Assessment of quality nursing care in healthcare facilities of Mnquma Sub-District
- Authors: Manyela, Nosiphiwo
- Date: 2019
- Subjects: Health facilities
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16747 , vital:40770
- Description: Aim: The purpose of the study was to assess the quality of patient care in the Primary Health Care (PHC) facilities of Mnquma Sub-district with the goal of improving or maintaining quality nursing in the area. Methodology: This study followed a quantitative research approach and it is descriptive in nature. The study involved 561 participants, of whom 406 participants were from urban clinics and 155 were from rural facilities, all these participants were attending clinics at Mnquma Sub-district. A structured questionnaire was used for data collection, since the participants were able to read and write in either English and or IsiXhosa. The data was analyzed with the help of a statistician using Statistical Package for Social Sciences (SPSS) program, software for windows version 21.0 Results: Results showed that participant’s responses to five of the twelve items on patient safety were found to have significant associations with residential setting. Rural participants were less likely to disagree with statements on availability of signage at the entrance of health establishment that indicates times when various services are offered, availability of the security guards to ensure patient safety, warning signs always put in place when the floors are wet, availability of at least one toilet for disabled patients in the health establishment and the fact that health professionals are always wearing name tags. This means that patient safety and security is practiced and implemented at the rural facilities according to the national core standards. The findings of the study confirmed that 13 items out of 19 under care and attitudes were found to have significant associations with residential setting. The items were patients spending less than 2 hours in the health facility; staff treating patients politely, illness being explained clearly to the patients, and ability of the patients to ask questions about their illness. Other items included nursing attitudes during opening and closing times of the health establishment, staff responding well when requested to assist, patients are being treated with empathy, patients are addressed by names and patients are being given all the treatment that they need, nurses explains the treatment side effects, and explains how to deal with side effects. This means that responses to these items depend on whether the patient is from a rural or urban clinic. Rural communities were found to be vi less likely to disagree with statements as compared to urban communities. This means that nurses are compliant with nursing care and attitudes in rural clinics. Findings of the study with respect to facility cleanliness, shows that there is no significant associations between the responses to the items which are: surroundings of the clinic are free of unpleasant smells, grounds of the clinic are clean, safe and clean grounds, bin waste inside and outside storage poses no health risks, and setting were detected. This means that the facilities are and cleanliness status remains the same across the residential settings. However, the younger age group was found be significantly more likely to disagree that toilets are clean and odorless and that grounds are safe and clean compared to the older age group. This suggests that the environment is clean except the toilets. Conclusion: Staffs at the facilities are at times ignorant and have negative attitudes at the opening and closing times and facilities have been reported to have long waiting times. The study indicated that the safety and security measures in the urban health facilities are not all practiced according to the National Core Standards checklist/Assessment tool, particularly wet warning signs, disabled toilets, and wearing of nametags. Majority of the participants indicated that, the status of cleanliness was on par at the urban and rural facilities.
- Full Text:
- Authors: Manyela, Nosiphiwo
- Date: 2019
- Subjects: Health facilities
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16747 , vital:40770
- Description: Aim: The purpose of the study was to assess the quality of patient care in the Primary Health Care (PHC) facilities of Mnquma Sub-district with the goal of improving or maintaining quality nursing in the area. Methodology: This study followed a quantitative research approach and it is descriptive in nature. The study involved 561 participants, of whom 406 participants were from urban clinics and 155 were from rural facilities, all these participants were attending clinics at Mnquma Sub-district. A structured questionnaire was used for data collection, since the participants were able to read and write in either English and or IsiXhosa. The data was analyzed with the help of a statistician using Statistical Package for Social Sciences (SPSS) program, software for windows version 21.0 Results: Results showed that participant’s responses to five of the twelve items on patient safety were found to have significant associations with residential setting. Rural participants were less likely to disagree with statements on availability of signage at the entrance of health establishment that indicates times when various services are offered, availability of the security guards to ensure patient safety, warning signs always put in place when the floors are wet, availability of at least one toilet for disabled patients in the health establishment and the fact that health professionals are always wearing name tags. This means that patient safety and security is practiced and implemented at the rural facilities according to the national core standards. The findings of the study confirmed that 13 items out of 19 under care and attitudes were found to have significant associations with residential setting. The items were patients spending less than 2 hours in the health facility; staff treating patients politely, illness being explained clearly to the patients, and ability of the patients to ask questions about their illness. Other items included nursing attitudes during opening and closing times of the health establishment, staff responding well when requested to assist, patients are being treated with empathy, patients are addressed by names and patients are being given all the treatment that they need, nurses explains the treatment side effects, and explains how to deal with side effects. This means that responses to these items depend on whether the patient is from a rural or urban clinic. Rural communities were found to be vi less likely to disagree with statements as compared to urban communities. This means that nurses are compliant with nursing care and attitudes in rural clinics. Findings of the study with respect to facility cleanliness, shows that there is no significant associations between the responses to the items which are: surroundings of the clinic are free of unpleasant smells, grounds of the clinic are clean, safe and clean grounds, bin waste inside and outside storage poses no health risks, and setting were detected. This means that the facilities are and cleanliness status remains the same across the residential settings. However, the younger age group was found be significantly more likely to disagree that toilets are clean and odorless and that grounds are safe and clean compared to the older age group. This suggests that the environment is clean except the toilets. Conclusion: Staffs at the facilities are at times ignorant and have negative attitudes at the opening and closing times and facilities have been reported to have long waiting times. The study indicated that the safety and security measures in the urban health facilities are not all practiced according to the National Core Standards checklist/Assessment tool, particularly wet warning signs, disabled toilets, and wearing of nametags. Majority of the participants indicated that, the status of cleanliness was on par at the urban and rural facilities.
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Challenges of the primigravida’s in accessing antenatal care early and regularly in Buffalo city Metropolitan Municipality, Eastern Cape Province, South Africa
- Seakamela, Khomotso Precious
- Authors: Seakamela, Khomotso Precious
- Date: 2019
- Subjects: Maternal health services Prenatal care
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16803 , vital:40775
- Description: According to National Department of Health (NDOH National :2015), antenatal care is free in South Africa’s public health system and nearly all pregnant women and girls attend an antenatal clinic at least once during their pregnancy. However, most pregnant women do not access antenatal care until the later stage of pregnancy. Such delays have been linked to nearly a quarter of avoidable maternal deaths in South Africa. According to World Health Organisation (WHO, 2016; 11), maternal mortality and morbidity are some of the most important global health issues facing the world today. Worldwide, approximately 1000 women die each day from pregnancy and childbirth related causes (WHO, 2016; 11). In addition, 99% of these maternal deaths occur in the developing world, with sub-Saharan Africa accounting for over half of these deaths. The international community has committed to improving maternal health by 2015 with Millennium Development Goal (MDG) number five, which aimed to reduce maternal mortality by three quarters and reach universal access to reproductive health care (www.worldbank.org/mdgs/). Even with this commitment, many countries like South Africa have failed to implement effective programs to reduce maternal mortality and morbidity, and women around the world continue to die and suffer from the complications of pregnancy and childbirth. According to NDOH (2015; 2), women who suspect that they might be pregnant should schedule a booking and visit to their clinic and begin antenatal care as soon as possible. These visits include a physical examination, which includes blood pressure checks, weight checks, providing a urine sample, testing for sexually transmitted infections and checking for tuberculosis. Depending on the stage of the pregnancy, healthcare providers may also do blood tests and examination, which includes an ultrasound. The purpose of the study was to to investigate the challenges of Primigravida’s in accessing antenatal care early and regularly in Buffalo City Metropolitan (BCM) and to assist in formulating recommendations for improving factors that are perceived as obstacles to the utilisation of antenatal care services in the BCM District. vii The study was conducted in five facilities at BCM (Dimbaza Community Health Centre, Empilweni Gompo Clinic, Moore Street Clinic, Central Clinic and Notyatyambo Clinic). BCM is one of the seven districts of Eastern Cape Province of South Africa. The seat of BCM is East London. The data was collected using cross-sectional, self-administered questionnaires that were conducted in selected health facilities of Buffalo City Metropolitan. In this study, the population consisted of primigravida’s between the ages of 18-35 who start clinic attendance in the second trimester of pregnancy at five facilities, Buffalo City Metropolitan. Findings: The biggest challenges, as expressed by the participants, were lack of money, unsuitable clinic times, work commitments, delays at clinic and family control. Most of the participants had good experiences of antenatal care. The timing of antenatal clinic attendance is not influenced by age, education, residential zone, employment status and proximity of clinic
- Full Text:
- Authors: Seakamela, Khomotso Precious
- Date: 2019
- Subjects: Maternal health services Prenatal care
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16803 , vital:40775
- Description: According to National Department of Health (NDOH National :2015), antenatal care is free in South Africa’s public health system and nearly all pregnant women and girls attend an antenatal clinic at least once during their pregnancy. However, most pregnant women do not access antenatal care until the later stage of pregnancy. Such delays have been linked to nearly a quarter of avoidable maternal deaths in South Africa. According to World Health Organisation (WHO, 2016; 11), maternal mortality and morbidity are some of the most important global health issues facing the world today. Worldwide, approximately 1000 women die each day from pregnancy and childbirth related causes (WHO, 2016; 11). In addition, 99% of these maternal deaths occur in the developing world, with sub-Saharan Africa accounting for over half of these deaths. The international community has committed to improving maternal health by 2015 with Millennium Development Goal (MDG) number five, which aimed to reduce maternal mortality by three quarters and reach universal access to reproductive health care (www.worldbank.org/mdgs/). Even with this commitment, many countries like South Africa have failed to implement effective programs to reduce maternal mortality and morbidity, and women around the world continue to die and suffer from the complications of pregnancy and childbirth. According to NDOH (2015; 2), women who suspect that they might be pregnant should schedule a booking and visit to their clinic and begin antenatal care as soon as possible. These visits include a physical examination, which includes blood pressure checks, weight checks, providing a urine sample, testing for sexually transmitted infections and checking for tuberculosis. Depending on the stage of the pregnancy, healthcare providers may also do blood tests and examination, which includes an ultrasound. The purpose of the study was to to investigate the challenges of Primigravida’s in accessing antenatal care early and regularly in Buffalo City Metropolitan (BCM) and to assist in formulating recommendations for improving factors that are perceived as obstacles to the utilisation of antenatal care services in the BCM District. vii The study was conducted in five facilities at BCM (Dimbaza Community Health Centre, Empilweni Gompo Clinic, Moore Street Clinic, Central Clinic and Notyatyambo Clinic). BCM is one of the seven districts of Eastern Cape Province of South Africa. The seat of BCM is East London. The data was collected using cross-sectional, self-administered questionnaires that were conducted in selected health facilities of Buffalo City Metropolitan. In this study, the population consisted of primigravida’s between the ages of 18-35 who start clinic attendance in the second trimester of pregnancy at five facilities, Buffalo City Metropolitan. Findings: The biggest challenges, as expressed by the participants, were lack of money, unsuitable clinic times, work commitments, delays at clinic and family control. Most of the participants had good experiences of antenatal care. The timing of antenatal clinic attendance is not influenced by age, education, residential zone, employment status and proximity of clinic
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experiences of female sex workers in Buffalo City Metropolitan Municipality, Eastern Cape
- Authors: Gcina, Boniswa Letticia
- Date: 2019
- Subjects: Prostitutes
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16730 , vital:40768
- Description: The phenomenon of female sex workers in South Africa is yet to be understood from both the cultural and legal perspectives. This gap leads to various challenges experienced by female sex workers in the country. The purpose of this study was to explore the experiences of female sex workers in Buffalo City Metropolitan, Eastern Cape Province. A descriptive phenomenological design was used to gain in-depth understanding and knowledge on the experiences of female sex workers’ in reality and social context. The study targeted female sex workers aged between 18-49 years for interviews. Purposive sampling technique was used to recruit female sex workers and four focus groups of five members in each group were interviewed to collect data. Due to the sensitivity of the research topic, ethical approvals were sought and granted by University of Fort Hare Research Ethics Committee and the Eastern Cape Department of Health. Further, informed consent was obtained from study participants before data collection begun. Data analysis was done by using Tesch’ method steps. The findings indicated that in Buffalo City Metropolitan the female sex workers were experiencing human rights violation, stigma and discrimination, they were at risk of contracting HIV due to the nature of their work, and they were at risk of being in conflict with the law due to the nature of sex work in South Africa. The study recommends on the decriminalization of sex work in order to decrease rate of violence, rape and exploitation of female sex workers; the closure of all Illegal brothels as they promote drugs and substance abuse among this vulnerable group; and provision of counselling sessions for female sex workers by the Department of Social Welfare. The study concludes that peer educators training and embarking on campaigns in the community, media and social networks to promote ‘Anti-violence against sex workers’ is necessary. Therefore, the female sex workers need to be protected by police from any form of abuse and violence by the community, clients and pimps. This can address the psychological stress displayed by female sex workers in the studydomain
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- Authors: Gcina, Boniswa Letticia
- Date: 2019
- Subjects: Prostitutes
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16730 , vital:40768
- Description: The phenomenon of female sex workers in South Africa is yet to be understood from both the cultural and legal perspectives. This gap leads to various challenges experienced by female sex workers in the country. The purpose of this study was to explore the experiences of female sex workers in Buffalo City Metropolitan, Eastern Cape Province. A descriptive phenomenological design was used to gain in-depth understanding and knowledge on the experiences of female sex workers’ in reality and social context. The study targeted female sex workers aged between 18-49 years for interviews. Purposive sampling technique was used to recruit female sex workers and four focus groups of five members in each group were interviewed to collect data. Due to the sensitivity of the research topic, ethical approvals were sought and granted by University of Fort Hare Research Ethics Committee and the Eastern Cape Department of Health. Further, informed consent was obtained from study participants before data collection begun. Data analysis was done by using Tesch’ method steps. The findings indicated that in Buffalo City Metropolitan the female sex workers were experiencing human rights violation, stigma and discrimination, they were at risk of contracting HIV due to the nature of their work, and they were at risk of being in conflict with the law due to the nature of sex work in South Africa. The study recommends on the decriminalization of sex work in order to decrease rate of violence, rape and exploitation of female sex workers; the closure of all Illegal brothels as they promote drugs and substance abuse among this vulnerable group; and provision of counselling sessions for female sex workers by the Department of Social Welfare. The study concludes that peer educators training and embarking on campaigns in the community, media and social networks to promote ‘Anti-violence against sex workers’ is necessary. Therefore, the female sex workers need to be protected by police from any form of abuse and violence by the community, clients and pimps. This can address the psychological stress displayed by female sex workers in the studydomain
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Psychosocial behaviour of male learners after traditional male circumcision in Mdantsane, Eastern Cape
- Authors: Bokolo, Nokwanda
- Date: 2019
- Subjects: Circumcision
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16709 , vital:40764
- Description: Male circumcision is an old Xhosa tradition that is still widely practised throughout South Africa. The Xhosa community in Eastern Cape, South Africa, values traditional male circumcision and regard it as a heritage from the ancestors, which prepares the initiate for transition to manhood. There are health problems and physical complications related to circumcision, although parental decisions regarding circumcision and the medical hygiene have been widely researched. However, scanty information exists on the psychological and social behaviours of male learners after male circumcision. The present study aims to fill the gap by exploring the psychosocial behaviors of male learners after traditional male circumcision in Eastern Cape, South Africa
- Full Text:
- Authors: Bokolo, Nokwanda
- Date: 2019
- Subjects: Circumcision
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16709 , vital:40764
- Description: Male circumcision is an old Xhosa tradition that is still widely practised throughout South Africa. The Xhosa community in Eastern Cape, South Africa, values traditional male circumcision and regard it as a heritage from the ancestors, which prepares the initiate for transition to manhood. There are health problems and physical complications related to circumcision, although parental decisions regarding circumcision and the medical hygiene have been widely researched. However, scanty information exists on the psychological and social behaviours of male learners after male circumcision. The present study aims to fill the gap by exploring the psychosocial behaviors of male learners after traditional male circumcision in Eastern Cape, South Africa
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Resilience towards adverse childhood experiences among public secondary school students in Alice, South Africa
- Authors: Obisesan , Matthew Tobiloba
- Date: 2019
- Subjects: Child development Child psychology
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16769 , vital:40772
- Description: Adverse childhood experiences (ACEs) are of great concerns in public health. They are traumatic experiences that occur during childhood. ACEs include various forms of abuse and maltreatment which can be emotional, physical, verbal and sexual, different degrees of household dysfunction such as growing up with substance abuse like drugs and alcohol, witnessing domestic violence, mental illnesses, crime in the home and parental disharmony. Although childhood adversities and traumatic experiences occur before the individual is 18 years of age, the effects of such experiences can last a lifetime causing mental and chronic medical illnesses. Resilience is perceived as an antidote to the detrimental effect of ACEs. It is a situation in which an individual displays a high level of effectiveness after a significant misfortune or adversity. This study was conducted to assess the level of resilience towards adverse childhood experiences among public secondary school children in Alice. Data were collected with the aid of a wellstructured questionnaire from 418 public high school students using Convenience sampling method. Factors influencing resilience among the learners were examined. Consequently, the data collected were analyzed using descriptive statistics and ordered logit regression model. From the results, it is observed that the majority of the learners live with their grandparents and the most prevalent form of ACEs is emotional abuse, followed by sexual abuse while community violence is the least common childhood adversity. This study further reveals that some of the respondents experienced more than one form of adverse childhood experience. In addition, irrespective of what the students have been through, they are largely observed to be resilient. Analysis from the ordered logit regression model shows that age, class in school, gender, religion, race and who the student lives with are significantly related to resilience. The study, therefore, recommends a functional counseling unit in the schools while student-teacher relationship must be encouraged
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- Authors: Obisesan , Matthew Tobiloba
- Date: 2019
- Subjects: Child development Child psychology
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16769 , vital:40772
- Description: Adverse childhood experiences (ACEs) are of great concerns in public health. They are traumatic experiences that occur during childhood. ACEs include various forms of abuse and maltreatment which can be emotional, physical, verbal and sexual, different degrees of household dysfunction such as growing up with substance abuse like drugs and alcohol, witnessing domestic violence, mental illnesses, crime in the home and parental disharmony. Although childhood adversities and traumatic experiences occur before the individual is 18 years of age, the effects of such experiences can last a lifetime causing mental and chronic medical illnesses. Resilience is perceived as an antidote to the detrimental effect of ACEs. It is a situation in which an individual displays a high level of effectiveness after a significant misfortune or adversity. This study was conducted to assess the level of resilience towards adverse childhood experiences among public secondary school children in Alice. Data were collected with the aid of a wellstructured questionnaire from 418 public high school students using Convenience sampling method. Factors influencing resilience among the learners were examined. Consequently, the data collected were analyzed using descriptive statistics and ordered logit regression model. From the results, it is observed that the majority of the learners live with their grandparents and the most prevalent form of ACEs is emotional abuse, followed by sexual abuse while community violence is the least common childhood adversity. This study further reveals that some of the respondents experienced more than one form of adverse childhood experience. In addition, irrespective of what the students have been through, they are largely observed to be resilient. Analysis from the ordered logit regression model shows that age, class in school, gender, religion, race and who the student lives with are significantly related to resilience. The study, therefore, recommends a functional counseling unit in the schools while student-teacher relationship must be encouraged
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Short regimen in the management of multi drug resistant tuberculosis in Buffalo City Metropolitan, Eastern Cape, South Africa
- Somfongo, Nomawethu Constance
- Authors: Somfongo, Nomawethu Constance
- Date: 2019
- Subjects: Tuberculosis Disease management
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16814 , vital:40776
- Description: Tuberculosis is an epidemic disease which is regarded as the tenth leading cause of death in the world (World Health Organization, 2014). New 580 000 cases of multidrug resistant tuberculosis have been reported by WHO (2014). Patients diagnosed with rifampicin/multi-drug resistant tuberculosis were usually treated for 18-24 months if they convert within the designated period of 4-6 months. Several trials were conducted in other countries like Burundi, Cameroon, Central African Republic, etc. on the use of short regimen of 9-12 months. Short regimen was introduced in January 2017 in South Africa and it has not been evaluated for its effectiveness in Buffalo City Metropolitan, South Africa. This study was conducted to examine RR/MDR TB outcomes following the introduction of a short regimen and the outcomes were based on the set target of 50% MDR TB success rate and 5.4% TB client lost to follow up rate as per the Annual Performance Plan (APP) of 2017/18. The conversion rate was also examined though the target was not set in APP. A retrospective study using a descriptive design was used to collect data at Nkqubela TB and Duncan Village Day hospitals which are in Buffalo City Metropolitan. The population of the study were all records of patients diagnosed, registered and initiated on rifampicin/multi-drug resistant TB in a short regimen in Nkqubela TB Hospital and Duncan Village Day Hospital between January 2017 and July 2017. All 118 patient records that met the inclusion criteria were enrolled in the study therefore convenience sampling was used. Ethical approval was obtained from the University of Fort Hare (ethical clearance number: MUP101SSOM01). Approval to conduct the study was also approved by the Eastern Cape Department of Health Ethics, BCM Health District Manager and two public hospitals. Two research assistants and one data capture signed oath of confidentiality prior data extraction. Unique codes were used to ensure anonymity and privacy and all data was treated in a confidential manner. Data was collected using a self-designed structured questionnaire which was tested for validity and reliability through pilot study. Data analysis was done by a statistician using Statistical Packages for Social Sciences version 24. RR/MDR TB outcomes of participants who were initiated on short regimen between January and July 2017 were examined between January and July 2018 at the end of 12 months. Findings showed that the majority of the affected age group was between the ages of 36-45 years in both genders (34.7%) with males (n=71) being highly affected than females (n=47). Bisho/King William’s Town sub-district was the most affected in Buffalo City Metropolitan (n=61). The majority of participants that were affected were the Africans (98.3%), unemployed (51.7%), people living with HIV/AIDS (62.7%) and those previously treated for TB (57.6%). Records revealed that participants living with HIV had a mean CD4 count of 194.5 and 202.4 and mean viral load of 203183.0 and 651888.7. Smokers and alcohol users were higher in males (20.3% and 16.9% respectively) than in females (2.5% and 5.1% respectively). Two patient records were missing and other four patient records were incompletely recorded to determine data on smoking and alcohol consumption. Findings revealed a smear conversion rate of 68.5% excluding 47 participants who had negative baseline smear results and one participant who had extra-pulmonary TB. Twenty one percent of the participants did not have consecutive smear results during the intensive phase. TB client lost to follow up rate was 13.5% (n=16) and 10 of all TB clients lost to follow up interrupted treatment for ≥5 months. Eleven TB clients lost to follow up were from Buffalo City Municipality Metropolitan. TB client lost to follow up was high in males (n=13). Rifampicin/multidrug resistant TB treatment success rate was 72.9% with mean response to treatment of 17.2 weeks. Weight (p0.005 and CI 2.750, 15.189) and body mass index (p0.004 and CI 1.232, 6.242) as well as duration of treatment interruption (p0.000 and CI -14.785, -8. 644) and duration of treatment (p0.001 and CI -65.385, -16.403) were statistically significant to treatment success. Based on these findings, it is therefore concluded that short regimen is effective in the management of RR/MDR TB despite high TB client lost to follow up rate. Decentralisation of drug resistant TB management; primary health care reengineering; use of NIMDR-trained nurses; tracing of TB interrupters; HIV management; electronic patient management system and review of how EDR register works; proper record keeping and proper recording; extensive and ongoing counselling, patient support, health education and patient monitoring; and political involvement; is recommended. Further research is recommended to identify patient and service related factors that affect TB treatment outcomes.
- Full Text:
- Authors: Somfongo, Nomawethu Constance
- Date: 2019
- Subjects: Tuberculosis Disease management
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16814 , vital:40776
- Description: Tuberculosis is an epidemic disease which is regarded as the tenth leading cause of death in the world (World Health Organization, 2014). New 580 000 cases of multidrug resistant tuberculosis have been reported by WHO (2014). Patients diagnosed with rifampicin/multi-drug resistant tuberculosis were usually treated for 18-24 months if they convert within the designated period of 4-6 months. Several trials were conducted in other countries like Burundi, Cameroon, Central African Republic, etc. on the use of short regimen of 9-12 months. Short regimen was introduced in January 2017 in South Africa and it has not been evaluated for its effectiveness in Buffalo City Metropolitan, South Africa. This study was conducted to examine RR/MDR TB outcomes following the introduction of a short regimen and the outcomes were based on the set target of 50% MDR TB success rate and 5.4% TB client lost to follow up rate as per the Annual Performance Plan (APP) of 2017/18. The conversion rate was also examined though the target was not set in APP. A retrospective study using a descriptive design was used to collect data at Nkqubela TB and Duncan Village Day hospitals which are in Buffalo City Metropolitan. The population of the study were all records of patients diagnosed, registered and initiated on rifampicin/multi-drug resistant TB in a short regimen in Nkqubela TB Hospital and Duncan Village Day Hospital between January 2017 and July 2017. All 118 patient records that met the inclusion criteria were enrolled in the study therefore convenience sampling was used. Ethical approval was obtained from the University of Fort Hare (ethical clearance number: MUP101SSOM01). Approval to conduct the study was also approved by the Eastern Cape Department of Health Ethics, BCM Health District Manager and two public hospitals. Two research assistants and one data capture signed oath of confidentiality prior data extraction. Unique codes were used to ensure anonymity and privacy and all data was treated in a confidential manner. Data was collected using a self-designed structured questionnaire which was tested for validity and reliability through pilot study. Data analysis was done by a statistician using Statistical Packages for Social Sciences version 24. RR/MDR TB outcomes of participants who were initiated on short regimen between January and July 2017 were examined between January and July 2018 at the end of 12 months. Findings showed that the majority of the affected age group was between the ages of 36-45 years in both genders (34.7%) with males (n=71) being highly affected than females (n=47). Bisho/King William’s Town sub-district was the most affected in Buffalo City Metropolitan (n=61). The majority of participants that were affected were the Africans (98.3%), unemployed (51.7%), people living with HIV/AIDS (62.7%) and those previously treated for TB (57.6%). Records revealed that participants living with HIV had a mean CD4 count of 194.5 and 202.4 and mean viral load of 203183.0 and 651888.7. Smokers and alcohol users were higher in males (20.3% and 16.9% respectively) than in females (2.5% and 5.1% respectively). Two patient records were missing and other four patient records were incompletely recorded to determine data on smoking and alcohol consumption. Findings revealed a smear conversion rate of 68.5% excluding 47 participants who had negative baseline smear results and one participant who had extra-pulmonary TB. Twenty one percent of the participants did not have consecutive smear results during the intensive phase. TB client lost to follow up rate was 13.5% (n=16) and 10 of all TB clients lost to follow up interrupted treatment for ≥5 months. Eleven TB clients lost to follow up were from Buffalo City Municipality Metropolitan. TB client lost to follow up was high in males (n=13). Rifampicin/multidrug resistant TB treatment success rate was 72.9% with mean response to treatment of 17.2 weeks. Weight (p0.005 and CI 2.750, 15.189) and body mass index (p0.004 and CI 1.232, 6.242) as well as duration of treatment interruption (p0.000 and CI -14.785, -8. 644) and duration of treatment (p0.001 and CI -65.385, -16.403) were statistically significant to treatment success. Based on these findings, it is therefore concluded that short regimen is effective in the management of RR/MDR TB despite high TB client lost to follow up rate. Decentralisation of drug resistant TB management; primary health care reengineering; use of NIMDR-trained nurses; tracing of TB interrupters; HIV management; electronic patient management system and review of how EDR register works; proper record keeping and proper recording; extensive and ongoing counselling, patient support, health education and patient monitoring; and political involvement; is recommended. Further research is recommended to identify patient and service related factors that affect TB treatment outcomes.
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Tuberculosis knowledge, attitudes and health-seeking behaviour among tuberculosis patients in Nelson Mandela Bay Municipality, sub district C, South Africa
- Authors: Onyango, Peggy
- Date: 2019
- Subjects: Tuberculosis
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16780 , vital:40773
- Description: The aim of this study was to examine the knowledge and attitude of Tuberculosis (TB) patients regarding TB disease, causes, treatment adherence and health seeking behaviour in Nelson Mandela Bay, sub district C, South Africa. A cross-sectional study was done in three community health centres in Nelson Mandela Bay Municipality sub district C, South Africa. It involved 327 respondents aged eighteen years and above who were on TB treatment for more than one month who were conveniently selected from the three clinics. 54.1% of the patients were males and 45.9% of the patients were females. A structured questionnaire was used to collect data. Frequency counts and percentages were used to analyse the data. Multivariate logistic regression analysis was used to examine the influence of demographic variables on the knowledge, attitude and health seeking behaviour towards TB. None of the demographic variables was statistically significant to determine the TB patients’ knowledge and attitude of TB disease, causes, treatment and adherence. Only housing was statistically significant (p<0.05) as a variable determining the knowledge of TB causes, treatment and adherence. Compared with the reference group (informal housing scheme), the knowledge of TB patients with formal housing scheme were 0.556 (95% CI: 0.316-0.977) higher to determine the correct knowledge. Spearman correlation was used to determine the statistical significance between knowledge-attitude (K-A), Knowledge-Health seeking behaviour (K-HSB) and attitude-health seeking behaviour (A-HSB). There was statistical significance association among the variables. Results show that TB knowledge was generally good amongst the TB clients. However, there was misconception that TB is caused by cold air, dust and that TB disease can change into HIV. More than half of the respondents felt that TB treatment is difficult, takes a long time, unpleasant and interferes with work /marriage. Health seeking behaviour was fair amongst the participants.
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- Authors: Onyango, Peggy
- Date: 2019
- Subjects: Tuberculosis
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/16780 , vital:40773
- Description: The aim of this study was to examine the knowledge and attitude of Tuberculosis (TB) patients regarding TB disease, causes, treatment adherence and health seeking behaviour in Nelson Mandela Bay, sub district C, South Africa. A cross-sectional study was done in three community health centres in Nelson Mandela Bay Municipality sub district C, South Africa. It involved 327 respondents aged eighteen years and above who were on TB treatment for more than one month who were conveniently selected from the three clinics. 54.1% of the patients were males and 45.9% of the patients were females. A structured questionnaire was used to collect data. Frequency counts and percentages were used to analyse the data. Multivariate logistic regression analysis was used to examine the influence of demographic variables on the knowledge, attitude and health seeking behaviour towards TB. None of the demographic variables was statistically significant to determine the TB patients’ knowledge and attitude of TB disease, causes, treatment and adherence. Only housing was statistically significant (p<0.05) as a variable determining the knowledge of TB causes, treatment and adherence. Compared with the reference group (informal housing scheme), the knowledge of TB patients with formal housing scheme were 0.556 (95% CI: 0.316-0.977) higher to determine the correct knowledge. Spearman correlation was used to determine the statistical significance between knowledge-attitude (K-A), Knowledge-Health seeking behaviour (K-HSB) and attitude-health seeking behaviour (A-HSB). There was statistical significance association among the variables. Results show that TB knowledge was generally good amongst the TB clients. However, there was misconception that TB is caused by cold air, dust and that TB disease can change into HIV. More than half of the respondents felt that TB treatment is difficult, takes a long time, unpleasant and interferes with work /marriage. Health seeking behaviour was fair amongst the participants.
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