Primary Health Care Nurses’ Experiences of treating Children with Atopic Eczema in Gauteng, South Africa

Abstract: The prevalence of atopic eczema has increased in most African countries, including South Africa. Most patients with allergic conditions are seen by non-allergy trained healthcare workers, a situation that is also true for South Africa. The aim of this study was to explore and describe the experiences of primary health care (PHC) nurses in managing children with atopic eczema in a district of Gauteng. Methods: A qualitative, explorative, descriptive, contextual design with phenomenology approach was used. The study population included nurses in PHC clinics in Gauteng who were selected by purposive sampling method. Data saturation determined the sample size, which occurred after three focus group discussions and four in-depth individual interviews. Data was analysed according to Tesch’s steps of qualitative data analysis. Lincoln and Guba’s model for trustworthiness and the ethical measures employed according to the Medical Research Council for South Africa..

Implementation and evaluation of management guidelines for atopic eczema for primary health care nurses : a Pilot study

Abstract: The primary health care (PHC) management guidelines for nurses treating children with atopic eczema were developed in a baseline study. The purpose of this study was to implement and evaluate the guidelines through a pilot study in a district in Gauteng, South Africa, in order to identify challenges and to adopt or adjust the guidelines for use by primary health care nurses in South Africa. The ultimate aim is to improve the child’s eczema and quality of life. A process evaluation research design was followed. Data was collected through 1) in-depth interviews with PHC nurses and also with the parents of children treated by these PHC nurses, and 2) documentation using the patient files of these children. The results showed that some aspects of the guidelines were used and seen as helpful, especially the complete emollient therapy and the evidence based health education. A simplified version of the guideline will be promoted for use by PHC nurses. The more detailed guideline could possibly be used as a basis to develop a short course on atopic eczema for PHC nurses

Clinical and financial burdens of secondary level care in a public sector antiretroviral roll-out setting (G F Jooste Hospital)

Background. Antiretroviral therapy (ART) is being extended across South Africa. While efforts have been made to assess the costs of providing ART via accredited service points, little information is available on its downstream costs, particularly in public secondary level hospitals.Objectives. To determine the cost of care for inpatients and outpatients at a dedicated antiretroviral referral unit treating and caring for antiretroviral-related conditions in a South African peri-urban setting; to identify key epidemiological cost drivers; and to examine the associated clinical and outcome data.Methods. A prospective costing study on 48 outpatients and 25 inpatients was conducted from a health system perspective. Incremental economic costs and clinical data were collected from primary sources at G F Jooste Hospital, Cape Town, over a 1-month period (March 2005). Results. Incremental cost per outpatient was R1 280, and per inpatient R5 802. Costs were dominated by medical staff costs (62% inpatient and 58% outpatient, respectively). Infectionspredominated among diagnoses and costs – 55% and 67% respectively for inpatients, and 49% and 54% respectivelyfor outpatients. Most inpatients and outpatients were judged by attending physicians to have improved or stabilised as a result of treatment (52% and 59% respectively).Conclusions. The costs of providing secondary level care for patients on or immediately preceding ART initiation can be significant and should be included in the government’s strategic planning: (i) so that the service can be expanded to meet current and future needs; and (ii) to avoid crowding out other secondary level health services