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An overview of occupational health in the Durban Metropolitan area.Jinabhai, Champaklal Chhaganlal. January 1981 (has links)
No abstract available. / Thesis (M.Med.)-University of Natal, Durban, 1981.
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Developing a provincial epidemiologic and demographic information system for health policy and planning in Kwazulu-Natal.Buso, D. L. January 2001 (has links)
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.
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Impact of delayed introduction of sulphadoxine-pyrimethamine and artemether-lumefantrine on malaria epidemiology in KwaZulu-Natal, South Africa.Junior, Anyachebelu Emmanuel. January 2007 (has links)
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.
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Perceptions of and attitudes to the compulsory community service programme for therapists in KwaZulu-Natal, 2005.Khan, Nasim Banu. January 2009 (has links)
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.
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Primary school teachers' knowledge of asthma in Umdoni subdistrict, KwaZulu-Natal.Govender, Desiree. 23 September 2013 (has links)
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.
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Perceived parental practices related to alcohol use by 16 to 18 year old adolescents in the public high schools in the Emawaleni District of KwaZulu-Natal.Ghuman, Shanaz. January 2009 (has links)
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.
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The epidemiology of motor vehicle collisions involving pedestrians in eThekwini Municipality, 2001-2006.Hobday, Michelle Bridget. January 2009 (has links)
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.
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Health science faculty employees' perceptions of organisational culture in the merger of the University of Durban-Westville and the University of Natal.Pillay, Shamla Devi. January 2010 (has links)
No abstract available. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2010.
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Measuring skilled attendance in the uThungulu District, KwaZulu-Natal in 2008.Mianda, Solange. January 2010 (has links)
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.
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Adapting the WHO Health Promoting Hospitals strategy for South African hospitals : an evaluation.Geddes, Rosemary Veronica. January 2008 (has links)
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.
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