Maternal health services in South Africa During the 10th anniversary of the WHO 'Safe Motherhood' initiative

The tenth anniversary of the World Health Organisation's 'Safe Motherhood' initiative is being celebrated this year and the organisation is using the opportunity to assess critically its gains, its strengths and its weaknesses. South Africa has taken some bold steps to address maternal health services, specifically introducing free health care for pregnant women and children under 5. In this paper we explore what further steps are necessary to ensure improved health outcome for pregnant women. South African health care administrations are, in some cases, engaged in broad health systems interventions at provincial level. This approach to improving health services is nonetheless frustrated by programme-specific initiatives, such as the introduction of female condoms or other piecemeal additions. We argue that making the systems function is the essential, primary step in the success of any intervention. The case of maternal health is explored in this paper

Perceptions of registered nurses regarding factors influencing service delivery in expanding programmes in a primary healthcare setting

The aim of this study was to explore and describe the perceptions of registered nurses regarding factors influencing service delivery regarding expansion programmes in a primary healthcare setting, using a qualitative approach. The registered nurses, who have been working in the clinics for more than two years and have been exposed to the expansion programmes there, were purposively sampled. Two focus group interviews were conducted in a neutral place and the data collected by the researcher Nnoi A. Xaba (N.A.X.). Data were analysed by the researcher and an independent co-coder using the Tesch method. Categories, subcategories and themes were identified; those that formed the basis of discussion were disabling factors, enabling factors, client-related factors, service-related factors and solutions to problems. It is recommended that integration of programmes and coordination be done at a provincial level and planned together with the training centres in order to alleviate problems in service delivery. Training on expansion programmes in the form of in-service education should be carried out continually in the region.Die doel van die studie was om die persepsie van geregistreerde verpleegkundiges met betrekking tot die faktore wat dienslewering van die uitbreidingsprogramme in ‘n primêre gesondheid opset beinvloed; te eksploreer en te beskryf. ‘n Kwalitatiewe benadering is gevolg in die iutvoering van die studie. ‘n Doelgerigte steekproef is uitgevoer vanuit geregistreerde verpleegkundiges wat vir langer as twee jaar in die klinieke werksaam was en blootgestel is aan die uitbreiding programme. Twee fokus groep onderhoude is deur die navorser Nnoi A. Xaba (N.A.X.) in ‘n neutrale opset uitgevoer. Data is deur die navorser en ʼn onafhanklike kodeerder ontleed volgens Tesch se metode van analise. Kategorieë, sub-kategorieë en temas was geidentifiseer. Die kategorieë fundamenteel tot die bespreking behels: remmende faktore, bydraende faktore, kliënt-verwante faktore, diens-verwante faktore, en oplossing van probleme. Daar word aanbeveel dat die integrasie en koordinasie van programme op provisiale vlak beplan word in samewerking met opleidings instansies om die dienslewerings probleem te verlig. In die streek behoort opleiding met betrekking tot die uitbreidingsprogramme deurlopend deur middel van indiensopleiding gedoen word

Determinants, outcomes and costs of ceftriaxone v. amoxicillin-clavulanate in the treatment of community-acquired pneumonia at Witbank Hospital

Background. Community-acquired pneumonia (CAP) is a major cause of death and morbidity worldwide. Treatment is centred on antibiotics with ceftriaxone and amoxicillin-clavulanate being some of the most commonly prescribed agents.Objective. To compare treatment outcomes and costs in patients receiving either of these two antibiotics at Witbank Hospital (WH).Methods. A total of 200 randomly selected adult patient files (100 receiving ceftriaxone and 100 amoxicillin-clavulanate) recording a diagnosis of CAP were studied to determine the length of hospital stay, comorbid conditions and treatment outcomes. A descriptive and comparable analysis was performed.Results. Male gender, higher CURB-65 scores and death were associated with the use of ceftriaxone. Severity of disease and previous antibiotic exposure influenced the duration of hospital admission.Conclusion. Gender and severity of disease (based on the CURB-65 score) were the determinants of antibiotic choice at WH. Male gender increased the likelihood of being treated with ceftriaxone, as did a CURB-65 score of >2. There were no differences in the outcomes of CAP patients treated with ceftriaxone compared with those treated with amoxicillin-clavulanate. Irrespective of antibiotic used, gender and severity of disease influenced treatment outcomes. Male gender was associated with a higher mortality and longer hospital stay. The average duration of stay for both antibiotics was not significantly different. Thus, only level 1 and 2 costs need to be considered when comparing the two regimens. On this basis, ceftriaxone was cheaper than amoxicillin-clavulanate.

The emerging health impact of voluntary medical male circumcision in Zimbabwe: An evaluation using three epidemiological models

Background Zimbabwe adopted voluntary medical male circumcision (VMMC) as a priority HIV prevention strategy in 2007 and began implementation in 2009. We evaluated the costs and impact of this VMMC program to date and in future. Methods Three mathematical models describing Zimbabwe’s HIV epidemic and program evolution were calibrated to household survey data on prevalence and risk behaviors, with circumcision coverage calibrated to program-reported VMMCs. We compared trends in new infections and costs to a counterfactual without VMMC. Input assumptions were agreed in workshops with national stakeholders in 2015 and 2017. Results The VMMC program averted 2,600–12,200 infections (among men and women combined) by the end of 2016. This impact will grow as circumcised men are protected lifelong, and onward dynamic transmission effects, which protect women via reduced incidence and prevalence in their male partners, increase over time. If other prevention interventions remain at 2016 coverages, the VMMCs already performed will avert 24,400–69,800 infections (2.3–5% of all new infections) through 2030. If coverage targets are achieved by 2021 and maintained, the program will avert 108,000–171,000 infections (10–13% of all new infections) by 2030, costing $2,100–3,250 per infection averted relative to no VMMC. Annual savings from averted treatment needs will outweigh VMMC maintenance costs once coverage targets are reached. If Zimbabwe also achieves ambitious UNAIDS targets for scaling up treatment and prevention efforts, VMMC will reduce the HIV incidence remaining at 2030 by one-third, critically contributing to the UNAIDS goal of 90% incidence reduction. Conclusions VMMC can substantially impact Zimbabwe’s HIV epidemic in the coming years; this investment will save costs in the longer term

A survey of trainee specialists experiences at the University of Cape Town (UCT): Impacts of race and gender

<p>Abstract</p> <p>Background</p> <p>Efforts to redress racial and gender inequalities in the training of medical specialists has been a central part of a dedicated programme in the Faculty of Health Sciences at the University of Cape Town (UCT). This study aimed to describe trends in race and gender profiles of postgraduate students in medical specialties (registrars) from 1999 to 2006 and to identify factors affecting recruitment and retention of black and female trainees.</p> <p>Method</p> <p>Review of faculty databases for race and gender data from 1999 to 2006. Distribution of an anonymous self-administered questionnaire to all registrars in 2005/2006.</p> <p>Results</p> <p>The percentage of African registrars doubled from 10% to 19% from 1999 to beyond 2002. The percentages of Africans, Coloureds and Indians rose steadily from 26% to 46% from 1999 to 2005, as did that of women from 27% to 44%. The institution's perceived good reputation, being an alumnus and originating from Cape Town were common reasons for choosing UCT for training. A quarter of respondents reported knowledge of a friend who decided against studying at UCT for reasons which included anticipated racial discrimination. Black respondents (23%), particularly African (50%), were more likely to describe registrarship at UCT as unwelcoming than white respondents (12%). Specific instances of personal experience of discrimination were uncommon and not associated with respondents' race or gender. Registrars who had had a child during registrarship and those reporting discrimination were more likely to rate the learning and research environment as poor (Odds Ratio, 4.01; 95% CI 0.98 – 16.47 and 1.99 95% CI 0.57 – 6.97, respectively).</p> <p>Conclusion</p> <p>The proportion of black and female registrars at the University of Cape Town has increased steadily from 1999 to 2006, most likely a result of systematic equity policies and procedures adopted in the faculty during this period. The data point to a need for policies to make the institution more welcoming to diversity and for strategies to address institutional culture and mentorship, with an aim to develop examples of best practices to share within and between institutions.</p

The role of suppliers in promoting sustainable mining

Abstract: The large part of mining operations relies heavily on suppliers for their smooth running. Since suppliers potentially influence mines economically, socially and environmentally, companies increasily demand high performance from these suppliers and in some cases have put systems in place to monitor their performance (Kumar & Chandrakar, 2012). It is not until recently that supply chains have been put under the same degree of scrutiny as the company’s main units (Pereseina, Jensen & Hertz, 2014). Thus supply chain management (SCM) was mainly concerned with the efficient and responsive system of production and delivery from raw material stage to final consumer. This paper focuses on the mining industry in South Africa. The establishment of a mine is almost certainly accompanied by distresses such as site exploitation, minewaste residuals contamination of the environment which happen on a greater scale than in many industries (Pattanayak et.al, 2013). Mining contributes to global warming and causes health hazards resulting from the carbon dioxide and methane which are greenhouse gasses released during mining activities. Sulphur dioxide, oxide of nitrogen and carbon monoxide are harmful gases that severely cause air pollution and acid rain (Muduli & Barve, 2011). The emissions of carbon and the conservation of water are huge concerns for mines. Being huge consumers of energy and resources, mines have occassionally found themselves on a collission course with government and civil society (Lam, Ho & Choy, 2014). With the growing concern of environmental issues and the associated regulation, supply chains have now become part of the broader debate on how industry meets the challenges of sustainability (Seitz & Wells, 2006). The attempt to address the conception of sustainability in supply chain has led to the development of variouus concepts such as sustainable supply chain management (Carter & Rogers, 2008), green supply chain (Kumar & Chandrakar, 2012), sustainable supply chain collaboration (Vachon & Klassen, 2006) and sustainable procurement (Leppelt, 2014). The implementation of sustainable supply chains is not without challenges. Thus the aim of the paper is to explore the role that suppliers play in promoting sustainability in supply chains. The paper is organised as follows: The next section is a literature review, followed by research methodology and the results sections. Finally, the paper concludes with some recommendations and directions for future researc

Production, characterisation and flocculation mechanism of bioflocculant TMT-1 from marine Bacillus pumilus JX860616

Bioflocculant from marine Bacillus pumilus JX860616 was characterised and its flocculation mechanism determined. The bacterium was identified by 16S rRNA and the bioflocculant was obtained through solvent extraction after optimum medium composition and culture conditions were established. The physicochemical analysis of the bioflocculant were obtained by scanning electron microscopic (SEM) equipped with elemental detector, Fourier transform infrared (IR) spectrophotometry. The highest flocculating activity (93.3%) was obtained with optimum medium composition of the energy sources of glucose and (NH4)2SO4 and culture conditions of; initial pH 6; and Ba2+ after 72 h, at the inoculum size of 2% (v/v). The bioflocculant (2.4 g/L) revealed to have a crystal-like porous structure and had the total carbohydrate of 83.1% w/w and proteins content of 6% w/w. The elemental analysis showed the presence of C (17.0), O (46.0), Na (4.3), Mg (6.8), P (4.1), S (7.0), Cl (5.9), K (7.4) and Ca (0.7) (% w/w). IR observations were indicative of hydroxyl, vinyl, amide and aliphatic amine groups. The bridging mechanism mediated by Ba2+ on colloidal Kaolin particles was proposed. The high flocculating activity of TMT-1 implied that it has a promise in industrial applications.Keywords: Bacillus pumilus JX860616, bioflocculant TMT-1, flocculating activity and flocculation mechanis