An outcome evaluation of the SHAWCO Saturday School Programme

Includes bibliographical references.This dissertation reports on an outcome evaluation of the Student Health and Welfare Centres Organisation (SHAWCO) Saturday Schools Programme. This is a professionally-run catch-up educational programme that engages two hundred Grade 12 Cape Town based students. Broadly, the goal of the programme is to provide learners with quality teaching with a view to increase their chances for acceptance into university education. According to the literature, there remain some inconsistencies in the effectiveness of catch-up programmes across various contexts and subject areas. Some proponents of catch-up education programmes continue to assert that such programmes have positive effects for underprepared pre-university students. However, some other researchers maintain opposing views. Additional evidence is thus required to unlock further the value of these programmes, as the need for their existence is well warranted within the realm of pre- and post- secondary school education. To evaluate the SHAWCO Saturday School Programme, a single-group, pre- and post-test quasi-experimental design was used. The evaluation used both the 2010 and 2011 cohorts of high school learners who came from 36 secondary schools located within underprivileged communities in Cape Town. Secondary data were obtained from the SHAWCO programme managers who use a nonprobability criterion sampling technique to select learners onto the programme based on a predetermined criterion (performance on two standardised academic potential tests). The selection criterion is such that only the first 200 high-performing learners get selected into the SHAWCO programme

Contextual and socio-economic factors that impact food purchasing patterns of health club members residing in a predominantly black- urban township in South Africa

Magister Public Health - MPHBackground: It is gradually being recognized that understanding individual-level socioeconomic and environmental predictors of food purchasing and thus healthy eating, is imperative in order to develop appropriate nutrition and health interventions. Understanding the complex world of food choice requires a meticulous examination of stimuli and deterrents of food choice all of which should be viewed comprehensively to include micro-level compositional socioeconomic aspects of individuals as well as macro-level contextual influences of food cost, availability and accessibility. Aim: This study sought to uncover some of the widely known environmental (contextual) and compositional (individual-level) socioeconomic factors that influence Health Club Members’ (HCMs) ability to access and afford healthy foods within the community where they live. Study design: The research employed both descriptive quantitative and qualitative study designs. [VI] Study population and sample: The target population which was also the sample comprised 50 Health Club Members who were residing in Harare and the surrounding area within Khayelitsha at the time of the study. Data collection and analysis: Data was collected by means of face to face quantitative interviews with 46 HCMs using questionnaires, in-depth interviews with 10 HCMs, Key informant interviews with 2 Community Health Workers, as well as observations of the community food environment. Quantitative data was analyzed using SPSS version 16.0 and MS Excel 2007 for Windows. Qualitative analysis was executed using framework and content analysis techniques. Results and conclusion: The study established that low socioeconomic status, poor access to healthy food choices, and lack of constant availability of such foods were primary challenges facing some of the HCMs in their quest to afford and access healthy food. In order to promote access to and availability of affordable healthy foods in the study setting, there may be a need for addressing not only individual socioeconomic challenges but also more upstream environmental drivers of food purchasing.Background: It is gradually being recognized that understanding individual-level socioeconomic and environmental predictors of food purchasing and thus healthy eating, is imperative in order to develop appropriate nutrition and health interventions. Understanding the complex world of food choice requires a meticulous examination of stimuli and deterrents of food choice all of which should be viewed comprehensively to include micro-level compositional socioeconomic aspects of individuals as well as macro-level contextual influences of food cost, availability and accessibility.Aim: This study sought to uncover some of the widely known environmental (contextual) and compositional (individual-level) socioeconomic factors that influence Health Club Members’(HCMs) ability to access and afford healthy foods within the community where they live.Study design: The research employed both descriptive quantitative and qualitative study designs.[VI]Study population and sample: The target population which was also the sample comprised 50 Health Club Members who were residing in Harare and the surrounding area within Khayelitsha at the time of the study.Data collection and analysis: Data was collected by means of face to face quantitative interviews with 46 HCMs using questionnaires, in-depth interviews with 10 HCMs, Key informant interviews with 2 Community Health Workers, as well as observations of the community food environment. Quantitative data was analyzed using SPSS version 16.0 and MS Excel 2007 for Windows. Qualitative analysis was executed using framework and content analysis techniques.Results and conclusion: The study established that low socioeconomic status, poor access to healthy food choices, and lack of constant availability of such foods were primary challenges facing some of the HCMs in their quest to afford and access healthy food. In order to promote access to and availability of affordable healthy foods in the study setting, there may be a need for addressing not only individual socioeconomic challenges but also more upstream environmental drivers of food purchasing

Short-term and sustained effects of a health system strengthening intervention to improve mortality trends for paediatric severe malnutrition in rural South African hospitals

BACKGROUND. Case fatality rates for childhood severe acute malnutrition (SAM) remain high in some resource-limited facilities in South Africa (SA), despite the widespread availability of the World Health Organization treatment guidelines. There is a need to develop reproducible interventions that reinforce the implementation of these guidelines and assess their effect and sustainability. OBJECTIVES. To assess the short-term and sustained effects of a health system strengthening intervention on mortality attributable to SAM in two hospitals located in the Eastern Cape Province of SA. METHODS. This was a theory-driven evaluation conducted in two rural hospitals in SA over a 69-month period (2009 - 2014). In both facilities, a health system strengthening intervention was implemented within the first 32 months, and thereafter discontinued. Sixty-nine monthly data series were collected on: (i) monthly total SAM case fatality rate (CFR); (ii) monthly SAM CFR within 24 hours of admission; and (iii) monthly SAM CFR among HIV-positive cases, to determine the intervention’s effect within the first 32 months and sustainability over the remaining 37 months. The data were analysed using Linden’s method for analysing interrupted time series data. RESULTS. The study revealed that the intervention was associated with a statistically significant decrease of up to 0.4% in monthly total SAM CFR, a non-statistically significant decrease of up to 0.09% in monthly SAM CFR within 24 hours of admission and a non-statistically significant decrease of up to 0.11% in monthly SAM CFR among HIV-positive cases. The decrease in mortality trends for both outcomes was only slightly reversed upon the discontinuation of the intervention. No autocorrelation was detected in the regression models generated during data analyses. CONCLUSION. The study findings suggest that although the intervention was designed to be self-sustaining, this may not have been the case. A qualitative enquiry into the moderating factors responsible for failure to sustain such an intervention, as well as the process of care, would add value to the findings presented in this study.DHE

Global core indicators for measuring WHO’s paediatric quality‑of‑care standards in health facilities: Development and expert consensus

There are currently no global recommendations on a parsimonious and robust set of indicators that can be measured routinely or periodically to monitor quality of hospital care for children and young adolescents. We describe a systematic methodology used to prioritize and define a core set of such indicators and their metadata for progress tracking, accountability, learning and improvement, at facility, (sub) national, national, and global levels. We used a deductive methodology which involved the use of the World Health Organization Standards for improving the quality-of-care for children and young adolescents in health facilities as the organizing framework for indicator development. The entire process involved 9 complementary steps which included: a rapid literature review of available evidence, the application of a peer-reviewed systematic algorithm for indicator systematization and prioritization, and multiple iterative expert consultations to establish consensus on the proposed indicators and their metadata

Upskilling nursing students and nurse practitioners to initiate and manage patients on ART: An outcome evaluation of the UKZN NIMART course

Background. Currently, there is a need in South Africa to implement strategies to upskill nurses in the clinical management of HIV and AIDS, for effective and efficient management of people living with HIV. One such strategy is the nurse-initiated management of antiretroviral therapy (NIMART) course.Objectives. To evaluate the effectiveness of the NIMART course in increasing the knowledge of trainees in select clinical competencies, to assess whether perceived knowledge gain varied according to individual-level characteristics of trainees, and to determine trainee perceptions of the value and delivery of the course.Methods. A 5-day training course focusing on various areas of HIV was developed and delivered by experts in the field of HIV to multiple cohorts of fourth-year nursing students at the University of KwaZulu-Natal, and to post-basic nursing practitioners, over a 5-year period. A single-group pre- and post-quasi-experimental design was used to assess knowledge change and perceptions about the course among 1 369 trainees who had benefitted from the course during the implementation period.Results. Post-workshop test scores were significantly higher than pre-workshop scores (p<0.0001), based on both pooled and cohort-specific data. For pooled analysis, the pre-test median score was 67% (interquartile range (IQR) = 60% - 73%) and the post-test median score was 77% (IQR = 70% - 80%), with p<0.0001. The knowledge gain was the highest in respect of HIV prevention, followed by prevention of mother-to-child transmission, then HIV treatment and lastly, general knowledge of HIV. The vast majority were very satisfied with the content of the training, although 31.3% strongly disagreedthat they were ready to apply the knowledge they had learned in their workplace.Conclusion. The training was generally well received, and improved the knowledge of participants in HIV and its management. However, this outcome represents short-term benefits of the programme, and there is a need for on-the-job mentorship and support in order to maximise on clinical outcomes related to HIV

Women’s perceptions of telephone interviews about their experiences with childbirth care in Nigeria: A qualitative study

Our objective is to investigate women’s perceptions of phone interviews about their experiences with facility childbirth care. The study was conducted between October 2020 and January 2021, in Gombe State, Nigeria. Participants were women aged 15–49 years, who delivered in ten study Primary Health Care centres, provided phone numbers, and consented to a follow-up telephone interview about their childbirth experience. The phone interviews took place 14 months after the delivery and consisted of a quantitative survey about women’s experiences of facility childbirth followed by a set of structured qualitative questions about their experiences with the phone survey. Three months later 20 women were selected, based on their demographic characteristics, for a further in-depth qualitative phone interview to explore the answers to the structured qualitative questions in more depth. The qualitative interviews were analysed using a thematic approach. We found that most of the women appreciated being called to discuss their childbirth experiences as it made them feel privileged and valued, they were motivated to participate as they viewed the topic as relevant and thought that their interview could lead to improvements in care. They found the interview procedures easy and perceived that the call offered privacy. Poor network connectivity and not owning the phone they were using presented challenges to some women. Women felt more able to re-arrange interview times on the phone compared to a face-to-face interview, they valued the increased autonomy as they were often busy with household chores and could rearrange to a more convenient time. Views about interviewer gender diverged, but most participants preferred a female interviewer. The preferred interview length was a maximum of 30 minutes, though some women said duration was irrelevant if the subject of discussion was important. In conclusion, women had positive views about phone interviews on experiences with facility childbirth care

Independent and interactive effects of HIV infection, clinical stage and other comorbidities on survival of children treated for severe malnutrition in rural South Africa: A retrospective multicohort study

BACKGROUND. There is still limited to no evidence on the independent and interactive effects of HIV infection, disease stage, baseline disease severity and other important comorbidities on mortality risk among young children treated for severe acute malnutrition (SAM) in South Africa (SA, using the World Health Organization (WHO) recommended treatment modality. OBJECTIVES. To determine baseline clinical characteristics among children with SAM and assess whether HIV infection, disease stage, critical illness at baseline and other comorbidities independently and interactively contributed to excess mortality in this sample. METHODS. We followed up children aged 6 - 60 months, who were admitted with and treated for SAM at two rural hospitals in SA, and retrospectively reviewed their treatment records to abstract data on their baseline clinical characteristics and treatment outcomes. In total, 454 children were included in the study. Descriptive statistical tests were used to summarise patients’ clinical characteristics. Kaplan- Meier failure curves were created for key characteristics and compared statistically using log-rank tests. Univariate and multivariate Cox regression was used to estimate independent and interactive effects. RESULTS. The combined case fatality rate was 24.4%. HIV infection, clinical disease stage, the presence of lower respiratory tract infection, marasmus and disease severity at baseline were all independently associated with excess mortality. The critical stage for higher risk of death was when cases were admitted at WHO stage III. The interactions of two or three of these characteristics were associated with increased risk of death when compared with having none, with HIV infection and critical illness showing the greatest risk (hazard ratio 22, p<0.001). CONCLUSION. The high HIV prevalence rate in the study setting and the resultant treatment outcomes support the notion that the WHO treatment guidelines should be revised to ensure that mechanisms for effective treatment of HIV comorbidity in SAM are in place. However, a much more rigorous study is warranted to verify this conclusion.DHE

To call or not to call: exploring the validity of telephone interviews to derive maternal self-reports of experiences with facility childbirth care in northern Nigeria

BACKGROUND: To institutionalise respectful maternity care, frequent data on the experience of childbirth care is needed by health facility staff and managers. Telephone interviews have been proposed as a low-cost alternative to derive timely and actionable maternal self-reports of experience of care. However, evidence on the validity of telephone interviews for this purpose is limited. METHODS: Eight indicators of positive maternity care experience and 18 indicators of negative maternity care experience were investigated. We compared the responses from exit interviews with women about their childbirth care experience (reference standard) to follow-up telephone interviews with the same women 14 months after childbirth. We calculated individual-level validity metrics including, agreement, sensitivity, specificity, area under the receiver operating characteristic curve (AUC). We compared the characteristics of women included in the telephone follow-up interviews to those from the exit interviews. RESULTS: Demographic characteristics were similar between the original exit interview group (n=388) and those subsequently reached for telephone interview (n=294). Seven of the eight positive maternity care experience indicators had reported prevalence higher than 50% at both exit and telephone interviews. For these indicators, agreement between the exit and the telephone interviews ranged between 50% and 92%; seven positive indicators met the criteria for validation analysis, but all had an AUC below 0.6. Reported prevalence for 15 of the 18 negative maternity care experience indicators was lower than 5% at exit and telephone interviews. For these 15 indicators, agreement between exit and telephone interview was high at over 80%. Just three negative indicators met the criteria for validation analysis, and all had an AUC below 0.6. CONCLUSIONS: The telephone interviews conducted 14 months after childbirth did not yield results that were consistent with exit interviews conducted at the time of facility discharge. Women's reports of experience of childbirth care may be influenced by the location of reporting or changes in the recall of experiences of care over time

The impact of HIV infection and disease stage on the rate of weight gain and duration of refeeding and treatment in severely malnourished children in rural South African hospitals

BACKGROUND: Evidence of the effects of HIV infection and clinical stage on the duration of refeeding and treatment (DRT) and the rate of weight gain (RWG) in severely malnourished children remains inconclusive. OBJECTIVES: To determine whether the RWG and DRT differ by baseline clinical characteristics, and to assess the effect of HIV status and disease stage on the relationship between these two clinical outcomes. METHODS: This was a retrospective record review of 346 patiens discharged between 2009 and 2013 following treatment for severe acute malnutrition (SAM) at two rural hospitals in South Africa. RESULTS: A third of the sample was HIV-positive, the RWG (measured as g/kg/day) was significantly slower in HIV-positive patients compared with HIV-negative cases (mean 5.2, 95% confidence interval (CI) 4.47 - 5.93 v. mean 8.51; CI 7.98 - 9.05; p<0.0001) and cases at stage IV of HIV infection had a significantly slower RWG (mean 3.97; CI 2.33 - 5.61) compared with those at stages I (mean 7.64; CI 6.21 - 9.07) (p<0.0001) and II (mean 5.87; CI 4.74 - 6.99). The mean DRT was longer in HIV-positive cases and those at advanced stages of HIV infection. HIV-positive cases were renourished and treated for almost 3.5 times longer than their HIV-negative counterparts to achieve a moderate RWG (5 - 10 g/kg/day). CONCLUSION: This study highlights the need to reconsider energy requirements for HIV-positive cases at different clinical stages, for more rapid nutritional recovery in under-resourced settings where prolonged hospitalisation may be a challenge.DHE

Regular measurement is essential but insufficient to improve quality of healthcare.

Ambrose Agweyu and colleagues argue that large scale improvements in quality of healthcare require strong change management as well as health information systems that can provide continuous and rapid feedbac