Developing lay health worker policy in South Africa: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Over the past half decade South Africa has been developing, implementing and redeveloping its Lay Health Worker (LHW) policies. Research during this period has highlighted challenges with LHW programme implementation. These challenges have included an increased burden of care for female LHWs. The aim of this study was to explore contemporary LHW policy development processes and the extent to which issues of gender are taken up within this process.</p> <p>Methods</p> <p>The study adopted a qualitative approach to exploring policy development from the perspective of policy actors. Eleven policy actors (policy makers and policy commentators) were interviewed individually. Data from the interviews were analysed thematically.</p> <p>Results</p> <p>Considerations of LHW working conditions drove policy redevelopment. From the interviews it seems that gender as an issue never reached the policy making agenda. Although there was strong recognition that the working conditions of LHWs needed to be improved, poor working conditions were not necessarily seen as a gender concern. Our data suggests that in the process of defining the problem which the redeveloped policy had to address, gender was not included. There was no group or body who brought the issue of gender to the attention of policy developers. As such the issue of gender never entered the policy debates. These debates focused on whether it was appropriate to have LHWs, what LHW programme model should be adopted and whether or not LHWs should be incorporated into the formal health system.</p> <p>Conclusion</p> <p>LHW policy redevelopment focused on resolving issues of LHW working conditions through an active process involving many actors and strong debates. Within this process the issue of gender had no champion and never reached the LHW policy agenda. Future research may consider how to incorporate the voices of ordinary women into the policy making process.</p

Balance, gait performance and muscular strength in the elderly

Fracture incidence is higher in urban than in rural inhabitants. Background factors such as physical activity and workload may have an influence on the tendency to fall, leading to fractures. We found that elderly women with a recent fracture of the distal radius appear to have impaired balance, an impairment that seems to normalise with time after fracture. The aim of this study was also to get normative data for healthy subjects of functional performance, such as balance, gait performance and muscular strength. Different populations were investigated. Men and women 50, 60, 70 and 80 years of age and women of 40 years from an urban and a rural area were investigated. Background factors such as age, gender, housing, medical status, workload and sparetime activities were collected. Urban subjects had significantly inferior balance compared with rural subjects and this difference increased with increasing age. The urban subjects walked faster but the rural subjects took longer steps. Sparetime activities correlated with balance and step length and workload with walking speed. Muscular strength of knee extension was significantly lower in the urban men and women in almost all age groups. This difference was not pronounced in knee flexion except for the oldest subjects. To investigate whether any of the clinical balance and gait performance tests could be related to computerised balance and muscular strength tests, 230 women, of 75 years of age were examined. The computerised balance platform test, could not be related to any of the clinical balance tests, gait performance tests or muscular strength tests. The clinical balance test was correlated with walking speed and step length. Extension and flexion strength of the knee and ankle dorsiflexion were also related to walking speed and step length. The heavier an individual was, the slower she walked and the shorter her steps, despite having stronger knee muscles. Women over the age of 65, who had participated for more than 20 years in physical exercise groups, had significantly better balance, gait performance and muscular strength of the knee and were less in need of home aid compared to urban women of the same age. When the active women were compared with age-matched rural women this difference was less pronounced. The results of this study emphasise the necessity of using correct normative data as regards balance, gait performance and muscular strength when different populations are compared

The physiotherapy clinical outcome variables scale predicts length of hospital stay, discharge destination and future home facility in the acute comprehensive stroke unit.

OBJECTIVE: The aims of this study were: to follow the course of recovery of motor function following acute stroke, as assessed by the Physiotherapy Clinical Outcome Variables Scale (COVS), and; to investigate the ability of this instrument to predict length of hospital stay, discharge destination and future home facility. METHODS: In this prospective longitudinal study, COVS was registered at admission and discharge from an acute stroke unit and at 3 months post-stroke onset. SUBJECTS: Sixty subjects were recruited consecutively from a sample of patients after first-ever acute stroke, and of these, 50 received follow-up assessment. OUTCOME VARIABLES: Length of hospital stay, discharge destination and home facility 3 months post-stroke. RESULTS: The overall COVS scores increased significantly during the 3-month follow-up. The admission COVS score correlated negatively with length of stay. A cut-off at 50 points and 41 points could predict discharge destination and future home facility, respectively. CONCLUSION: COVS measures improvements and can predict length of hospital stay, discharge destination and future home facility. Thus, it could be used in early prediction for effective planning of the acute stroke unit services and efficient discharge planning

Falls among dizzy patients in primary healthcare: an intervention study with control group.

The objective of this study is to investigate whether vestibular rehabilitation can improve balance, reduce self-perceived handicap because of dizziness and, if possible, reduce falls among dizzy patients in primary healthcare. The study also finds out which of the balance measures and measure of self-perceived handicap, if any, predicted the risk of falls. The design of this study is an intervention study with control group. Fifty-eight patients, 65 years and older, with multisensory dizziness were taken as participants. The intervention group trained vestibular rehabilitation twice a week for 9 weeks. All patients were assessed at baseline and after 3 months, with four different balance measures and the Dizziness Handicap Inventory. After 6, 9 and 12 months, a follow-up by telephone was performed and, at 12 months, the patients also filled out a Dizziness Handicap Inventory questionnaire. Statistically significant differences were found between the groups between baseline and 3 months in one static balance measure and in one dynamic measure (P=0.038 and 0.044). In total, 40 falls were reported, 31 were classified as intrinsic falls, 26 of them caused by vertigo and nine falls were classified as extrinsic. No difference was found between the two groups in proportions of patients who fell. Poor ability to stand in tandem stance doubled the risk for falls. Vestibular rehabilitation can improve balance in elderly patients with multisensory dizziness. Vertigo is a common cause of falls in this group of patients and vestibular rehabilitation is a feasible treatment