1,720,967 research outputs found
Qualitative Assessment of the Utilisation of Tier.Net Health Information among facility and programme managers In Ekurhuleni district, Gauteng
No full textMagister Commercii - MCom (IM) (Information Management)The South African National Department of Health (NDOH) developed TIER.net - a three-tiered
health information system to improve the quality of routine data collection and for the proactive
information-driven management of the HIV/AIDS care and treatment programme. Current
quarterly reports indicate inefficiencies in the national HIV/AIDS treatment programme, which
point to high proportions of patients on antiretroviral therapy (ART) lost to follow up, low
proportions of patients with viral-load tests done, and numerous instances of drug and
commodity stock-outs. This means that even though information generated from TIER.net is
readily available to facility managers and programme coordinators in the HIV and AIDS/
Sexually Transmitted Infection/TB (HAST) programme, the information is not effectively used
to inform programme planning, implementation and monitoring. The current study evaluated
the use of information generated from the TIER.net information system among facility and
programme managers in the Ekurhuleni District, Gauteng Province by considering technical,
behavioural and organisational factors that influence use
Adherence to highly active antiretroviral therapy among patients in the Keetmanshoop antiretroviral therapy programme, Namibia
Get PDFMagister Public Health - MPHThe government of Namibia established a comprehensive HIV/AIDS treatment and care programme in 2002. This programme provides anti-retroviral treatment to all eligible HIV patients in the public health sector. The antiretroviral treatment programme in Keetmanshoop started in October 2003. Adherence to treatment regimes in HIV care is a key factor in determining clinical outcomes and is associated with improved survival among HIV and AIDS patients. Sustained high levels of adherence (95% or more) are essential for the success of highly active antiretroviral therapy (HAART). Maintaining high adherence levels is therefore a major concern in HIV/AIDS treatment programmes. This study investigated
adherence to HAART among patients in the Keetmanshoop antiretroviral therapy (ART)clinic and the factors that affect adherence.Aim of the research The aim of the research was to describe adherence to HAART and factors influencing adherence among patients in Keetmanshoop ART clinic, Namibia.Objectives: 1. To describe levels of adherence to HAART amongst clients at Keetmanshoop ART clinic. 2. To assess the changes in CD4 count and body weight of clients on HAART over a 12 month period.3. To assess factors associated with adherence to HAART.4. To analyse associations between CD4 count and adherence.
5. To analyse associations between changes in body weight and adherence. Methodology: A quantitative descriptive cross-sectional survey was used. The study population included all clients 18 years and above, who were on HAART for one year or more at the Keetmanshoop clinic. One hundred and six clients participated in the study. Data was collected through an interview with the participants and a review of clinical records. Results: Most respondents had good adherence levels; with 86.1% reporting optimal adherence levels.The respondents also showed an increase of median CD4 counts from 126 cells/μl at baseline to 304 cells/μl at 12 months and an increase in body weight from an average of 50kg at baseline to an average of 57kg at 12 months. Adherence levels were found to have an impact on CD4 cell counts and on body weight, with respondents who had sub-optimal adherence experiencing a drop in median CD4 cell counts and median body weight by 12 months.Living far from the clinic (>10km) was found to be the only factor significantly associated with sub-optimal adherence.Conclusion: The study showed a positive correlation between adherence levels and CD4 cell counts and body weight gain. In the absence of viral load, CD4 cell count testing can be used as a measure of adherence. Though most respondents appear to be adhering well to HAART, a sub-optimal adherence rate of >10% is a concern for the Keetmanshoop ART programme and will need to be addressed. There is a need for further research to determine the level of default or attrition from HAART in the programm
Qualitative Assessment of the Utilisation of Tier.Net Health Information among facility and programme managers In Ekurhuleni district, Gauteng
Get PDFMagister Commercii - MCom (IM) (Information Management)The South African National Department of Health (NDOH) developed TIER.net - a three-tiered
health information system to improve the quality of routine data collection and for the proactive
information-driven management of the HIV/AIDS care and treatment programme. Current
quarterly reports indicate inefficiencies in the national HIV/AIDS treatment programme, which
point to high proportions of patients on antiretroviral therapy (ART) lost to follow up, low
proportions of patients with viral-load tests done, and numerous instances of drug and
commodity stock-outs. This means that even though information generated from TIER.net is
readily available to facility managers and programme coordinators in the HIV and AIDS/
Sexually Transmitted Infection/TB (HAST) programme, the information is not effectively used
to inform programme planning, implementation and monitoring. The current study evaluated
the use of information generated from the TIER.net information system among facility and
programme managers in the Ekurhuleni District, Gauteng Province by considering technical,
behavioural and organisational factors that influence use
Patient satisfaction with public primary health care service delivery in Khomas region, Windhoek district Namibia
Get PDFMagister Public Health - MPHPrimary Health Care (PHC) services in Namibia are based on the principles of equity,availability, accessibility, affordability of services, and community participation and empowerment. According to the Namibian Constitution and the National Health Policy,all Namibians should have equal access to public health services at no cost to the patient.The government places a high premium on the involvement of communities in PHC through communication, consultation and respectful interaction between health workers and patients and communities in the interests of quality service delivery. Services provided at PHC facilities include immunisations, antenatal care, post-natal care, family planning, health education, tuberculosis and malaria treatment, outreach services, antiretroviral treatment (ART), and the Prevention of Mother to Child Transmission(PMTCT) programme.
Numerous complaints have been received from patients relating to patients' admissions at clinics, long waiting hours, over-crowded facilities, poor communication between patients and nurses, and non-availability of some medications and medical officers at some of the PHC facilities.This study investigated patient satisfaction and the reasons for reported poor nursepatient
relations at PHC facilities in Khomas region in Namibia. The objectives of the study were to describe patient’s perceptions concerning quality of service delivery at PHC clinics, to explore factors related to the clinic environment that might influence
perceived quality of care and to describe the nature of nurse-patient relations.
Methodology A descriptive, qualitative study was conducted among randomly selected patients (15) and registered nurses (5) at five purposively selected PHC clinics in Khomas region, in the Windhoek district. Five sisters-in-charge from the designated facilities were interviewed as key informants.Data was collected through key informant interviews and focused interviews with nurses and patients, respectively. Data on the participants’ experiences and perceptions of using the health services, as well as factors influencing nurse-patient relations and patient
satisfaction was collected. Interview data was recorded on audiotape and transcribed verbatim. Data from key informants was captured in field notes. Thematic analysis of transcribed data was conducted.Results Low patient satisfaction with services was confirmed as a key problem facing four out of the five health facilities visited in Khomas region. Patient dissatisfaction was mostly
related to the long waiting times, which in turn, was caused by increased patient numbers as a result of the escalating HIV/AIDS and tuberculosis (TB) epidemics, ART roll out and increased immigration to Windhoek. Other factors attributed to low patient satisfaction were poor communication between health providers and patients, nonavailability of family planning and immunisation services, and frequent stock-outs of some prescribed medicines.ConclusionsThe findings of this study support the need to rethink nurse-patient relations for greater patient satisfaction and quality of service delivery in the public Primary Health Care facilities in Khomas region. Greater care should be taken to inform patients about service
days and the staffing limitations at health facilities, and to educate and empower patients for self-care. Communication strategies should target negative perceptions about service delivery at PHC clinics in the communities. In-service training in areas like case management, different PHC disciplines and communication skills are needed to improve the competency of nurses. In addition, motivation of nurses needs to be addressed through recognition and appreciation from management in order to avoid frustrations and negative attitudes towards patients. Motivation of nurses can be improved by paying attention to their work environment and the physical structure of health facilities
Barriers to adherence to antiretroviral treatment in a regional hospital in Vredenburg, Western Cape
Get PDFMagister Public Health - MPHBackground: South Africa has one of the most severe HIV epidemics globally, with an estimated 737,000 AIDS related deaths annually and over a million children rendered orphans due to AIDS in 2006. However in 2007, the South African government made a giant commitment to dealing effectively with the AIDS epidemic by implementing a National Strategic Plan (NSP), which had as one of its principal objectives the provision of antiretroviral medications to 80% of all people in need of the treatment by 2011. By the end of June 2011, the rollout of antiretroviral therapy continued to be successful with 1.4 million persons started on antiretroviral therapy and treatment initiation rates reaching 30, 000 per month. Patients have to subject to an uncompromising adherence of taking at least 95% of
antiretroviral medication as prescribed, because poor adherence to ART leads to treatment failure, viral mutations and the development of drug resistance. Of major concern to ART programmes are the current obstacles that patients’ face in lieu of treatment. Aim: The aim of this study was to explore the barriers to adherence to antiretroviral treatment among patients in a public ART programme in Vredenburg, Western Cape. Methodology: An explorative qualitative study was conducted where data was collected through interviews with 18 patients receiving treatment from the Vredenburg hospital. Data was audio-tape recorded, transcribed in full and thematic content analysis done. Results: The study identified awareness of HIV status, disclosure, unemployment, lack of transport,insufficient feeding, disability grants, alcohol and alternative forms of therapy as well as stigma as major barriers to adherence. Whereas inadequate follow ups, recklessness in the way patients’ HIV results were handled, long waiting times and the fear of picking up other types of infections from other patients in the OPD also came under major criticisms from patients. Finally, the sharing of experiences at clinic visits, good healthcare provider’s patient relationships, believing in the treatment, good treatment literacy, being a parent and having children to take care of, the use of pill boxes, social and spiritual support from family members and friends were identified as factors that positively influenced adherence. Conclusion:
HIV/AIDS has been a stigmatized illness since its onset in the early 1980s and, these results highlight that such stigma has yet to dissipate in Vredenburg. Therefore, stigma and disclosure must remain at the forefront of the ART programme implementation in Vredenburg; while long term projects that can support ART users economically should be created through partnerships with non-governmental organizations and the government of South Africa to optimize adherence in the community
Knowledge, beliefs and practice about sexual concurrent partnering amongst education students at a tertiary institution in rural Namibia
Get PDFDoctor EducationisBackground: In an attempt to avert the HIV/AIDS epidemic, more research has been conducted to determine why the epidemic is more devastating in Southern African countries than anywhere else in the world. Heterosexual transmission is believed to be driving the epidemic in many sub-Saharan African countries. Recent research has indicated that having concurrent sexual partners is one of the factors contributing to the fast spread of HIV transmission in this region.Aim: This study aimed to describe the level of knowledge about the risk of HIV transmission posed by concurrent sexual partnering as well as beliefs and practices about concurrent partnering among education students at the Rundu College of Education(RCE) in the Kavango region of Namibia. Concurrent partnering was defined as a situation where a person has more than one sexual partner at the same time, during the
twelve months preceding the study.Methodology: There were 374 students registered for the 2009 academic year at RCE.All registered students were targeted for the study and 278 completed the questionnaire,yielding a response rate of 73.4%. The survey described prevalence of concurrent partnering, knowledge about risk posed by concurrent partnering as well as beliefs about concurrent partnering.Data collected was analyzed using Statistical Programs for Social Sciences (SPSS).Descriptive statistics were used to describe the prevalence of sexual concurrency,knowledge about risk posed by concurrent partnering and beliefs about concurrent partnering among the study population. Frequency of concurrency was cross tabulated with demographic variables like age group, sex and year of study as well as by knowledge and beliefs about sexual concurrent partnering.Results: The prevalence of concurrency in this sample was 9.4% with significantly higher prevalence (13.0%) among male students compared to females (5.3%). Males reported knowledge levels of 85.7% to 88.4% while females reported knowledge levels of 89.3% and 93.1%. More men (28.8%) than women (10.7%) agreed with the statement that sexual concurrency is a sign of manhood (p=0.00). Further, more male students(27.9%) compared to female students (6.1%) agreed with the statement that sexual concurrency is part of African culture and should continue (p=0.00).Conclusion: The study results show a high knowledge of risk posed by concurrency. It further reveals that a high number of people believe that concurrency is acceptable especially among men.HIV prevention activities promoting partner reduction and mutual fidelity should be implemented. Such activities should focus more on behavior change rather than on information giving. There is a need to create platforms for community members to debate
on cultural beliefs about sexual concurrency
A 12 year review of routine data for deliveries by teenaged women in public sector health care facilities in the Western Cape Province, South Africa, from 2000 – 2012
Get PDFMagister Public Health - MPHBackground: The factors that underlie teenage pregnancies are complex and
multifactorial. The prevailing perception is that teenage pregnancies are increasing in South Africa. However, the empirical extent and trends in teenage births in the Western Cape Province are not well understood. A systematic analysis of routine health information for the data element.Delivery in facility to women under 18 years for the period 1 April 2000 to 31 March 2012 is presented in order to contribute to documenting and understanding how this problem manifests in the Western Cape Province.Objectives:The objectives of the study were to describe the trends in the number of deliveries for women under the age of 18 years in the Western Cape Province for the period 1 April 2000 until 31 March 2012, and to compare the trends within and between districts. A secondary aim was to explore the quality and usefulness of Routine Health Information in the Western Cape
Province focusing on the dataset for deliveries for women under the age of
18 years.Methods:The data for the Province extracted from the Sinjani system (the data repository for health information management in the Western Cape Department of Health) was subjected to a trend analysis at the Provincial,
District and Sub-District level. The absolute numbers of all deliveries, and
deliveries for women under the age of 18 years as well as proportions of
deliveries for women under the age of 18 years were compared across districts, years and seasons. Results were discussed with senior managers in the Department of Health as compared to performance indicators presented
in workshop settings to triangulate and help interpret findings.Findings
The key finding is that both the absolute number of deliveries for women
under the age of 18 years and the deliveries for women under the age of 18
years relative to all deliveries have declined steadily since 2007, while 8 absolute numbers of deliveries in 2012 were only slightly higher than in 2000-2001, despite an increase of 19.4% in the total population of the Province between 2002 and 2011. Despite the decline in the number of deliveries for women under the age of 18 years, the number of deliveries remains high. Seasonal increases in numbers of deliveries coincide with school holidays in most districts. The data analysis also revealed challenges with the quality of the data, and that it is not possible to determine the age distribution of deliveries across women under 18 years from the provincial data set. Routinely collected data do not permit analysis or comparison of
births at the ward level where significant socio-economic variations are likely to influence fertility.Conclusions and Recommendations:The data did not support widespread perceptions of rapidly increasing teen births. The declining birth rates and relatively stable proportion of under 18 births relative to all births suggest that adding new indicators throughout the entire routine information system is not justified on public health or economic grounds. However, more detailed and disaggregated evidence is needed to inform locally tailored interventions and could be obtained from alternate sources of information such as point prevalence surveys, annual surveys, or data collection at sentinel sites. While teenage birth rates are not increasing, they remain high. It is recommended that additional service delivery models be explored to ensure that sexual reproductive health
services are strengthened and delivered in a manner that would be acceptable to young people. Further, it is recommended that programmatic interventions that target the sexual reproductive health choices made by young people be scaled up in partnership with intersectoral partners and communities in order to mitigate against seasonal increases in the number of deliveries for women under 18 years of age
Comparison of loss to follow-up amongst HIV and AIDS patients in care and treatment in Kisumu, Kenya
Get PDFMagister Public Health - MPHBackground: Even though there have been marked increases in the number of patients accessing HIV care and treatment in sub-Saharan Africa, challenges in patient retention remain. Most health systems in sub-Saharan Africa routinely report on loss to follow up of patients, but only a limited number of factors associated with loss to follow up are measured. In Kenya there is limited research on loss to follow up in HIV care and treatment programs. This study reports on rates of loss to follow up and factors associated with loss to follow up at the New NyanzaProvincial General Hospital (NNPGH) in Kisumu, Kenya. Methods: A retrospective cohort study of 4,740 adult patients that was registered for HIV and AIDS care and treatment between 2003 and 2008 was conducted. Data was analysed using SAS 9.2 and STATA 10. Cox proportional hazard ratio was calculated to describe the association between risk factors and loss to follow up. Results of the total 4740 patients, 64.6% were female, males [median age of 36 (IQR 30-44) years vs. 32 (IQR 26-39) years for females] were older than females, more males (68.3%) were married, more females (6.2%) had no education and 68% of all patients enrolled had been lost to follow up over 6 years. Risk for lost to follow up was greater amongst males (Adjusted Hazard Ratio (AHR) =1.12; 95% Confidence Interval (CI) = 1.02-1.22); younger patients(15-30 vs. >40 years: AHR=1.37, 95%CI = 1.23 – 1.53; and 31-40 vs. >40 years: AHR=1.15, 95%CI=1.03-1.28); those who were unemployed (AHR=1.14, 95%CI=1.05-1.25); and having advanced HIV disease (WHO stage 4 vs. WHO stage 1: AHR=1.53, 95%CI=1.29-1.81). Patients on ART (AHR=0.64, 95%CI=0.52-0.78) at enrollment were less likely to be lost to follow-up compared to those in HIV care. Conclusion: More attention is needed in developing retention strategies for patients with much focus on patients on care. Targeted intervention is required to improve retention amongst males, unemployed patients, patients with advanced HIV disease and younger patients. Additionally, targeted follow up in the community for patients on care is required
Prevalence and risk factors of adverse events during treatment of drug resistant tuberculosis in a setting of high human immunodeficiency virus co-infection in Namibia : 2009-10
Get PDFMagister Public Health - MPHNamibia is currently coping with a dual burden of human immunodeficiency (HIV) and HIV-associated tuberculosis (TB). In 2010, HIV prevalence was 18.8%, the TB case notification rate was 634 per 100,000 population, while TB/HIV co-infection was 58% in 2009. There were 372 reported cases of drug-resistant TB (DR-TB) in 2009. This study assessed the prevalence, profile and outcome of adverse events (AEs) associated with the treatment of DR-TB, and risk factors for the adverse events. The researcher used a cross-sectional design. Data was collected from the treatment records of all patients treated for DR-TB (N = 59) at the study facility between January 2008 and February 2010. Descriptive statistics were used to describe the frequency of the adverse events and logistic regression to analyse the association between possible risk factors and (specific) adverse events, with stratification (sub-group analysis) and multivariate analysis to adjust for measured confounders. Results of logistic regression analysis are reported as odds ratio (OR), 95% confidence interval (CI) and p-value, where p<0.05 was considered to be statistically significant. A total of 141 adverse events were experienced by 90% (53/59) of patients in the sample. HIV-associated TB occurred in 31 (53%) of the sample. The prevalence of gastrointestinal tract (GIT) adverse events was 64%, tinnitus 45%, joint pain 28% and decreased hearing 25%. Abdominal pain, rash, nausea, decreased hearing and joint pain were found to be more common in people living with HIV than in HIV-negative patients. Moderate-to-severe adverse events were mostly experienced after four weeks of DR-TB treatment (OR 6.4; 95% CI 1.6 – 25.6, p= 0.01). Drug-resistant TB patients who were coinfected with HIV were more prone to experiencing three or more adverse events (OR 3.9; 95% CI 1.2 – 13.6, p= 0.03). Patients treated with zidovudine-based ART were at an increased risk of experiencing nausea (OR 7.5; 95% CI 1.1 -51.5, p=0.04). Females were associated with an increased risk of skin rash (OR 15.7; 95% CI 1.7 – 143.7, p=0.01). The use of cycloserine-based DR-TB regimens was associated with joint pain (OR 6.5; 95% CI 1.6 – 25.8, p=0.01), while the risk of ototoxicity was associated with the use of amikacin-containing regimens (OR 12.0; 95% CI 1.3 – 111.3, p=0.03). Adverse events were found to be more common among patients treated for DR-TB (90% prevalence), particularly during the intensive phase of TB therapy. Most of these adverse events were mild and tolerable. Some adverse events were more common among DR-TB patients who were co-infected with HIV than in HIV-negative patients. The characteristics and risk factors of the serious adverse events need further research. The use of cycloserine-based DR-TB regimens was associated with joint pain. Findings of the risk factor analysis are inconclusive because of the small sample size, which severely limited the power of the study. Clinicians should invest more time in the prevention and management of adverse events, and should pay greater attention to the needs of HIV co-infected DR-TB patients who are using second-line anti-TB medications, especially those who are concomitantly undergoing treatment using antiretroviral medicines
Assessing knowledge, attitude and practices of male condom use among male employees fifty years and older at a diamond mining company in Namibia
Get PDFMagister Public Health - MPHBackground: The HIV / AIDS pandemic have been characterized as the greatest natural challenge ever to confront humanity and one of the great moral causes of our time (World Bank, 2007). Although, the HIV and AIDS pandemic is a global problem, some regions of the world, notably sub-Saharan Africa are hardly hit by the pandemic. Namibia is one of the sub-Saharan African countries which are badly affected by the HIV and AIDS pandemic. It is estimated that about 360 000 Namibians were infected with HIV by 2010. This translates to a national HIV prevalence of (18.8%). The National HIV and AIDS Response Department has designed various interventions and strategies to curb the spread of the HIV. Promotion of male condoms promotion is one of the key strategies being advocated. If used consistently and correctly, male condoms are regarded as an effective preventive tool of HIV transmission. However, changing individual’s sexual behaviors and lifestyle to make condom use part of their sexual life seems to be the challenge. In Namibia most of the research in the area of HIV and AIDS were done among the youth and population aged between 15 – 49 years. Hence, this study looks at older men as a neglected population. Aim: The aim of the current study was to assess knowledge, attitudes and practices of condom use among male employees age 50 (fifty) years and older at a mining company in Southern Namibia. Methodology: A descriptive, cross-sectional survey utilizing quantitative research approach was applied. Data was collected through face-to-face interviewing male employees, age fifty years and older, while at work at the Mine Area 1 (MA1). Data was captured in excel and imported into SPSS version 16.0. Chi-square test was used to determine the association between KAP variables and the socio-demographic characteristics of the respondents. The level of statistical significance was set at 0.05. Results: Among 105 respondents (males, mean age 54.5 years), more than half lived in the singe sex male hostels. Knowledge about condom use was good but there remained a significant number of the respondents whose knowledge was insufficient. A high percentage of the respondents suggested that HIV positive individuals should always use condom every time they have sexual intercourse. Conclusion: This study showed that respondents are not at a high risk of contracting HIV infection due to lack of knowledge on condom use though some of them possessed insufficient knowledge. Thus, to minimize the likelihood of HIV infection targeted interventions including peer education programmes were suggested, and working with the community in the area. Moreover, a more comprehensive knowledge attitude and practice study among mine employees from various sections of the mine would be beneficial to identify the level of risk within the total employee population
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