Complementary surveillance strategies and interventions to inform a tuberculosis care cascade for children

Paediatrics and Child Healt

Towards a values-based model to manage joint academic appointments in the health sector in South Africa

Joint appointments in the health sector in South Africa are made to serve both service and academic functions in one post. Typically the employing organisations are unequal, as one of them is the paying organisation while the other is the academic employer. This practice has been in existence for decades, and is ruled by expediency rather than being based on values. Joint employees experience role confusion, job confusion, dual loyalty confusion and being managed according to the rules of two organisations. This suboptimal situation leads to lower-than-expected performance in the eyes of both employing organisations. In this study the knowledge and problem areas of joint appointments were explored. The first part of the study consisted of a questionnaire analysis of the knowledge and view of problems as expressed by joint staff as well as by human resources (HR) practitioners. Group discussions, as well as the major part of the study, namely, interviews with senior management staff of both organisations were then conducted. In order to complete the study, an analysis was made of values that might inform on the problem. Joint staff members were found to have limited knowledge of the work requirements of a joint employee, and expressed concern about loyalty and role confusion. When the values were discussed with senior management staff, some values were identified as informing on possible solutions such as joint establishment of vision, joint objectives, respect for all components of the job, as well as generic values, including honesty, transparency, fairness, diversity and others. A framework is suggested commenting on the potential place for a values-based approach. From this a model is proposed by means of which a values-based process can be initiated by a top-level agreement meeting (“meeting of the minds”) of both employers that may lead to a single joint vision and set of objectives. From this agreement a policymaking joint body can establish the rules, while application and implementation are monitored by local joint management committees.Dissertation (MCom)--University of Pretoria, 2011.Human Resource Managementunrestricte

Patents and the quality, safety and efficacy of medicines

The impact of patent circumvention potentially has serious implications with regard to medicine quality, safety and efficacy, even if it was intended to improve accessibility and affordability of medicines. Companies should therefore conduct adequate research in order to understand the effect of patent circumvention on the quality, safety and efficacy of medicine.

Risk factors and circumstances surrounding suicides in correctional centres in Gauteng, South Africa

Suicides occur in correctional centres even though the behaviour of offenders is supposed to be closely monitored and regulated. The present study set out to identify and describe the risk factors and circumstances surrounding suicides in selected correctional centres in Gauteng (Johannesburg, Zonderwater, Boksburg and Kgosi Mampuru II). Qualitative methods, in particular semi-structured interview and focus group strategies, were followed to obtain data from two psychologists, two social workers, nine case management officers and twelve offenders. In addition, the case files of eight offenders who committed suicide in a correctional centre were scrutinised for information regarding their backgrounds, mental health, contact with their families, sentences and parole applications. The study identified an array of risk factors associated with suicide in correctional centres that can be categorised in terms of individual, interpersonal and structural contributors. Important risk factors include contact with families, mental health, type of cell accommodated in, access to prescription medication and overcrowding. The general strain and escape theories are used to explain the phenomenon of suicide in correctional centres.http://www.crimsa.ac.za/acta.htmlhb201

Child contact management in high tuberculosis burden countries: A mixed-methods systematic review

Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide. Considering the World Health Organization recommendation to implement child contact management (CCM) for TB, we conducted a mixed-methods systematic review to summarize CCM implementation, challenges, predictors, and recommendations. We searched the electronic databases of PubMed/MEDLINE, Scopus, and Web of Science for studies published between 1996–2017 that reported CCM data from high TB-burden countries. Protocol details for this systematic review were registered on PROSPERO: International prospective register of systematic reviews (#CRD42016038105). We formulated a search strategy to identify all available studies, published in English that specifically targeted a) population: child contacts (<15 years) exposed to TB in the household from programmatic settings in high burden countries (HBCs), b) interventions: CCM strategies implemented within the CCM cascade, c) comparisons: CCM strategies studied and compared in HBCs, and d) outcomes: monitoring and evaluation of CCM outcomes reported in the literature for each CCM cascade step. We included any quantitative, qualitative, mixed-methods study design except for randomized-controlled trials, editorials or commentaries. Thirty-seven studies were reviewed. Child contact losses varied greatly for screening, isoniazid preventive therapy initiation, and completion. CCM challenges included: infrastructure, knowledge, attitudes, stigma, access, competing priorities, and treatment. CCM recommendations included: health system strengthening, health education, and improved preventive therapy. Identified predictors included: index case and clinic characteristics, perceptions of barriers and risk, costs, and treatment characteristics. CCM lacks standardization resulting in common challenges and losses throughout the CCM cascade. Prioritization of a CCM-friendly healthcare environment with improved CCM processes and tools; health education; and active, evidence-based strategies can decrease barriers. A focused approach toward every aspect of the CCM cascade will likely diminish losses throughout the CCM cascade and ultimately decrease TB related morbidity and mortality in children

Exposing students to a simulation of the online platform used by the South African revenue service

Purpose – Students completing their tertiary education at a university may be equipped with theoretical knowledge with little to no practical experience. In order to bridge this gap in practical skills, a computer simulation was developed based on the e-filing platform of the South African Revenue Services (SARS). Students were exposed to this self-developed computer simulation to answer the question: to what extent will the e-filing simulation improve students' confidence to practically apply their theoretical knowledge? Design/methodology/approach – The research applied a pre–post questionnaire research method to gauge the students' ability to apply their theoretical knowledge to a practical scenario before and after the simulation. Findings – From the results, it is apparent that the students were inspired with confidence in getting to terms with the application of their theoretical knowledge in a real-life scenario. The computer simulation provided the platform for learning to take place in a practical environment without the risk of errors that would translate into real financial consequences. Originality/value – The contribution of this research can be found in a teaching intervention that may support the training of future tax professionals in practical application skills. The contribution can be extended to the enhancement of education in the field of taxation, particularly with the results' showing that the students experienced high levels of increased confidence in their application of theoretical knowledge to real-life scenarios

Prevalence of respiratory health symptoms among landfill waste recyclers in the City of Johannesburg, South Africa

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Mortality in South African children and adolescents routinely treated for tuberculosis

BACKGROUND: In South Africa, tuberculosis (TB) is a leading cause of death among those abstract, 20 years of age. We describe changes in TB mortality among children and adolescents in South Africa over a 13-year period, identify risk factors for mortality, and estimate excess TBrelated mortality. METHODS: Retrospective analysis of all patients ,20 years of age routinely recorded in the national electronic drug-susceptible TB treatment register (2004–2016). We developed a multivariable Cox regression model for predictors of mortality and used estimates of mortality among the general population to calculate standardized mortality ratios (SMRs). RESULTS: Between 2004 and 2016, 729 463 children and adolescents were recorded on TB treatment; 84.0% had treatment outcomes and 2.5% (18 539) died during TB treatment. The case fatality ratio decreased from 3.3% in 2007 to 1.9% in 2016. In the multivariable Cox regression model, ages 0 to 4, 10 to 14, and 15 to 19 years (compared with ages 5 to 9 years) were associated with increased risk of mortality, as was HIV infection, previous TB treatment, and extrapulmonary involvement. The SMR of 15 to 19-year-old female patients was more than double that of male patients the same age (55.3 vs 26.2). Among 10 to 14-year-olds and those who were HIV-positive

Early mortality in tuberculosis patients initially lost to follow up following diagnosis in provincial hospitals and primary health care facilities in Western Cape, South Africa

In South Africa, low tuberculosis (TB) treatment coverage and high TB case fatality remain important challenges. Following TB diagnosis, patients must link with a primary health care (PHC) facility for initiation or continuation of antituberculosis treatment and TB registration. We aimed to evaluate mortality among TB patients who did not link to a TB treatment facility for TB treatment within 30 days of their TB diagnosis, i.e. who were “initial loss to follow-up (ILTFU)” in Cape Town, South Africa. We prospectively included all patients with a routine laboratory or clinical diagnosis of TB made at PHC or hospital level in Khayelitsha and Tygerberg sub-districts in Cape Town, using routine TB data from an integrated provincial health data centre between October 2018 and March 2020. Overall, 74% (10,208/13,736) of TB patients were diagnosed at PHC facilities and ILTFU was 20.0% (2,742/13,736). Of ILTFU patients, 17.1% (468/2,742) died, with 69.7% (326/468) of deaths occurring within 30 days of diagnosis. Most ILTFU deaths (85.5%; 400/468) occurred in patients diagnosed in hospital. Multivariable logistic regression identified increasing age, HIV positive status, and hospital-based TB diagnosis (higher in the absence of TB treatment initiation and being ILTFU) as predictors of mortality. Although hospitals account for a modest proportion of diagnosed TB patients they have high TB-associated mortality. A hospital-based TB diagnosis is a critical opportunity to identify those at high risk of early and overall mortality. Interventions to diagnose TB before hospital admission, improve linkage to TB treatment following diagnosis, and reduce mortality in hospital-diagnosed TB patients should be prioritised

Excellent treatment outcomes in children treated for tuberculosis under routine operational conditions in Cape Town, South Africa

Background Tuberculosis (TB) remains a leading cause of death in children globally. While recognised that HIV infection increases the risk of developing TB, our understanding of the impact of HIV on risk of mortality for children treated for TB is limited. We aimed to identify predictors of mortality in children treated for drug- susceptible TB. Methods A retrospective analysis of all children (<15 years) routinely treated between 2005 and 2012 for drug-susceptible TB in Cape Town was conducted using the programmatic electronic TB treatment database. Survival analysis using cox regression was used to estimate hazard ratios for death. Logistic regression was used to estimate the odds of unfavourable outcomes. Results Of 29,519 children treated for and notified with TB over the study period, <1% died during TB treatment and 89.5% were cured or completed treatment. The proportion of children with known HIV status increased from 13% in 2005 to 95% in 2012. Children under 2 years had an increased hazard of death (aHR: 3.13; 95%CI:1.78 5.52) and greater odds of unfavourable outcome (aOR: 1.44; 95%CI:1.24-1.66) compared to children 10-15 years. HIVpositive children had increased mortality compared to HIV-negative children (aHR: 6.85; 95%CI:4.60-10.19) and increased odds of unfavourable outcome (aOR: 2.01; 95%CI:1.81-2.23). Later year of TB treatment was a protective predictor for both mortality and unfavourable outcome