Measuring quality of life in South Africa : a household-based development index approach

This study commences with an overview of the concept “quality of life” as perceived from a developmental point of view. The study focuses on the current measures of the improvements in quality of life which operate at different measurement levels. Most of the measures are economic in nature like household income and income per capita, gross domestic product (GDP) and Gross national product (GNP) (Todaro, 1997). Other quantitative measures considered by the current study include measures of wealth particularly the Living standards measurement (LSM) by the South African advertising and research foundation (SAARF), Consumer confidence index (CCI), Index of economic well-being and the Human Development index (HDI) among others (Hagerty et al., 2001). A household-based measure using nominal level data, the LSM in particular tracks improvements in household wealth (as opposed to household income) through changes in household possession of durable items. Subjective measures of quality of life and changes in life satisfaction are looked at by the current study, including studies by Erikson (1993), Moller (1987, 1996, 1997) and, the wellbeing measures by Diener and Suh (1997) amongst others. Quality of life however, is not just about money as economics might have it portrayed. It is not just about how individuals feel because, according to Diener and Suh (1997), feelings are in most cases a response to external influences. Quality of life is a complex and multidimensional phenomenon which needs to be viewed holistically. As a result this study embarked on developing a measure of quality of life (a quality of life index) using household data pertaining to socio-economic aspects. The level of measurement for the data is ordinal. Operatinalised at household level, the measure was intended to analyse changes in household quality of life (QOL) between 1996 and 1999. Data for October household surveys for the period 1999-1996 was used in the study. The analysis focused on changes in household access to selected indicators of quality of life. The study applied cluster analysis to group households accessing similar QOL indicators into QOL groups. Identifying the indicator or indicators which differentiate the QOL conditions among QOL groups was achieved through the use of discriminant function analysis. The entire array of QOL groups or clusters from a particular set of data (OHS 1996-OHS1999) constituted the QOL index. The main findings of this study are that broadly, there has been an improvement in household quality of life (QOL), basing on the developed measure of quality of life. This is revealed by an increase in the number of clusters of households or QOL groups from five in 1996 to eight in 1999. The study attributes the increase in QOL groups to an increase in households’ ability to access the selected QOL indicators. In spite of the increase in the number of QOL clusters, the study finds that proportionally fewer households are found in the QOL groups with better material living conditions (i.e. measurable QOL) than otherwise. This is contrary to the expected pattern in development terms based on empirical evidence in South Africa (see SAARF, 2002; SAARF, 2004; Stats SA, 1996; Stats SA, 2001; Stats SA, 2004). The study also finds that female headed households are generally predominant in groups with poor QOL. Discriminant function analysis results highlight access to toilet, refuse disposal services and water source as discriminant indicators in addition to Highest level of education completed by a household head and, Employment status of household head, among others. The latter consistently differentiate between groups of households throughout the reference period except in 1999. Findings relating to the influence of household material conditions on perceived quality of life show that proportionately more households in groups with the better access to the selected QOL indicators being satisfied with life than otherwise. A point worthy noting is the consistency in the proportions of households which felt that things had not changed after all, irrespective of the groups’ ranks, throughout the reference period. The key conclusion drawn from these findings is that low levels of education and employment status among household heads strongly influence household quality of life. These two indicators have been found to consistently differentiate the QOL conditions among the QOL groups that emerged. Groups on the poor side of the QOL index are characterized by high unemployment, illiteracy and dysfunctional levels of education for most household heads therein. Most households belonging to the poorest QOL groups are rural-based (found in Eastern Cape, Limpopo, Kwazulu Natal and Mpumalanga), with poor access to basic services identified under discriminant function analysis. The situation is likely to be complicated by the existence of substantial proportions of households headed by people aged 15-19 identified in this study. This needs to be taken seriously particularly in the current era of the HIV/AIDS pandemic (see HSRC, 2002; Rosa, 2003). The study’s findings have revealed that poor QOL among households is not related to the sex of the household head. Although female headed households are predominant in groups of households with poor QOL conditions, adjacent to such groups are households in groups with almost equally poor living conditions the majority of which are males-headed. What is needed therefore is a holistic focus on the factors that impede households’ ability to sustain better living conditions. Most of the study’s recommendations reinforce initiatives which are being undertaken in the development agenda. For instance the need to improve people’s level of education does not need any more emphasis given the study’s results. Sustaining improved household QOL will require households to have a capability of meeting their needs. Successful completion of education – tertiary as opposed to functional literacy- opens channels for households to lead a better life. Achieving this level of education requires time, which from a demographic point of view, most of the currently uneducated household heads may not have. While much has been done in enabling households to access basic services like housing, electricity and water, payment for such services remains the responsibility of individual households. Inability to pay for services – due to unemployment and lack of education-will just perpetuate household dependency on social grants. It is also recommended that in-depth qualitative studies be undertaken to establish the apparent consistent gap between objective living conditions and subjective life satisfaction among households if realistic policy objectives are to be achieved. The study recommends a further application of the formulated QOL index particularly on current data with similar indicators. A more rigorous thinking around the weighting of individual QOL indicators will iron out the inconsistencies observed in the study’s results. This will provide an opportunity to standardise the indicators, update the results of the QOL index while enhancing triangulation at the same time.Thesis (DPhil(Sociology))--University of Pretoria, 2008.SociologyDPhilunrestricte

Effect of staff motivation on retention of nurses in Kenyatta National Hospital

A Thesis submitted in partial fulfillment of the requirements for the Degree of Master of Business Administration in Healthcare Management at Strathmore Business SchoolThe provision of quality and affordable healthcare remains a challenge for many countries and has been shown to be constrained by many factors including economic, social and political factors. This then results in an imbalance between the supply and demand for health services. Shortage of skilled health workers then provides further strain on improving access to quality health services. Therefore, there is a need to establish how to make the most of this rare resource, including how to work on the retention of the health care workers. The study was anchored on Herzberg Two Factor Theory that argues that individuals are interested at two different areas of motivation. First level includes psychological needs such as advancement, personal growth, the nature of work, responsibility, and achievement (motivators). Second group of factors the “hygiene/extrinsic are work related like salaries, work conditions, policies and administration. This study aim was to investigate the effect of staff’ motivation on the retention of nurses at Kenyatta National Hospital (KNH). The specific objectives were to determine the effect of financial incentives, career development, working conditions and personal factors affecting retention of nurses in Kenyatta National Hospital- Kenya. Using a mixed methods cross sectional study design, both quantitative and qualitative data was collected from nurses working at Kenyatta National Hospital (KNH). A sample of 228 nurses were randomly selected for self-administered questionnaires for the study. To complement the quantitative data, qualitative data was collected through purposive in-depth interviews with 10 departmental heads in the nursing cadre to understand factors that influenced nurse’s motivation at work. The quantitative data was analyzed using Statistical Package for Social Scientist (SPSS). Descriptive statistics such as frequencies and percentages were used to summarize data while logistic regression was used to estimate adjusted odds ratios. Qualitative data was analysed manually using thematic analysis of issues emerging from the data and informed by findings from the questionnaires. Results showed that nurse’s intention to leave KNH was 60 percent and that age, education, availability of career development initiatives, desire for better working conditions and need for a better pay significantly influenced nurses’ intention to leave KNH. The recommendations from this study include ensuring revision of any CBA agreed on that will look into nurses being paid for overtime hours worked, access car loans and mortgages, ensure nurses are provided with basic career development opportunities such as career talks and scholarship opportunities. Additionally, nurses ought to be provided with good social welfare facilities. The other incentive is provision of clean and safe work environment for nurses. And importantly to review workload at the facility to allow fair distribution and motivate their nurses

Pre-departure Training for Healthcare Students Going Abroad: Impact on Preparedness

Background: Many medical and nursing schools offer opportunities for students to participate in global health experiences abroad, but little is known about the efficacy of pre-departure training in preparing students for these experiences. Objectives: The primary aim was to identify characteristics of pre-departure training associated with participants’ reporting a high level of preparedness for their global health experiences. Secondary objectives included identifying students’ preferred subjects of study and teaching modalities for pre-departure training. Methods: A questionnaire was distributed to all medical and nursing students at our institution from 2013 to 2015. Questions addressed prior global health experiences and pre-departure training, preferences for pre-departure training, and demographic information. Findings: Of 517 respondents, 55% reported having a prior global health experience abroad, 77% of whom felt prepared for their experience. Fifty-three percent received pre-departure training. Simply receiving pre-departure training was not associated with perceived preparedness, but pre-departure training in the following learning domains was: travel safety, personal health, clinical skills, cultural awareness, and leadership. Perceiving pre-departure training as useful was also independently associated with self-reported preparedness. Students’ preferred instruction methods included discussion, lecture, and simulation, and their most desired subjects of study were travel safety (81%), cultural skills (87%), and personal health (82%). Conclusions: Incorporating travel safety, personal health, clinical skills, cultural awareness, and/or leadership into pre-departure training may increase students’ preparedness for global health experiences. Student perceptions of the usefulness of pre-departure training is also associated with self-reported preparedness, suggesting a possible “buy-in” effect

Identifying barriers for out of hospital emergency care in low and low-middle income countries: a systematic review

Background: Tuberculosis (TB) in children is frequently paucibacillary and non-severe forms of pulmonary TB are common. Evidence for tuberculosis treatment in children is largely extrapolated from adult studies. Trials in adults with smear-negative tuberculosis suggest that treatment can be effectively shortened from 6 to 4 months. New paediatric, fixed-dose combination anti-tuberculosis treatments have recently been introduced in many countries, making the implementation of World Health Organisation (WHO)-revised dosing recommendations feasible. The safety and efficacy of these higher drug doses has not been systematically assessed in large studies in children, and the pharmacokinetics across children representing the range of weights and ages should be confirmed. Methods/design: SHINE is a multicentre, open-label, parallel-group, non-inferiority, randomised controlled, two-arm trial comparing a 4-month vs the standard 6-month regimen using revised WHO paediatric anti-tuberculosis drug doses. We aim to recruit 1200 African and Indian children aged below 16 years with non-severe TB, with or without HIV infection. The primary efficacy and safety endpoints are TB disease-free survival 72 weeks post randomisation and grade 3 or 4 adverse events. Nested pharmacokinetic studies will evaluate anti-tuberculosis drug concentrations, providing model-based predictions for optimal dosing, and measure antiretroviral exposures in order to describe the drug-drug interactions in a subset of HIV-infected children. Socioeconomic analyses will evaluate the cost-effectiveness of the intervention and social science studies will further explore the acceptability and palatability of these new paediatric drug formulations. Discussion: Although recent trials of TB treatment-shortening in adults with sputum-positivity have not been successful, the question has never been addressed in children, who have mainly paucibacillary, non-severe smearnegative disease. SHINE should inform whether treatment-shortening of drug-susceptible TB in children, regardless of HIV status, is efficacious and safe. The trial will also fill existing gaps in knowledge on dosing and acceptability of new anti-tuberculosis formulations and commonly used HIV drugs in settings with a high burden of TB. A positive result from this trial could simplify and shorten treatment, improve adherence and be cost-saving for many children with TB. Recruitment to the SHINE trial begun in July 2016; results are expected in 2020. Trial registration: International Standard Randomised Controlled Trials Number: ISRCTN63579542, 14 October 2014. Pan African Clinical Trials Registry Number: PACTR201505001141379, 14 May 2015. Clinical Trial Registry-India, registration number: CTRI/2017/07/009119, 27 July 2017

Global Health Career Interest among Medical and Nursing Students: Survey and Analysis

BackgroundGlobal health experiences undertaken in international settings (GHEs) are becoming an increasingly prevalent aspect of health professions education and, as such, merit comprehensive analysis of the impact they have on students and host communities.ObjectiveTo assess the associations between demographic/experiential factors and the interest of health professions students in careers involving global health.MethodsA cross-sectional survey was administered online to a convenience sample of medical and nursing students at Johns Hopkins University. Questions addressed level of interest in a global health career, prior GHEs, and demographic information. Items were either Likert scale or multiple choice. Various regression analyses were performed.FindingsOf 510 respondents, 312 (61.2%) expressed interest in a global health career and 285 (55.9%) had prior GHEs. Multivariate logistic regression found female sex, age ≥27 years, household income ConclusionsSimply participating in a global health experience abroad is not significantly associated with interest in a global health career. However, sex, age, household income, and research-related GHEs are significantly associated with global health career interest. These findings may inform the development of global health programs at medical and nursing schools and can guide efforts to increase the number of health care professionals entering global health careers

Re-examining the effect of door-to-balloon delay on STEMI outcomes in the context of unmeasured confounders: a retrospective cohort study

Literature studying the door-to-balloon time-outcome relation in coronary intervention is limited by the potential of residual biases from unobserved confounders. This study re-examines the time-outcome relation with further consideration of the unobserved factors and reports the population average effect. Adults with ST-elevation myocardial infarction admitted to one of the six registry participating hospitals in Australia were included in this study. The exposure variable was patient-level door-to-balloon time. Primary outcomes assessed included in-hospital and 30 days mortality. 4343 patients fulfilled the study criteria. 38.0% (1651) experienced a door-to-balloon delay of >90 minutes. The absolute risk differences for in-hospital and 30-day deaths between the two exposure subgroups with balanced covariates were 2.81 (95% CI 1.04, 4.58) and 3.37 (95% CI 1.49, 5.26) per 100 population. When unmeasured factors were taken into consideration, the risk difference were 20.7 (95% CI −2.6, 44.0) and 22.6 (95% CI −1.7, 47.0) per 100 population. Despite further adjustment of the observed and unobserved factors, this study suggests a directionally consistent linkage between longer door-to-balloon delay and higher risk of adverse outcomes at the population level. Greater uncertainties were observed when unmeasured factors were taken into consideration