No abstract available. / Thesis (MMed)-University of Natal, Durban, 1993.

Introduction: Inadequate water supply and sanitation adversely affects the health and socio-economic development of communities. Since 2003, more than 40 000 households in peri-urban and rural areas within eThekwini Municipality, South Africa, have been provided with urine diversion toilets, safe water and hygiene education. eThekwini Municipality have requested that these interventions be evaluated to monitor their effect on health outcomes. Aim: The aim of the study is to describe the baseline situation in respect of sanitation, safe water and hygiene behaviour in Intervention Areas in eThekwini Municipality and compare these to Control Areas. Methods: An observational analytic cross sectional study design was undertaken. A multi-stage sampling procedure was followed and six study areas were randomly selected. Three Intervention Areas (urine diversion toilets) were matched with three Control Areas (no urine diversion toilets). A total of 1337 households, comprising of 7219 individuals, were included in the study. A Household Questionnaire a and an Observational Protocolb was administered by fieldworkers. Data was entered onto a custom designed EpiData database, processed and analysed using SPSS version 13. Results: The baseline characteristics revealed that Intervention and Control areas were very similar other than the provision of urine diversion toilets, safe water and hygiene education in the Intervention area. The Intervention area scored higher than the Control area (2.31 vs. 1.64) with regard to having a cleaner toilet, with no flies, no smells, having hand-washing facilities and soap provided close to the toilet. Some of the collected data from questionnaire responses were not consistent with the fieldworkers observations. It was reported that 642 households in the Control and 621 in the Intervention areas washed their hands with soap, whilst only 396 households in the Control and 309 in the Intervention areas were observed to have washed their hands with soap. Conclusion: Households in the Control area are at a greater risk of developing diarrhoeal and other related diseases. The provision of safe water, urine diversion toilets and hygiene education in the Intervention area has proved to be successful. Recommendations: eThekwini municipality must expand the package of services c to the Control areas. Sustainable hygiene education programmes must continue to be implemented and be evaluated over time. Plate 1: Inside view of the UD Toilet Plate 2: Ground tank providing 200 litres free water Plate 3: Hygiene education material Plate 4: External rear view of the UD toilet / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2007.

No abstract available. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2006.

Human Immunodeficiency Virus (HIV) infection and Auto-Immune Deficiency Syndrome (AIDS) have spread globally during the past twenty-eight years and 67% of people living with HIV live in sub-Saharan Africa. HIV and AIDS are now the leading cause of death in this region. Worldwide, it is the fourth biggest killer. Nurses in health institutions in South Africa face challenges as result of increased number of very sick and terminally ill patients who are admitted to the hospital due to HIV and AIDS epidemics. Workloads have increased with no concomitant increase in number of staff to care for the patients. Aim: This study aims to identify dynamics of care of professional patients with HIV and AIDS by nurses and make recommendations that will deal with these problems. Methods: A qualitative study was conducted with the study population drawn from professional nurses who were involved in the care of patients with HIV and AIDS in the medical wards at Ngwelezana Hospital for at least five years. One focus group discussion was also conducted. The sample was selected purposively. Results: The study revealed many issues affecting the care nurses gave to patients with HIV and AIDS and the personal challenges (physical and emotional) they faced in the course of their work. Amongst these are contextual challenges which pertained mainly to health system issues- lack of institutional support and incentives, heavy workload with concomitant increase in number of patients attended to by nurses, training needs of nurses and multidisciplinary team work. Nurses had to deal with personal challenges such as helplessness, frustration, anger, death anxiety, physical and emotional stress. However, there were positive experiences such as empathy and self-actualisation in being able to care for terminally ill patients and seeing some of them get better with treatment. Recommendations: These include the need to address the training needs of nurses about management of HIV and AIDS, institutional support for nurses, critical incident debriefing and community awareness. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2010.

BACKGROUND : Many professional nurses have left the employment to work in developed countries. Quality patient care is declining because the few PNs that are rendering care have limited expertise. Literature review showed that nurse managers have a role to play in retention of staff. PURPOSE : The study aims to analyze the leadership styles and organizational factors toward the retention of professional nurses working in public health facilities. POPULATION : Professional nurses in four public hospitals, four union managers, twelve professional nurses working abroad and representative from SANe. A total of 188 participated in the study which formed part of the 70% of the sample. DESIGN : A Case study design which included both quantitative and qualitative approaches. Observations in the wards and document analysis were done guided by a case protocol. INSTRUMENTS : Revised Nursing Work Index and Revised Conditions of work effectiveness was administered among the professional nurse and chief professional nurses. Chief nursing service managers and union managers were interviewed using interview guides. Focus groups among professional nurses who had overseas experiences were conducted. Reliability was maintained by having a Cronbachs alpha of above 0.70 in all variables except leadership. RESULTS : Cases presented differently in all aspects, except Case C who was consistent in all the variables. The professional nurses in Case C viewed their CNSM as being visible and accessible. Case A and B were similar in terms of the organizational factors. All CNSM verbalized that they were willing to send PNs for educational programmes but the DOH policy was allowing nurses to work anywhere in the province. PNs had little access to resources on time to do tasks and paperwork as compared to access to support and opportunity.CONCLUSION : PNs are willing to stay in their organizations provided they will be given educational and promotional opportunities. There was a relationship between organizational factors and retention. Leadership factors showed a weak negative relationship with other variables. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.

Radiology is rapidly changing in the 21st century and globally there is a transition of radiology departments to digital imaging technology. The major challenge confronting radiology practices is to obtain cost savings and productivity gains once PACS is established. The purpose of the study is to undertake an incremental cost analysis of PACS compared to a conventional radiology department. Cost savings of the system was also determined in terms of productivity gains. An incremental cost analysis for Chest X-rays, CT Brain scans with and without contrast, MRI Brain scans with and without contrast was performed. The overall incremental cost between a PACS site and a conventional radiography site was determined in the study. The net present value technique was also determined to evaluate the capital budgeting requirements for both systems. The incremental costs for capital, RIS and image production for the PACS as well as the conventional system were performed. The incremental costs for both capital and RIS show an increase. In contrast, the incremental PACS image cost shows a reduction. This study provides a number of South African Radiology Departments which plan to introduce PACS in the near future with a bench mark for the financial implications incurred during the implementation phase. It assists other facilities in deciding on implementing PACS and contributes to the development of methodologies within the South African context. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, 2012

Background: The HIV epidemic has greatly affected sub-Saharan Africa, with the highest prevalence in the world found in Swaziland. One in three pregnant women in Swaziland has HIV. One of the PMTCT strategies is primary prevention of HIV among women who are uninfected. Understanding the reasons why pregnant women continue to seroconvert is the key in meeting this strategy. Purpose: The purpose of this study is to determine the factors associated with seroconversion among pregnant women utilizing Raleigh Fitkin Memorial Hospital in 2012. Objectives: The objectives of this study are to: determine the proportion of HIV non-infected pregnant women who are retested for HIV during pregnancy; determine the gestational age at which pregnant women are retested for HIV; establish the proportion of women who were initially HIV non-infected and seroconverted during pregnancy; and establish the factors associated with seroconversion during pregnancy. Methods: An observational cross-sectional study design with both descriptive and analytic components was carried out at Raleigh Fitkin Memorial Hospital. Systematic sampling was used for the recruitment of 381 pregnant women who were initially HIV non-infected. An interviewer-administered questionnaire and chart review were used to collect demographic and clinical data. The data was analyzed using descriptive and analytic statistics. Results: The results of the study show that demographic factors such as age and educational level are associated with HIV seroconversion during pregnancy. The findings also highlight how partner factors play a role in HIV seroconversion. The results indicate that sexual behaviours 333of the pregnant women contribute greatly to HIV seroconversion. Conclusion: Pregnant women continue to engage in risky sexual behaviours during pregnancy and there is need to strengthen counseling on preventive measures throughout the antenatal care period. There is also need for programs to explore possibility of providing antiretroviral drugs for pre-exposure prophylaxis to all HIV negative women during pregnancy. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2013.

Primary health care (PHC) is the first component of the health system that provides patients with first-level care. PHC must be supported by a strong referral system whereby PHC nurses can refer patients with conditions beyond their capabilities to medical officers for further management using referral letters. The medical officers also using referral letters refer stable patients back to the PHC clinics for follow up and management. The aim of study was to determine factors related to patients bypassing primary health care facilities and accessing the district hospital as point of first contact in the Umuziwabantu health sub-district of KwaZulu-Natal. This research investigates the referral patterns of patients as well as the factors affecting the referral patterns of patients between PHC facilities and the district hospital. The study was conducted at the Gateway Clinic of St Andrew’s Hospital and its outpatient department. The following groups were excluded from the study: any patients who arrived at the clinic with a referral letter from another facility, any children who were brought there by another child, and any who were unwilling to take part in the study. The researcher made use of open-ended and structured questions to interview 720 patients over a period of six months. The overall findings show that a large part of the Umuziwabantu sub-district is still served by mobile clinics. Since mobile clinics do not visit each point daily, patients from mobile points often go to the hospital for any health-related problems. There is the widespread perception that a hospital provides better service than a PHC clinic. The Local Government (LG) clinic only sees a limited number of patients. The main reasons given by patients for bypassing their local PHC clinics are: 1. Mobile clinic unavailability on that day; 2. The hospital is closer. 3. Patients are used to coming to the hospital. 4. Patients are doing things in town and then decide to combine this visit with hospital visit. Three-hundred-and-sixty-one patients had only minor ailments and a further 95 required chronic treatment which could have been dispensed at PHC clinics. Only 264 of patients surveyed should have been seen at the Hospital. Conclusions from the study were that patients would use their local PHC clinics if there were enough fixed clinics and the LG clinic had more staff to attend to more patients than the number they are currently attending. The clinic-upgrading programme needs to be improved and fast-tracked. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2011.

Introduction Health-care service in South Africa, especially in the public sector, is fraught with numerous problems, including ineffective operations management in health care facilities. This contributes to poor service delivery and a lackluster work environment. Non-value-adding activities result in, inter alia, long cycle and waiting times, and low staff morale. With Lean thinking, health care managers could tackle specific issues to improve operational efficiency. Aim The purpose of the study was to apply Lean thinking, and to determine its effect on efficiency and staff morale within the outpatient department at Catherine Booth Hospital, in order to inform recommendations to improve operational efficiency in rural district hospital outpatient departments. Methods An operational action-research study design was used. The study sample consisted of all service nodes and employees of the outpatient department in Catherine Booth Hospital. Cycle and waiting times were iteratively measured for all service nodes. Statistical analyses on pre- and post-intervention results were carried out. Results Cycle and waiting time targets were met and exceeded in three service nodes, but only the Investigations node showed statistically significant results (cycle time reduced from 16.7 to 12.2 minutes; p=0.04; and waiting time reduced from 11.93 to 10 minutes; p=0.03). The waiting time for Consulting Rooms improved significantly (80.95 to 74.43 minutes; p<0.0001). Significant decreasing trends in waiting times over the study period were found in Patient Administration (p=0.04), Patient Screening (p<0.0001) and Consulting Rooms (p<0.0001). The trend in average operational efficiency improved over time from 16.35% to 20.13%. The implementation of Lean had a positive impact on the proportion of OPD staff satisfied with their jobs (increased from 21.1% to 77.8%; p<0.0001) and proportion of staff that felt motivated (increased from 15.8% to 77.8%; p<0.0001). Discussion Rural public sector hospitals require a novel and evidence-based approach to improving operational efficiency and staff morale in OPDs and other departments. Lean implementation had a positive impact on cycle and waiting times in all service nodes. Attitude towards teamwork and communication strength are positively impacted by the process of Lean implementation. However, factors such as differing priorities and logic among staff in the OPD and management negatively affect the outcomes of Lean implementation. Conclusion and recommendations The application of Lean principles, tools and techniques is possible in a rural district hospital OPD, without any demands on staff in terms of learning and adopting a new quality-improvement management approach by which to improve operational efficiency. The lessons learnt from the implementation of Lean thinking at a rural hospital used in this study may be emulated for quality improvement across similar hospitals and its sustainability can be assessed further. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2013.

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