Factors contributing to tuberculosis mortality among new tuberculosis patients in Zululand Health District
- Authors: Dlamini, Khulekani Zakheleni
- Date: 2018
- Subjects: Mortality Tuberculosis -- Mortality Tuberculosis -- Patients
- Language: English
- Type: Thesis , Masters , Public Health
- Identifier: http://hdl.handle.net/10353/10667 , vital:35657
- Description: During the period ranging from 2011 to 2013, Zululand Health District reported tuberculosis (TB) related mortality cases above the WHO’s norm of 10 percent. This raised concerns because TB is curable even if the person is HIV positive. The overall performance of TB programme in South Africa concealed the actual problem of TB related mortality in the country and most particularly in Zululand Health District. The aim of the study was to examine factors contributing to TB mortality, and the extent of TB related mortality in Zululand Health District. A retrospective, descriptive study was conducted to review records of data on the electronic TB register at the district level in order to ascertain the relationship between TB mortality and the contributory factors associated with TB mortality. The TB data was analysed using descriptive and inferential statistics to test the null hypothesis at the significance level of p< 0.05. The study was limited to only new patients enrolled between the periods from the 1st January 2012 to the 31 December 2013. The study found that TB/HIV comorbidity was a main factor contributing to mortality among new TB patients. Eighty percent (80%) of all patients who died were HIV positive. Poor CD4 monitoring, delays or failure to initiate TB/HIV comorbid patients was one of the factors associated with mortality (p < 0.0001, OR 0.51) among this cohort of patients. Poor DOT support system significantly (p< 0.0008, OR 0.81) contributed to mortality in this district. The study also found significant association between mortality and failure to initiate comorbid patient on co-trimoxazole prophylaxis (Chi-square =9.1; df=1; p=0.0025). Tuberculosis and HIV comorbidity, and delays or failure to providing antiretroviral therapy to HIV positive patients were the main factors responsible for TB mortality in Zululand Health District. The whole phenomenon was attributable to health worker related factors. Good TB/HIV clinical management guidelines and protocols developed by the Department of Health, and distributed to all health facilities did not alleviate the problem. Support and supervision could translate policies and protocols to action.
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- Date Issued: 2018
Perceptions, knowledge and attitudes of women towards maternal deaths at Qaukeni Sub-district in OR Tambo Health District in Eastern Cape Province, South Africa
- Authors: Mayekiso, Nomahlubi Dorcas
- Date: 2018
- Subjects: Maternal health services--South Africa--Eastern Cape Mothers--Mortality
- Language: English
- Type: Thesis , Masters , Public Health
- Identifier: http://hdl.handle.net/10353/11194 , vital:37203
- Description: BACKGROUND AND AIM: Maternal mortality is a global problem, with the risk of deathever present during pregnancy, labour and postnatal, particularly in developing countries. The purpose of the study was to explore the perceptions, knowledge and attitudes of women of child-bearing age concerning maternal deaths in Qaukeni Sub-District, Eastern Cape Province, South Africa. METHODS: A descriptive, contextual, exploratory research design was used to explore the perceptions, knowledge and attitudes of child-bearing-age women. Interviews were conducted with 21 purposively selected multiparous pregnant women. FINDINGS: Some of the participants knew signs and symptoms of pregnancy as well as danger signs during pregnancy such as haemorrhage, sepsis, high blood pressure and complications of unsupervised home deliveries; while others had little knowledge about these signs and symptoms. Some participants knew about the causes of maternal deaths and a number of them had beliefs that can be construed as myths. The use of herbal medications in pregnancy, such as gwarugwaru and mbelekisane, were highlighted as a problem in maternal health, with serious complications that can lead to maternal deaths. The participants have negative attitudes towards the clinics and hospitals due to the ill treatment they received from health professionals in labour wards, which may have led to the loss of lives of women and children. Lack of resources, unskilled traditional birth attendants, lack of accountability and responsibility by health professionals were contributory factors towards maternal deaths. CONCLUSIONS: Lack of resources, unskilled traditional birth attendants, lack of accountability and the irresponsibility of professional nurses and doctors were all pointed out by participants as either direct or indirect causes of maternal deaths. The recommendations include frequent in-service training for unskilled birth attendants, and the provisions of more professional nurses and doctors. Campaigns also need to be held to highlight the risks that women are exposed to during pregnancy, and the importance of early interventions.
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- Date Issued: 2018
Physiological traits, anthropometric characteristics and motor development of rural children in Nkonkobe Municipality, South Africa
- Authors: Idamokoro, Mere
- Date: 2018
- Subjects: Motor learning Children -- Physiology Children -- Anthropometry -- South Africa
- Language: English
- Type: Thesis , Masters , Human Movement Science
- Identifier: http://hdl.handle.net/10353/10061 , vital:35314
- Description: Aim: The purpose of this study was to examine the physiological, anthropometric and motor development characteristics of rural children between the ages of 5 – 7 years old. Methods: The study involved 305 school children (159 boys and 146 girls) randomly selected from primary schools in Alice sub-district, Nkonkobe Municipality. Body weight, height, skinfold thickness and girth measurements were measured using standard procedures. Overweight and obesity were defined using body mass index (BMI) for age and gender. Derived variables were: fat mass, fat-free mass, fat mass index, fat-free mass index, waist-to-hip ratio, waist-to-height ratio and subscapular-to-triceps ratio. Motor development levels were measured and assessed using Test of Gross Motor Development –Second Edition (TGMD-2). Blood pressure was measured using aneroid sphygmomanometer. Results: Boys had higher mean values of blood pressure (69.19 ± 7.30 and 38.15 ± 5.91) compared to girls (68.39 ± 7.97 and 37.11 ± 7.53). The proportion of overweight among girls (15.75 percent) was higher compared to boys (10.69 percent). Likewise, the percentage of obesity among boys (16.35 percent) was higher compared to girls (10.27 percent). The motor development results showed that girls (40.9 ± 6.54) performed better than boys (39.7 ± 6.64) in locomotor skills test. Conversely, boys (39.8 ± 7.62) performed better than girls (38.6 ± 7.29) in object control. Conclusion: The prevalence of overweight and obesity among the children is alarmingly high and concerning for the health. At all ages, girls had higher body fat percentage and fat mass than the boys. However, FFMI and WHR were higher in boys compared to the girls. There is no gender difference in the waist-to-height ratio and STR of both boys and girls. The locomotor raw score is higher in girls than in boys; however, the object control raw score is higher in boys compared to girls. The non-correlation of BMI with TGMD-2 tests suggests an equal potential of motor development among the children, regardless of their body fatness. There is need for obesity prevention programme in schools, which should involve all the stakeholders (teachers, parents/guardians, government, NGOs). The programme should focus on creating awareness concerning child body weight, healthy dietary intake and regular BMI screening in schools.
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- Date Issued: 2018
Screening for cardiometabolic risk factors among commercial drivers in Buffalo City Metropolitan Municipality, Eastern Cape, South Africa
- Authors: Adedokun, Aanuoluwa Odunayo
- Date: 2018
- Subjects: Diabetes -- South Africa -- Eastern Cape Obesity -- South Africa -- Eastern Cape Commercial vehicles
- Language: English
- Type: Thesis , Masters , Nursing Science
- Identifier: http://hdl.handle.net/10353/10431 , vital:35463
- Description: Cardio-metabolic risk factors are the aggregates of conditions that increase the susceptibility of developing cardio-metabolic diseases such as cardiovascular diseases (CVD) and diabetes. This includes insulin resistance, obesity, hyperglyceamia, dyslipoproteinemia, hyperinsulinemia and hypertension. This condition are worsen by smoking and physical inactivity as they mostlyare not easily detected. This was a cross-sectional survey of 403 commercial taxi drivers at ten different taxi ranks in BCMM. The study utilized a convenient sampling technique for the participants of the study. The WHO STEPwise approach was used for data collection. The WHO STEPwise questionnaire was used for a face-to-face interview. Socio-demographic (sex, age, marital status, driving experience, income) and behavioural characteristics (smoking, alcohol consumption, consumption of sweet drinks, physical activity, and dietary intake) of participants were obtained. Also, objective reports concerning anthropometric measurements (weight, height, waist and hip circumference), blood pressure and biochemical measurement that is the blood glucose measurement. All anthropometric measurements were taken following a standard procedure using a Lufkin nonextensible flexible anthropometric tape (W606PM), Rosscraft, Canada and a SECA weighing scale and stadiometer (Hamburg, Germany). Blood pressure was checked also in accordance with standard protocols using a Medic+ Digital Blood Pressure Monitor Model 1219 (Hamburg, Germany). A validated ACCU-CHEK glucose monitoring apparatus (Mannheim, Germany) wasused for blood glucose measurement. Overweight and obesity was defined as a body mass index (BMI) of 25.0 kg/m2 –29.9 kg/m2 and≥ 30 kg/m2, respectively. Pre-hypertension was defined according JNC-8 criteria a systolic blood pressure of 120- 139 mmHg and diastolic of BP 80-89 mmHg while hypertension was defined as an average of two systolic BP ≥140mmHg and/or diastolic BP of ≥90mmHg or a history of hypertension or anti hypertensive medication use. Diabetes status was determined using the fasting blood glucose (FBG) test and defined as a FBG ≥ 7.0mmol/L or self-reports of history or current diabetes medication use (treatment), while pre-diabetes was defined as a FBG of 5.6-6.9mmol/L. Awareness of diabetes was defined as self-reported history of diabetes among the people with diabetes. Metabolic syndrome status was determined according to the National agreement among makers of abdominal obesity. Statistical Package for Social Sciences (SPSS) was used for data analysis. The mean age of the participants was 43.3 (SD12.5) years. The prevalence of overweight and obesity was 34.0 percent and 38.0 percent, respectively. Age, marital status, period of driving, not-smoking, hypertension and diabetes were significantly associated with obesity. In logistic regression analysis, after adjusting for confounding factors, only age (OR 1.6, CI 1.0-2.7), hypertension (OR 3.6, CI 2.3-5.7) and non-smoking (OR 2.0, CI 1.3-3.1) were the independent and significant determinants of obesity. The prevalence rates of abdominal obesity by waist circumference (WC), waist-hip-ratio (WHR), waist-to-height ratio (WHtR) and neck circumference (NC) were 61.5 percent, 67.5 percent, 80.1 percent and 65.3 percent, respectively. A strong correlations exists between WHR and WC (>0.64); and WHtR and WC (>0.62). There exists a good agreement between WC and WHR. Also, a moderate agreement exists between WC and WHtR, WC and NC, WHR and WHtR, and WHtR and NC. The prevalence of above normal body composition for participants with hypertension was 71.0 percent, 65.9 percent, 63.2 percent and 66.5 percent by WC, WHR, WHtR and NC, respectively. For diabetes, the prevalence was 20.6 percent, 19.4 percent, 17.0 percent and 18.6 percent by WC, WHR, WHtR and NC, respectively. Waist circumference was a stronger predictor of hypertension and diabetics, with odds ratio of 3.7 (95 percent CI: 2.3-6.1 and 3.1 (95 percent CI: 1.6-6.0), compared to NC, with odds ratio of 1.7 (95 percent CI: 1.1-2.8). The prevalence of pre-hypertension was 33.7 percent and hypertension was 57.0 percent. Age, marital status, level of education, period of driving, obesity, alcohol, sweet drinks consumption and diabetes were significantly associated with hypertension. After adjusting for confounders, age >35 years (P=0.004), obesity and alcohol use (P<0.001), period of driving >5years (p=0.028) and diabetes (P=0.003) were significant predictors of hypertension. Prevalence of pre-diabetes and diabetes was 17 percent and 16 percent, respectively. Of those who were diabetic (n=63), the majority were aware of their diabetes status (n=43) and were on treatment (n=30). Age, marital status, level of education, period of driving, obesity, sweet drinks consumption, physical activities and hypertension were significantly associated with diabetes. Only age >35 (AOR= 3.6, CI 1.2-11.1), ever married (AOR= 3.3, CI 1.5-7.0) and hypertension (AOR= 3.4, CI 1.7-6.8) were the independent predictors of diabetes after adjusting for confounders. The prevalence of metabolic syndrome was 22 percent. Age, marital status, level of education, physical inactivity and period of driving were significantly associated with metabolic syndrome. After adjusting for confounders, only age above 35 years (Adjusted Odd Ratio [AOR] =3.8, CI=1.4- 9.5), ever married (AOR=3.0, CI=1.6-5.3) and period of driving above five years (AOR= 2.4, CI=1.2-4.7) were the significant and independent predictors of metabolic syndrome. About 30 percent of the participants were daily smokers, 37 percent consume alcohol regularly and only 18 percent were physically active, while 82 percent were physically inactive. In conclusion, there was a high prevalence of obesity, hypertension and diabetes among the commercial drivers in this setting, which is associated with unhealthy lifestyles (smoking, excessive alcohol consumption, physical inactivity). Interventions aimed at promoting cardiovascular health of commercial drivers such as health education and workplace screening, should prioritize weight reduction, healthy eating and physical activity in this population.
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- Date Issued: 2018
Secrets that kill : reflections on violation of cultural rights enshrined in the constitution and human rights through traditional circumcision
- Authors: Mlisa, Lily Rose Nomfundo
- Date: 2018
- Subjects: Human rights--South Africa Circumcision Circumcision--Law and legislation
- Language: English
- Type: Thesis , Masters , Public Health
- Identifier: http://hdl.handle.net/10353/11150 , vital:37176
- Description: The study was based on four research objectives: (1) to identify philosophy, psychology, cultural reasons behind the harsh and traumatic experiences of young Xhosa boys and their mothers during ukwaluka (male circumcision) as a mark for transition to manhood; (2) to review perceptions concerning the role of mothers during the male circumcision (MC) process (3) identify cultural and psycho-social construction and meaning of MC and (4) to explore recommended possible strategies on managing MC-related traumas and deaths in the Sub-Saharan region and Eastern Cape Province in particular. Desktop literature review methodology was followed. An in depth literature review was conducted on diverse website search engines using a set of inclusion criteria. Published articles from 1995 to 2015 were selected. Thematic content analysis was used to categorise and interpret emerging themes from the reviewed articles as aligned to set research objectives. Results revealed diverse philosophical and cultural perceptions around MC, its construction and meaning among different cultures whether circumcising or non-circumcising cultures. In addition, various reasons are laid out for the harsh treatment given to initiates in different settings. Results also indicated that the MC is no longer a secret due to social media profuse publications about it. The impact of education and health care benefits around medical male circumcision (MMC) has influenced women from both non-circumcising and circumcising cultures to accept it. It is recommended that MC should continue under strict observation of prescribed protocols to lessen or prevent malpractices in the process. MMC is also highly recommended. In addition, the government and traditional leaders have to continue to conduct capacity building of traditional surgeons, prospective initiates and initiates including nurses and family members about crucial protocols and health matters around MC. Finally, results recommend best practices that could be learnt from other circumcising cultures to restore the respect of MC in the Eastern Cape, as well as inclusion of women in the MC process management.
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- Date Issued: 2018
The effectiveness of employee assistance programme and its contribution in the improvement of employee productivity in the Department of Health, OR Tambo District : a case study of forensic pathology laboratory
- Authors: Siyangaphi, Thembinkosi
- Date: 2018
- Subjects: Employee assistance programs -- South Africa -- Eastern Cape Labor productivity Employee motivation -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , Public Health
- Identifier: http://hdl.handle.net/10353/10542 , vital:35603
- Description: The Employee Assistance Programme (EAP) is a programme used by organizations to address problems related to drug addiction, stress and family problems, aimed at enhancing both work productivity and promoting high morale among the workers. The employees in the Department of Health (DoH) are faced with many challenges which affect them, personally, and their output at work. The OR Tambo District is currently faced with high levels of absenteeism, stress, low morale amongst health staff members, resulting in most employees resigning from the service. Others die due to ill health caused by high levels of stress and depression. Some employees are being dismissed for unethical behaviour, which include, among other things, alcohol and drug abuse and abuse of state resources, non-performance and absenteeism. Furthermore, due to the shortage of staff which results in a very high workload for the incumbents, some employees experience burnout, stress, depression and exhaustion. The main objective of the study was to assess the effectiveness of the Employee Assistance Programme among OR Tambo health workers in order to improve their work productivity and performance. The study applied a descriptive, quantitative design. The target population were all employees in the Forensic Pathology Laboratory in OR Tambo District and the sample included Managers, FPOs, Supervisors and General Assistants. The questionnaire was used to collect data. The major findings of the study demonstrated that most workers are dissatisfied with their personal growth and development in the organization. Furthermore, the results indicate that respondents are not satisfied with the decision space in their job functions, salary and benefits. The findings of this study demonstrated that most employees of the Department of Health experienced health, emotional and financial problems relating to alcohol and drug abuse, stress and work overload in their workplace. The study shows that the managers referred their employees for cases related to poor performance, absenteeism, alcohol and drug abuse, tiredness, employee and health problems; changes which were noticeable after referral. One of the major conclusions and recommendations that have been drawn in this study is that EAP is a good programme in terms of its contribution to work productivity of employees, however, it needs to be marketed and services should be utilized effectively.
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- Date Issued: 2018