scholarly journals TB prevention cascade at a district hospital in rural Eastern Cape, South Africa

2021 ◽  
Vol 11 (2) ◽  
pp. 97-100
Author(s):  
B. J. van de Water ◽  
T. N. Meyer ◽  
M. Wilson ◽  
C. Young ◽  
B. Gaunt ◽  
...  
Keyword(s):  
South Africa ◽  
District Hospital ◽  
Close Contact ◽  
Primary Care Providers ◽  
Preventive Therapy ◽  
Eastern Cape ◽  
Care Providers ◽  
District Health ◽  
District Hospitals ◽  
Close Contacts

SETTING: Rural Eastern Cape, South Africa.OBJECTIVE: To identify steps in the TB preventive care cascade from routinely collected data among TB patients at a district hospital prior to the implementation of a novel TB program.DESIGN: This was a retrospective study. We adapted the TB prevention cascade to measure indicators routinely collected at district hospitals for TB using a cascade framework to evaluate outcomes in the cohort of close contacts.RESULTS: A total of 1,722 charts of TB patients were reviewed. The majority of patients (87%) were newly diagnosed with no previous episodes of TB. A total of 1,548 (90%) patients identified at least one close contact. A total of 7,548 contacts were identified with a median of 4.9 (range 1–16) contacts per patient. Among all contacts identified, 2,913 (39%) were screened for TB. Only 15 (0.5%) started TB preventive therapy and 122 (4.4%) started TB treatment. Nearly 25% of all medical history and clinical information was left unanswered among the 1,722 TB charts reviewed.CONCLUSION: Few close contacts were screened or started on TB preventive therapy in this cohort. Primary care providers for TB care in district health facilities should be informed of best practices for screening and treating TB infection and disease.

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

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.

scholarly journals Preceptors’ perceptions of assessing clinical associate students at district hospital sites

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Aloysious Kakia ◽  
Ian Couper
Keyword(s):  
Medical Practice ◽  
District Hospital ◽  
Student Assessment ◽  
Practical Experience ◽  
Eastern Cape ◽  
Structured Interviews ◽  
District Hospitals ◽  
University Support ◽  
Distributed Platform ◽  
The University

Background: Preceptors are key stakeholders in distributed health professions’ education. They supervise students in the clinical setting to enable them to have a practical experience with patients, and they assess students’ skills at the highest tier of clinical assessment. The university where this study was done conducts a distributed Bachelor of Clinical Medical Practice course on a distributed platform which is dependent on preceptors at the training sites. Understanding the perceptions of preceptors, as major stakeholders, regarding the student assessment they do will assist the faculty to provide better support and development that might be needed and assist in maximising the benefits of distributed training.Aim: The aim of this study was to explore the perceptions of preceptors regarding assessing clinical associate students at district hospitals in the Bachelor of Clinical Medical Practice programme.Setting: The study was conducted at a rural university in the Eastern Cape province of South Africa.Methods: This was a qualitative study involving nine preceptors who were purposively selected from three district hospital training sites based on their involvement in assessing clinical associate students. Semi-structured interviews were conducted, recorded, transcribed and thematically analysed.Results: Four themes emerged from thematic analysis: assessment issues, preceptor issues, student issues and university support issues. Preceptors are committed and enthusiastic in training and assessing the clinical associate students but require input from the university in terms of training and ongoing support.Conclusion: Lack of training threatens the validity of preceptor assessment. Academic institutions should train and support preceptors to enable them better to fulfil their roles.

scholarly journals Health workers' views on factors affecting caregiver engagement with bubble CPAP

2020 ◽  
Author(s):  
Sangwani Salimu ◽  
Maggie Woo Kinshella ◽  
Marianne Vidler ◽  
Mwai Banda ◽  
Laura Newberry ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Workers ◽  
Health Management ◽  
Care Providers ◽  
District Health ◽  
Severe Respiratory Distress ◽  
Good Communication ◽  
District Hospitals ◽  
Bubble Cpap

Abstract Background Severe respiratory distress is a leading cause of mortality among neonates in Malawi. Despite evidence on the safety, cost effectiveness and efficacy of bubble continuous positive airway pressure (CPAP) in managing the condition, its use in Malawian health facilities is limited and little is known about caregivers' engagement with perspectives of bubble CPAP. The purpose of this study was to explore caregiver perspectives for bubble CPAP at both central and district hospitals and key factors that enable effective caregiver engagement in Malawi. Methods This was a descriptive qualitative study employing secondary analysis of 46 health care worker in-depth interviews. We interviewed the health workers about their thoughts on caregiver perspectives regarding use of bubble CPAP. We implemented the study at a tertiary facility and three district hospitals in southern Malawi. This was a part of a larger study to understand barriers and facilitators to implementing neonatal innovations in resource-constrained hospitals. Interviews were thematically analysed in NVivo 12 software (QSR International, Melbourne, Australia). Health workers were purposively selected to include nurses, clinicians and district health management involved in the use of bubble CPAP.Results Emerging issues included caregiver fears around bubble CPAP equipment as potentially harmful to their new-borns and how inadequate information provided to caregivers exacerbated knowledge gaps and was associated with refusal of care. However, good communication between health care providers and caregivers was associated with acceptance of care. Caregivers’ decision-making was influenced by relatives and peer advocates were helpful in supporting caregivers and alleviating fears or misconceptions about bubble CPAP.Conclusions Since caregivers turn to relatives and peers for support, there is need to ensure that both relatives and peers are counselled on bubble CPAP for improved understanding and uptake. Health workers need to provide simplified, accurate, up-to-date information on the intervention as per caregivers’ level of understanding. Notably, contextualised comprehensible information will help alleviate caregivers’ fear and anxieties about bubble CPAP.

scholarly journals Development of a training programme for primary care providers to counsel patients with risky lifestyle behaviours in South Africa

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Zelra Malan ◽  
Bob Mash ◽  
Kathy Everett-Murphy
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Nurse Practitioners ◽  
Communicable Disease ◽  
Primary Care Providers ◽  
Training Programme ◽  
Care Providers ◽  
Clinical Nurse ◽  
Lifestyle Behaviours ◽  
Behaviour Change Counselling

Background: We are facing a global epidemic of non-communicable disease (NCDs), which has been linked with four risky lifestyle behaviours. It is recommended that primary care providers (PCPs) provide individual brief behaviour change counselling (BBCC) as part of everyday primarycare, however currently training is required to build capacity. Local training programmes are not sufficient to achieve competence.Aim: This study aimed to redesign the current training for PCPs in South Africa, around a new model for BBCC that would offer a standardised approach to addressing patients’ risky lifestyle behaviours.Setting: The study population included clinical nurse practitioners and primary care doctors in the Western Cape Province.Methods: The analyse, design, develop, implement and evaluate (ADDIE) model provided a systematic approach to the analysis of learning needs, the design and development of the training programme, its implementation and initial evaluation.Results: This study designed a new training programme for PCPs in BBCC, which was based on a conceptual model that combined the 5As (ask, alert, assess, assist and arrange) with a guiding style derived from motivational interviewing. The programme was developed as an eight-hour training programme that combined theory, modelling and simulated practice with feedback, for either clinical nurse practitioners or primary care doctors.Conclusion: This was the first attempt at developing and implementing a best practice BBCC training programme in our context, targeting a variety of PCPs, and addressing different risk factors.

scholarly journals Beyond health care providers’ recommendations: understanding influences on infant feeding choices of women with HIV in the Eastern Cape, South Africa

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Oladele Vincent Adeniyi ◽  
Anthony Idowu Ajayi ◽  
Moshood Issah ◽  
Eyitayo Omolara Owolabi ◽  
Daniel Ter Goon ◽  
...  
Keyword(s):  
South Africa ◽  
Health Care ◽  
Infant Feeding ◽  
Health Care Providers ◽  
Eastern Cape ◽  
Care Providers ◽  
Women With Hiv ◽  
Feeding Choices

scholarly journals “Those women have hope in us and if you explain properly, they understand”: Health workers' views on factors affecting caregiver engagement with bubble CPAP

2020 ◽  
Author(s):  
Sangwani Salimu ◽  
Maggie Kinshella ◽  
Marianne Marianne ◽  
Mwai Banda ◽  
Laura Newberry ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Workers ◽  
Health Management ◽  
Care Providers ◽  
District Health ◽  
Severe Respiratory Distress ◽  
Good Communication ◽  
District Hospitals ◽  
Bubble Cpap

Abstract Background Severe respiratory distress is a leading cause of mortality among neonates in Malawi. Despite evidence on the safety, cost effectiveness and efficacy of bubble continuous positive airway pressure (CPAP) in managing the condition, its use in Malawian health facilities is limited and little is known about health workers engagement with perspectives of bubble CPAP. The purpose of this study was to explore caregiver perspectives for bubble CPAP at both central and district hospitals and key factors that enable effective caregiver engagement in Malawi. Methods This was a descriptive qualitative study employing secondary analysis of 46 health care worker in-depth interviews. We interviewed the health workers about their thoughts on caregiver perspectives regarding use of bubble CPAP. We implemented the study at a tertiary facility and three district hospitals in southern Malawi. This was a part of a larger study to understand barriers and facilitators to implementing neonatal innovations in resource-constrained hospitals. Interviews were thematically analysed in NVivo 12 software (QSR International, Melbourne, Australia). Health workers were purposively selected to include nurses, clinicians and district health management involved in the use of bubble CPAP. Results Emerging issues included caregiver fears around bubble CPAP equipment as potentially harmful to their new-borns and how inadequate information provided to caregivers exacerbated knowledge gaps and was associated with refusal of care. However, good communication between health care providers and caregivers was associated with acceptance of care. Caregivers’ decision-making was influenced by relatives and peer advocates were helpful in supporting caregivers and alleviating fears or misconceptions about bubble CPAP. Conclusions Since caregivers turn to relatives and peers for support, there is need to ensure that both relatives and peers are counselled on bubble CPAP for improved understanding and uptake. Health workers need to provide simplified, accurate, up-to-date information on the intervention as per caregivers’ level of understanding. Notably, contextualised comprehensible information will help alleviate caregivers’ fear and anxieties about bubble CPAP. Key words : bubble CPAP, neonates, caregiver, perspectives, peers, Malawi

scholarly journals A geospatial analysis of two-hour surgical access to district hospitals in South Africa

2020 ◽  
Author(s):  
Kathryn Chu ◽  
Angela J Dell ◽  
Harry Moultrie ◽  
Candy Day ◽  
Megan Naidoo ◽  
...  
Keyword(s):  
South Africa ◽  
District Hospital ◽  
Surgical Care ◽  
Sub Saharan Africa ◽  
Surgical Capacity ◽  
Surgical Access ◽  
District Hospitals ◽  
Government Hospitals ◽  
Sub Saharan ◽  
Improve Access

Abstract Background: In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within two hours. The objective was to identify the proportion of the population living within two hours of a district hospital with surgical capacity in South Africa. Methods: All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods. Results: Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Conclusion: Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.

scholarly journals Are there decision support tools that might strengthen the health system for perinatal care in South African district hospitals? A review of the literature

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ntombifikile Maureen Nkwanyana ◽  
Anna Silvia Voce
Keyword(s):  
South Africa ◽  
Decision Making ◽  
Decision Support ◽  
Health System ◽  
District Hospital ◽  
Perinatal Care ◽  
Decision Support Tools ◽  
Hospital Level ◽  
District Hospitals ◽  
Support Tools

Abstract Background South Africa has a high burden of perinatal deaths in spite of the availability of evidence-based interventions. The majority of preventable perinatal deaths occur in district hospitals and are mainly related to the functioning of the health system. Particularly, leadership in district hospitals needs to be strengthened in order to decrease the burden of perinatal mortality. Decision-making is a key function of leaders, however leaders in district hospitals are not supported to make evidence-based decisions. The aim of this research was to identify health system decision support tools that can be applied at district hospital level to strengthen decision-making in the health system for perinatal care in South Africa. Methods A structured approach, the systematic quantitative literature review method, was conducted to find published articles that reported on decision support tools to strengthen decision-making in a health system for perinatal, maternal, neonatal and child health. Articles published in English between 2003 and 2017 were sought through the following search engines: Google Scholar, EBSCOhost and Science Direct. Furthermore, the electronic databases searched were: Academic Search Complete, Health Source – Consumer Edition, Health Source – Nursing/Academic Edition and MEDLINE. Results The search yielded 6366 articles of which 43 met the inclusion criteria for review. Four decision support tools identified in the articles that met the inclusion criteria were the Lives Saved Tool, Maternal and Neonatal Directed Assessment of Technology model, OneHealth Tool, and Discrete Event Simulation. The analysis reflected that none of the identified decision support tools could be adopted at district hospital level to strengthen decision-making in the health system for perinatal care in South Africa. Conclusion There is a need to either adapt an existing decision support tool or to develop a tool that will support decision-making at district hospital level towards strengthening the health system for perinatal care in South Africa.

scholarly journals Patient-level predictors of detection of depressive symptoms, referral, and uptake of depression counseling among chronic care patients in KwaZulu-Natal, South Africa

2020 ◽  
Vol 7 ◽  
Author(s):  
Christopher G. Kemp ◽  
Ntokozo Mntambo ◽  
Max Bachmann ◽  
Arvin Bhana ◽  
Deepa Rao ◽  
...  
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Depressive Symptoms ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Resource Settings ◽  
Low Resource ◽  
Patient Level ◽  
Kwazulu Natal

Abstract Background Integration of depression treatment into primary care could improve patient outcomes in low-resource settings. Losses along the depression care cascade limit integrated service effectiveness. This study identified patient-level factors that predicted detection of depressive symptoms by nurses, referral for depression treatment, and uptake of counseling, as part of integrated care in KwaZulu-Natal, South Africa. Methods This was an analysis of baseline data from a prospective cohort. Participants were adult patients with at least moderate depressive symptoms at primary care facilities in Amajuba, KwaZulu-Natal, South Africa. Participants were screened for depressive symptoms prior to routine assessment by a nurse. Generalized linear mixed-effects models were used to estimate associations between patient characteristics and service delivery outcomes. Results Data from 412 participants were analyzed. Nurses successfully detected depressive symptoms in 208 [50.5%, 95% confidence interval (CI) 38.9–62.0] participants; of these, they referred 76 (36.5%, 95% CI 20.3–56.5) for depression treatment; of these, 18 (23.7%, 95% CI 10.7–44.6) attended at least one session of depression counseling. Depressive symptom severity, alcohol use severity, and perceived stress were associated with detection. Similar factors did not drive referral or counseling uptake. Conclusions Nurses detected patients with depressive symptoms at rates comparable to primary care providers in high-resource settings, though gaps in referral and uptake persist. Nurses were more likely to detect symptoms among patients in more severe mental distress. Implementation strategies for integrated mental health care in low-resource settings should target improved rates of detection, referral, and uptake.

Knowledge of Intensive Care Nurses Regarding the Monitoring of Early Enteral Nutrition

2018 ◽  
Vol 20 (2) ◽  
Author(s):  
Nomaxabiso Mildred Mooi
Keyword(s):  
Intensive Care ◽  
Enteral Nutrition ◽  
Primary Care Providers ◽  
Hospital Length ◽  
Public Hospitals ◽  
Hospital Length Of Stay ◽  
Early Enteral Nutrition ◽  
Eastern Cape ◽  
Care Providers ◽  
Cross Sectional

Early initiated and uninterrupted enteral nutrition is associated with the reduction of disease severity, diminished complications, decreased hospital length of stay, and favourably affects the outcomes of critically ill patients. The aim of the study was to assess the knowledge of early enteral nutrition (EEN) monitoring among intensive care unit (ICU) nurses in selected facilities in the Eastern Cape, South Africa. A quantitative, descriptive and cross-sectional design was followed. A total of 115 questionnaires were distributed and 70 were returned giving a response rate of 61 per cent. Data were analysed using the Statistical Package for Social Sciences, version 21. The results showed that younger and less experienced nurses in private hospitals were more knowledgeable about EEN than the nurses in public hospitals. Regarding tolerance and adequacy monitoring, 60 per cent of the respondents reported the availability of enteral nutrition protocols while 40 per cent of the respondents disagreed that the protocols were available, which clearly stated a lack of efficient monitoring practices. Further, the varied knowledge reported by ICU nurses could be related to unclear protocols regarding procedures to be followed in monitoring tolerance and complications of EEN in the ICUs. Nurses, as primary care providers, should be equipped with the necessary knowledge to be able to advocate for EEN and to monitor the tolerance and adequacy of nutrient delivery.

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