in Primary Health Care; 57% of clinics had at least one professional nurse on duty with a PHC diploma. The proportion of nurses trained in short courses ranged between 4% and 47%. Fifty-six out of fifty-eight (97%) of clinics had telephones; 57% reported problems with telephones. Eighty-eight out of one hundred and seven (88%) of selected referral letters did not have adequate information. Only 32% of urgently referred patients were collected by an ambulance within 1 hour. All 58 clinics had the Essential Drug List (EDL) available; availability of the other guidelines ranged between 29% and 79%. Discussion The percentage of clinic nurses with a PHC diploma or trained on short courses indicates that most clinic nurses render health services without or with inadequate knowledge and skills. Poor quality of referral letters and inefficient transportation of referred patients, especially emergencies, confirm a weak referral support system. User perceptions of the referral system have not been explored. Recommendations Training and support of clinic nurses needs to be prioritised to improve patient assessment and management, as well as the quality of referral letters. District management should advocate for improvement of patient transportation. Future studies should explore the use of referral letters by and training of, clinic nurses; as well as determine user perceptions. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2010.

Introduction Lake Mzingazi is the only suitable source of domestic water supply for the Richards Bay community. Rapid industrialisation in the city of uMhlathuze, accompanied by an influx of people, has resulted in informal settlement occurring around the lake. The uncontrolled activities of this development threaten to pollute the water source. Previous studies in1979 conducted by Council of Scientific & Industrial Research indicated that Lake Mzingazi water was still within acceptable limits in terms of the Department of Water Affairs & Forestry guidelines. The lake water quality was that of a Class I water resource, which is excellent for domestic use. Pollution of the lake can result from diffuse sources of pollution due to settlement of communities around it. Water purification costs could escalate thus forcing an increase in water tariffs. If pollution resulted in the lake being unable to be utilized, the Richards Bay community will be seriously affected, as it would necessitate the importing of water from distant regions. Either way, the expense of acquiring water would increase. All living organisms rely on adequate water for their survival. Worse still are human beings for their water should not only be adequate but should be of good quality to prevent health risks and even death. It is in view of these possibilities that the study was undertaken. Aim The aim of the study is to assess the extent of physical, chemical and biological pollution in Lake Mzingazi due to non-point sources and to recommend necessary protection measures that need to be implemented to prevent any negative health impact on surrounding communities. At present there are no restrictions and no protection of the lake from pollution except that no recreation is allowed into the lake at present. Methods Several objectives were set in order to focus on specific issues. One of the objectives was to inform the communities around the lake about the study. Sampling of the lake water was conducted monthly from June to November 2006 (using a boat). Pictures of areas around the lake were also taken for further analysis. At each sampling run, 36 samples were taken and delivered to a laboratory accredited by the South African National Accreditation Standards for analyses. Six sampling runs were completed. Secondary data for the period of 1998 to 2005 were obtained from uMhlathuze Municipality in order to establish pollution trends and for comparison purposes with the Department of Water Affairs and Forestry guidelines. Results The findings of the study revealed that the quality of the lake water is still within acceptable limits when compared with the Department of Water Affairs & Forestry guidelines; however, informal settlement threatens the future of the lake by encroaching into the lake banks. Discussion There is definitely a risk of pollution to Lake Mzingazi as long as there are no pollution prevention plans in place. Recommendations All data should be stored in a centralized information system to avoid losing valuable information. The Water Services Authority must develop and maintain a water quality-monitoring programme that will capture all changes occurring in the lake. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2009.

Introduction A plethora of health indicators have been added into the District Health Information System (DHIS) since its adoption and implementation as the routine health information for South Africa in 1999. The growing demand for the production and dissemination of routine health information has not been equally matched by improvements in the quality of data. In the health sector the value of monitoring and evaluation is not simply the product of conducting monitoring and evaluation but, rather from discussing and using performance indicators to improve health service delivery. Aim The aim of this study was to classify health care indicators in the national health data sets used for planning, monitoring and evaluation and to review the data management practices of personnel at provincial and district level. Methods An observational, cross sectional study with a descriptive component was conducted, in 2009, using a finite sample population from district and provincial level across eight provinces. The study participants completed a self-administered questionnaire which was e-mailed to them. Results A total of 32 (52%) participants responded to the questionnaire and of this total 21 (65.5%) responses were from district level and 11 (34.4%) from provincial level. The National Indicator Data Set, the key source for primary health care and hospital data, was implemented in 1999 with approximately 60 indicators. In less than 10 years it has grown in size and presently contains 219 performance indicators that are used for monitoring and evaluating service delivery in the public health sector. Whilst both district and provincial level personnel have a high awareness (83%) of the DHIS data sets there is variability in the implementation of these data sets across provinces. The number of indicators collected in the DHIS data sets for management decisions are “enough”, however a need was expressed for the collection of community health services data and district level mortality data. Similarities were noted with other studies that were conducted nationally with respect to data sharing, utilisation and feedback practices. Data utilisation for decision making was perceived by district level personnel to be adequate, whereas provincial level personnel indicated there is inadequate use of data for decision making. Whilst 87.1% of personnel indicated that they produce data analysis reports, 71.9% indicated that they never get feedback on the reports submitted. The top 4 data management constraints include: lack of human resources, lack of trained and competent staff, lack of understanding of data and information collected and the lack of financial and material resources. There was agreement by district and provincial level personnel for the need for additional capacity for data collection at health facility level. Discussion The increasing need for accurate, reliable and relevant health information for planning, monitoring and evaluation has highlighted critical areas where systems need to be developed in order to meet the information and reporting requirements of stakeholders at all levels in the health system Recommendations An overarching national policy for routine health information systems management needs to be developed which considers the following: emerging national and international reporting requirements, human resources requirements for health information and integration of systems for data collection. In the short-term a review of the National Indicator Data Set needs to be conducted. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2010.

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.