Assessing teenagers' knowledge, attitudes and perceptions towards teenage pregnancy. The case of a Durban High School.

Teenage childbearing is a global social and health concern. South Africa is not spared from the problems of teenage pregnancy be they related to health or to the social sphere. Researchers have been entreated to investigate teenagers’ sexual behaviour and the determinants to their behaviour especially in light of HIV/AIDS and other sexually related diseases. Various programmes and interventions have been developed and implemented in an effort to manage prevalence rates and address the challenges of teenage pregnancy. Inspite of these concerted efforts, pregnancy rates continue to increase. These efforts have been hampered by the absence of the voice of teenagers in research as interventions implemented do not adequately capture the complexity of teenage pregnancy. Research has also divorced teenagers from the environment within which teenage pregnancy takes place and as a result come up with interventions that are not pro teenagers. The absence of teenagers’ input in these interventions results in little uptake of interventions as teenagers feel no ownership or entitlement to these intervention. This study therefore seeks to bridge the gap by addressing teenage pregnancy from the perspective of teenagers themselves and locates teenage pregnancy within the lived experiences of teenagers. Guided by the Social Ecology Model and The Health Belief Model, this study seeks to analyse teenagers’ knowledge, attitudes and perceptions towards teenage pregnancy. This study is qualitative in nature and is situated within the interpretive paradigm that enables the researcher to explore people’s lived experiences. Using the case study approach, the study employs focus group discussions to elicit information from participants on their knowledge, attitudes and perceptions towards teenage pregnancy. The study concludes that knowledge; attitudes and perceptions are influenced and affected by various factors such as peer pressure, lack of adequate information and gender dynamics. To address teenage pregnancy challenges, there is a need for addressing the structural factors that influence teenagers’ knowledge, attitudes and perceptions. Knowledge on safe sex and contraception abounds though this knowledge does not to translate to positive health affirming behaviour. This gap is attributed to the structural factors that influence and affect health behaviour. As such these factors, such as entrenched poverty and lack of proper sexual health communication need to be addressed if teenage pregnancy is to be managed

Laporan Pelaksanaan Magang Di Dinas Kesehatan Kabupaten Sumbawa Barat Analisis Situasi Kesehatan Keluarga Dan Gizi Masyarakat Di Kabupaten Sumbawa Barat Tahun 2016-2019

Dinas Kesehatan Daerah Kabupaten menjadi unsur pelaksana urusan Pemerintahan yang menjadi kewenangan daerah. Dinas Kesehatan dipimpin oleh Kepala Dinas Kesehatan yang berkedudukan di bawah dan bertanggung jawab kepada Gubernur/Bupati/Walikota melalui Sekretaris Daerah untuk melaksanakan Urusan Pemerintahan di bidang kesehatan yang menjadi kewenangan Daerah dan Tugas Pembantuan yang diberikan kepada Daerah. Salah satu Undang-Undang No. 25 Tahun 2004 tentang Sistem Perencanaan Pembangunan Nasional (SPPN), menjelaskan bahwa Sistem Perencanaan Pembangunan Nasional adalah satu kesatuan tata cara perencanaan pembangunan untuk menghasilkan rencana pembangunan dalam jangka panjang, jangka menengah dan tahunan yang dilaksanakan oleh unsur penyelenggara negara dan masyarakat di tingkat pusat dan daerah. Selanjutnya dalam Peraturan Pemerintah Nomor 8 Tahun 2008 Tentang Tahapan, Tata Cara Penyusunan, Pengendalian dan Evaluasi Pelaksanaan Rencana Pembangunan Daerah dijelaskan bahwa Rencana Strategis Satuan Kerja Perangkat Daerah yang selanjutnya disingkat dengan Renstra-SKPD adalah dokumen perencanaan SKPD untuk periode 5 (lima) tahun. Rencana strategis (Renstra) Satuan Kerja Perangkat Daerah (SKPD) adalah dokumen perencanaan SKPD untuk periode 5 (lima) tahun berfungsi sebagai pedoman penyusunan Rencana Kinerja Tahunan (RKT), Rencana Kerja (Renja) dan anggaran SKPD serta digunakan sebagai instrument evaluasi keberhasilan dan kegagalan kinerja SKPD dalam kurun 5 (lima) sesuai dengan tugas pokok dan fungsinya dalam penyelenggaraan Pemerintahan Daerah. Rencana Strategis Dinas Kesehatan Kabupaten Sumbawa Barat merupakan penjabaran teknis di bidang kesehatan dari visi, misi, dan program Bupati Sumbawa Barat yang tertuang dalam Rencana Pembangunan Jangka Menengah Daerah (RPJMD). Rencana Strategis Dinas Kesehatan Kabupaten Sumbawa Barat Tahun 2018-2021 memuat tujuan, sasaran strategis, kebijakan, program dan kegiatan pembangunan bidang kesehatan sesuai dengan tugas dan fungsi Dinas Kesehatan

The role of public participation for the implementation of local economic development policy in urban municipalities: a case study of the Egodini Mall in Bulawayo, Zimbabwe.

Masters Degree. University of KwaZulu-Natal, Durban.The parley of this study unfolds in conformity with the ascension that citizen participation in policy and planning process within the local government is of importance. The rationale of this dissertation is to examine the role of public participation in the implementation of local economic development policies: a case study of the Egodini Mall in Bulawayo, Zimbabwe. Local Municipalities operating under the authority of the ministry of local government have been awarded the sole responsibility to arrange roles, duties, and responsibilities with regards to economic development. One of the objectives of introducing local government in Zimbabwe is to foster citizen participation in policy and planning processes. Undertaking this study helped expose the problem to the extent which the concept of public participation has an impact on the overall local economic policy development initiatives within local municipalities. This study made use of both quantitative and qualitative data collection methods. For the gathering of data, the researcher used focus groups, documents analysis and semi-structured interviews. The study was conducted in the local municipality of the City of Bulawayo in Zimbabwe. Utilizing the researcher’s judgment, respondents were identified for responding through focus group discussions, questionnaires, and in-depth interviews. For this desired study, the sample size included twenty-nine (29) local community members, twenty-(20) officials from the Bulawayo City Council, twenty (20) officials from the residency associations, twenty(20) representatives from the local economic stakeholders in Bulawayo. In total data was collected from eighty-nine (89) respondents who in total formed part of the study. For the sampling of the participants, the researcher employed both probability and nonprobability sampling techniques. Data collected was analysed using the SPSS (Statistical Package for Social Sciences) data analysis package thereby fully analysing the data in both thematic analysis and statistical analysis. The study exposed that public participation is essential for LED policy formulation and implementation. The study further revealed that the Bulawayo City Council ought to take advantage of the different environmental measures and must ensure and make use of prevailing environmental factors such as political, technological, social and population mobilizers to ensure active citizenship participation. The study recommended that the Bulawayo City Council shifts from the bottleneck form of governance that favours the centralisation of decisions to a more beauracratic governance system that recognizes the importance of public participation for LED policies that are community averse

Birth Preparedness and Complication Readiness among Women with Pregnancy and Childbirth related Complications at Kenyatta National Teaching and Referral Hospital, Kenya

Background: In developing countries, particularly those in Sub-Saharan Africa, women and newborns continue to face increased risks of mortality and morbidity during the time of pregnancy, birth and postpartum. Preparing for childbirth and being ready for complications is a key strategy in reducing maternal mortality and morbidity as this would reduce delay in obtaining skilled maternal care especially during childbirth. This survey was evaluating birth preparedness and complication readiness (BPCR) among womenseeking services at Kenyatta National Teaching and Referral Hospital.Methods: A cross-sectional hospital-based study was conducted among women admitted in the antenatal and postnatal ward. Data was collected using a standardised questionnaire. A respondent was considered to have satisfactory BPCR if she reported that she had identified the place of delivery, made prior financial arrangements and organised for means of transport to place of childbirth and/or for the time of obstetric emergencies ahead of childbirth.Results: The survey recruited 353 women aged between 15 and 44 years. Majority were married (n=288, 81.6%) and unemployed (n=232, 65.7%). Additionally, most of the participants were multiparous (n=345,97.7%) and had made at least 1 visit at the Antenatal Clinic during their current pregnancy (n=331, 93.8%). The proportion of women whose BPCR was rated as satisfactory was 56.7% (95% confidence interval, (CI) 49.7% - 63.6%). Factors associated with satisfactory BPCR included: being married (OR10.66, 95%CI5.21-21.83), having post-secondary education (OR 11.52, 95% CI 6.62-20.05), being in formal employment (OR 4.14, 95%CI2.51-6.82), gestation >28 weeks (OR=1.83,95%CI1.08-3.09), multiparity (OR=1.87,95%CI1.21-2.88), visiting Antenatal Care Clinic (OR=9.31, 95% CI 2.70-32.09)and particularly visiting the clinic more than 2 times (OR=4.43, 95% CI 2.75-7.13).Conclusions: The study documented sub-optimal BPCR. This highlights the need to review the current strategies and approaches being utilised to promote BPCR

Stakeholders’ Perspectives of Domestic Tourism Revival in Namibia Amidst the Covid-19 Pandemic

The study is premised on the notion that a systematic comprehension of stakeholders’ perspectives on domestic tourism is crucial in developing a sustainable and resilient tourism sector in sub-Saharan Africa. The focus of this paper is on stakeholders in the tourism industry in the Khomas region of Namibia located in the central highlands of the country. The study aimed to gather stakeholders’ views on how the domestic tourism industry can be revived in the wake of the Covid-19 pandemic. Semi-structured interviews were done with 35 purposively sampled tourism stakeholders in the Khomas region. The results of the study showed that Namibia focuses attention mostly on international tourism neglecting the domestic market. The locals feel excluded from tourism and prices of tourism products are generally viewed as exorbitant by domestic tourists. As a result, this leads to resentment towards tourism operators by the locals. The study also concludes that several structural issues are hindering effective collaboration among key stakeholders in the Namibian tourism industry

Drug resistant tuberculosis in Kenya: trends, characteristics and treatment outcomes, 2008 – 2016

Background: Drug resistant (DR) tuberculosis (TB) remains a major public health concern. Failure to treat patients with TB adequately increases the risk of transmission of infection to the general population. Treatment of DR TB is characterized by lengthy treatment duration, use of toxic and less effective drugs and high likelihood of adverse treatment outcomes that include adverse drug reactions, high mortality and loss to follow up.Objective: To determine the trends, characteristics and treatment outcomes of patients >15 years notified with DR‐TB in Kenya from 2008 to 2016Design: Retrospective descriptive cross‐sectional studySetting: Tuberculosis treatment centers in KenyaSubjects: Persons above 15 years notified with DR TBResults: We reviewed records of 1903 DR‐TB patients who were notified between 2008 and 2016. The public sector made the highest contribution of the notified cases (80%). Most of the cases were male (62.3%). The HIV testing rate was 99.5%, with the TB/HIV co‐infection being 36%. Initiation of antiretroviral therapy among those who tested positive for HIV was 94.6%. Co‐trimoxazole preventive therapy uptake was 99.3%. Most patients had secondary DRTB (77.3%). Multi‐drug resistant TB accounted for 78.4% of the DR TB cases while mono drug resistance was observed in 26% of the cases. Treatment success was achieved in 79% of the cases. Mortality and treatment failure during the study period was 11% and 0.2% respectively.Conclusion: An upward trend in notified DR‐TB cases was observed during the period under review. The public sector gave the most contribution. Active surveillance on patients lost to follow up while on treatment and poor drug adherence will be of importance to reduce the potential of development of drug resistance

Socio-economic status and health care utilization in rural Zimbabwe: findings from Project Accept (HPTN 043)

Zimbabwe’s HIV epidemic is amongst the worst in the world, and disproportionately effects poorer rural areas. Access to almost all health services in Zimbabwe includes some form of cost to the client. In recent years, the socio-economic and employment status of many Zimbabweans has suffered a serious decline, creating additional barriers to HIV treatment and care. We aimed to assess the impact of i) socio-economic status (SES) and ii) employment status on the utilization of health services in rural Zimbabwe. Data were collected from a random probability sample household survey conducted in the Mutoko district of north-western Zimbabwe in 2005. We selected variables that described the economic status of the respondent, including: being paid to work, employment status, and SES by assets. Respondents were also asked about where they most often utilized healthcare when they or their family was sick or hurt. Of 2,874 respondents, all forms of healthcare tended to be utilized by those of high or medium-high SES (65%), including private (65%), church-based (61%), traditional (67%), and other providers (66%) (P=0.009). Most respondents of low SES utilized government providers (74%) (P=0.009). Seventy-one percent of respondents utilizing health services were employed. Government (71%), private (72%), church (71%), community-based (78%) and other (64%) health services tended to be utilized by employed respondents (P=0.000). Only traditional health services were equally utilized by unemployed respondents (50%) (P=0.000). A wide range of health providers are utilized in rural Zimbabwe. Utilization is strongly associated with SES and employment status, particularly for services with user fees, which may act as a barrier to HIV treatment and care access. Efforts to improve access in low-SES, high HIVprevalence settings may benefit from the subsidization of the health care payment system, efforts to improve SES levels, political reform, and the involvement of traditional providers

TELEMEDICINE USE IN HEALTH FACILITY DURING COVID-19 PANDEMIC: LITERATURE REVIEW

Background: The policy of imposing restrictions on community activities during the Covid-19 pandemic is a challenge to the accessibility of health services. Therefore, we need the best solution for safe access to health services. Aims: This study aims to analyze telemedicine use in health facilities during the Covid-19 pandemic by looking at comparisons and similarities in use and reviewing the inhibiting and supporting factors for the success of telemedicine. Methods: The research method is a literature review that was obtained through the Scopus database and published in 2020-2021 in English. Cleaning of articles was carried out with the inclusion and exclusion criteria so that seven articles were reviewed. Results: The lack of multidisciplinary use, healthcare practitioners' inability to connect with patients, under-integrated systems, and lack of technological knowledge and capacity all hinder telemedicine adoption. Positive patient feedback, a well-supported telemedicine service system, and partnerships with specialists all help make telemedicine more effective. Conclusion: During a pandemic, the use of telemedicine in healthcare settings is extremely beneficial for healthcare providers and patients during healthcare consultations, and there are supporting aspects such as WHO recognition and simplicity of operation. However, obstacles remain, such as a lack of specialized knowledge and multidisciplinary technology

Outcomes of Kenyan children under five years of age, initiated on isoniazid preventive therapy following exposure to bacteriologically confirmed pulmonary tuberculosis, 2013-2016

Background: Isoniazid preventive therapy (IPT) is one of the key interventions in achieving the End TB Strategy of 90% reduction in Tuberculosis (TB) incidence by 2030 compared with 2015. One of the key pillars in achieving this is preventive treatment of persons at high risk of contracting TB. This group includes children less than five years exposed to bacteriologically confirmed TB. Despite Kenya national IPT roll out in 2015, there still exists limited information on its programmatic coverage, outcomes and missed opportunities for initiation of IPT.Objective: To determine the coverage, outcomes and missed opportunities for initiation of IPT among children under-five years in contact with bacteriologically confirmed pulmonary tuberculosis (PTB) in Kenya.Design: Cross sectional descriptive study.Setting: All the 47 counties in Kenya.Subjects: Children under-five years exposed to bacteriologically confirmed PTB initiated on IPT and notified between 2013 and 2016.Results: During the study period (2013-2016), a total of 6,507 children aged less than five years who were exposed to bacteriologically confirmed PTB were initiated on IPT. The number of children initiated on IPT increased from 721 in 2013 to 3306 in 2016.The number of counties notifying cases increased from 26 in 2013 to 47 in 2016. Treatment completion was 78%, 87% and 82% for 2013, 2014 and 2015 respectively. Of the 1390 children who had completed the 6 month-course of IPT during the study period, 9%had no TB, 7% were not accessed while84% had no documentation of outcomes by the end of the follow up period of 24 months. Missed opportunities for initiation of IPT reduced from 90% (7109) in 2013 to 60% (4872) in 2016.Conclusion: IPT coverage and completion rates have improved from 721 in 2013 to 3306 in 2016 and 78% in 2013 to 82% in 2015 respectively. Despite this, Kenya is yet to meet the targets set by the World Health Organization (WHO). Sustainable measures need to be put in place to achieve the WHO targets

Spatial and temporal distribution of notified tuberculosis cases in Nairobi County, Kenya, between 2012 and 2016

Background: Tuberculosis (TB) is an infectious disease of major public health concern globally. The disease has showed space‐time variations across settings. Spatial temporal assessment can be used to understand the distribution and variations of TB disease.Objective: To determine the spatial and temporal distribution of notified TB cases in Nairobi County, Kenya, between 2012 and 2016Design: A cross sectional studySetting: Nairobi County, KenyaSubjects: Tuberculosis cases notified in Tuberculosis Information for Basic Units from 2012 to 2016Results: A total of 70,505 cases of TB were notified in Nairobi County between 2012 and 2016, with male to female ratio of 3:2 and HIV coinfection rate of 38%.The temporal analysis showed a declining trend of the notified cases. The spatial clusters showed stability in most areas while others varied annually during the study period. The space‐time analysis also detected the four most likely clusters or hotspots. Cluster 1 which covered the informal settlements of Kibera, Kawangware and Kangemi with 4,011observed cases against 2,977expected notified TB cases(relative risk (RR) 1.37, p<0.001). Further, Cluster 2 covered Starehe and parts of Kamukunji, Mathare, Makadara, Kibra and Dagoretti North Constituencies (RR 1.93, p<0.001; observed and expected cases were 4,206 and 2,242, respectively.Conclusion: This study identified high TB case notifications, declining temporal trends and clustering of TB cases in Nairobi. Evidence of clustering of TB cases indicates the need for focused interventions in the hotspot areas. Strategies should be devised for continuous TB surveillance and evidence based decision making