Towards equity: a retrospective analysis of public sector radiological resources and utilization patterns in the metropolitan and rural areas of the Western Cape Province of South Africa in 2017

Abstract Background The reduction of inequality is a key United Nations 2030 Sustainable Development Goal (WHO, Human Resources for Health: foundation for Universal Health Coverage and the post-2015 development agenda, 2014; Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020). Despite marked disparities in radiological services globally, particularly between metropolitan and rural populations in low- and middle-income countries, there has been little work on imaging resources and utilization patterns in any setting (Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020; WHO, Local Production and Technology Transfer to Increase Access to Medical Devices, 2019; European Society of Radiology (ESR), Insights Imaging 6:573-7, 2015; Maboreke et al., An audit of licensed Zimbabwean radiology equipment resources as a measure of healthcare access and equity, 2020; Kabongo et al., Pan Afr Med J 22, 2015; Skedgel et al., Med Decis Making 35:94-105, 2015; Mollura et al., J Am Coll Radiol 913-9, 2014; Culp et al., J Am Coll Radiol 12:475-80, 2015; Mbewe et al., An audit of licenced Zambian diagnostic imaging equipment and personnel, 2020). To achieve equity, a better understanding of the integral components of the so called “imaging enterprise” is important. The aim was to analyse a provincial radiological service in a middle-income country. Methods An institutional review board-approved retrospective audit of radiological data for the public healthcare sector of the Western Cape Province of South Africa for 2017, utilizing provincial databases. We conducted population-based analyses of imaging equipment, personnel, and service utilization data for the whole province, the metropolitan and the rural areas. Results Metropolitan population density exceeds rural by a factor of ninety (1682 vs 19 people/km2). Rural imaging facilities by population are double the metropolitan (20 vs 11/106 people). Metropolitan imaging personnel by population (112 vs 53/106 people) and equipment unit (1.7 vs 0.7/unit) are more than double the rural. Overall population-based utilization of imaging services was 30% higher in the metropole (289 vs 214 studies/103 people), with mammography (24 vs 5 studies/103 woman > 40 years) and CT (21 vs 6/103 people) recording the highest, and plain radiography (203 vs 171/103 people) the lowest differences. Conclusion Despite attempts to achieve imaging equity through the provision of increased facilities/million people in the rural areas, differential utilization patterns persist. The achievement of equity must be seen as a process involving incremental improvements and iterative analyses that define progress towards the goal.

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Public Sector Radiological Resources and Utilization Patterns in the Western Cape Province of South Africa

10.21203/rs.3.rs-89229/v1 ◽

2020 ◽

Author(s):

Beulah Christina van Zyl ◽

Michelle Monique Barnard ◽

Amanda Fernandez ◽

Keith Cloete ◽

Matodzi Mukosi ◽

...

Keyword(s):

South Africa ◽

Service Utilization ◽

Population Based ◽

Plain Radiography ◽

Middle Income Country ◽

Western Cape ◽

Western Cape Province ◽

Middle Income ◽

X Ray ◽

Utilization Patterns

Abstract Background There are marked disparities in radiological resources globally, particularly between metropolitan and rural populations. The World Health Organization (WHO) suggests that 90% of low- and middle-income country (LMIC) imaging needs can be addressed by one X-ray and ultrasound machine for every 50000 people. However, this figure is untested, as limited work on radiological resources and service utilization patterns globally, particularly in LMICs exists. The aim was to analyze provincial radiological service in a middle-income country. Methods An institutional review board-approved retrospective audit of radiological data for the public healthcare sector of the Western Cape Province (WCP) of South Africa (SA) for 2017, utilizing databases of the WCP Department of Health and Stats SA. We conducted population-based analyses of imaging equipment, personnel, and service utilization data for the province, metropolitan and rural areas. Results Metropolitan population density exceeds rural (1682 vs 19 people/km 2 ; 89:1). Rural imaging facilities by population are double the metropolitan (19 vs 11/10 6 people). Provincially, there are 36 X-ray and 18 ultrasound units/10 6 people. Rural X-ray (39.3 vs 33.6/10 6 people), ultrasound (24.7 vs 14.5/10 6 people) and mammography (14 vs 5 units/10 6 women > 40 years) resources exceed metropolitan by 17, 70 and 180 percent, respectively. Metropolitan personnel resources by population (n = 112 vs 53/10 6 people) and equipment unit (1.7 vs 0.7/10 6 people) are double the rural. Provincial imaging studies totalled 1.2778 million, averaging 262 examinations/10 3 people and 1.3 investigations/patient. Radiography (n=935607,73%) and ultrasound (n=202639,16%) together constituted 89% (n=1138246) of studies. Population-based utilization of imaging services was 30% higher in the metropole (279 vs 214 studies/10 3 people), with mammography (24 vs 5 studies/10 3 woman >40 years; 517%) and CT (21 vs 6/10 3 people; 380%) recording the highest differentials and plain radiography (203 vs 171/10 3 people; 19%) the lowest. Conclusion Our findings support the WHO contention that approximately ninety percent of a population’s diagnostic imaging needs can be met by plain radiography and ultrasound and underscore the complexity of achieving equitable utilization of services between rural and metropolitan areas.

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An assessment of preliminary food-based dietary guidelines for infants 6–12 months of age in the Little Karoo area of the Western Cape Province of South Africa

Public Health Nutrition ◽

10.1017/s1368980007249742 ◽

2007 ◽

Vol 10 (9) ◽

pp. 869-877 ◽

Cited By ~ 1

Author(s):

J Van der Merwe ◽

L Bourne ◽

D Marais

Keyword(s):

South Africa ◽

Focus Group ◽

Breast Feeding ◽

Rural Areas ◽

Urban Areas ◽

Dietary Guidelines ◽

Western Cape ◽

Focus Group Interviews ◽

Western Cape Province ◽

Group Interviews

AbstractObjectiveThis study aimed to assess mother's/caregiver's understanding, practical application and cultural acceptability of a preliminary set of South African food-based dietary guidelines (FBDGs) for children aged 6–12 months living in the Little Karoo area of the Western Cape Province.DesignAn observational, descriptive and cross-sectional study design was followed. Focus group interviews, recorded on videotape, were analysed for qualitative data. Quantitative questionnaires measured knowledge and comprehension of guidelines, perceived constraints to compliance with and importance of guidelines as well as socio demographic data prior to the focus group interviews.SettingAfrikaans-, English- and Xhosa-speaking communities of the Little Karoo area of the Western Cape Province of South Africa, including the urban areas of Oudtshoorn, Bongulethu, Bridgton, Toekomsrus and the adjacent rural areas of Dysselsdorp, Calitzdorp, Uniondale, Ladismith and Zoar.SubjectsSixty-four mothers or caregivers to infants 6–12 months of age were included in the sample.ResultsInformation obtained through the questionnaires supported what was said during discussions. Although perceived as important by the majority of respondents, some of the guidelines were not well understood without prior explanation. Such guidelines were those pertaining to meal frequency and cup feeding, while application of the guideline to prolonged breast-feeding seemed the most problematic.ConclusionsThe FBDGs for this age group will have to be supported by extensive and appropriate educational material to be effective when introduced to the public. The fact that the applicability of the guideline to prolonged breast-feeding seemed to be the most problematic is a cause for concern.

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Maternal Risk Factors for Fetal Alcohol Syndrome in the Western Cape Province of South Africa: A Population-Based Study

American Journal of Public Health ◽

10.2105/ajph.2003.037093 ◽

2005 ◽

Vol 95 (7) ◽

pp. 1190-1199 ◽

Cited By ~ 122

Author(s):

Philip A. May ◽

J. Phillip Gossage ◽

Lesley E. Brooke ◽

Cudore L. Snell ◽

Anna-Susan Marais ◽

...

Keyword(s):

Risk Factors ◽

South Africa ◽

Fetal Alcohol Syndrome ◽

Population Based ◽

Western Cape ◽

Maternal Risk Factors ◽

Fetal Alcohol ◽

Western Cape Province ◽

Population Based Study ◽

Maternal Risk

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Autism in the Western Cape province of South Africa: Rates, socio-demographics, disability and educational characteristics in one million school children

Autism ◽

10.1177/1362361320978042 ◽

2020 ◽

pp. 136236132097804

Author(s):

Sarosha Pillay ◽

Madeleine Duncan ◽

Petrus J de Vries

Keyword(s):

South Africa ◽

Autism Spectrum Disorder ◽

Rural Areas ◽

Children With Autism ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Racial Groups ◽

Western Cape ◽

Western Cape Province ◽

English Speaking

The prevalence of autism spectrum disorder in South Africa is unknown and, to date, very little research has been performed within school systems that could inform the rates, distribution and profile of needs of children with autism spectrum disorder in education. We performed a comprehensive database search of all children with autism spectrum disorder in the formal education system in the Western Cape province of South Africa and compared the findings with population demographic expectations of the province. From a population of 1,154,353 children attending schools in the province, a total of 940 children with a diagnosis of autism spectrum disorder were identified, representing a rate of 0.08%. The male: female ratio was 5.5:1. There was a significant difference in the self-reported racial and language composition of the autism spectrum disorder sample compared with the Western Cape demographics where a higher proportion of children with autism spectrum disorder were from White racial groups and English-speaking homes. Eighty-nine percent of children with autism spectrum disorder were in Special Schools and only 10% were in Ordinary/Mainstream Schools. Most of the children (83%) attended schools in the City of Cape Town and only 17% in rural areas. Co-occurring intellectual disability was reported in 22.2% of the population, attention-deficit/hyperactivity disorder in 2.6% and epilepsy in 0.7%. Data showed a 76.03% increase in autism spectrum disorder in schools between 2012 and 2016, with an average increase of 15.18% per year. Findings suggested an under-representation of autism spectrum disorder in schools and an under-identification of co-occurring conditions. Results indicate that despite being one of the better-resourced provinces in South Africa, the Western Cape is not equipped to identify and meet the culturally and linguistically diverse needs of its communities. We propose strengthening of educational systems for children with autism spectrum disorder in the Western Cape, and similar investigations in other South African provinces. Lay abstract There is very little information about autism spectrum disorder in South Africa and not much is known about children with autism spectrum disorder and their educational needs. In this study, we searched for all children with autism spectrum disorder attending schools in the Western Cape province of South Africa and compared our findings with the profile of people living in the province. We found fewer children with autism spectrum disorder in schools than expected (0.08%) and co-occurring conditions (intellectual disability = 22.2%, attention-deficit/hyperactivity disorder = 2.6% and epilepsy = 0.7%) were reported at lower rates. More children were from White racial groups and from English-speaking homes compared with the Western Cape population demographics. Most of the children (89%) attended schools for children with Special Educational Needs and only 10% were in Ordinary/Mainstream schools. Eighty-three percent attended schools in urban areas and 17% in rural areas. There was a 76.03% increase in children with autism spectrum disorder in schools between 2012 and 2016. Our findings support the need for better identification and reporting of children with autism spectrum disorder in the education system. We propose urgent review and strengthening of education systems for children with autism spectrum disorder in the Western Cape province and in other parts of South Africa.

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Occupational fatality under-reporting in rural areas of the Western Cape Province, South Africa

Safety Science ◽

10.1016/s0925-7535(97)00016-7 ◽

1997 ◽

Vol 25 (1-3) ◽

pp. 113-122 ◽

Cited By ~ 7

Author(s):

G.H. Schierhout ◽

A. Midgley ◽

J.E. Myers

Keyword(s):

South Africa ◽

Rural Areas ◽

Western Cape ◽

Western Cape Province

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Trends in public sector radiological usage in the Western Cape Province, South Africa: 2009–2019

South African Journal of Radiology ◽

10.4102/sajr.v25i1.2251 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Monica Van Wijk ◽

Michelle M. Barnard ◽

Amanda Fernandez ◽

Keith Cloete ◽

Matodzi Mukosi ◽

...

Keyword(s):

South Africa ◽

Public Sector ◽

Medical Imaging ◽

Conventional Radiography ◽

Plain Radiography ◽

Whole Body ◽

Western Cape ◽

Western Cape Province ◽

Middle Income ◽

Main Driver

Background: Although global use of medical imaging has increased significantly, little is known about utilisation trends in low- and middle-income countries (LMICs).Objectives: To evaluate changes over a decade in public sector diagnostic imaging utilisation at provincial level in a middle-income country.Method: A retrospective analysis of medical imaging utilisation in the Western Cape Province of South Africa in 2009 and 2019. Use of conventional radiography, ultrasonography (US), fluoroscopy, CT, MRI, digital subtraction angiography (DSA) and whole-body digital radiography was assessed by total studies and studies/103 people, for the whole province, the rural and metropolitan areas. Mammography utilisation was calculated for every 103 females aged 40–70 years.Results: The provincial population and total imaging investigations increased by 25% and 32%, respectively, whilst studies/103 people increased by 5.5% (256 vs 270/103), with marked variation by modality. Provincial US, CT and MRI utilisation/103 people increased by 111% (20 vs 43/103), 78% (10 vs 18/103) and 32% (1.9 vs 2.5/103) respectively, whilst use of fluoroscopy (3.6 vs 3.7/103) and mammography (14.2 vs 15.9/103 women aged 40–70 years) was steady and plain radiography decreased by 20% (216 vs 196/103). For CT, mammography and fluoroscopy, percentage utilisation increases/103 people were higher in the rural than metropolitan areas.Conclusion: Population growth is the main driver of overall imaging utilisation in our setting. The relatively constant imaging workload per 1000 people, albeit with increasing ultrasound, CT and MR utilisation, and decreasing use of plain radiography, reflects improved provincial imaging infrastructure, and appropriate use of available resources.

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