Measles elimination - Is it achievable? Lessons from an immunisation coverage survey

Objectives. To detennine routine measles coverage at district level and to explore reasons for immunisation failure in Mpumalanga Province, South Africa.Design. An adaptation of the World Health Organisation (WHO) Expanded Programme on Immunisation (EFl) cluster sampling method was used to make a random selection of 30 clusters in each of 21 health districts, 630 clusters in total. Seven individuals from the age group 12 - 23 months were randomly selected from each cluster and immunisation status and source were transcribed from their child health records. Where no immunisations were administered, reasons provided by parents or guardians were recorded.Setting. Mpumalanga Province, South Africa.Results. The weighted valid population coverage with measles vaccine for children aged 12 - 23 months in Mpumalanga Province was 71.1% (95% confidence interval 64.9 - 78.5%); this was the lowest of all EPI antigens. There was marked heterogeneity in measles coverage across the province, with a coefficientof variation of 22.2%. Districts with the lowest coverage shared borders with neighbouring provinces. District measles coverage was highly positively correlated with diphtheria, pertussis and tetanus (DPT3) coverage (r = 0.960, P = 0.000). There was a strong negative correlation between ranked measles campaign coverage and routine measles immunisation coverage. Obstacles to immunisation accounted· for nearly half (49%) of all reasons for immunisation failure, while lack of information and lack of motivation accounted for 30% and 22%, respectively.Conclusions. Survey results highlight the need for supplementary immunisation, including non-selective campaigns, if Mpumalanga is to achieve the South African goal of measles elimination by 2002. The value of determining district resolution coverage in order to identify areas with low measles coverage requiring supplementary intervention was also demonstrated. A strong negative correlation between routine and campaign coverage deserves further study in other settings

Rabies: an evidence-based approach to management

Human rabies in South Africa is largely due to infection with the classical rabies virus (genotype 1), with the yellow mongoose the commonest vector except in KwaZulu-Natal, Eastern Cape, Mpumalanga and now Limpopo provinces where the dog is predominantly responsible for most bites. Rabies is always fatal in humans but can be prevented by timeous administration of post exposure prophylaxis( PEP). This article discusses an evidence-based approach to rabies management in South Africa. South African Family Practice Vol. 49 (7) 2007: pp. 35-4

Eyes wide open: perceived exploitation and its consequences

Drawing on the array of literature on exploitation from several social science disciplines, we propose a new way of seeing employer-employee relationships by introducing the concept of perceived exploitative employee-organization relationships, distinguish it from related concepts, and conduct five studies to develop a scale and test our theoretical model of the effects of such employee perceptions. Contributing to the Employee-Organization Relationships and workplace emotions literatures, perceived exploitation is defined as employees’ perceptions that they have been purposefully taken advantage of in their relationship with the organization, to the benefit of the organization itself. We propose and find that such perceptions are associated with both outward-focused emotions of anger and hostility toward the organization and inward-focused ones of shame and guilt at remaining in an exploitative job. In two studies including construction workers and a time-lagged study of medical residents, we find that the emotions of anger and hostility partially mediate the effects of perceived exploitation on employee engagement, revenge against the organization, organizational commitment, and turnover intentions, whereas the emotions of shame and guilt partially mediate the effects of perceived exploitation on employee burnout, silence, and psychological withdrawal

Factors affecting the implementation of nurse-initiated antiretroviral treatment in primary health care clinics of Limpopo Province, South Africa

Introduction: The implementation of nurse-initiated antiretroviral (ARV) treatment at primary health care clinics was introduced in 2010 as a response to lower the HIV prevalence rate in the community. Aim: The aim of the study was to identify the factors affecting the implementation of nurse-initiated ARV treatment in primary health care clinics referring patients to Dr CN Phatudi Hospital, Limpopo Province. Methodology: A qualitative study was conducted in 2013 with a purposeful sample of nurses from 12 clinics involved in the nurse-initiated antiretroviral treatment (NIMART) programme. Two free-attitude focus groups and two individual interviews were conducted (audio- and video-recorded whilst the researcher took field notes). These interviews were transcribed verbatim and analysed using the colour-coding as well as cut-and-paste methods.Results: Common themes that emerged from the individual and focus-group interviews were: (1) lack of resources, which included health care workers, drugs, stationery, telephones, poor training and inadequate workspace; (2) factors affecting treatment adherence, such as stigma, poverty, poor roads and the restrictions on the ‘one pill’ regime; (3) support from management and the visiting doctor and (4) nurses’ work satisfaction. Conclusion: Two of the themes that emerged acted as barriers to the implementation of the NIMART programme, namely: (1) lack of resources and (2) factors affecting treatment adherence. The two other themes enhanced the implementation of the NIMART programme, namely: (1) support visits and (2) nurses’ work satisfaction

Reasons for and perceptions of patients with minor ailments bypassing local primary health care facilities

Introduction: Despite having access to several clinics and health centres in their local communities, numerous patients opt to go directly to hospitals for non-emergencies and minor ailments. Reasons for this include their perceptions of the quality of primary health care services, the attitudes and perceptions of health workers, opening hours of clinics, community involvement and participation, and drug and equipment availability as well as the quality of infrastructure. Perceptions of size, a lack of specialty care and limited services were most frequently mentioned as reasons why patients bypassed their local primary health care facilities.Aim: This study aimed to identify the reasons given by patients presenting with minor ailments, for bypassing their local primary health care facilities in the Greater Tzaneen municipal area to Letaba Hospital.Methods: A cross-sectional descriptive study was performed at Letaba Hospital over a three-month period, from 23 June 2008 to 15 August 2008, in which non-referred patients presenting with minor ailments were randomised and entered into the study on a voluntary basis. A preset questionnaire was utilised for data-collection purposes. A total of 293 participants were included in the study. The questionnaire aimed to determine the demographic profile of patients who present with minor ailments at hospital, to explore the reasons why these patients bypass their local clinics and to evaluate their knowledge, perceptions and attitudes regarding their local clinics.Results: Most patients indicated that they came to the hospital because they wanted to be seen by a doctor, followed by the request to see a dentist. The study identified that patients expressed both positive and negative opinions concerning their local clinics.Conclusion: Numerous factors influence the service-seeking behaviour of rural patients. Patients bypass their local clinics due to perceptions regarding the quality of health care services at the hospital. Improving the quality aspects of clinics and enhancing the services rendered will not only increase the utilisation of clinic services, but also reduce hospital overcrowding

Community healthcare workers’ satisfaction with ward-based outreach team services in Tshwane district, South Africa

Background: The incorporation of community healthcare worker (CHW) involvement in the management of patients is in line with the 2006 World Health Report, which advocates increased community participation and the systematic delegation of tasks to less specialised cadres. For CHWs to function optimally, satisfaction in their duties is paramount to promote quality healthcare. The health minister included ward-based outreach teams (WBOT) as part of the National Health Insurance.1 CHWs form an important link between healthcare facilities and the communities. This study aimed to measure the satisfaction level of the CHWs with WBOT services in the Tshwane district of South Africa.Method: A cross-sectional study on CHWs was conducted in seven sub-districts. Data were obtained by trained data collectors using a piloted self-administered structured questionnaire from October 12 to November 3, 2015 in three local official languages. The study population of CHWs was 1 600. Using a 95% confidence level and 5% confidence interval, the sample size was 310. However, we over-sampled to 431 participants.Results: The mean age was 36 years (SD ± 9.46). The majority were females (82.1%); more than three-quarters (77%) had secondary education. The majority were satisfied with the WBOT services whereby 59.8% was the lowest score and 98.4% the highest score. Close to two-thirds (62%) were not satisfied with their monthly stipends. The majority of the younger members of the team (20–40 years) were not valued by their co-workers (70% or 181/255) [p = 0.03]. The overall satisfaction (n = 8593) was 73.4% (p 0.001).Conclusion: Overall satisfaction of CHWs with WBOT is good news. Dissatisfaction regarding stipend/compensation must be addressed. CHWs should be valued and motivated

Perceptions of community health workers on their training, teamwork and practice: a cross-sectional study in Tshwane district, Gauteng, South Africa

Background: In 2011, South Africa established ward-based outreach teams (WBOTs) comprising Community Health Workers as part of strategies to strengthen primary healthcare. The new community health workers (CHWs) lacked experience of the programme. This study aimed at assessing perceptions of community health workers on their training, teamwork and practice.Methods: This was a cross-sectional study conducted among CHWs in the seven regions of Tshwane health district between October and November 2015. Data were collected from 431 CHWs in eight Community Health Centres and 11 clinics using a pre-tested, self-administered questionnaire. Outcome measures were CHWs’ perceptions on training, teamwork and practice regarding WBOT programme.Results: A total of 431 CHWs formed the study sample. Participants had a mean age of 36 years (SD ± 9.46). The majority (88.2%) were female. Some 77% had completed secondary school. Overall, most CHWs perceived their training (86.4%), teamwork(87.6%) and practices (67.7%) to be good (p = 0.001). The majority were able to provide efficient health care despite the challenges experienced, which were lack of equipment, walking long distances, and safety on the streets and in households with patients who had mental health problems among others. Fisher’s exact test showed a significant association between training and work challenges (p = 0.006).Conclusion: The study findings showed that most CHWs had good perceptions regarding their training, teamwork and practice. Several concerns raised by CHWs suggest the need for stakeholders to ensure availability of resources for optimal functioning of CHWs

An effective training strategy for communicable disease control nurses

Communicable diseases remain the leading cause of morbidity and mortality in sub-Saharan Africa. Delivery of programmes to control priority infectious diseases is implemented\ud at provincial and district level. This challenging task requires both technical and management skills. However, few, if any, structured programmes for training staff responsible for providing leadership in communicable disease\ud control currently exist. A novel accredited training programme was developed in Mpurnalanga province in rural South Africa, as a partnership between provincial government\ud and universities in South Africa and Australia. This venture focused on providing an applied knowledge-base and the skills necessary to function effectively within a challenging environment. Over a four-year period two seperate capacity-building programmes were designed, implemented and formally assessed. The first focused on technical aspects of disease control, while the second sought to provide applied management skills. A combination of intensive one-week residential blocks, coupled with monthly one-day training sessions and workplace application within the province was used. The programme is described and the results of an evaluation presented. The impact of the model on the control of diseases, containment of outbreaks and execution of operational research has been documented in peer-reviewed publications. For the nurses involved, the programme positively impacted on their confidence, camaraderie and professional competence, while expanding their professional horizons. The district health system appears to haven been enhanced, both within and beyond the communicable disease control area. Links to web-based training materials are provided for potential adaptation and application in other developing settings. This model provided a cost-effective approach to training nurses responsible for communicable disease control programmes without disrupting service delivery

Households’ satisfaction with the healthcare services rendered by a ward-based outreach team in Tshwane district, Pretoria, South Africa

Introduction: Households’ satisfaction is an important and commonly used indicator for measuring quality in health care. An amelioration of primary health care services at the level of households, by utilising community health workers, has led to a good healthcare system in many countries, such as Brazil. In South Africa, little is known about the satisfaction of households (HH) regarding the healthcare services they receive from ward-based outreach teams (WBOTs). A study was undertaken to determine this phenomenon.Methods: The study used a cross-sectional study design. Tshwane district had established 39 ward-based outreach teams at the time of the study and households were conveniently selected. Hence the study population was estimated to be 3 600. Using 99% confidence level and 5% confidence interval, the sample size was 660, and oversampled to 765 since all households present during the data collection were willing to be included in the survey. Data collected was captured on Microsoft Excel and analysed using SAS, version 9.2.Results: Interviews were held with members of the families, who were willing to participate. Participants’ ages ranged from 18 to 110, mean age 53.1years (SD = 19.7). The study participants included more females (74.0%), and 45.2% were single. The majority (89.8%) were unemployed. Overall satisfaction was seen in 692 participants (90.7%). Outcome of satisfaction according to sex (91.9%), age (90.7%) and employment (90.8%) was not statistically significant with p-value 0.05.Conclusions: The findings of households’ satisfaction regarding the healthcare services rendered by the ward-based outreach team in Tshwane district, Pretoria, South Africa showed a high level of satisfaction from the households. This high level of satisfaction was referred to as excellent and was not associated with sex, age or employment status. A recommendation is made to all stakeholders that the ward-based outreach team programme cover all municipal wards in the country in order to raise the level of households’ satisfaction with the healthcare system

Awareness of the Ward Based Outreach Team and the services offered by the programme in the Tshwane health district, South Africa

Background: The Ward Based Outreach Team (WBOT) is an organised team approach to a healthcare system based on the principles of epidemiology, primary health care, preventive medicine and health promotion. Globally, it has become a primary care response to many health challenges such as universal health coverage. The beneficiaries are community members, also referred to as households.Methods: The study assessed the awareness of the WBOT and the services offered by the programme in the Tshwane health district of South Africa. This was a cross-sectional survey conducted in all seven sub-districts of the health district. The health district is further sub-divided into 150 health wards. Eighty-five health wards were randomly selected for the study. Using the sample size calculator, with a confidence interval of 5% and confidence level of 99%, the sample size of participants was 654. However, during the data collection process there was over-sampling of up to 764. Participants were recruited by convenience sampling. Data were collected between October 12 and December 3, 2015, using a pre-piloted, structured questionnaire administered by 14 trained field workers.Results: The study obtained 6 288 responses from the 764 participants. The responses were grouped into two sections, ‘Yes’ and ‘No’. A summary of the responses showed that the number of ‘yes’ responses, the number of participants who were aware of the WBOT and the services offered by the programme were higher than the number of participants who were unaware of the programme. The figures were 5 590 (88.8%) ‘yes’ responses and 698 (11.1%) ‘no’ responses.Conclusion: In summary, the awareness of the WBOT and the services offered by the programme in the Tshwane health district, South Africa is evaluated to be 88.8%