290 research outputs found
Epidemiology and burden of chronic pain within the Eastern Cape Province, South Africa
No full textPhilosophiae Doctor - PhDPain is a complex biopsychosocial phenomenon that can have a profound impact on people's lives (Access Economics [AE], 2007). lts clinical relevance is well known - pain is suggestive of "actual or potential tissue damage" and plays a role in the diagnosis and clinical management of diseases and/or injury (International Association for the Study of Pain [IASP], 1986). It has both sensory and emotional aspects and is behaviourally expressed by how it is communicated by the sufferer and by its effect on the sufferer's behaviour (IASP, 1986; Linton, 2005; AE, 2007). Even though the experience of pain is associated with tissue damage or is described in terms of such damage, this association is variable so that "the size of an injury can be a poor guide as to how much an individual experiences pain" (AE, 2007). In fact, pain can exist without an objective evidence of tissue damage making pain the "ultimate subjective experience" (Odendaal, 2006). This phenomenon may relate to the fact that the interpretation of nociceptive signals as pain is influenced by a number of personal and environmental factors including past experience, integrity of the nervous system, beliefs and the situation in which tissue damage occurs (Eccleston, 2001; Turk, 2002a; Flor and Hermann, 2004; AE, 2007). As such, decisive and objective measurements are difficult to arrive at and pain is not always easily assessed by the healthcare provider. The translation of pain from acute to chronic however, means that pain and discomfort remains
beyond the normal time of healing and by definition, persists either continuously or intermittently for 3 months or longer (Elliot et al., 1999). This changes the physiognomy of pain and the condition of chronic pain ensues. Chronic pain is an important but often neglected public health problem. It is disabling and associated with interference in normal activities of daily living (ADLs) such as work, home chores, family and sporting activities. Research shows that chronic pain is a key complaint that motivates many to seek health care (Crook et al., 1984, 1989; Sullivan et al., 1990; Smith et al., 1996; Mantyselka et al., 2001, 2002; Eriksen et al., 2004; AE, 2007) leading to high and ongoing
consumption of treatments (AE, 2007). In fact, studies have shown that persons with chronic pain use health services up to five times more frequently than the rest of the population (Von Korff et al., 1990, 1991; Elliot et al., 1999; Eriksen et al., 2004). Side-effects of treatment
are common with medication use including gastric problems such as ulcerations, nausea, constipation and mental slowing or confusion which can affect functioning. Chronic pam is also associated with mood and sleep disturbances such as depression or adjustment problems and trouble getting to sleep and/or frequent wakening during the night. For the sufferer, the effect of disuse of the aspect of the body in which pain is experienced is another manifestation of chronic pain. Muscles and joints become de-conditioned and pain sufferers may lose general body fitness (AE, 2007). Within the community, pain is a common cause of considerable suffering and disability affecting the general health and quality of life of individuals (Von Korff et al., 1990, 1992; Magni et al., 1990,1993; Walsh et al., 1992; Smith et al., 1996,2001; Verhaak et al., 1998; Elliot et al., 1999, 2002; Blyth et al., 2001; Reyes-Gibby et al., 2002; Lanteri-Minet et al., 2003). Significant amounts of working days are lost among the labour force impacting a profound economic and social toll on society (Bowsher et al., 1991; Elliot et al., 1999; Blyth et al., 2003; Igumbor et al.,2003). Simply put, "chronic pain is a human tragedy" (Odendaal, 2006). It is a serious and common problem that causes distress to patients and their caregivers, is a burden on health care professionals and health care resources and results in significant lost productivity. Chronic pain is therefore a problem of public health importance
Evaluation of the implementation of the North West protocol on the management of severe malnutrition at Mafikeng provincial hospital and Thusong hospital in the North West province of South Africa
No full textMagister Public Health - MPHThe aim of this study is to evaluate the management of severe malnutrition in the two selected hospitals in North West Provinc
Epidemiology and burden of chronic pain within the Eastern Cape Province, South Africa
No full textPhilosophiae Doctor - PhDPain is a complex biopsychosocial phenomenon that can have a profound impact on people's lives (Access Economics [AE], 2007). lts clinical relevance is well known - pain is suggestive of "actual or potential tissue damage" and plays a role in the diagnosis and clinical management of diseases and/or injury (International Association for the Study of Pain [IASP], 1986). It has both sensory and emotional aspects and is behaviourally expressed by how it is communicated by the sufferer and by its effect on the sufferer's behaviour (IASP, 1986; Linton, 2005; AE, 2007). Even though the experience of pain is associated with tissue damage or is described in terms of such damage, this association is variable so that "the size of an injury can be a poor guide as to how much an individual experiences pain" (AE, 2007). In fact, pain can exist without an objective evidence of tissue damage making pain the "ultimate subjective experience" (Odendaal, 2006). This phenomenon may relate to the fact that the interpretation of nociceptive signals as pain is influenced by a number of personal and environmental factors including past experience, integrity of the nervous system, beliefs and the situation in which tissue damage occurs (Eccleston, 2001; Turk, 2002a; Flor and Hermann, 2004; AE, 2007). As such, decisive and objective measurements are difficult to arrive at and pain is not always easily assessed by the healthcare provider. The translation of pain from acute to chronic however, means that pain and discomfort remains
beyond the normal time of healing and by definition, persists either continuously or intermittently for 3 months or longer (Elliot et al., 1999). This changes the physiognomy of pain and the condition of chronic pain ensues. Chronic pain is an important but often neglected public health problem. It is disabling and associated with interference in normal activities of daily living (ADLs) such as work, home chores, family and sporting activities. Research shows that chronic pain is a key complaint that motivates many to seek health care (Crook et al., 1984, 1989; Sullivan et al., 1990; Smith et al., 1996; Mantyselka et al., 2001, 2002; Eriksen et al., 2004; AE, 2007) leading to high and ongoing
consumption of treatments (AE, 2007). In fact, studies have shown that persons with chronic pain use health services up to five times more frequently than the rest of the population (Von Korff et al., 1990, 1991; Elliot et al., 1999; Eriksen et al., 2004). Side-effects of treatment
are common with medication use including gastric problems such as ulcerations, nausea, constipation and mental slowing or confusion which can affect functioning. Chronic pam is also associated with mood and sleep disturbances such as depression or adjustment problems and trouble getting to sleep and/or frequent wakening during the night. For the sufferer, the effect of disuse of the aspect of the body in which pain is experienced is another manifestation of chronic pain. Muscles and joints become de-conditioned and pain sufferers may lose general body fitness (AE, 2007). Within the community, pain is a common cause of considerable suffering and disability affecting the general health and quality of life of individuals (Von Korff et al., 1990, 1992; Magni et al., 1990,1993; Walsh et al., 1992; Smith et al., 1996,2001; Verhaak et al., 1998; Elliot et al., 1999, 2002; Blyth et al., 2001; Reyes-Gibby et al., 2002; Lanteri-Minet et al., 2003). Significant amounts of working days are lost among the labour force impacting a profound economic and social toll on society (Bowsher et al., 1991; Elliot et al., 1999; Blyth et al., 2003; Igumbor et al.,2003). Simply put, "chronic pain is a human tragedy" (Odendaal, 2006). It is a serious and common problem that causes distress to patients and their caregivers, is a burden on health care professionals and health care resources and results in significant lost productivity. Chronic pain is therefore a problem of public health importance
Paediatric severe - acute malnutrition and the recommended WHO treatment modality: an epidemiological and quality care assessment in the context of HIV comorbidity
No full textThe current study was, in part, prompted by the high case fatality rates for severe acute malnutrition in two district hospitals in the Eastern Cape Province in South Africa. These case fatality rates were being attributed to Human Immunodeficiency Virus infection rather than to mismanagement by nurses involved in the hospital management of SAM cases. There were also some anecdotes from clinicians in the same hospitals that, depending on the clinical stage of HIV infection, the World Health Organisation's ten-step protocol may show no effect. This left some uncertainties as to whether these guidelines are suitably designed for use during the management of HIV-positive children who are severely malnourished and at different HIV clinical stages. This study sought to reinforce the design of a longstanding facility-based intervention originally developed to improve the management of severe acute malnutrition in two district hospitals in South Africa. The aim was to design an improved intervention which was implemented and evaluated to determine its potential effect on treatment outcomes, specifically in the context of high HIV comorbidity. The study also sought to provide the context for the effectiveness of this intervention, in terms of its implementation fidelity and associated moderating factors. Lastly, the study evaluated the sustainability of the intervention after it was discontinued
Perceived built environment and physical activity: relationships and consequences on prevalent cardiovascular disease and risk factors in urban and rural South Africa
No full textPhilosophiae Doctor - PhD (School of Public Health)Built environment (BE) attributes have been associated with a variety of health risks and
outcomes, including cardiovascular disease (CVD) incidence and mortality. However, most of
the existing evidence is from high-income countries which exhibit different BE attributes than
those from an African context
Ampliación a Escala del Manejo Mejorado de la Desnutrición Aguda Grave Para Pacientes Hospitalizados: Factores Clave y Experiencias de Sudáfrica, Bolivia, Malawi, y Ghana
No full textSevere acute malnutrition (SAM) can have a high mortality, especially in very ill children treated in the hospital. Many medical and nursing schools do not adequately, if at all, teach how to manage children with SAM. There is a dearth of experienced practitioners and trainers to serve as exemplars of good practice or participate in capacity development. We consider 4 country studies of scaling up implementation of WHO guidelines for improving the inpatient management of SAM within under-resourced public sector health services in South Africa, Bolivia, Malawi, and Ghana. Drawing on implementation reports, qualitative and quantitative data from our research, prospective and retrospective data collection, self-reflection, and our shared experiences, we review our capacity-building approaches for improving quality of care, implementation effectiveness, and lessons learned. These country studies provide important evidence that improved inpatient management of SAM is scalable in routine health services and scalability is achievable within different contexts and health systems. Effectiveness in reducing inpatient SAM deaths appears to be retained at scale. The country studies show evidence of impact on mortality early in the implementation and scaling up process. However, it took many years to build workforce capacity, establish monitoring and mentoring procedures, and institutionalize the guidelines within health systems. Key features for success included collaborations to build capacity and undertake operational research and advocacy for guideline adoption; specialist teams to mentor and build confidence and competency through supportive supervision; and political commitment and administrative policies for sustainability. For frontline staff to be confident in their ability to deliver appropriate care competently, an enabling environment and supportive policies and processes are needed at all levels of the health system
Investigating predictors of health-related quality of life and functional status in middle-aged to older adults with hypertension in a selected urban community
No full textPhilosophiae Doctor - PhDIntroduction: In this study, predictors of health-related quality of life and functional status in
people with hypertension were investigated. Hypertension is the leading preventable cause of
premature death.
Aims: The aims of the study were to (1) assess the relationships between socio-demographic
variables, psychosocial variables and disease morbidity with health-related quality of life (HRQoL)
and functional status (FS) outcome variables, and (2) develop multivariate predictive
models to predict H-RQoL (social, psychological, physical and environmental) and FS physical
component summary (PCS) and mental component summary (MCS) outcomes.
Methods: A sample of 173 hypertensive participants was subjected to self-administered
questionnaires to assess their levels of H-RQoL and FS. Secondary data, including anthropometric
and blood pressure measurements, disability and chronic disease were used from the South African
Prospective Urban Rural Epidemiology Study, University of the Western Cape. Additional data
were collected using a series of questionnaires, 1.) a personal and demographic questionnaire, 2.)
the World Health Organization Quality of Life – Brief, the Medical Outcomes Survey Short-Form
36 version 2 (SF 36 v2), and 3.) the Proactive Coping Inventory (PCI) questionnaire.
Using systematic data analysis, we assessed (1) relationships between socio-demographic,
psychosocial and disease morbidity variables through correlational analysis (Pearson r, ANOVA),
and (2) the value of socio-demographic, psychosocial and disease morbidity variables in predicting
H-RQoL and FS through multivariate regression analysis yielding six separate regression models.
Results: Findings revealed demographic factors (education, marital status), psychosocial factors
(coping, stress) and disability were significant predictors of H-RQoL and FS. Marital status, home,
work, and financial stress was significantly associated with improved physical, social relationships
and environmental quality of life. Engaging in reflective, strategic, preventive, instrumental,
emotional and avoidance coping had a significant and positive effect on physical quality of life,
but had significant negative effects on social relationships (and environmental quality of life.
Having several disabilities negatively affected the quality of life across all subscales. For FS, the
PCS was significantly associated with age, marital status and employment, and negatively with
strategic, emotional support seeking and avoidance coping. Financial stress, stress at home, and
religious group involvement were significantly associated with the MCS.
Predictors in the psychological QoL model explained 28% of the variance in the model. Having
secondary schooling (p=0.002) and some stress at home (p=0.001) significantly predicted the
psychological quality of life. Not belonging to a religious group (p=0.019) had a positive influence
on social relationships QoL and having moderate financial stress (p=0.028) had a negative impact,
explaining 27% of the variance in the model. Having a college or university education (p=0.039)
and utilising reflective coping (p=0.006) predicted increased physical QoL significantly, whereas
strategic coping predicted decreased physical QoL. Predictors in the physical QoL model
explained 23% of the variance in the model. Possessing a college or university education (p=0.009)
and being unemployed because of illness or old age (p=0.029) significantly predicted increased
environmental QoL. Having several limitations (p=0.002) resulted in five times lower
environmental QoL. The predictors in the model could explain only 19% of the variance in the
model. The final model for the PCS revealed reflective coping (p=0.042) was the only predictor
that increased physical FS. Being currently married (p=0.001), divorced or separated (p=0.013),
having secondary schooling (p=0.003) or college or university education (p=0.004), engaging in
avoidance coping (p=0.043) and having several disabilities (p=0.000) significantly decreased
physical FS, explaining 40% of the variance in the model. In the MCS final model, emotional
coping (p=0.053) increased mental FS. Being currently married (p=0.011), divorced or separated
(p=0.006), having stopped working because of illness (p=0.008), having moderate home stress
(p=0.041) and financial stress (p=0.015) predicted decreased MCS significantly. Predictors in the
MCS model explained 36% of the variance in the model.
Conclusion: Through the use of a theoretical framework, the Wilson-Cleary model of healthrelated
quality of life facilitated a fuller understanding of the several factors impacting H-RQoL
and FS. Therefore, it is recommended that large-scale studies investigate the causal relationship
between these factors. The study highlights the adverse impact of disability and presence of
comorbid diseases on QoL and functional status. The value of the study lies in the fact that
assessing how an individual perceives his or her health is necessary to develop appropriate
treatment strategies which should lead to positive health outcomes.2022-08-3
Contextual and socio-economic factors that impact food purchasing patterns of health club members residing in a predominantly black- urban township in South Africa
No full textMagister Public Health - MPHBackground: It is gradually being recognized that understanding individual-level
socioeconomic and environmental predictors of food purchasing and thus healthy eating, is
imperative in order to develop appropriate nutrition and health interventions. Understanding the
complex world of food choice requires a meticulous examination of stimuli and deterrents of
food choice all of which should be viewed comprehensively to include micro-level
compositional socioeconomic aspects of individuals as well as macro-level contextual influences
of food cost, availability and accessibility.
Aim: This study sought to uncover some of the widely known environmental (contextual) and
compositional (individual-level) socioeconomic factors that influence Health Club Members’
(HCMs) ability to access and afford healthy foods within the community where they live.
Study design: The research employed both descriptive quantitative and qualitative study
designs.
[VI]
Study population and sample: The target population which was also the sample comprised 50
Health Club Members who were residing in Harare and the surrounding area within Khayelitsha
at the time of the study.
Data collection and analysis: Data was collected by means of face to face quantitative
interviews with 46 HCMs using questionnaires, in-depth interviews with 10 HCMs, Key
informant interviews with 2 Community Health Workers, as well as observations of the
community food environment. Quantitative data was analyzed using SPSS version 16.0 and MS
Excel 2007 for Windows. Qualitative analysis was executed using framework and content
analysis techniques.
Results and conclusion: The study established that low socioeconomic status, poor access to
healthy food choices, and lack of constant availability of such foods were primary challenges
facing some of the HCMs in their quest to afford and access healthy food. In order to promote
access to and availability of affordable healthy foods in the study setting, there may be a need for
addressing not only individual socioeconomic challenges but also more upstream environmental
drivers of food purchasing.Background: It is gradually being recognized that understanding individual-level
socioeconomic and environmental predictors of food purchasing and thus healthy eating, is imperative in order to develop appropriate nutrition and health interventions. Understanding the complex world of food choice requires a meticulous examination of stimuli and deterrents of food choice all of which should be viewed comprehensively to include micro-level compositional socioeconomic aspects of individuals as well as macro-level contextual influences of food cost, availability and accessibility.Aim: This study sought to uncover some of the widely known environmental (contextual) and compositional (individual-level) socioeconomic factors that influence Health Club Members’(HCMs) ability to access and afford healthy foods within the community where they live.Study design: The research employed both descriptive quantitative and qualitative study
designs.[VI]Study population and sample: The target population which was also the sample comprised 50 Health Club Members who were residing in Harare and the surrounding area within Khayelitsha at the time of the study.Data collection and analysis: Data was collected by means of face to face quantitative interviews with 46 HCMs using questionnaires, in-depth interviews with 10 HCMs, Key informant interviews with 2 Community Health Workers, as well as observations of the
community food environment. Quantitative data was analyzed using SPSS version 16.0 and MS Excel 2007 for Windows. Qualitative analysis was executed using framework and content analysis techniques.Results and conclusion: The study established that low socioeconomic status, poor access to healthy food choices, and lack of constant availability of such foods were primary challenges facing some of the HCMs in their quest to afford and access healthy food. In order to promote
access to and availability of affordable healthy foods in the study setting, there may be a need for addressing not only individual socioeconomic challenges but also more upstream environmental drivers of food purchasing
Development of the Public Health model of Community participation in the Kwazulu - Natal primary health care system
No full textPhilosophiae Doctor - PhD (School of Public Health)The purpose of this study was to develop the public health model of community participation
for the KwaZulu-Natal primary health care system. The model is intended to improve the
understanding of community participation and to explore its potential value in strengthening
the facilitation of health promotion in the health facilities
Paediatric severe-acute malnutrition and the recommended WHO treatment modality: An epidemiological and quality care assessment in the context of HIV/AIDS comorbidity
No full textPhilosophiae Doctor - PhDThe current study was, in part, prompted by the high case fatality rates for severe acute malnutrition in two district hospitals in the Eastern Cape Province in South Africa. These case fatality rates were being attributed to Human Immunodeficiency Virus infection rather than to mismanagement by nurses involved in the hospital management of SAM cases. There were also some anecdotes from clinicians in the
same hospitals that, depending on the clinical stage of HIV infection, the World Health Organisation's ten-step protocol may show no effect. This left some uncertainties as to whether these guidelines are suitably designed for use during the management of HIV positive children who are severely malnourished and at different HIV clinical stages. This study sought to reinforce the design of a longstanding facility-based intervention originally developed to improve the management of severe acute malnutrition in two district hospitals in South Africa.
The aim was to design an improved intervention which was implemented and evaluated to determine its potential effect on treatment outcomes, specifically in the context of high HIV comorbidity. The study also sought to provide the context for the effectiveness of this intervention, in terms of its implementation fidelity and associated moderating factors. Lastly, the study evaluated the sustainability of the
intervention after it was discontinued. Methods The current study reports on the development, implementation and evaluation of an
intervention to improve the management of severe acute malnutrition in two district hospitals in the Eastern Cape Province. A Sequential Explanatory Mixed Method Design was used. During the study, the effect of HIV infection, disease stage and other clinical characteristics on the survival of children with severe acute malnutrition was assessed. The relationship between the rate of weight gain and duration of hospitalisation based on HIV status and disease stage were also examined. The data were collected prospectively during the study using retrospective record review of a total of 450 severely malnourished children who were admitted and treated at the two facilities from 2009 to 2013.A pre-tested 76- item patient evaluation form was used to collect data on patient characteristics on admission, treatment processes and outcomes. Data analysis was performed using STATA13.0 and involved simple descriptive computation of quantitative variables
as well as non-parametric tests to compare groups between and within hospitals. Kaplan-Meier curves and Cox proportional hazard modelling were used to analyse time to event data. The study also assessed the impact of the intervention at time intervals on outcomes of interest. The analysis focused on modelling and plotting monthly mortality statistics collected over a period of 69 months. This was done to detect related trend and level changes before, immediately (after the first two months) and after (following the two months) the removal of the intervention. Lastly ethnographic and focus group enquiries were used to explain the quantitative results. Two focus group discussions were held in each hospital with clinicians and the management staff. This was done at the end of phase three. The focus group data were analysed using the framework analysis approach
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