Thesis (MSc(Med)(Pharmacy) ) -- University of Limpopo, 2013. / Introduction: Primary Health Care (PHC) is regarded as the first level of contact with the
National Health System with health care services provided mainly by nurses with varying
competences. PHC is about interaction with people thus the quality of PHC depends
extensively on the competence of the people who provide it. Therefore, the way health care
personnel are trained and how capacity continues to be developed is of fundamental
importance to PHC. Following the Alma-Ala Declaration, policies, such as the National Drug
Policy (NDP) were developed in South Africa to guide health care services. The NDP
resulted in the formulation of Standard Treatment Guidelines/Essential Medicine List
(STGs/EML). Emphasis has been placed on all prescribers to strictly adhere to these
guidelines when providing clinical patient care. Despite these developments reports still
indicate that antibiotics are irrationally used when treating respiratory infections. It is
therefore imperative that localised reasons for deviations from the STGs/EML when treating
respiratory conditions are thoroughly investigated to facilitate relevant interventions.
Objectives: The objectives of the study were to: (1) document the treatment prescribed to
children up to 12 years of age for respiratory conditions, (2) assess adherence of the
authorised prescribers to the 2008 PHC STGs/ EML and (3) determine factors impacting on
deviations from the 2008 STGs/EML.
Method: Twenty randomly selected PHC facilities in the district participated in the study. In
each of the 20 selected PHC facilities, three prescribers were randomly selected for the
structured interview and auditing of their prescription registers. Five prescriptions from each
of the sampled prescription registers of the selected authorised prescribers, containing any
of the children's respiratory conditions to be studied, were audited. A total of 15 prescriptions
from each of the selected PHC facilities were audited. Descriptive statistics was used to
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analyse data and responses to categorical variables were summarised as frequency
counts and percentages. Results were presented as tables, figures and graphs.
Results: Pneumonia (39.7%) was found to be the most common respiratory condition seen
at Umkhanyakude Health District followed by the common cold and influenza. Amoxicillin
(52%) was the most often prescribed antibiotic for these respiratory conditions. Only 4% of
prescribers showed full adherence to the 2008 PHC STGs/EML. While prescribers had a
positive attitude towards the 2008 PHC STGs/EML, their sense of adherence, content
understanding of these guidelines, as well as knowledge of medicine used for respiratory
conditions, were exaggerated. Failure to accurately diagnose respiratory conditions and lack
of implementation and monitoring strategies were also amongst the factors impacting on
adherence.
Conclusion: Adherence to the 2008 PHC STGs/EML for the treatment of respiratory
conditions in children up to 12 years of age was found to be a challenge in Umkhanyakude
PHC facilities with only four percent of prescribers adhering to these guidelines. The
Umkhanyakude Health District Management team must consider employing multifaceted
interventions from the recommendations of this study in order to improve adherence to the
PHC STGs/EML.
Recommendations: Strategies such as intensified monitoring and evaluation, improved
supervision, targeted training and education together with compulsory in-service training are
recommended to improve adherence to the STGs/EML in the Umkhanyakude Health District.
Guideline implementation strategies with integrated approaches to guideline dissemination
must also be strengthened.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ul/oai:ulspace.ul.ac.za:10386/1076 |
| Date | January 2013 |
| Creators | Hlongwana, Simangele. I. |
| Contributors | Helberg, E. A., Dr Bezuidenhout, S |
| Publisher | University of Limpopo (Medunsa Campus) |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Relation | 6.0 |
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