175 research outputs found
Evaluation of health promotion roles and services offered by health workers in the Nelson Mandela Bay Municipality of Eastern Cape, South Africa.
No full textDoctoral Degree. University of KwaZulu-Natal, Durban.Background: Various factors affect the role of healthcare workers (HCWs) in health promotion (HP).
The Nelson Mandela Bay Municipality (NMBM) public health service is overstretched and there is
minimal evidence of health promoting healthcare services. This research project evaluated the roles and
services of HCWs on HP as well as the views of patients regarding the HP services they received from
HCWs in the municipality.
Methods: A phased quantitative cross-sectional study was conducted to address the study aim and
objectives. In phase one, 495 HCWs randomly sampled from 23 healthcare facilities in NMBM
completed a structured questionnaire. In phase two, 500 patients completed a structured questionnaire
regarding the quality of HP services received using the interview method. Descriptive and inferential
analyses were conducted using StataIC 15.
Results: Three groups of indicators classified as facility related indicators (FRI), healthcare workers’
related indicators (HRI), and outcome related indicators (ORI) emerged for measuring HP. The study
identified thirteen categories of enablers and eight categories of hindrances. Eleven enablers and six
hindrances were associated with tertiary hospitals, and none was recorded for the other health care
levels. Collaboration among disciplines and organizations (Coeff: 2.16, 95% CI: 1.28 - 3.66) and
programme planning (Coeff: 0.375, 95% CI: 0.23 - 0.62) were the predictors of HP and disease
prevention (DP) enablers among medical doctors. On the other hand, ‘healthcare facilities promoting
treatment more than DP’ (Coeff: 2.03, 95% CI: 1.30-3.14) and ‘absence of practice guidelines
incorporating HP’ (Coeff: 2.79, 95% CI: 1.66-4.70) were the predictors of HP and DP hindrances among
medical doctors and allied health workers (AHWs), respectively. Furthermore, most of the HCWs
(75.78%; n=363) reported absence of coordinated HP training for staff in their facilities. Similarly, the
attitude that ‘HP is a waste of time’ (adjusted Coeff 0.51, 95% CI 0.31 - 0.83) influenced the practice
for AHWs. Results of the second phase study were categorized into three phases namely - pre-admission
phase (PAP), admission phase (ADP), and post admission phase (POP). The ADP showed that patients’
health behaviours improved by 1.54 times by their interactions with nurses compared to their
interactions with medical doctors.
Conclusion: This study shows that the healthcare system is more committed to biomedical care as
against health promotion services at all levels of healthcare. The implementation of HP services requires
changes in HCWs behaviour, patients’ attitude and very importantly, structural reorganization and
reprioritization
Acceptability and effectiveness of rapid ART initiation: patients’ and healthcare workers’ perspectives.
No full textDoctoral Degree. University of KwaZulu-Natal,Durban.The Joint United Nations Programme on HIV/AIDS is leading the global effort to end AIDS as a public health threat by 2030. In achieving these goals, emphasis has been on the 95–95–95 targets that by 2030, 95% of people living with HIV know their HIV status. However, the focus is on achieving the second 95 and third 95; having 95% of people diagnosed with HIV initiating on treatment within the expected timeframe and 95% of those on treatment obtaining a suppressed viral load. Commendable efforts have been made in increasing HIV testing numbers however, same day initiation on treatment and achieving viral load suppression remains a challenge. According to the WHO recommendations; same day (ART) initiation should be offered to all people living with HIV following a confirmed diagnosis. This study determined the factors influencing the acceptability and implementation of Universal Test and Treat by both patients and healthcare workers. Universal Test and Treat is a prevention strategy encourages that if a person tests HIV positive, irrespective of the persons CD4 count and clinical staging at the time of testing they will have to begin treatment immediately. Furthermore, patient’s clinical outcomes following test and treat in eThekwini municipality in KwaZulu-Natal were determined. This study was cross-sectional and used prospective - mixed methodology to collect data from 403 patients who either accepted or deferred same day ART initiation from June 2020 to May 2021. A structured questionnaire was used to collect demographic information, sexual behaviour, acceptance of same day ART initiation and knowledge of Universal Test and Treat on the day of HIV diagnosis. Key informant in-depth interviews were conducted with healthcare workers and patients were followed up at 6 months after HIV diagnosis to determine clinical outcomes for both groups, rapid and deferred ART initiators using medical charts and electronic databases. Two different analysis univariate and multivariate logistic regression were performed to examine associations between same day ART initiation and several explanatory factors. Logistic regression was performed to examine associations between same day ART initiation and several explanatory factors, retention in care, clinical outcomes and facility related factors. Thematic analysis was used to assess experiences, knowledge and observations of healthcare workers in implementing the Universal Test and Treat policy. Among the 403 participants same-day initiation was 69.2% (n=279). In an adjusted analysis (age, gender, level of education were adjusted at 0.5 significance level in univariate level) number of sexual partners (aOR: 0.35; 95% CI: 0.15-0.81), HIV status of the partner (aOR: 5.03; 95% CI: 2.74-9.26), knowledge of universal test and treat (aOR: 1.97; 95% CI: 1.34-2.90), support from non-governmental organizations (chi-square = 10.18; p-value= 0.015 and provision of clinic staff (chi-square = 7.51; p value = 0.006) were identified as major factors influencing uptake of same-day ART initiation. In the bivariate analysis; gender (OR: 1.672; 95% CI: 1.002–2.791), number of sexual partners (OR: 2.092; 95% CI: 1.07–4.061), age (OR: 0.941; 95% CI: 0.734–2.791), ART start date (OR: 0.078; 95% CI: 0.042–0.141) and partner HIV status (OR: 0.621; 95% CI: 0.387–0.995) were significantly associated with viral load detection and retention in care. (All variables that were significant at e.g. 0.5 level in univariate). Our results suggest a steady increase in uptake of same day ART initiation with poor retention in care. The results also emphasise a vital need to not only streamline processes to increase immediate ART uptake further but also ensure retention in care in order to meet the 95-95-95 targets. The findings of the study contribute to knowledge useful for strengthening rapid ART initiation implementation by considering individual patient factors, healthcare workers’ perspectives and facility level factors. The qualitative findings revealed variations in UTT knowledge, experiences and observations among diverse healthcare workers from the four clinics in different geographical settings. While training on UTT and SDI of ART initiation was conducted at the inception of the implementation phase, the understanding and interpretation varied especially between clinicians and non-clinical healthcare providers. Denial, feeling healthy, fear of disclosure, limited knowledge about ART, fear of ART side effects, fear of stigma and discrimination were some of the factors HCW observed as hindering uptake of SDI. These findings relate to some of the reasons given by patients with fear of disclosure frequently mentioned by those who deferred SDI of ART
The role of community engagement and involvement for community empowerment in health settings: the case of Ingwavuma community, KwaZulu-Natal, South Africa = Iqhaza Lokusebenzisana nomphakathi Nokufaka Ukuhlonyiswa Komphakathi Ezinhlelweni Zezempilo: Kubhekwa Umphakathi waseNgwavuma, KwaZulu-Natali, eNingizimu Afrikha.
No full textDoctoral Degree. University of KwaZulu-Natal, Durban.Community Engagement (CE) in health research can improve a community's ability to address its own health needs and health inequalities, while ensuring that researchers understand community priorities. However, if effective CE processes are not used, communities will not be empowered to make effective decisions about their own health and wellbeing. This study is based on community-based health research projects; the Malaria and Bilharzia in South Africa (MABISA) and Tackling Infections Disease Burden in Africa-South Africa (TIBA-SA) implemented by the KwaZulu-Natal Ecohealth Program (KEP). I evaluated CE processes and outcomes, with a focus on schistosomiasis and malaria in a rural community of Ingwavuma, uMkhanyakude district in KwaZulu-Natal. The research approach was both qualitative and quantitative (mixed methods) with data collected through 34 in-depth interviews, 4 focus group discussions and 338 household questionnaires. Data was collected from heads of households, community advisory board members, community research assistants, primary school principal and KEP research team (including the project principal investigator and administrators). Data was collected in line with the five-stages of Community Engagement Vancouver Coastal Health framework. Data was analysed using QSR International Pty Ltd, NVivo 12 Pro and Chi-square tests were performed to assess associations between demographic variables and respondents’ knowledge and information of projects. The Principal Investigators informed the community about the project through community leaders (headmen) before the project commencement. As community members were involved at every stage of the process, from conceptualisation to dissemination, the study provided empirical evidence that collaborative partnerships lead to win-win outcomes. Involving headmen (indunas), CAB members, and CRAs in the project ensured shared goals, reciprocity, and mutual benefit, demonstrating the project's intention to help the community. Nearly half (48%) of the surveyed community members had never heard of MABISA. Ninety-four percent (94%) and ninety-seven percent (97%) of respondents had heard of bilharzia and malaria. Nearly the same proportions knew how both diseases are transmitted, thus demonstrating empowerment of community members on schistosomiasis and malaria issues. This study contributed to the understanding of best practices for community empowerment. The study provided information on how communities can positively influence their lives and manage their health problems. Such information can be extracted from the thesis and presented in vernacular language from the area. Furthermore, the thesis provided information of empowering researchers on how they can empower communities through effective engagement. Policy briefs that can be generated from the thesis provided useful information on community empowerment to policymakers and other stakeholders.
Iqoqa.
Ukusebenzisana Nomphakathi ocwaningweni lwezempilo kungathuthukisa ukukwazi komphakathi ukubhekana nezidingo zawo zezempilo nokungalingani bese uqinisekisa ukuthi abacwaningi bayaziqonda izidingongqangi zomphakathi. Lolu cwaningo lwalugxile kumaphrojekthi ocwaningo lwezempilo olugxile emphakathini; uMalaleveva, iMalaria neSichenene, iBilharzia eNingizimu Afrikha noMthwalo Wokutheleleka ngesifo iTacIqokling e-Afrikha- eNingizimu Afrikha kwasetshenziswa eZinhlelweni Zezempilo eziphathelene nemvelo KwaZulu-Natali. Ngahlola izinqubo zokusebenzisana nomphakathi kanye nemiphumela yesiyingi Ingwavuma, noMkhanyakude. Kwasetshenziswa izindlela zombili yocwaningo kwakuyizo zombili eyocwaningo lobunjalo botho neyenanikubala nemininingo eyaqoqwa kusetshenziswa izinhlwayalwazi ezijulile ezingama-34, izingxoxo zamaqoqo acwaningwayo ama-4 kanye nezinhla zemibuzo yemindeni engama-338. Imininingo yaqoqwa ezinhlokweni zamakhaya, kumalungu abeluleki bemiphakathi, abasizi bocwaningo lomphakathi, othishanhloko bezikole zamabanga aphansi nethimba locwaningo (kubandakanya nabaphenyi abakhulu bephrojekthi nabaphathi). Imininingo yahlaziywa kusetsheniswa iQSR International Pty Ltd, NVivo 12 Pro nokuhlola ngeChi-square kwenziwa ukuze kuhlolwe ukuhlobana phakathi kwamavariyebuli olwazimidanti ngempilo yomuntu nolwazi lwabaphendulayo kanye nolwazi lwephrojekthi. Abaphenyi abakhulu bazisa umphakathi ngephrojekthi ngabaholi bomphakathi (izinhloko) ngaphambi kokuqalwa kwephrojekthi. Njengoba amalungu omphakathi babeyingxenye yazo zonke izigaba zenqubo kusuka ekusungulweni nasekusabalalisweni, ucwaningo lwanikeza ubufakazi obubonakalayo bobudlelwane obusebenzisanayo obuholela emiphumeleni eyimpumelelo. Ukufaka izinhloko (izinduna), amalungu esigungu esilawula umphakathi kanye nabasizi bocwaningo lomphakathi kwiphrojekthi kwaqinisekiswa ngezinhloso okwabelwana ngazo, ukushintshisana, ukuzuza ngokulinganayo, ukukhombisa okuhloswe iphrojekthi okungukusiza umphakathi. Balinganiselwa kwabangaba yisigamu esingama-(48%) samalungu omphakathi ahlolwa abangakaze bezwe ngeMABISA. Abangamaphesenti angamashumi ayisishiyagalolunye nane (94%) namaphesenti angamashumi ayisishiyagalolunye nesikhombisa (97%)abaphendula babezwile ngesichenene nomalaleveva. Kucishe kube yingxenye efanayo eyayazi ngokuthi utheleleka kanjani ngalezi zifo zombili, bakukhombisa ukuhlomisa amalungu omphakathi ngokuphathelene nesichenene, ischistosomiasis nomalaleveva. Lolu cwaningo lwahlomisa umphakathi kakhulu ngokumele ukwenze. Ucwaningo lwanikezela ngolwazi lokuthi ungenza kanjani umphakathi ukusiza izimpilo zawo nokulawula izinkinga zawo zezempilo. Ulwazi olunjalo lungakhiswa kuyithesisi bese lethulwa ngolimi lwendabuko endaweni. Ngaphezu kwalokho, ithesisi yanikezela ngolwazi oluhlomisa abacwaningi ngokuthi bangayihlomisa kanjani imiphakathi ngokusebenzisana. Kungakhelwa kuyithesisi nokushiwo inqubomgomo kunikezele ngolwazi oluzosetshenziswa ekuhlomiseni umphakathi kubakhi bezinqubomgomo nabanye okusetshenziswana nabo
Host immune responses to plasmodium berhei ANKA and trichinella Zimbabwenisis infection in balb/c mice.
No full textDoctoral Degree. University of KwaZulu-Natal, Durban.Four objectives were pursued in this study; (i) metabolic and adaptive immune responses induced in BALB/c mice infected with a tissue-dwelling nematode, Trichinella zimbabwensis were measured, (ii) differential cytokine and antibody responses induced in mice infected with T. zimbabwensis were determined, (iii) cytokines, anti-Trichinella and anti-Plasmodium antibody responses in mice mono- and co-infected with Trichinella zimbabwensis and Plasmodium berghei ANKA were determined and (iv) the effect of antihelminthic treatment against T. zimbabwensis on immunity and malaria disease outcomes was determined. Groups of BALB/c mice were mono- or co-infected with a crocodilederived T. zimbabwensis (Code 1SS1209) and P. berghei ANKA parasites. At various time points, metabolic parameters such as levels of water and food intake, glucose and insulin were measured. Cytokine and antibody responses were also measured by ELISA. Parasite burden and survival rates were used to determine malaria disease outcomes. The results showed that primary T. zimbabwensis infection was characterised by significantly elevated levels of insulin (p < 0.001) that were accompanied with hypophagia, weight loss, altered host compensatory feeding mechanisms. Parasite specific antibodies and Th1/Th2/Th17 and T-regulatory immune responses were elevated. In co-infection, it was observed that T. zimbabwensis induced immunomodulation that conferred protection against Plasmodium growth and early death. Anti-helminthic treatment enhanced antibody and cytokine production in mono- and co-infection mice (p < 0.001) and negatively affected malaria parasite multiplication by improving survivorship of co-infected mice by 42.85% (p < 0.001). From the study, it was concluded that T. zimbabwensis parasites induce mixed Th1/Th2/Th17 immune responses, alter host glucose metabolism and trigger immunomodulation that ameliorated malaria disease outcome. Anti-helminthic treatment acted as an immunomodulator for cytokine and antibody production, ameliorated malaria infection and improved survivorship of co-infected mice. The study shows that malaria coinfection with T. zimbabwensis and anti-helminthic treatment improves survival, enhances immunity and ameliorates malaria. It further shows that deworming may be used as an integrated control measure in areas where malaria and helminths are co-endemic
What does "good" community and public engagement look like? Developing relationships with community members in global health research
No full textCommunity and public engagement (CPE) is increasingly becoming a key component in global health research. The National Institute for Health Research (NIHR) is one of the leading funders in the UK of global health research and requires a robust CPE element in the research it funds, along with CPE monitoring and evaluation. But what does "good" CPE look like? And what factors facilitate or inhibit good CPE? Addressing these questions would help ensure clarity of expectations of award holders, and inform effective monitoring frameworks and the development of guidance. The work reported upon here builds on existing guidance and is a first step in trying to identify the key components of what "good" CPE looks like, which can be used for all approaches to global health research and in a range of different settings and contexts. This article draws on data collected as part of an evaluation of CPE by 53 NIHR-funded award holders to provide insights on CPE practice in global health research. This data was then debated, developed and refined by a group of researchers, CPE specialists and public contributors to explore what "good" CPE looks like, and the barriers and facilitators to good CPE. A key finding was the importance, for some research, of investing in and developing long term relationships with communities, perhaps beyond the life cycle of a project; this was regarded as crucial to the development of trust, addressing power differentials and ensuring the legacy of the research was of benefit to the community. [Abstract copyright: Copyright © 2022 Hickey, Porter, Tembo, Rennard, Tholanah, Beresford, Chandler, Chimbari, Coldham, Dikomitis, Dziro, Ekiikina, Khattak, Montenegro, Mumba, Musesengwa, Nelson, Nhunzvi, Ramirez and Staniszewska.
Enhancing Schistosomiasis Control Strategy for Zimbabwe: Building on Past Experiences
No full textSchistosoma haematobium and Schistosoma mansoni are prevalent in Zimbabwe to levels that make schistosomiasis a public health problem. Following three national surveys to map the disease prevalence, a national policy on control of schistosomiasis and soil transmitted helminths is being developed. This paper reviews the experiences that Zimbabwe has in the area of schistosomiasis control with a view to influence policy. A case study approach to highlight key experiences and outcomes was adopted. The benefits derived from intersectoral collaboration that led to the development of a model irrigation scheme that incorporates schistosomiasis control measures are highlighted. Similarly, the benefits of using plant molluscicides and fish and duck biological agents (Sargochromis codringtonii and Cairina moschata) are highlighted. Emphasis was also placed on the importance of utilizing locally developed water and sanitation technologies and the critical human resource base in the area of schistosomiasis developed over years. After synthesis of the case studies presented, it was concluded that while there is a need to follow the WHO recommended guidelines for schistosomiasis control it is important to develop a control strategy that is informed by work already done in the country. The importance of having a policy and local guidelines for schistosomiasis control is emphasized
Barriers and enablers to task shifting for caesarean sections in sub-Saharan Africa: a scoping review
No full textTask shifting of Caesarean-sections to non-physician clinicians (NPCs) has raised concerns over NPCs‘ competences and rationale of using them in facilities where medical doctors (MDs) are scarce to provide mentorship. We conducted a scoping review to provide an update on NPCs‘ contribution to C-sections including barriers and enablers to task shifting. Using the PRISMA Flow Diagram, we identified 15 eligible articles from Google Scholar, PubMed and Africa Index Medicus using specific search terms and a pre-established inclusion criterion. All 15 studies characterised NPCs: their names, training, challenges and enablers to task shifting. NPCs performed 50%-94% C-sections. Outcomes of such C-sections were comparable to those performed by MDs. Enablers included supportive policies, pre-existing human resources for health shortage, wellresourced health facilities and supervision of NPCs. Weak health systems were major barriers. While NPCs make a significant contribution to accessing C-sections services, there is need to address challenges to fully realize benefits.Le transfert de tâches des césariennes à des cliniciens non médecins (CNP) a suscité des inquiétudes quant aux compétences de ces derniers et aux raisons de les utiliser dans des établissements où les médecins ne sont pas en mesure de fournir un mentorat. Nous avons procédé à un examen de la portée afin de fournir une mise à jour de la contribution des CNP aux césariennes, y compris les obstacles et les facteurs permettant le transfert de tâches. À l'aide du diagramme de flux PRISMA, nous avons identifié 15 articles éligibles de Google Scholar, PubMed et Africa Index Medicus en utilisant des termes de recherche spécifiques et un critère d'inclusion préétabli. Les 15 études ont toutes caractérisé les PNJ: leurs noms, leur formation, leurs défis et les moyens de transférer des tâches. Les PNJ ont réalisé des césariennes de 50% à 94%. Les résultats de telles césariennes étaient comparables à ceux obtenus par les médecins. Les catalyseurs incluaient des politiques de soutien, des ressources humaines préexistantes pour lutter contre la pénurie en matière de santé, des établissements de santé disposant de ressources suffisantes et la supervision des CNP. La faiblesse des systèmes de santé constituait un obstacle majeur. Bien que les CNP apportent une contribution importante à l‘accès aux services des césariennes, il est nécessaire de relever les défis pour tirer pleinement parti des avantages. Keywords: Task shifting; task sharing; caesarean section, associate clinicians; comprehensive emergency obstetric care; clinical officers; non-physician cliniciansAfr J Reprod Health 2019; 23[3]: 149-16
Community engagement: health research through informing, consultation, involving and empowerment in Ingwavuma community
No full textIntroductionThe goal of community involvement in health research is to improve a community’s ability to address its own health needs while ensuring that researchers understand and consider the community’s priorities. Recent data show that socio-economic and environmental challenges continue to be a barrier to informing, consulting, involving and empowering communities in community-based health research beneficial to them. The aim of this study was to assess the extent to which the Ingwavuma community in KwaZulu-Natal Province, in rural South Africa, was informed, consulted, involved and empowered about two research projects conducted between 2014 and 2021.MethodsThe study used the modified random-route procedure to administer a standardized questionnaire to 339 household heads selected randomly. The questionnaires were administered face-to-face. The sample size was estimated using the Yamane sample size generating formula. Chi-square tests were performed to assess associations between demographic variables (age, gender, education, village) and respondents’ knowledge and information of the projects, Malaria and Bilharzia in Southern Africa and Tackling Infections to Benefit Africa as well as their participation.ResultsThe communities were generally well-informed about the health projects that were being carried out. Fewer than half of those who had heard about the projects had directly participated in them. The majority had been tested for one or more diseases and conditions, mostly high blood pressure, diabetes, and schistosomiasis, and had participated in a community feedback group; many had given their children’s permission to be tested for schistosomiasis or to participate in project research activities. Others participated in public awareness campaigns and surveys. There was some evidence of a consultation process in the form of public consultation discussed in the projects, and not much discussion on empowerment.DiscussionThe findings demonstrate that researchers’ CE approach was adaptable as communities were largely educated, involved, and subsequently empowered though without much consultation and that researchers had provided a space for sharing responsibilities in all engagement process decision-making. For the empowerment of the community, projects should take into account the intrapersonal and personal aspects affecting the community’s capacity to effectively benefit from the information, consultation, involvement, and empowerment procedures
Cost-effectiveness analysis of malaria interventions using disability adjusted life years: a systematic review
No full textCommunity Engagement and Collaboration between Researchers and Community Stakeholders for Schistosomiasis and Malaria Projects in Ingwavuma, uMkhanyakude District, KwaZulu-Natal
No full textCommunity engagement is a multiphase process that is crucial for successful community-based health interventions. This study investigates the collaborative phase of community engagement, specifically within a co-developed framework implemented in uMkhanyakude District, South Africa. A qualitative case study approach was employed to explore the experiences of key community stakeholders during the collaborative phase of project implementation. Data collection involved key informant interviews, focus group discussions, and direct observation. The findings demonstrate the potential for effective collaboration among village headmen, community advisory board members, and community research assistants to address local health challenges. Community research assistants played a particularly valuable role in facilitating participatory research and hands-on engagement with researchers. However, several barriers hindered the collaborative process, including demanding work conditions, communication issues regarding compensation, inappropriate behavior from the research team, and culturally insensitive interactions. While community-based participatory research offers a promising collaborative approach for addressing health issues, a careful consideration of local socio-cultural dynamics is essential to avoid misunderstandings and overcome potential barriers. Addressing these challenges is crucial to ensuring that collaborative partnerships effectively empower communities and achieve sustainable improvements in health outcomes
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