More than three decades after the outbreak of the AIDS pandemic, sub-Saharan Africa is home to the largest epidemic in the world. Over 70% of infected people live in this region and are aged 15–49 years. Given that it is at this age that young adults are more likely to start families, their death as a result of AIDS gives rise to the crisis of AIDS-orphaned children. Several studies show that the number of AIDS orphans is on the rise and can reach up to 18 million throughout the continent. Generally, patients expect to be admitted in formal health care facilities for adequate treatment but the absence of cure and an increasing number of infected make it difficult for them to be treated as in-patients. In order to fill the gap, the elderly care for AIDS patients and take on the parenting role of AIDS orphans. However, there is not much information on the implications of caregiving on the well-being of the elderly. This dissertation aims at shedding light on this issue – using data from an informal settlement in the province of KwaZulu-Natal – in order to highlight the risks to the health of elderly caregivers. The elderly are the primary caregivers to thousands of AIDS patients and AIDS-orphaned children across sub-Saharan Africa. Their caregiving activities are strenuous and repetitive on a daily basis. Through qualitative data collected from 14 elderly caregivers, this project found that their well-being was compromised by several caregiving activities and the expectations placed upon them were unbearable. The vulnerability of caregivers was emphasized by the high number of dependents that resulted in lowered standard of living. There was also the risk of contracting HIV during caregiving since the elderly were not able to afford protective equipment. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

<p>This study aimed to contribute to the current debate around equity in health care resource allocation by measuring the current allocation of resources, relative to need in the Northern Cape. It also discussed the level of inequities in health financing/expenditure and staffing at the primary health care level between different districts of the Northern Cape.</p>

The aim of the study was to gain an understanding on the experiences of enrolled nurses with regard to caring for people living with HIV and AIDS in one of the rural hospital in Vhembe district, in order to make recommendations for guiding and supporting those enrolled nurses. This study followed qualitative approach using interpretative phenomenological analysis design. Data were collected from 11 purposively selected participants using semi structured interviews. Data were analysed using interpretative phenomenological analysis framework for data analysis. Three super-ordinate themes emerged from data analysis namely: resources, support and impact of working with HIV positive patients. The study revealed that enrolled nurses are failing to provide proper care to people living with HIV and AIDS due to inadequate resources and lack of support. This situation has negative impact on the health of enrolled nurses providing care to people living with HIV and AIDS. Recommendations are put forth to improve resources, enhance support and for mitigating impacts experienced by enrolled nurses when caring for people living with HIV and AIDS at a rural hospital in Vhembe district of Limpopo province. / Health Studies / M.P.H.

The presence of poverty, unemployment and children been infected or affected by HIV/Aids contributed to a high level of children in need of care and protection (Patel, 2005:165) and forced communities to came up with a ways of addressing this increasing need of alternative care. Cluster foster care schemes were one of the initiatives that were started spontaneously by community members to address need for more alternative care options (Colby-Newton, 2006:18). This form of alternative care was also included with the proclamation of the Children’s Act, 38 of 2005 and the Children’s Amendment Act, Act 41 of 2007 (Matthias, 2010:172-176). Although cluster foster care schemes are acknowledge and practice as a form of alternative care for children in need of care and protection the operationalising thereof remain a grey area. In an unpublished study by Taback and Associates, it was suggested that further research should be conducted regarding elements that need to be included in the operationalising of cluster foster care schemes (Taback and Associates, 2010:4). The above form the motivation for this study and also provide the basis for the formulation of the research question namely: “What are the operational elements necessary for the operationalising of cluster foster care schemes?” Following from the research problem and research question, the goal for this research was to explore and describe the present functioning of cluster foster care schemes in order to identify operational elements to be documented in a guideline for service providers and social workers. The researcher made use of qualitative research approach to explore and describe the participants’ perception on the research problem. This research endeavour firstly falls in the ambit of the phenomenology research design, which aimed to describe the conscious experience of the everyday life of the participants, which were in this study the managers of cluster foster care schemes as well as foster parents that provide foster care as part of a cluster foster care scheme. In addition to this the researcher also opted to include the exploratory, descriptive and contextual research design, which guided the exploration, description and contextualising of the views of the participants on elements needed to operationalise cluster foster care schemes. In order to achieve the above the researcher the researcher decided to make use of an intervention research model by Rothman and Thomas (1994:3-51), namely the “Intervention Develop and Design” framework (IDD framework). In this study the researcher only used phases one to phase four and certain steps of the IDD framework to develop the operational guidelines for the operationalising of cluster foster care schemes. In concluding the report of the study, the researcher provided summaries of and conclusions related to the background rational; research questions; goals and task objective of the study; the research methodology implemented; the empirical findings and literature consulted; and the developed operational guidelines. He concluded the document with recommendation related to the research process and methodology employed; research findings; and recommendation for further research on the research topic. / Social Work / D. Soc.Sc. (Social Work)

The unique physical features of the child with Down syndrome (DS) may lead to stigmatization and social isolation of the child, as well as their entire families. A child with DS may require some help and constant attention from the primary caregiver and may even be permanently dependent, depending on the severity of DS. The researcher has explored and described the experiences of primary caregivers of children with DS in the Kwazakhele community while caring for these children. The research study employed a qualitative, exploratory, descriptive and contextual research design. The research population included primary caregivers of children with DS who were between ages of two years and older because a DS diagnosis can be delayed and only be discovered later in life. Purposive sampling was used to select the research participants. The data was collected using in-depth one-on-one interviews, and all interviews were recorded using a voice recorder. Thematic analysis as a version of content analysis was used, meaning the researcher used themes and sub-themes to analyze data with the help of an independent coder. A pilot study was conducted before undertaking the actual research using the same methods and designs as those of the main study. Strategies were implemented throughout the study to ensure trustworthiness and adherence to ethical principles. The study findings revealed that the participants experienced diverse emotions upon initially finding out that their child has DS. The participants indicated that they had to modify their lives including having to give up their personal lives just to ensure that their children got the best care and their full attention. It appeared that some participants got full support from their partners and families, while other participants had no support system. With further exploration, it emerged that the study participants shared some positive experiences with their children with DS. However, they indicated a need for relevant education facilities for their children as well as community support. Recommendations were made with regard to nursing education, nursing practice and nursing research.

This study explored and described the strategies used by nurses to manage newly diagnosed HIV positive pregnant women who do not return to the clinic within a month following diagnosis, for continuity of care. The main aim was to prevent mother-to-child transmission of HIV (PMTCT). Method: The study sites were two accredited antiretroviral- ante-natal care (ARV-ANC) clinics at the Dimbaza community health centre (CHC) and the East London Hospital Complex (ELHC) which comprises of Cecilia Makiwane and Frere hospitals, in the Buffalo City Metropolitan Municipality (BCM). The majority of health personnel at these clinics are professional nurses. An in-depth semi structured interview guide was used to collect data through focus group interviews from professional nurses who work in these units. They were required to share their experiences about intervention strategies used for newly diagnosed HIV- positive, pregnant women who fail to return for continuity of care within a month after diagnosis. Results: Follow up of these women is done by tracking them (by calling them; calling the clinic nearest to their homes and doing home visits). Decentralisation of further management and care to the nearest clinic was also cited, especially for the patients who stay far from these accredited sites. Family support was also mentioned as a strategy to intervene for the non-compliant patients. Challenges: The challenges that were encountered with these interventions include wrong contact details, wrong addresses and being evasive when visited at home. Another challenge cited was related to the stigma attached to the diagnosis and the tracking devices used, for example, the car as it is familiar to the community it serves. Despite known benefits for early initiation of HIV treatment newly diagnosed HIV- positive, pregnant women continue to refrain from accessing care after diagnosis, thus posing a risk to the transmission of HIV to the baby and further comprising their own health. They miss out on general HIV management and ante-natal care. Conclusion: The identified intervention strategies used by nurses to follow up newly diagnosed HIV- positive, pregnant women need to be reinforced and strategies put in place to control the related challenges for a better response by the patients.

MPM / Oliver Tambo Institute of Governance and Policy Studies

MPM / Oliver Tambo Institute of Governance and Policy Studies

In English / This study investigates the resilience of caregivers at a Gauteng-based hospice with patients living with HIV/AIDS. The primary focus of this study was to describe the impact on caregivers working with terminally ill patients predominantly with HIV/AIDS. Six participants were selected for this study utilising purposive sampling. Their ages ranged between 30 and 70 years. For the purpose of data collection, face-to-face semi-structured interviews were undertaken. In analysing data, the themes and sub-themes were extracted and presented by employing thematic analysis. The findings of this study revealed that in times of adversity and setbacks most caregivers utilise various skills to bounce back, and they still showed contentment in serving community members. However, caregivers have also voiced the concern that the support offered at work was not sufficient in meeting their needs. Recommendations for further research, on the resilience of caregivers when working with terminally ill patients is highlighted. / Psychology / M.A. (Clinical Psychology)

Submitted in fulfilment of the requirements for D.Tech: Nursing in the Faculty of Health Sciences, Durban University of Technology, 2009. / BACKGROUND In South Africa, Integration of Services Policy was enacted in 1996 with the aim of increasing health service utilization by increasing the accessibility of all services at Primary Health Care (PHC) level. However, the problem with the policy arises in the implementation of integrated PHC (IPHC) as there is no agreed upon understanding of what this phenomenon means in the South African context. Hence, there is a need for shared views on this phenomenon. METHODS A cross-sectional study, using a qualitative approach was employed in this study in order to analyze IPHC in KwaZulu-Natal (KZN). A grounded theory approach was selected as it is a method known for its ability to make the greatest contribution in areas where little research has been done and when new viewpoints are needed to describe the familiar phenomenon that is not clearly understood. Policy makers and co-ordinators of PHC at national, provincial and district levels as well as PHC nurses at functional level participated in the study. The data was collected by means of observations and interviews. The sample size for interviews was comprised of 38 participants. RESULTS It emerged that there were three core categories that were used by the participants as discriminatory dimensions of IPHC in South Africa. These core categories were (a) comprehensive health care, (b) supermarket approach and (c) one stop shop. Based on the findings of the study, it was concluded that the phenomenon, IPHC meant different things in different contexts. / Durban University of Technology, Research Post Grad Development and Support Departments