Exploring the diagnostic ability of the ADOS in special needs schools in the greater eThekwini area : a blinded study.

Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.Autism Spectrum Disorders (ASDs) are increasing in prevalence worldwide, including in developing countries like South Africa. If the assumption that ASDs manifests similarly across all cultures, then the Autism Diagnostic Observation Schedule (ADOS), the western gold standard for diagnosing ASDs, will be able to accurately discriminate those children that have ASDs from those that do not. The ADOS was designed to increase the likelihood of children displaying ASD type behaviours to facilitate a diagnosis, but this may negatively impact on scores obtained by African children which are socialised to be respectful as opposed to spontaneous. This research study formed part of the larger KwaZulu-Natal-ASD1 (K-ASD) study, and aimed to explore the diagnostic ability of the ADOS in special needs schools in the greater eThekwini area. The study design used a matched blinded sample comprising of an atypically developing ASD and non-ASD group from Black, White and Indian ethnicities. The sample came from special needs schools. The experimental group thus comprised people with ASD and the control group was a learning disabled group that did not have ASD. This study compared Autism Diagnostic Observation Schedule (ADOS) algorithm scores of a sample of 26 children (6-11 years of age) who were administered modules 1-3 of the ADOS with the clinical diagnoses for each of these children. Using McNemar’s Westlake Schuirmann Test of equivalence it was found that the clinician diagnoses and the ADOS coding algorithm results were statistically equivalent. Thus, no significant difference existed between the two methods of diagnosis. The ADOS showed greater sensitivity in identifying symptoms associated with ASD than did the clinician diagnoses. An ANOVA revealed significant differences in the communication and the reciprocal social interaction algorithm’s. This indicates a cultural variation in behaviours, since Black participants behaved in various gestural ways that were significantly different to the manner in which Whites behaved to the ADOS testing

Telegestão de rede de rega em aproveitamentos hidroagrícolas

Dissertação de mestrado, Engenharia Eléctrica e Electrónica, Instituto Superior de Engenharia, Universidade do Algarve, 2016O apoio ao desenvolvimento da agroindústria está na génese do Grupo Hubel, quer na vertente agronómica quer nas vertentes tecnológicas, como por exemplo telecomunicações, tecnologias de informação e automação. A agroindústria carece de tecnologias fiáveis, eficientes, inovadoras e competitivas de modo a dar resposta às crescentes necessidades desta indústria para possibilitar um aumento de eficiência e rentabilidade. Dentro da agroindústria, a agricultura está a assistir a uma revolução tecnologia denominada “Agricultura de Precisão”, esta agricultura assenta na premissa que é possível medir, prever e actuar em todos os factores que interfiram com o bom desenvolvimento das culturas de modo a minimizar os riscos de perdas de capitais e racionalização dos recursos naturais disponíveis. Para melhor gerir, armazenar, contabilizar e racionalizar a água para a rega, foram criados em Portugal diversos aproveitamentos hidroagrícolas, com especial incidência na zona de influência da barragem do Alqueva. Enquanto colaborador do Grupo Hubel, tive o privilégio de participar no projecto e na construção de vários destes aproveitamentos, ao nível da automatização das redes de rega e no desenvolvimento de sistemas de informação para o seu controlo e gestão. No presente relatório descrevo essencialmente as actividades, enquanto profissional de engenharia, que desenvolvi na concepção e instalação dos sistemas de automatização acima referidos. Dando especial enfoque ao projecto, à análise de soluções e de arquiteturas de comunicação e de automação, realçando os aspectos de aquisição e comunicação de dados. Por último, efectuo uma pequena abordagem às redes LPWAN em que assentam a maioria das soluções IoT

Using an action learning methodology to develop skills of health managers: experiences from KwaZulu-Natal, South Africa

Abstract Background Strong management skills are key to improving performance of health systems. Action learning, a technique to develop management skills, has been used successfully with health managers but not usually among lower level managers or in low and middle-income countries (LMICs). Methods This study uses a qualitative approach to explore experiences, successes and challenges of using an action learning approach to improve skills of managers in neonatal units in KwaZulu-Natal (KZN), South Africa. Eight action learning groups were convened with neonatal unit managers from all 39 district hospitals in KZN, each group had 4–6 participants. Meetings were conducted by a facilitator trained in action learning techniques, and groups met a minimum of ten times over a one-year period. After completion of the intervention, 14 in-depth interviews were conducted with purposively selected action learning participants. Data was transcribed and analysed using framework analysis. Results Neonatal unit managers found that action learning generated a sense of empowerment in their abilities, trust and confidence among participants was nurtured, problem solving and critical thinking skills were developed, and a continuous support system was created. The action learning process led to several positive changes in neonatal units, which enhanced the quality of care for patients. A number of challenges were also identified, mainly relating to administrative issues such as the provision of a skilled facilitator, permission to attend action learning meetings and logistical issues, including transport and other financial implications. Conclusions This paper illustrates that action learning can be an effective and practical method to support public health workers to manage their health units despite the challenges associated with the method. Time, energy and financial resources used to facilitate action learning for this cadre of health workers is rewarded by improved skills of managers and better quality of care for patients

Insights into health care seeking behaviour for children in communities in KwaZulu-Natal, South Africa

Background: South African infant and child mortality remains high, with many deaths occurring outside the formal health services. Delayed health care seeking represents a large proportion of these deaths. Aim: To generate knowledge about the role of, and influences on, caregivers with regard to decision-making about when and where to seek care for sick children. Setting: Two communities in KwaZulu-Natal. Methods: A qualitative, exploratory design employing participatory research techniques was used to undertake focus group discussions with community members. Results: Health care seeking for a sick child was described as a complex process influenced by multiple carers using multiple providers. Decision-making about seeking health care for a sick child was not an individual effort, but was shared with others in the household and guided by how the symptoms were perceived, either a Western illness or African illness. A sick child could either be treated at home or be taken to a variety of places including clinics, private doctors, traditional healers, faith healers and hospitals. Traditional healers were associated with the treatment of illnesses perceived to be traditional. Few participants said that they would take their child back to the original health provider if the child remained ill, but would move from one provider to another until the child’s health improved. Conclusion: The formal health system needs to ensure that sick children are identified and managed appropriately to reduce child deaths. Knowledge and understanding of health care seeking behaviour for sick children by carers is an important aspect. Interventions need to be designed with these contextual issues in mind

Trust of community health workers influences the acceptance of community-based maternal and child health services

Background: Community health workers (CHWs) are a component of the health system in many countries, providing effective community-based services to mothers and infants. However, implementation of CHW programmes at scale has been challenging in many settings. Aim: To explore the acceptability of CHWs conducting household visits to mothers and infants during pregnancy and after delivery, from the perspective of community members, professional nurses and CHWs themselves. Setting: Primary health care clinics in five rural districts in KwaZulu-Natal, South Africa. Methods: A qualitative exploratory study was conducted where participants were purposively selected to participate in 19 focus group discussions based on their experience with CHWs or child rearing. Results: Poor confidentiality and trust emerged as key barriers to CHW acceptability in delivering maternal and child health services in the home. Most community members felt that CHWs could not be trusted because of their lack of professionalism and inability to maintain confidentiality. Familiarity and the complex relationships between household members and CHWs caused difficulties in developing and maintaining a relationship of trust, particularly in high HIV prevalence settings. Professional staff at the clinic were crucial in supporting the CHW’s role; if they appeared to question the CHW’s competency or trustworthiness, this seriously undermined CHW credibility in the eyes of the community. Conclusion: Understanding the complex contextual challenges faced by CHWs and community members can strengthen community-based interventions. CHWs require training, support and supervision to develop competencies navigating complex relationships within the community and the health system to provide effective care in communities

Autonomy and infant feeding decision-making among teenage mothers in a rural and urban setting in KwaZulu-Natal, South Africa

Abstract Background The nutritional status of infants born to teenage mothers can be sub-optimal compared to those born to older mothers. One contributing factor is inappropriate feeding practices adopted by teenage mothers. Little is known about how infant feeding decisions are made among teenage mothers, particularly in under resourced settings. In this study we prospectively explored autonomy and infant feeding decision-making among teenage mothers in a rural and urban setting in KwaZulu-Natal, South Africa. Methods This study adopted a qualitative longitudinal design. Thirty pregnant participants were recruited to the study cohort, from the catchment area of two hospitals (one urban and one rural). Participants were purposively selected to include teenagers, HIV positive, and working pregnant women. We report findings from ten teenage mothers, aged between 15 and 19 years, who participated in the larger cohort (n = 5 rural; n = 5 urban). Monthly in-depth interviews were conducted with participating mothers for 6 months starting 2 weeks after delivery. All interviews were conducted in the local language, transcribed verbatim and translated into English. Data was coded using NVivo v10 and framework analysis was used. Results Findings from this study showed that teenage mothers had knowledge about recommended feeding practices. However, our findings suggest that these mothers were not involved in infant feeding decisions once they were at home, because infant feeding decision-making was a role largely assumed by older mothers in the family. Further, the age of the mother and financial dependency diminished her autonomy and ability to influence feeding practices or challenge incorrect advice given at home. Most feeding advice shared by family members was inappropriate, leading to poor infant feeding practices among teenage mothers. Returning to school and fear of breastfeeding in public were also barriers to exclusive breastfeeding. Conclusion Teenage mothers had a limited role in the infant feeding decision-making process. Health workers have an important role to play in ensuring that knowledge about infant feeding is shared with the mother’s family where infant feeding choices are made. This will improve support for teenage mothers, and may also positively impact on the nutritional status of children

Fragmentation of maternal, child and HIV services: A missed opportunity to provide comprehensive care

Background: In South Africa, coverage of services for mothers and babies in the first year of life is suboptimal despite high immunisation coverage over the same time period. Integration of services could improve accessibility of services, uptake of interventions and retention in care. Aim: This study describes provision of services for mothers and babies aged under 1 year. Setting: Primary healthcare clinics in one rural district in KwaZulu-Natal, South Africa. Methods: All healthcare workers on duty and mothers exiting the clinic after attending well-child services were interviewed. Clinics were mapped to show the route through the clinic taken by mother–baby pairs receiving well-child services, where these services were provided and by whom. Results: Twelve clinics were visited; 116 health workers and 211 mothers were interviewed. Most clinics did not provide comprehensive services for mothers and children. Challenges of structural layout and deployment of equipment led to fragmented services provided by several different health workers in different rooms. Well-child services were frequently provided in public areas of the clinic or with other mothers present. In some clinics mothers and babies did not routinely see a professional nurse. In all clinics HIV-positive mothers followed a different route. Enrolled nurses led the provision of well-child services but did not have skills and training to provide comprehensive care. Conclusions: Fragmentation of clinic services created barriers in accessing a comprehensive package of care resulting in missed opportunities to provide services. Greater integration of services alongside immunisation services is needed