Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Nurses, midwives and clinical officers referred to as Mid-level Practioners (MLPs) play
an important role in the health care system especially in rural Africa. With particular
reference to rural Uganda, due to the large shortage of doctors, MLPs handle most of
the duties usually meant for doctors, at health centre IV(s). From 2009 to 2011, two
training interventions of MLPs were performed at 36 sites in Uganda by the Integrated
Infectious Disease Capacity Building Evaluation (IDCAP). The two interventions were:
Integrated Management of Infectious Diseases (IMID) and On-site Support Services (OSS)
which aimed at improving MLPs’ case management for four diseases: HIV, TB, pneumonia
and malaria. In this thesis, we have developed three mathematical models to investigate
the effect of the two training interventions on these infectious diseases. All the models
are formulated using systems of ordinary differential equations which are structured in
three age groups: [0, 5), [5, 14) and [14, 50). We explored the effect of the two training
interventions in the context of malaria-pneumonia, HIV-TB co-infections and the four
diseases together. Our analysis shows that: i) For malaria-pneumonia, both IMID and
the combination of IMID and OSS reduce the number of cases, deaths and prevalence of
disease but have no effect on the incident episodes of disease. ii) Results from the HIVTB
model propose that HIV and TB testing are important steps in quality of health care
and are capable of offsetting slightly negative effects of reduction in ART enrollment and
provision of treatment. iii) The HIV-TB-malaria-pneumonia (HTMP) model concurs with
the results of the first two models and its results demonstrate that high coverage levels
of the training interventions increase the positive effects that the interventions have on
mortality and morbidity. Overall, our results suggest that training of MLPs is much more
effective for the short term duration diseases such as malaria and pneumonia, where the
baseline values for most of the performance indicators are ≥ 0.6, but not so much for
long term duration diseases such as HIV and TB, whose baseline values for most of the
performance indicators are < 0.6. The results further highlight that problems such as case
detection and drug stock-outs need to be addressed in order for training to have substantial
impact, especially in instances where the performance indicator proportions are low. / AFRIKAANSE OPSOMMING: Verpleegsters, vroedvroue en kliniese beamptes wat gesamentlik na verwys word as midvlak
praktisyns (MVPs) , speel n belangrike rol in die gesondheidsorg sisteem, veral in
landelike dele van Afrika. Met spesifieke verwysing na gesondheid sentrums in Uganda,
waar daar te min dokters is, hanteer MVPs die meeste van die pligte wat eintlik deur
dokters verrig moet word. Vanaf 2009 tot 2011 is twee opleidingsprogramme vir MVPs by
36 fasiliteite in Uganda deur die Integrated Infectious Disease Capacity Building Evaluation
(IDCAP) organisasie aangebied. Die twee programme staan bekend as: Integrated
Management of Infectious Diseases (IMID) and On-site Support Services (OSS). Beide die
programme stel ten doel om die MVPs se pasint bestuur vir die siektes MIV, tuberkulose
(TB), longontsteking en malaria te verbeter. Drie wiskundige modelle word in hierdie tesis
ontwikkel om die effek van die opleidingsprogramme op hierdie oordraagbare siektes te
ondersoek. Al die modelle word geformuleer deur gebruik te maak van stelsels van gewone
differensiaal vergelykings wat gestruktureer is in drie ouderdomsgroepe: [0, 5), [5, 14) en
[14, 50). Die effek van die opleidings programme word in die konteks van longontstekingmalaria
mede-infeksie, MIV- TB mede-infeksie en al vier siektes gelyk, ondersoek. Die
analise wys dat: i) Vir longontsteking-malaria mede-infeksie het beide IMID en die kombinasie
van IMID en OSS die aantal siekte-gevalle, sterftes en die prevalensie van die siektes
verminder, maar het geen effek op die insidensie van siekte-gevalle nie. ii) Resultate van
die MIV-TB model dui aan dat MIV en TB toetsing n belangrike aspek van die gehalte
van sorg is en dat dit die effense negatiewe effek van die afname in ART inskrywing en
voorsiening van behandeling, teenstaan. iii) Die MIV-TB-longontsteking-malaria model
(HTMP) stem ooreen met die resultate van die bogenoemde twee modelle en demonstreer
dat ho dekking van die opleidingsprogramme die positiewe effek van die programme op
mortaliteit en morbiditeit verhoog. In geheel stel die resultate van hierdie studie voor
dat die opleiding van MVPs baie meer effektief is vir die korttermyn siektes soos malaria
en longontsteking waarvoor die meeste van die beginwaardes van die prestasie-aanwysers
≥ 0.6 is, maar nie soveel vir lang-termyn siektes soos MIV en TB waarvoor die meeste
van die beginwaarde van die prestasie-aanwysers < 0.6 is. Die resultate dui verder aan dat
opleiding nie voldoende is wanneer die prestasie-aanwysers < 0.6 is nie en dat probleme
soos die opsporing van siekte-gevalle en n gebrek aan medisyne by die klinieke aangespreek
moet word vir opleiding om aansienlike impak te hê.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/85637 |
| Date | 12 1900 |
| Creators | Ssebuliba, Doreen |
| Contributors | Ouifki, Rachid, Stellenbosch University. Faculty of Science. Dept. of Mathematical Sciences. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 190 p. |
| Rights | Stellenbosch University |
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