Male partner involvement in the prevention of mother-to-child transmission (PMTCT) of HIV program in Mthatha, South Africa : women's perpsective

Thesis (MPhil)--Stellenbosch University, 2013.ENGLISH ABSTRACT: Although the significant impact that male partners have on the health decisions and well-being of women have been well documented, prevention of mother-to-child transmission (PMTCT) programmes in many countries, including South Africa, has largely been targeted exclusively at HIV-positive women. This study focused on women’s perception of male involvement in the prevention-of-mother-to-child-transmission of HIV program in South Africa. A qualitative study was conducted among HIV-positive pregnant women who were on the PMTCT program at a clinic in Mthatha, Eastern Cape Province. Semi-structured interviews and a focus group discussion were conducted among 20 participants and were audio-taped, transcribed, translated and analyzed. The main findings show that respondents recognized the benefits associated with as well as showed positive attitudes towards male participation in the PMTCT programme; participants expressed the view that although most of their partners provided financial support during pregnancy, they were not involved in the PMTCT program; and they believed that partner involvement would be in the interest of their unborn children. Perceived obstacles to male partners’ involvement included socio-cultural factors, fear of knowing their HIV status and factors relating to health care systems. Suggested ways of encouraging male participation from respondents included writing invitational notes on women antenatal cards, adjusting current labour practices (so that men could be permitted to attend clinics with their partners) and the use of peer educators for mobilizing male participation. The study concluded that the positive attitudes of women on male participation and the benefits it may hold, point towards the possible re-designing of the PMTCT program in South Africa, where more male involvement would be encouraged as an integral part of this prevention strategy.AFRIKAANSE OPSOMMING: Hoewel die beduidende impak wat manlike metgeselle op die gesondheidsbesluite en welstand van vroue het deeglik opgeteken is, was programme rakende moeder-na-kind-oordrag (PMTCT) in talle lande, insluitende Suid-Afrika, grotendeels eksklusief op vroue gerig wat MIV-positief is. Dié studie het gefokus op vroue se persepsies van manlike betrokkenheid in PMTCT van die MIV-program in Suid-Afrika. ‘n Kwalitatiewe studie is by ‘n kliniek in Mthatha in Oos-Kaapland onder vroue wat swanger en MIV-positief is uitgevoer – hulle was deel van die PMTCT-program. Semi-gestruktueerde onderhoude en ‘n fokusgroep-bespreking is met deelnemers gedoen; dié onderhoude is op oudioband opgeneem, vertaal en geanaliseer. Die belangrikste bevindinge toon dat respondent die voordele van manlike betrokkenheid in die PMTCT-program besef en ook positief daarteenoor ingestel is; deelnemers het die mening uitgespreek dat hoewel die meeste van hulle metgeselle geldelike steun tydens swangerskap bied, hul nie by die PMTCT-program betrokke is nie; en hulle glo dat metgesel-betrokkenheid tot voordeel sou strek van hulle ongebore kind(ers). Persepsies oor hindernisse ten opsigte van manlike betrokkenheid, het sosio-kulturele faktore ingesluit, asook vrees vir wat hulle MIV-status is en faktore wat met gesondheidsorgstelsels verband hou. Voorgestelde wyses deur respondente om manlike deelname aan te moedig, het die skryf van uitnodigings op vroue se voorgeboortelike kaarte ingesluit, asook dat arbeidspraktyke aangepas word sodat mans toegelaat word om hulle metgeselle na klinieke te vergesel en die gebruik van portuurgroep-opvoeders met die oog op die mobilisering van manlike deelname. Ten slotte word gemeld dat die positiewe ingesteldheid van vroue ten opsigte van manlike betrokkenheid en die voordele wat dit moontlik kan inhou, dui op die moontlike herontwerp van die PMTCT-program in Suid-Afrika waar groter manlike betrokkenheid aangemoedig sou word as integrale deel van hierdie voorkomingstrategie

ACCOUNTING: BEYOND PRACTICE BRIDGING THE GAP THROUGH TERTIARY INSTITUTIONS

The awareness about the fact that the frontier of accounting is increasingly expanding beyond professional practice is inchoate in Nigeria. The role of accounting extends further to research and policy formulations for Governments and corporate organizations as it assumes a multi-dimensional sine qua non in budgeting and budgetary control, environmental impact measurement, forensics and other socio-political and economic policy measures. This awareness level should be increased substantially through tertiary education. There is a unilateral stereotype of the profession (in Nigeria) especially among students always tending to practice as the core of the accounting profession hence the purpose of this article is to unmask the ills of the propaganda for professional practice as the core of the accounting profession in Nigeria; and to emphasize the three parts of the profession (research, policy and practice) according to Guthrine et al (2011). There is little awareness about the benefits of undertaking research and/or policy based orientation in Nigerian institutions limiting students’ focus to becoming only professional practitioners. With this comes low number of senior academics in the field of Accounting experienced in most tertiary institutions. Tertiary institutions should be the “place of orientation” for the three aspects of accounting; nurturing and developing students’ interest, so this paper strongly rejects the overbearing clamor for professional practice as the core of the profession. This paper is based on the authors’ assuming opinions, observations and perspective with respect to realities in the academic environment hence subjective

DESIGN, FABRICATION AND EVALUATION OF DIGITAL TILT TEST DEVICE

Due to the high and fluctuating exchange rate, obtaining devices and equipment for practical demonstration of theoretical contents of engineering and applied science courses in developing countries is becoming a herculean task. To sustain the practical aspect of these courses, some of the devices have to be locally manufactured. In this study, a digital tilt test device for determining the basic friction angle and joint roughness coefficient (JRC) of rock samples was designed and fabricated using majorly local materials. Comparing the device's results with those obtained from the Profilometer, there was a satisfactory correlation between the two results. The device is much cheaper to manufacture locally than the imported onesTherefore, it is recommended that the device be used for estimating the friction angle and JRC of rock samples. Similar devices with simple mechanisms should be manufactured locally in higher institutions to reduce dependency on foreign devices, which are expensive

Doctors’ practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study

Background: Unnecessary blood transfusion exposes recipients to potential harms. Aim: The aim of this study was to describe blood transfusion practice and explore doctors’ attitudes towards transfusion. Setting: A hospital providing level 1 and 2 services. Methods: A mixed-methods study design was used. In the cross-sectional descriptive component, a sample was taken from patients transfused over a 2-month period. Blood use was categorised as for medical anaemia or haemorrhage, and appropriate or not. The qualitative component comprised a purposeful sample for focus group and individual semistructured interviews. Results: Of 239 patients sampled, 62% were transfused for medical anaemia and 38% for haemorrhage. In the medical anaemia group, compliance with age-appropriate transfusion thresholds was 69%. In medical anaemia and haemorrhage, 114 (77%) and 85 (93.4%) of recipients had orders for ≥ 2 red blood cell (RBC) units, respectively. In adults ≥ 18 years old with medical anaemia, 47.1% of orders would have resulted in a haemoglobin (Hb) > 8 g/dL. Six doctors participated in focus group and eleven in individual interviews. There was a lack of awareness of institutional transfusion guidelines, disagreement on appropriate RBC transfusion thresholds and comments that more than one RBC unit should always be transfused. Factors informing decisions to transfuse included advice from senior colleagues, relieving symptoms of anaemia and high product costs. Conclusion: Most orders were for two or more units. In medical anaemia, doctors’ compliance with RBC transfusion thresholds was reasonable; however, almost half of the orders would have resulted in overtransfusion. The attitudes of doctors sampled suggest that their transfusion practice is influenced more by institutional values than formal guidelines. Keywords: red blood cell transfusion; doctors’ attitudes; doctors’ practice; transfusion thresholds; overtransfusion; descriptive study; qualitative study

Umbilical vein catheterisation for the family physician working in primary health care

This is part of a series of articles on vascular access in emergencies. The other two articles were on intra osseous lines and central venous lines. These are critical lifesaving emergency skills for the primary care professional. In this article, we will provide an overview of umbilical vein catheterisation highlighting its importance, the indications, contraindications, techniques, complications and nursing considerations. By familiarising healthcare providers with this procedure, we hope to enhance their knowledge and skills, ultimately leading to improved outcomes in the neonatal population

Intraosseous line insertion for the primary health care physician

Early rapid access to the vascular system is essential in emergencies and is lifesaving. In this article, we will provide information on the common sites used, the equipment that is required, the indications and contraindications for intraosseous line insertion, how to correctly and safely do the procedure, medication that can be administered, post insertion line management and possible complications. This is a lifesaving procedure and primary healthcare physicians should acquire this skill

FACTORS INFLUENCING THE CHOICE OF PRIVATE UNIVERSITIES IN NIGERIA BY UNDERGRADUATE STUDENTS

As a result of new government initiatives, private universities are sprouting in Nigeria. These institutions, which supplement higher education, are now faced with the problem of attracting enough students. The study looked at the factors that influence students' decision to enrol in a private institution in Nigeria and the amount to which these factors influence their decision. The study also looks into whether there are any major differences in the elements students consider while choosing a university based on their demographic traits. For this study, the primary research approach was descriptive survey research. With a total student enrolment of 5,590, Al-Hikmah University was chosen as the case study for private universities in Nigeria, and the first-year students with an enrollment of 1450 were used as the research population. A total of 300 students were used in the study. A structured questionnaire with a reliability coefficient of 0.95 was utilized as the tool. The data were examined using descriptive statistics, and the hypotheses were tested using T-value statistics at the 0.05 level of significance. Affordability offers of the desired program, reputation/academic quality, the flexibility of schedule, hands-on learning/real-world experience in curriculum, location/security, and availability of facilities are the seven (7) major factors that influence students' choice of private universities in Nigeria, according to the findings of this research study. The study also demonstrates that male and female students have very different perspectives on the primary elements that impact students' decisions to attend private institutions in Nigeria. The findings of this study will help private institutions have a better knowledge of what students value when deciding which private university to attend, and then make any necessary changes and adjustments, as well as improve academic quality, to increase student enrollmen

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial