Hospital reform and staff morale in South Africa: a case study of Dr Yusuf Dadoo Hospital

Objectives: This study explored major factors that influenced staff motivation at a district hospital in South Africa following hospital reforms and comparison of these factors across the two main staff categories.Design: This study was a cross-sectional descriptive survey.Settings and subjects: This study included all medical and nursing staff working at the district hospital.Outcome measures: A semi-structured questionnaire coded for anonymity was used. It comprised three sections: the introduction, demographic information and a list of factors to which participants responded by indicating their level of agreement or disagreement using the Likert’s scale. The questionnaire’s reliability was confirmed using Cronbach’s coefficient alpha with a value of 0.9.Results: Of the 179 participants, 122 returned the questionnaires. This equated to a response rate of 68%. The staff expressed more demotivation than motivation. Major factors that played a role were institutional in character, namely poor management and leadership, unfavourable institutional policies and administration practices with regard to staff development, conflictual inter- and intraprofessional relationships, a paucity of equipment and retention and recruitment strategies. The unique motivator was the individual value of the vocational aspect of the profession. Distance travelled to the workplace did not have any association with the identified motivating and demotivating factors.Conclusion: Staff motivation is crucial in any institution or organisation. Presently, the South African healthcare sector is undergoing transformation in terms of implementation of National Health Insurance. The effectiveness of the healthcare system in achieving its goals will be impacted by the prioritisation of institutional strategies that contribute to staff motivation. Managers’ skills in healthcare facilities are critical to the success of the implementation of reforms in South Africa.Keywords: hospital reform, staff morale, quality of care, healthcare resource

The procedural skills of rural hospital doctors

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Market segmentation and consumer willingness to pay for high fibre products : the case of Johannesburg and the surrounding areas, South Africa

Functional foods constitute a growing focus for research, product development and consumer interest in recent years. This study investigated the factors that affect willingness to pay for high fibre food on the market as well as respondents’ attitude towards the purchase of these products. The results indicated that those consumers in the high income group were more health conscious than their low income counterparts and willing to pay for high fibre products. The results showed that health risk perceptions as well as regulatory programmes affected consumers’ willingness to pay. The results also showed that at low percentage prices consumers were willing to pay for high fibre products. Gender and marital status did not seem to have an influence on willingness to buy for any of the selected products. Findings of the study could encourage food manufacturers to carry on with developments of functional foods since willingness to pay increased with increase in income.Agriculture, Animal Health and Human Ecolog

Adherence to antiretroviral therapy, virologic failure and workload at the Rustenburg Provincial Hospital

Background: Adherence to antiretroviral therapy (ART) is a strong predictor of progression to AIDS and death. It remains the most important potentially alterable factor that determines treatment outcomes.Methods: The study is a cross-sectional survey of self-reported adherence to ART and associated factors. It included a randomly selected sample of 100 adult patients who began ART between June 2006 and December 2007. A modified Adult AIDS Clinical Trials Group questionnaire was used. The analysis compared self-reported adherence levels by factor and viral load test results.Results: Only 71% of patients had an adherence > 95%. Poor adherence was related to changes in daily routines (being away from home [21%] and busy with other things [17%]). All patients with symptoms suggestive of clinical depression had virologic failure. More unemployed patients (50.7%) had virologic failure than did employed patients (40%) (p = < 0.05). The clinic had a tenfold increase in patient enrolment and a ninefold decline in staff-to-patient ratio, and the proportion of patients lost to follow-up doubled in the preceding four years.Conclusion: Adherence to ART was poor. The capacity of the clinic to manage patients adequately has declined significantly. Decentralisation of ART services to primary health care facilities should be considered.Keywords: adherence; ART; HIV; human resource; South Afric

Closing the prevention of mother-to-child transmission gap in Nigeria: an evaluation of service improvement intervention in Nigeria

Objectives: The objective was to assess improvement, or lack thereof, in the uptake of prevention of mother-to-child transmission (MTCT) services at selected sites supported sites by the Global HIV/AIDS Initiative Nigeria (GHAIN). Design: The study used aggregated monthly service statistics to evaluate service improvement efforts that were conducted before and after these were undertaken between July 2007-June 2008. Settings and subjects: The service improvement efforts took place in 60 public healthcare facilities. Outcome measures: The study measured changes in the number of pregnant women who attended antenatal clinics for the first time, the number of pregnant women tested for human immunodeficiency virus (HIV), the number of HIV-positive women receiving antiretroviral (ARV) prophylaxis, and the service ratio, an indicator of the relative uptake of ARV prophylaxis. An estimate of MTCT events that were averted through ARV prophylaxis taken by the pregnant women was also calculated. Results: One hundred and twenty thousand, five hundred and thirty-seven women attended an antenatal clinic (ANC) for the first time. There was an average of 167.4 monthly attendances per facility. ANC attendance increased per facility by 11.1 women monthly post-intervention (p-value &lt; 0.01). The uptake of HIV testing was 87%, with a monthly average increase of 17.8 women tested per facility (p-value &lt; 0.01). ARV prophylaxis uptake rose from 3.3-5.4 women per facility per month (p-value &lt; 0.01). The service ratio per facility improved from 5.3 women receiving ARVs to 6.5 for every 10 women who tested positive for HIV (p-value &lt; 0.01). Applying risk reduction estimates of different ARV  regimens, it was estimated that between 88-169 MTCT events were averted pre-intervention, and 143-276 events, post-intervention. Conclusion: Service improvement intervention improved the utilisation of PMTCT services. It should be a key intervention that is used to close the PMTCT gap in Nigeria.Keywords: HIV, PMTCT, evaluation, Nigeria, service improvement, effectivenes

Hospital reform and staff morale in South Africa : a case study of Dr Yusuf Dadoo hospital

OBJECTIVES: This study explored major factors that influenced staff motivation at a district hospital in South Africa following hospital reforms and comparison of these factors across the two main staff categories. DESIGN: This study was a cross-sectional descriptive survey. SETTINGS AND SUBJECTS: This study included all medical and nursing staff working at the district hospital. OUTCOME MEASURES: A semi-structured questionnaire coded for anonymity was used. It comprised three sections: the introduction, demographic information and a list of factors to which participants responded by indicating their level of agreement or disagreement using the Likert’s scale. The questionnaire’s reliability was confirmed using Cronbach’s coefficient alpha with a value of 0.9. RESULTS: Of the 179 participants, 122 returned the questionnaires. This equated to a response rate of 68%. The staff expressed more demotivation than motivation. Major factors that played a role were institutional in character, namely poor management and leadership, unfavourable institutional policies and administration practices with regard to staff development, conflictual inter- and intraprofessional relationships, a paucity of equipment and retention and recruitment strategies. The unique motivator was the individual value of the vocational aspect of the profession. Distance travelled to the workplace did not have any association with the identified motivating and demotivating factors. CONCLUSION: Staff motivation is crucial in any institution or organisation. Presently, the South African healthcare sector is undergoing transformation in terms of implementation of National Health Insurance. The effectiveness of the healthcare system in achieving its goals will be impacted by the prioritisation of institutional strategies that contribute to staff motivation. Managers’ skills in healthcare facilities are critical to the success of the implementation of reforms in South Africa.www.safpj.co.zaam201

Oral complications of HIV disease in children in the post 1998 era of HAART : a descriptive cross sectional study of prevalences, retrospective and clinical

INTRODUCTION : The administration of HAART* has changed the frequency and character of the oral complications of HIV disease. AIMS AND OBJECTIVES : This study describes and compares the incidence and status of dental caries and the number and type of oral mucosal lesions in hospital outpatients with these data in institutionalized children who had accepted a dedicated oral and dental management programme for HIV-infected patients. DESIGN : This was a retrospective, descriptive cross-sectional study in which existing medical records were reviewed and a clinical examination performed. METHODS : The oral cavity of each patient was examined by two calibrated clinicians who used mouth mirrors under artificial light. The presence and status of dental caries and the presence of oral soft tissue lesions were recorded using, respectively, the WHO Oral Health Surveys Basic Methods and the diagnostic classification and criteria for oral soft tissue lesions associated with HIV of the ECClearinghouse. RESULTS : Oral lesions and dental caries were significantly higher (p<0.001) in hospital outpatients than in institutionalized children. Caries prevalence (p = 0.002) and severity p<0.0001) were significantly higher in hospital outpatient children receiving HAART than in those not on HAART. CONCLUSIONS : The prevalence of oral lesions was significantly reduced (p = 0.025) in children receiving HAART. Caries prevalence was significantly higher in children receiving HAART than in those not on HAART.http://www.sada.co.zaam201

The prevalence of HIV associated oral lesions among adults in the era of HAART

INTRODUCTION: The overall prevalence of HIV associated oral lesions among adults has decreased since the advent of highly active anti-retroviral therapy (HAART). AIMS AND OBJECTIVES: This study describes the prevalence and types of oral mucosal lesions in adults, who accepted a dedicated oral and dental programme for HIV-infected patients. The incidence of oral lesions and the CD4 cell counts on those patients, were related to cases receiving HAART and to those who were not. DESIGN: This was a retrospective, descriptive cross-sectional study. METHODS: Patients were interviewed, using a structured questionnaire to obtain information regarding medical history, current medications and demographic details. Data relating to CD4 cell counts were extracted from clinical medical records of the patient. In each case, the oral cavity of the sitting patient was examined under artificial light, by a clinician using a mouth mirror. Oral lesions were categorised in accordance with EC-Clearinghouse diagnostic criteria. RESULTS: The prevalence of HIV-associated oral lesions was significantly reduced (p <0.001) in patients receiving HAART. There was, however, no significant difference (p = 0.29) in mean CD4 counts between patients receiving HAART and those not receiving HAART. The presence of oral lesions was statistically significantly, associated with both CD4 counts of <200 cells/mm3 (p<0.001) and the absence of HAART (p = 0.033). CONCLUSIONS: The study confirmed that the incidence of oral lesions and of pseudo-membranous candidiasis in particular, were statistically significantly reduced in patients receiving HAART.http://www.sada.co.zaam2013ay201

Closing the prevention of mother-to-child transmission gap in Nigeria: an evaluation of service improvement intervention in Nigeria

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Objectives: The objective was to assess improvement, or lack thereof, in the uptake of prevention of mother-to-child transmission (MTCT) services at selected sites supported sites by the Global HIV/AIDS Initiative Nigeria (GHAIN). Design: The study used aggregated monthly service statistics to evaluate service improvement efforts that were conducted before and after these were undertaken between July 2007-June 2008. Settings and subjects: The service improvement efforts took place in 60 public healthcare facilities. Outcome measures: The study measured changes in the number of pregnant women who attended antenatal clinics for the first time, the number of pregnant women tested for human immunodeficiency virus (HIV), the number of HIV-positive women receiving antiretroviral (ARV) prophylaxis, and the service ratio, an indicator of the relative uptake of ARV prophylaxis. An estimate of MTCT events that were averted through ARV prophylaxis taken by the pregnant women was also calculated. Results: One hundred and twenty thousand, five hundred and thirty-seven women attended an antenatal clinic (ANC) for the first time. There was an average of 167.4 monthly attendances per facility. ANC attendance increased per facility by 11.1 women monthly post-intervention (p-value < 0.01). The uptake of HIV testing was 87%, with a monthly average increase of 17.8 women tested per facility (p-value < 0.01). ARV prophylaxis uptake rose from 3.3–5.4 women per facility per month (p-value < 0.01). The service ratio per facility improved from 5.3 women receiving ARVs to 6.5 for every 10 women who tested positive for HIV (p-value < 0.01). Applying risk reduction estimates of different ARV regimens, it was estimated that between 88–169 MTCT events were averted pre-intervention, and 143–276 events, post-intervention. Conclusion: Service improvement intervention improved the utilisation of PMTCT services. It should be a key intervention that is used to close the PMTCT gap in Nigeria.https://doi.org/10.1080/20786204.2013.1087431055pubpub