Antimicrobial stewardship in South Africa: a scoping review of the published literature

Abstract Objectives To map published data of antimicrobial stewardship (AMS) interventions that are currently being carried out in hospitals and clinics in the public and private health sectors of South Africa in line with the antimicrobial resistance (AMR) strategy of South Africa. Methods A systematic scoping review was conducted to identify AMS initiatives in the public and private health sectors of South Africa for the period 1 January 2000 to 31 March 2019. An electronic search of databases was made including PubMed, Scopus, a key medical journal (South African Medical Journal), University of KwaZulu-Natal (UKZN) WorldCat iCatalogue and AMR networks: Federation of Infectious Diseases Societies in South Africa (FIDSSA). Reference lists of published articles were also reviewed for inclusion. Keywords included ‘antimicrobial antibiotic stewardship South Africa’. Findings Of a total of 411 articles, using a stepwise screening process, 18 articles were selected for inclusion in the review. The interventions/initiatives were divided into four broad categories: (i) AMS intervention: prescription audits and usage; (ii) AMS intervention: education and its impact; (iii) other AMS interventions; and (iv) the role of different healthcare professionals in AMS. Conclusions The data identifies a need for and the value of AMS in both the public and private health sectors of South Africa. Initiatives are carried out across both sectors but more attention needs to be focused on AMS implementation in line with the National AMR Strategy of South Africa. Collaboration between the different sectors will aid in overcoming the AMR challenge.

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The benefits and dangers for churches and ministry institutions to work in a regulated environment, with reference to professionalising religious practice via South African Qualifications Authority and the National Qualifications Framework Act

HTS Teologiese Studies / Theological Studies ◽

10.4102/hts.v74i4.4802 ◽

2018 ◽

Vol 74 (4) ◽

Cited By ~ 1

Author(s):

Graham A. Duncan

Keyword(s):

Higher Education ◽

South Africa ◽

South African ◽

Religious Practice ◽

Educational Institutions ◽

Public And Private ◽

The Public ◽

National Qualifications Framework ◽

Fit For Purpose

Since 1994 and the coming of democracy to South Africa there has been a concerted attempt to develop a coherent, unified educational system that will redress the inequities of the apartheid systems. Significant to this ongoing process is the field of higher education, where relevant legislation has been enacted in order to bring coherence and consistency to the education system in the public and private sectors. Significant issues have arisen with regard to the provision made by private religious educational institutions, especially those who have experienced difficulties in being accredited by statutory bodies. This paper seeks to explore these issues and suggest ways forward that are appropriate within an emerging unitary system of education that is fit for purpose in Africa and particularly South Africa, taking as a case study the formation of the Association of Christian Religious Practitioners.

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A qualitative study of the factors influencing the global migration of anatomical pathologists in KwaZulu-Natal, South Africa

Health SA Gesondheid ◽

10.4102/hsag.v19i1.811 ◽

2014 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Nadeem Cassim ◽

Shaun Ruggunan

Keyword(s):

South Africa ◽

South African ◽

Human Resources For Health ◽

The United States ◽

Human Relations ◽

Global Migration ◽

The Public ◽

Kwazulu Natal ◽

Depth Interviews ◽

Insight Into

Background: The aim of the present study was to identify the factors that influence the global migration of South African anatomical pathologists working in the province of KwaZulu-Natal.Objective: The present study answered the question ‘what factors influence Kwazulu-Natal-based histopathologists to emigrate out of South Africa?’, thus providing insight into an under-researched medical specialisation.Methods: A qualitative approach and purposive sampling were used. Data included 11 in-depth interviews with histopathologists working in KwaZulu-Natal (KZN), and one interview with a former KZN-based histopathologist now working in the United States. The interviews were recorded and transcribed. The data were coded for patterns, and these patterns generated themes. The processes of coding and thematic generation were iterative.Results: Six themes were discovered from the data. Of these, five themes suggested reasons for the potential emigration of histopathologists. These included: lack of recognition by clinical doctors, lack of career-pathing opportunities, the deterrent of compulsory service in the public sector upon qualifying, socio-economic and political instability in South Africa, and endemic levels of crime. A sixth theme revealed that remuneration was not a deciding factor as to whether histopathologists choose to emigrate.Conclusions: Remuneration was not revealed to be a reason for emigration, as these specialists’ salaries are commensurate with global salaries. The findings, whilst not generalisable, suggest that more work needs to be done on the human relations aspects of retention for these medical specialists. This has implications for human resources for health policy. Agtergrond: Die doel van hierdie artikel is om die faktore te identifiseer wat die globale migrasie van Suid-Afrikaanse anatomiese patoloë wat in die provinsie van KwaZulu-Natal werk, beïnvloed.Doelwit: Hierdie artikel beantwoord die vraag: ‘Watter faktore beïnvloed histopatoloë wat in KwaZulu-Natal gebaseer is om uit Suid-Afrika te migreer?’, en verskaf sodoende insig in ’n ondernagevorste mediese spesialisasie.Metodes: ’n Kwalitatiewe benadering en doelgerigte steekproefneming is gebruik. Die data het 11 diepgaande onderhoude met histopatoloë wat in KwaZulu-Natal (KZN) werk en een onderhoud met ’n voormalige KZN-gebaseerde histopatoloog wat nou in die Verenigde State werk, ingesluit. Die onderhoude is opgeneem en getranskribeer. Die data is vir patrone gekodeer en hierdie patrone het temas gegenereer. Die koderingsproses en tematiese generering was herhalend.Resultate: Ses temas is in hierdie data ontdek. Hiervan het vyf temas redes vir die moontlike migrasie van histopatoloë voorgestel. Dit sluit in gebrek aan erkenning deur kliniese dokters, gebrek aan loopbaangeleenthede, die afskrikmiddel van verpligte diens in die openbare sektor na kwalifisering, sosio-ekonomiese en politieke onstabiliteit in Suid-Afrika, en endemiese misdaadvlakke. ’n Sesde tema het aan die lig gebring dat vergoeding nie ’n beslissende faktor is in histopatoloë se keuse om te migreer nie.Gevolgtrekkings: Vergoeding blyk nie ’n rede vir migrasie te wees nie, aangesien die salarisse van hierdie spesialiste in ooreenstemming met globale salarisse is. Hoewel dit nie veralgemeenbaar is nie, stel die bevindings voor dat meer werk aan die menseverhouding-aspekte gedoen moet word om hierdie mediese spesialiste te behou. Dit het implikasies vir menslike hulpbronne in gesondheidsbeleid.

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Gold sales forecasting: The Box-Jenkins methodology

Risk Governance and Control Financial Markets & Institutions ◽

10.22495/rgcv7i1art7 ◽

2017 ◽

Vol 7 (1) ◽

pp. 54-60

Author(s):

Johannes Tshepiso Tsoku ◽

Nonofo Phukuntsi ◽

Lebotsa Daniel Metsileng

Keyword(s):

South Africa ◽

Time Series ◽

South African ◽

Model Identification ◽

Percentage Error ◽

Public And Private ◽

The Public ◽

Diagnostic Checking ◽

Resource Economy ◽

Best Fit

The study employs the Box-Jenkins Methodology to forecast South African gold sales. For a resource economy like South Africa where metals and minerals account for a high proportion of GDP and export earnings, the decline in gold sales is very disturbing. Box-Jenkins time series technique was used to perform time series analysis of monthly gold sales for the period January 2000 to June 2013 with the following steps: model identification, model estimation, diagnostic checking and forecasting. Furthermore, the prediction accuracy is tested using mean absolute percentage error (MAPE). From the analysis, a seasonal ARIMA(4,1,4)×(0,1,1)12 was found to be the “best fit model” with an MAPE value of 11% indicating that the model is fit to be used to predict or forecast future gold sales for South Africa. In addition, the forecast values show that there will be a decrease in the overall gold sales for the first six months of 2014. It is hoped that the study will help the public and private sectors to understand the gold sales or output scenario and later plan the gold mining activities in South Africa. Furthermore, it is hoped that this research paper has demonstrated the significance of Box-Jenkins technique for this area of research and that they will be applied in the future.

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The Integration of Medical Records Management Requirements in ICTs

Advances in Electronic Government, Digital Divide, and Regional Development - Cases on Electronic Record Management in the ESARBICA Region ◽

10.4018/978-1-7998-2527-2.ch003 ◽

2020 ◽

pp. 49-67

Author(s):

Lungile P. Luthuli ◽

Trywell T. Kalusopa

Keyword(s):

South Africa ◽

Medical Records ◽

Management Practices ◽

Private Hospital ◽

Support Service ◽

Records Management ◽

Extensive Literature ◽

Public And Private ◽

The Public ◽

Kwazulu Natal

This study comparatively investigates the integration of medical records management requirements in the ICTs/electronic health systems in two hospitals: a public and private hospital in the Umhlathuze Area, KwaZulu-Natal Province, South Africa. The study made a comparison and examined whether the current management practices support service delivery in the context of the Batho Pele principles. In doing this, the study reviewed extensive literature on records management by assessing the depth of the integration of ICTs in the management of medical records in South Africa. The targeted study sample in both the public and private hospital was 193.

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Nurdle drifters around South Africa as indicators of ocean structures and dispersion

South African Journal of Science ◽

10.17159/sajs.2019/5372 ◽

2019 ◽

Vol 115 (5/6) ◽

Cited By ~ 4

Author(s):

Eckart H. Schumann ◽

C. Fiona MacKay ◽

Nadine A. Strydom

Keyword(s):

South Africa ◽

South African ◽

Surface Wind ◽

The South ◽

Surface Layers ◽

Wind Drift ◽

The Public ◽

Larval Stages ◽

Kwazulu Natal ◽

Wind Events

Dispersion processes in the ocean typically involve wind, ocean currents and waves. All these factors were included in an analysis to model nurdle dispersion from an accidental spill in Durban Harbour, South Africa, in October 2017. Nurdle sightings on beaches by members of the public are used as indicators of the dispersion which extended over 2000 km of the South African coastline in a period of 8 weeks. Using known oceanographic current structures, satellite imagery, wave data and surface wind drift values of between 5% and 8% of wind speed, good agreement was found between the modelled dispersion and nurdle sightings. In particular, it was found that nurdles remained in specific sections of the coast for long periods, and that sporadic wind events were required to move them into new coastal areas. Such results may also contribute to understanding the dispersal behaviours and strategies adopted by larval stages of marine organisms, particularly fishes, that have pelagic larval durations that extend over weeks to months. The event was recognised as a major pollution incident rivalling other nurdle spillages reported worldwide, and extensive efforts were made to collect the nurdles, particularly along the northern KwaZulu-Natal coast. However, 9 months later, less than 20% had been recovered. The results emphasise the connectivity of different ocean regions, and in particular that pollution of the ocean is not a localised activity. Matter discharged at one point will disperse over a wide area – in this case, significantly further afield than the area of recovery operations. Significance: Wind drift in the upper metre or two of the ocean has been notoriously difficult to quantify, and the spread of nurdles along the South African coastline can only be explained by using drift percentages two or three times the generally accepted value of 3% or less. Nonetheless, it is important to realise that there are substantial differences in dispersion rates between the upper few centimetres of the ocean and that even a metre or two deeper. The rapid manner in which nurdles, and other microplastics, can be dispersed is important in terms of understanding the spread of this form of pollution in the world’s oceans. The results also confirm the important role that wind can play in the movement of eggs, larvae and invertebrates and the significance of vertical migrations in and out of the surface layers.

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Transforming the Rural Agricultural Landscape Through Groundwater Optimisation: Exploring A Chinese-South African Partnership

Commonwealth Youth and Development ◽

10.25159/1727-7140/3307 ◽

2018 ◽

Vol 15 (1) ◽

Author(s):

Nirmala Dorasamy ◽

Olayemi Bakre

Keyword(s):

South Africa ◽

South African ◽

Agricultural Landscape ◽

Agricultural Practices ◽

Subsistence Farming ◽

Water Shortages ◽

Subsistence Farmers ◽

Farming Communities ◽

Standards Of Living ◽

Kwazulu Natal

The majority of the South African rural populace is directly or indirectly engaged in agricultural practices to earn a livelihood. However, impediments such as climate change, water shortages, and inadequacy of institutional support have undermined these once thriving subsistence farming communities. Furthermore, poor leadership in hydrology, coupled with a lack of depth in skills at all government levels to facilitate the understanding of the importance of groundwater, has made it near impossible for subsistence farmers to benefit optimally from groundwater. The 2012 drought experienced in South Africa paralysed several subsistence farming communities in KwaZulu-Natal. To revamp subsistence farming and assist these farmers across South Africa, the Department of Water and Sanitation launched interventions, but despite the enormous resources expended, indicators (e.g. unsustainable farming practices, poor crop yield, pitiable living conditions, and poor standards of living) provide evidence that these interventions have not yielded the desired results. This paper seeks to suggest practicable interventions aimed at reducing the vulnerability of subsistence farmers in KwaZulu-Natal. The study pursued a qualitative approach in that it solicited the views of experts on groundwater and in related fields to gain an in-depth perspective. Some of the core challenges undermining the sustainability and growth of subsistence farming in the study area were found to be the inadequacy of experts on groundwater, water shortages, institutional deficiencies, lack of political will, and lack of coordination among stakeholders. Pragmatic recommendations are made to address these challenges, among other things to encourage a South African-Chinese partnership in the hydrology sector.

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Investigating competencies needed by European-trained doctors in rural South African hospitals

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v12i1.2322 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

James R. Barnacle ◽

Oliver Johnson ◽

Ian Couper

Keyword(s):

South Africa ◽

South African ◽

Online Survey ◽

Rural District ◽

Eastern Cape ◽

Rural Medicine ◽

Rural South ◽

District Hospitals ◽

Kwazulu Natal ◽

Postgraduate Diploma

Background: Many European-trained doctors (ETDs) recruited to work in rural district hospitals in South Africa have insufficient generalist competencies for the range of practice required. Africa Health Placements recruits ETDs to work in rural hospitals in Africa. Many of these doctors feel inadequately prepared. The Stellenbosch University Ukwanda Centre for Rural Health is launching a Postgraduate Diploma in Rural Medicine to help prepare doctors for such work.Aim: To determine the competencies gap for ETDs working in rural district hospitals in South Africa to inform the curriculum of the PG Dip (Rural Medicine).Setting: Rural district hospitals in South Africa.Methods: Nine hospitals in the Eastern Cape, KwaZulu-Natal and Mpumalanga were purposefully selected by Africa Health Placements as receiving ETDs. An online survey was developed asking about the most important competencies and weaknesses for ETDs when working rurally. The clinical manager and any ETDs currently working in each hospital were invited to complete the survey.Results: Surveys were completed by 19 ETDs and five clinical managers. The top clinical competencies in relation to 10 specific domains were identified. The results also indicate broader competencies required, specific skills gaps, the strengths that ETDs bring to South Africa and how ETDs prepare themselves for working in this context.Conclusion: This study identifies the important competency gaps among ETDs and provides useful direction for the diploma and other future training initiatives. The diploma faculty must reflect on these findings and ensure the curriculum is aligned with these gaps.

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Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa

Antibiotics ◽

10.3390/antibiotics10010094 ◽

2021 ◽

Vol 10 (1) ◽

pp. 94

Author(s):

Carolyn Tarrant ◽

Andrew M. Colman ◽

David R. Jenkins ◽

Edmund Chattoe-Brown ◽

Nelun Perera ◽

...

Keyword(s):

South Africa ◽

Sri Lanka ◽

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Low Income ◽

System Level ◽

Comparative Approach ◽

Structured Interviews ◽

Public And Private ◽

The Uk

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.

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