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Magister Scientiae (Physiotherapy) - MSc(Physio) / Reduced adherence levels have been demonstrated by some patients affected with Osteoarthritis. Therefore, this study aimed at exploring the barriers and facilitators regarding patient adherence towards physiotherapy rehabilitation programs in the management of osteoarthritis in Nairobi, Kenya. The objectives of the study were to determine the clinical profile of patients with osteoarthritis on physiotherapy rehabilitation programs, to explore the patient-reported barriers and facilitators towards physiotherapy rehabilitation programs and exploring physiotherapists’ perceptions of patient adherence towards physiotherapy rehabilitation programs. The study setting was at the Kenyatta National Hospital physiotherapy clinic in Nairobi, Kenya.

MPH / Department of Public Health / Post-apartheid South Africa’s healthcare system improved with many community members being able to easily access basic health care services. However, patient waiting time has remained a critical issue. Patients are well-known for arriving at healthcare facilities very early for the reason of avoiding lengthy queues. This, however, does not solve their problem. The purpose of the study was to explore factors influencing patient waiting time in Nthabiseng clinic in the Capricorn district of the Limpopo Province. The study was conducted at Nthabiseng clinic in the Capricorn District. A qualitative approach was adopted, and a sample was chosen from a targeted population through purposive sampling. Data were collected through a one-to-one semi-structured interview and analysed through the Thematic Data Analysis approach. The study found out that the Department of Health does not have a patient waiting time specific policy or legislative framework and/or a guiding document. It also showed that healthcare professionals define and calculate patient waiting time differently. Moreover, what is an acceptable waiting time to one is an unacceptable waiting time to another. The study recommended that a policy and Standard Operation Procedure be drafted to guide healthcare professionals on how to improve waiting time in their specific facilities.

One of the impacts of the rising demand for community health services, primarily used by seniors, is that hospitals are often faced with the challenge of having patients finish the acute phase of their treatment and yet are unable to discharge them due to the lack of a bed in a more appropriate community care setting. The frequency of this challenge has led to the designation of “alternative level of care” (ALC) being ascribed to patients who remain in the hospitals due to insufficient capacity downstream. The thesis focuses on a model that seeks to address patient flow through the community care network (CCN) and finding capacity allocation policies for the different facilities that resolves the ALC challenge using scenario analysis. A queuing network model with general routings and nodes’ blocking has been developed and a heuristic approximation method has been employed for solving the model. Blocking probabilities and the number of blocked patients are derived as performance metrics of the CCN. We test the accuracy of the queuing model through a simulation model and the behaviours of the system in different scenarios are investigated in the simulation model and our policy insights and conclusions are provided.

The cornerstone in the fight against HIV/AIDS is prevention followed by the access to and use of highly active antiretroviral treatment (HAART). Adherence is the greatest patient- enabled predictor of treatment outcome for the patients on HAART, as good adherence leads to a decrease in disease progression and death. There is no ‘gold standard’ in the measurement of adherence. Also, factors that influence adherence and hence the prevalence of adherence differ across different settings making it necessary to determine local adherence prevalence as well as factors that might impact on it. This was a cross sectional study which assessed the prevalence of one- week adherence to antiretroviral therapy at St Rita’s hospital through an abridged version of the questionnaire developed by the Adult Aids Clinical Trials Group in the United States. Results from the questionnaires were compared to the results from a decrease in plasma viral load to undetectable limits within six months. The study found out that the prevalence of one- week adherence by self-report was 96.8% (95% CI: 93.2 – 98.9%). Using a decrease in viral load to undetectable limits within six months of initiating treatment as a tool to assess adherence, the prevalence in this study was 96%. A combined prevalence of 94% was found for this study. These results were identical to a few results locally but it was much higher than most local studies. The explanation for this apparent higher adherence rate might be that the study site has not reached its maximum capacity for the delivery of service as it is still operating at just below the staff/patient ratio recommended by the Department of health. The study also found out that being a member of an AIDS support group was a facilitator to adherence while lack of adherence counselling and monitoring is a barrier. Based on these findings it is therefore recommended that measures should be put in place to ensure improving existing adherence counselling and monitoring, encouraging patients to belong to at least one AIDS support group, more decentralization of antiretroviral therapy roll out to the districts that are yet to roll out and providing financial assistance through improved access to disability grants for those who qualify and income generating activities for the unemployed that do not qualify for disability grant.

A research report submitted to the faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine. Johannesburg, 2017. / In South Africa, very little is known regarding the spectrum of clinical illnesses for which older patients are admitted to hospital. Within this group who are admitted, even less is known of the burden of HIV disease. This study investigated the clinical indications for acute medical admission in adults over the age of 50 years at Chris Hani Baragwanath Academic Hospital. The study also determined the prevalence of HIV infection of those with HIV, their access and adherence to treatment. Methods: This was a prospective, observational study of patients over 50 years of age who were acutely admitted to the medical wards of Chris Hani Baragwanath Academic Hospital (CHBAH) between August 2014 to March 2015. Results: A total of 200 participants 50 years and older were enrolled, 34% HIV-positive, 37% HIV-negative and 29% whose HIV status was unknown. The HIV-positive group was younger (p <0.0001), had poorer access to pension funds (p<0.0001) and higher burdens of acute infectious illness when compared to their HIV-negative counterparts (p<0.0068). HIV-negative patients had higher rates of acute cardiovascular and haematological conditions (p<0.0001) and higher rates of chronic non-communicable disease (p<0.0004), predominantly diabetes mellitus (p<0.0095) and hypertension (p<0.0024). Conclusion: In older patients hospitalised for acute illness, both infectious and non-communicable disease play a significant role however, in those with HIV, the infectious burden of disease is more prominent while non-communicable chronic disease predominated in those without HIV. / LG2018

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Excerpt: The conclusions in the study by Sanford et al. (2011) were not supported by their findings. The main conclusion states that preparing students to be comfortable with cancer patients of all severities will provide students with the necessary skills to gain confidence in their cancer patient care. However, the above study did not test or explore this issue. That is, students were not given any particular preparation so that their level of confidence could be explored. Students were simply told to share their good and bad experiences during their routine clinical education. The above conclusion reaches beyond the study findings into an area of conjecture, but the conjecture is presented as a well-supported finding from the study.

Background: Emergence of SARS-CoV-2 pandemic has shifted the focus on infectious diseases and their healthcare and economic burden. However, chronic diseases have been a major focus for over two decades. Four risk behaviors or factors have played a critical role in increasing rates of chronic diseases, and one of such risk factors is physical inactivity that leads to obesity. Obesity has always been associated with chronic conditions, however their association among hospitalized patients is limited. Methods: This study utilized the National Inpatient Sample Data 2019 (NIS 2019) after recoding necessary variables. The study outcome was obesity, defined using ICD-10 diagnosis with a documented BMI ≥ 30kg/m2. The study covariates include patient demographics (age at admission, sex, race) patient behavioral characteristics (drug abuse, smoking, and alcohol ), aspirin use, and comorbid conditions (depression, dementia, chronic lung disease, hypertension, and diabetes with or without complications). Logistic regression analyses were conducted to identify the patient demographics, behavioral characteristics, and comorbid conditions associated with obesity among hospitalized patients in the US. Odds ratios and 95% confidence intervals were reported,with P-value <0.05. Results: The study sample included 6,043,654 hospitalized patients. Among all inpatients, 17.7% of patients reported being obese. The average age at admission was 58.4 (Std 20.16) years, 57.1% were females. Inpatients with diabetes (27.6%) were 135% more likely of having obesity compared with those without diabetes (aOR 2.35, CI 2.35-2.36, p<0.0001). Furthermore, 53.7% of inpatients had hypertension and were 97% more likely to be obese than those without hypertension (1.97, 1.97-1.98, p<0.0001). Similarly, 12.8% of those with depression are 33.1% more likely to be obese than those without depression. Also, 14.5% of inpatients who used aspirin were 10.9% more likely to be obese than those who did not use aspirin. About 21.1% of hospitalized patients had chronic lung disease, and were 8% more likely to be obese than those without chronic lung disease (1.08, 1.07-1.09, p<0.0001). On the other hand, 16.8% of inpatients were smokers and were 7.3% less likely to have obesity than non-smokers (0.73, 0.726-0.730, p<0.0001). Also, 5.43% of inpatients were noted to have abused alcohol and are 6.70% less likely to be obese (0.67, 0.67-0.67, p<0.0001). Furthermore, 6.38% of inpatients had dementia, and are 4.01% less likely to be obese than those without dementia. Conclusion: Obesity remains an important global public health concern. The study found that hospitalized patients with underlying hypertension, chronic lung disease or diabetes, and use of aspirin were strongly associated with obesity. Thus, it is imperative to expand and evaluate the role of current interventions or policies around overweight/obesity to hospitalized patients thereby reducing the existing burdened healthcare system.