Identifying gaps in the continuum of care for cardiovascular disease and diabetes in two communities in South Africa: Baseline findings from the HealthRise project

Abstract Objective This study assesses indicators for service provision along the continuum of care for maternal health at subnational levels in South Africa. It applies the emerging construct of adequacy of the continuum of care to assess multi-dimensionality of available indicators. Using adequacy and the process of assessment in the study, the comprehensiveness of the continuum of care for improving maternal health outcomes can be assessed. Results We found indicators along the adequacy dimensions of care utilization and access, linkages of care, and quality of care in the routine district health information system. The General Household Survey contained indicators for the social determinants of health on the continuum of care framework. Indicator gaps include health promotion during and after pregnancy, maternal nutrition, empowerment and quality of care. At present, the available indicators measure about 74% of the interventions on the continuum of care framework. We make recommendations regarding improvements needed to better measure and monitor the continuum of care for maternal health. These involve actions within the health system and include integration of non-health system indicators.

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An Evaluation of the Role of an Intermediate Care Facility in the Continuum of Care in Western Cape, South Africa

International Journal of Health Policy and Management ◽

10.15171/ijhpm.2017.52 ◽

2017 ◽

Vol 7 (2) ◽

pp. 167-179 ◽

Cited By ~ 1

Author(s):

Sikhumbuzo A. Mabunda ◽

Leslie London ◽

David Pienaar

Keyword(s):

South Africa ◽

Care Facility ◽

Continuum Of Care ◽

Intermediate Care ◽

Western Cape ◽

The Continuum

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Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa

10.21203/rs.3.rs-97082/v1 ◽

2020 ◽

Author(s):

Mamothena Carol Mothupi ◽

Jeroen De Man ◽

Hanani Tabana ◽

Lucia Knight

Keyword(s):

South Africa ◽

Maternal Health ◽

Service Delivery ◽

Social Determinants Of Health ◽

Social Determinants ◽

Composite Index ◽

Health Service Delivery ◽

Continuum Of Care ◽

Determinants Of Health ◽

The Continuum

Abstract Introduction: The continuum of care is a recommended framework for comprehensive health service delivery for maternal health, and it integrates health system and social determinants of health. There is a current lack of knowledge on a measurement approach to monitor performance on the framework. In this study we aim to develop and test a composite index for assessing the maternal health continuum in South Africa. Materials and Methods: The composite index was computed as a geometric mean of four dimensions of adequacy of the continuum of care. Data was sourced from the district health information system, household surveys and the census. The index formula was tested for robustness when alternative inputs for indicators and standardization methods were used. The index was used to assess performance in service delivery in the North West province of South Africa, as well as its four districts over a five-year period (2013-2017). The index was validated by assessing associations with maternal health and other outcomes. And factor analysis was used to assess the statistical dimensions of the index. Results: The provincial level index score increased from 62.3 in 2013 to 74 in 2017, showing general improvement in service delivery over time. The district level scores also improved over time, and our analysis identified areas for performance improvement. These include social determinants of health in some districts, and access and linkages to care in others. The provincial index was correlated with institutional maternal mortality rates (rs=-0.90, 90% CI = (-1.00, -0.25)) and the Human Development Index (r=0.97, 95% CI = (0.63, 0.99). It was robust to alternative approaches including z-score standardization of indicators. Factor analysis showed three groupings of indicators for the health system and social determinants of health. Conclusions: This study demonstrated the development and testing of a composite index to monitor and assess service delivery on the continuum of care for maternal health. The index was shown to be robust and valid, and identified potential areas for service improvement. A contextualised version can be tested in other settings within and outside of South Africa.

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Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa

PLoS ONE ◽

10.1371/journal.pone.0252182 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0252182

Author(s):

Mamothena Carol Mothupi ◽

Jeroen De Man ◽

Hanani Tabana ◽

Lucia Knight

Keyword(s):

South Africa ◽

Maternal Health ◽

Service Delivery ◽

Social Determinants Of Health ◽

Social Determinants ◽

Composite Index ◽

Health Service Delivery ◽

Continuum Of Care ◽

Determinants Of Health ◽

The Continuum

Introduction The continuum of care is a recommended framework for comprehensive health service delivery for maternal health, and it integrates health system and social determinants of health. There is a current lack of knowledge on a measurement approach to monitor performance on the framework. In this study we aim to develop and test a composite index for assessing the maternal health continuum in a province in South Africa with the possibility of nationwide use. Materials and methods The composite index was computed as a geometric mean of four dimensions of adequacy of the continuum of care. Data was sourced from the district health information system, household surveys and the census. The index formula was tested for robustness when alternative inputs for indicators and standardization methods were used. The index was used to assess performance in service delivery in the North West province of South Africa, as well as its four districts over a five-year period (2013–2017). The index was validated by assessing associations with maternal health and other outcomes. And factor analysis was used to assess the statistical dimensions of the index. Results The provincial level index score increased from 62.3 in 2013 to 74 in 2017, showing general improvement in service delivery over time. The district level scores also improved over time, and our analysis identified areas for performance improvement. These include social determinants of health in some districts, and access and linkages to care in others. The provincial index was correlated with institutional maternal mortality rates (rs = -0.90, 90% CI = (-1.00, -0.25)) and the Human Development Index (r = 0.97, 95% CI = (0.63, 0.99). It was robust to alternative approaches including z-score standardization of indicators. Factor analysis showed three groupings of indicators for the health system and social determinants of health. Conclusions This study demonstrated the development and testing of a composite index to monitor and assess service delivery on the continuum of care for maternal health. The index was shown to be robust and valid, and identified potential areas for service improvement. A contextualised version can be tested in other settings within and outside of South Africa.

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Secondary health conditions and their impact on the wellbeing of people with spinal cord injury, South Africa: Patients perspective.

10.21203/rs.2.16532/v1 ◽

2019 ◽

Author(s):

SONTI PILUSA ◽

Myezwa Hellen ◽

Potterton Joanne

Keyword(s):

South Africa ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Continuum Of Care ◽

Health Conditions ◽

Primary Data ◽

Structured Interviews ◽

Cord Injury ◽

The Impact ◽

The Continuum

Abstract Background Long-term rehabilitation that includes preventive care for people with spinal cord injury is key to promoting health. There is evidence that secondary health conditions (SHCs) are prevalent complications across the continuum of care for people with spinal cord injury, leading to recurrent hospitalization and poor quality of life. In order to develop a context-based prevention model of care and strategies in South Africa, there is a need to understand the lived experiences of people with spinal cord injury (SCI).Aim To describe people with spinal cord injury’s experiences of secondary health conditions and the impact these have on their wellbeing.Methods A qualitative descriptive design using semi-structured interviews was adopted. Purposive sampling was used to collect data from 17 participants with SCI who attend outpatient medical care at a tertiary rehabilitation hospital in Gauteng, South Africa. Primary data were collected from August 2018-July 2019. All interviews were transcribed verbatim and analysed using a thematic analysis approach.Results People with spinal cord injury experience a range of secondary health conditions, of which pain, bowel and bladder issues were the most common. The presence of SHCs had an impact on the psychological, physical and social wellbeing of the participants.Conclusion There is a need for prevention interventions (health education and screening) for SHCs throughout the continuum of care and at all levels of prevention. Further research on factors influencing the prevention and management of SHCs is needed.

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Gaining patient experience insights

Conference Proceedings of the Academy for Design Innovation Management ◽

10.33114/adim.2019.05.253 ◽

2019 ◽

Vol 2 (1) ◽

Author(s):

Maitane GARCÍA-LÓPEZ ◽

Ester VAL ◽

Ion IRIARTE ◽

Raquel OLARTE

Keyword(s):

Type 1 Diabetes ◽

Patient Experience ◽

Patient Perspective ◽

Continuum Of Care ◽

Theoretical Framework ◽

Cognitive Responses ◽

The Continuum

Taking patient experience as a basis, this paper introduces a theoretical framework, to capture insights leading to new technological healthcare solutions. Targeting a recently diagnosed type 1 diabetes child and her mother (the principal caregiver), the framework showed its potential with effective identification of meaningful insights in a generative session. The framework is based on the patient experience across the continuum of care. It identifies insights from the patient perspective: capturing patients´ emotional and cognitive responses, understanding agents involved in patient experience, uncovering pain moments, identifying their root causes, and/or prioritizing actions for improvement. The framework deepens understanding of the patient experience by providing an integrated and multi-leveled structure to assist designers to (a) empathise with the patient and the caregiver throughout the continuum of care, (b) understand the interdependencies around the patient and different agents and (c) reveal insights at the interaction level.

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Faculty Opinions recommendation of Overcoming barriers to low-vision rehabilitation services: improving the continuum of care.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718202362.793490301 ◽

2014 ◽

Author(s):

Roy G Cole

Keyword(s):

Low Vision ◽

Continuum Of Care ◽

Rehabilitation Services ◽

Low Vision Rehabilitation ◽

Vision Rehabilitation ◽

The Continuum

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HIV and cardiovascular disease in sub-Saharan Africa: Demographic and Health Survey data for 4 countries

BMC Public Health ◽

10.1186/s12889-021-11218-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Leonard E. Egede ◽

Rebekah J. Walker ◽

Patricia Monroe ◽

Joni S. Williams ◽

Jennifer A. Campbell ◽

...

Keyword(s):

South Africa ◽

Cardiovascular Disease ◽

Health Survey ◽

Survey Design ◽

Logistic Models ◽

Population Data ◽

Demographic And Health Survey ◽

Sub Saharan Africa ◽

Sub Saharan ◽

The Relationship

Abstract Background Investigate the relationship between two common cardiovascular diseases and HIV in adults living in sub-Saharan Africa using population data provided through the Demographic and Health Survey. Methods Data for four sub-Saharan countries were used. All adults asked questions regarding diagnosis of HIV, diabetes, and hypertension were included in the sample totaling 5356 in Lesotho, 3294 in Namibia, 9917 in Senegal, and 1051 in South Africa. Logistic models were run for each country separately, with self-reported diabetes as the first outcome and self-reported hypertension as the second outcome and HIV status as the primary independent variable. Models were adjusted for age, gender, rural/urban residence and BMI. Complex survey design allowed weighting to the population. Results Prevalence of self-reported diabetes ranged from 3.8% in Namibia to 0.5% in Senegal. Prevalence of self-reported hypertension ranged from 22.9% in Namibia to 0.6% in Senegal. In unadjusted models, individuals with HIV in Lesotho were 2 times more likely to have self-reported diabetes (OR = 2.01, 95% CI 1.08–3.73), however the relationship lost significance after adjustment. Individuals with HIV were less likely to have self-reported diabetes after adjustment in Namibia (OR = 0.29, 95% CI 0.12–0.72) and less likely to have self-reported hypertension after adjustment in Lesotho (OR = 0.63, 95% CI 0.47–0.83). Relationships were not significant for Senegal or South Africa. Discussion HIV did not serve as a risk factor for self-reported cardiovascular disease in sub-Saharan Africa during the years included in this study. However, given the growing prevalence of diabetes and hypertension in the region, and the high prevalence of undiagnosed cardiovascular disease, it will be important to continue to track and monitor cardiovascular disease at the population level and in individuals with and without HIV. Conclusions The odds of self-reported diabetes in individuals with HIV was high in Lesotho and low in Namibia, while the odds of self-reported hypertension in individuals with HIV was low across all 4 countries included in this study. Programs are needed to target individuals that need to manage multiple diseases at once and should consider increasing access to cardiovascular disease management programs for older adults, individuals with high BMI, women, and those living in urban settings.

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