Diarrhoea management in primary health care facilities in the Cape metropole region: the caregivers' perspective

Master of Public Health - MPHThis mini-thesis, assessed the use of ORT as a treatment for childhood diarrhoea in primary health care facilities in the Cape Metropole from the caregivers' perspective. Awareness and knowledge of oral rehydration therapy (ORT) and the preparation abilities of sugar salt solution (SSS) by caregivers of children younger than 5 years attending the health facilities were assessed. The availability of resources and utensils for the use of ORS packets and SSS and the accessibility to health facilities by caregivers were also determined. Using a cross sectional descriptive study design, a baseline situation review was carried out. Primary health care facilities in three heath districts namely; Khayelitsha, Nyanga and Oostenberg were purposely selected. Ninety-two caregivers in 12 facilities participated in the study. Basic analyses of quantitative data were done using Epi-Info 2002 software. Qualitative data were analysed manually. The study found that according to caregivers, all facilities used ORS packets as their immediate treatment for uncomplicated diarrhoea, and recommended sugar salt Diarrhoea Management in PHC Facilities solution as home treatment. Ninety-one percent of caregivers used ORT at home before they presented to the health facility.Of the caregivers who were advised by the health worker to use SSS at home, 60.7%, 55.8% and 60.2% in Oostenberg, Khayelitsha and Nyanga districts respectively remembered the correct ingredients and quantities to make the solution at home. Of those given ORS packets, 94.5%, 99.0% and 98.5% respectively, remembered the quantity of water to be mixed with each packet. Packets were found to be convenient and were preferred by many caregivers as compared to SSS. The advice or health education messages given to caregivers were often unclear, and there were language barriers in Brighton and Bloekombos clinics in the Oostenberg district. A litre bottle was available in 47% of caregivers' homes, 82 % had a teaspoon and all of them had access to running water. Twelve percent and 11 % admitted to not having sugar and salt respectively when they wanted to make SSS. Eighty-eight percent walked to the health facility and 12% used taxis or buses. The study concludes that ORT is widely used in primary health care facilities for diarrhoeal disease treatment, however caregiver's knowledge and preparation abilities of SSS is still limited. The resources and utensils to prepare ORT at home were fairly available in many homes, which makes SSS preparation at home feasible and acceptable

Analysis of the implementation of an antiretroviral treatment programme in KwaZulu- Natal province

Philosophiae Doctor - PhDThe rapid expansion of the ART programme in South Africa has placed an additional service demand on an already stretched public health infrastructure. The main aim of this study was therefore to analyse the implementation of the ART programme in KwaZulu- Natal province using the Donabedian Model of structure, process and outcome in order to develop an ART delivery model. Ethical approval to conduct this research was issued by the University’s Senate Research Committee. The first phase of the study used a descriptive quantitative approach to review existing data from government departments to analyse the ART programme. A checklist with the list of indicators for the three elements of the study; the structure, process and outcome were used to collect data. A pilot study was conducted and the Cronbach Alpha test was used to determine the rigour of the study. In the second phase, a systematic review of studies on implementation of the existing models of ART programme was conducted using quantitative descriptive approach. The Quality Appraisal Tool was used to determine the validity of the research findings from the literature. In phase 3, both qualitative and quantitative approaches were used to conduct the Delphi study which included a group of experts in the field of HIV and ART programme. Responses from the participants were modified to determine the reliability of the study. The study found that there were structural problems such as shortages of antiretroviral drugs and delays in the return of laboratory results. The systematic literature review found that there were only two community-based ART models in South Africa, namely; the adherence clubs and community-based adherence clubs. These two models of ART delivery were implemented only in Cape Town

Knowledge, beliefs and attitudes of community health workers about hypertension in the Cape Peninsula, South Africa

This article explores the perceptions and attitudes of community health workers (CHWs) about hypertension. The level of knowledge of hypertension, as well as their personal attitude towards this is crucial in the style and quality of their interventions. CHWs, whose role in health promotion is being increasingly recognised, can help contain or reduce the prevalence of hypertension by influencing the community to adopt healthy lifestyles. Forty-three CHWs employed by Zanempilo in two study areas, Sites B and C in Khayelitsha in the Cape Peninsula, South Africa, were included in the study. Firstly, focus group discussions were conducted with 17 purposively selected CHWs to explore attitudes, beliefs and perceptions of hypertension. Secondly, interviews were conducted to assess their basic knowledge about causes, prevention and control of hypertension. The focus group discussions revealed that CHWs were uncertain about the causes of hypertension. They also found it difficult to grasp the fact that people without risk factors, such as overweight or a family history of hypertension, could be hypertensive. Many CHWs believe in traditional medicines and home-brewed beer as the best treatment for hypertension. They believe that people who take medical treatment become sicker and that their health deteriorates rapidly. Risk factors of hypertension mentioned during the structured interviews include inheritance, lack of physical activity, consuming lots of salty and fatty food. Conclusions drawn from the findings of the CHWs’ responses highlighted their insufficient knowledge about hypertension as a chronic disease of lifestyle. Meanwhile they are expected to play a role in stimulating community residents’ interest in the broad principle of preventive health maintenance and follow-up. Data obtained from this research can be used for the planning of health-promotion programmes. These should include preventing hypertension and improving primary management of individual sufferers. Because of their working relations and close link with CHWs, community nurses in primary health-care facilities need to recognise these beliefs and attitudes since these may differ from their own

Effect of a mother-to-child HIV prevention programme on infant feeding and caring practices in South Africa

Objectives. To conduct a rapid assessment of the impact of the Khayelitsha Prevention of Mother-to-Child Transmission (MTCD programme on infant care practices among programme participants and the local population.Study design. Cross-sectional survey and qualita.tive indepth interviews.Setting, Khayelitsha, a large formal and informal settlement of about 300 000 people on the outskirts of Cape Town. At the time of the study the lllV seroprevalence rate among antenatal women was about 15% and the MfCT programme had enrolled nearly 800 infected women.Subjects. Seventy randomly selected caregivers with young children in the survey; m-depth structured interviews with 11 nutrition counsellors and 11 mothers enrolled in the programme.Results. Caregivers have good knowledge of the spread and prevention of HIV. A majority knew that breast-feeding can transmit lllV but 90% stated that this did not affect their feeding decisions. Over 80% had stopped exclusively breast-feeding by the time their infants were 3 moniths of age. All of the respondents felt that being diagnosed HIVpositive would result in serious social and domestic consequences. None of the health workers could correctly estimate the risk of spreading lllV through breast-feeding and many reported feeling confused about what they should counsel mothers. All the mothers on the programme reported exclusive formula-feeding. Some had serious problems with preparation and feeding of formula milk. Nearly all reported running out of feeds before being able to fetch new supplies. None reported any negative social effects of not breast-feeding. Most of the mothers endorsed the programme and felt that it had given them strength to face up to and plan for the consequences of their diagnosis.Conclusion. This rapid appraisal of the infant feeding and care component of the MTCf programme has raised a number of important challenges which health managers and policymakers need to address. Similar assessments in the new pilot sites will be important