ETD Collection
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Item Evaluation of the casuality department at Polokwane Mankweng Hospital Complex in the Limpopo Province(2014) Mohapi, Morongwa CarolineBACKGROUND: One of the key challenges facing the Limpopo Department of Health and Social Development in the area of Casualty Care is the lack of trained personnel and the inappropriate referral and utilisation of these services. There has been no known study conducted in this area in the South African context and therefore this study was undertaken to evaluate the services rendered within the Casualty Department at the Polokwane Mankweng Hospital Complex with specific reference to material and human resources as well as efficiency of the unit. AIM: To evaluate the Hospital Casualty Department in the Polokwane Mankweng Hospital Complex in terms of caseload, influencing factors and implications on resource utilisation during a one year study period. METHODOLOGY: A cross sectional study design was employed in this study. A retrospective record review was done and information was extracted from various sources of hospital information systems. No primary data was collected for this study. The setting of this study was the Casualty Departments at Polokwane Mankweng Hospital Complex. The two hospitals constituting this complex are situated 30 km apart in Polokwane and Turfloop respectively. Data was collected on various variables that are relevant to the functioning of, and resource utilisation in the Casualty Unit of this Complex. Variables including that of caseload, patient profiles, service costs and workload on human resources were measured. RESULTS: This study based on retrospective review of records of 250 patients’ records selected by a simple random sample from a cohort of 14,113 patients who attended the Casualty Department of the Polokwane Mankweng Hospital Complex during one year study period. One fifth of the patients were referred from other health facilities and more than 60% of the patients were discharged after receiving treatment which implied that these patients could be managed at a regional or district hospital. More patients with medical aid bypassed the referral system. Almost half of the patients arrived after-hours (from 18h00 to 6h00). This is the first study in the Limpopo Province which looked at the direct cost per patient at the Casualty Department. In 2008/09, overall expenditure was R 10,321,401.42 (including R 954,168.45 for pharmacy products, other consumables R 177,261.16 and Laboratory tests R 1,866,233.25). Overall the Department accounts for an estimated R 7,323,804 in personnel annual expenditure of the hospital. Unit personnel cost per patient was estimated at R518.94 (70.96% of total recurrent cost), while the unit costs for the Pharmaceuticals, Stores and Laboratory tests were; R67.23 (9.24%), R12.56 (1.72%) and R132.24 (18.08%) per patient respectively. Overall the combined unit cost was estimated at R731.34 per single emergency care patient excluding the capital costs. CONCLUSION: The results of the study will be used to guide the allocation of appropriate resources, and to highlight the need to implement an effective referral system, which will assist in reducing the workload.Item Pervasive computing and public health research in Africa: mobile phones in the collection, analysis and dissemination of health research(2014-02-18) Van Heerden, AlastairWith aging populations and rising health care costs, many high-income countries are exploring mobile computing technologies to improve the efficiency and effectiveness of health care provision. These technologies, which underpin the field of pervasive computing, introduce a new model of human–computer interaction. Instead of the scenario where a single user interacts with a desk-bound “personal” computer, pervasive computing envisions a world embedded with small, inexpensive, portable networked devices able to communicate seamlessly with each other. In common with resource-rich countries, the field of pervasive computing has the potential to promote and support healthy population development in middle and low-income countries, and this, therefore, has relevance for South Africa. Current estimates suggest that there are between 28 and 32 million mobile phones in South Africa. This means that around 60% of all South Africans own, or have access to, mobile telecommunication. Over 900 000 km2 of the country is covered by the GSM (Global System for Mobile Communication) network of Vodacom, the largest telecommunications company in the country. Over 90% of South Africa is provided with access to mobile connectivity through shared agreements between the country’s major telecommunications networks. Aims The ubiquity of mobile phones has resulted in their receiving increasing attention from public health researchers. Yet a better understanding of how mobile phones could support health research in South Africa is still an emerging field with many unanswered questions. This thesis attempts to fill some of these gaps in our current knowledge. In particular, the primary aim of this work is to implement and evaluate the use of mobile phones as instruments with which to collect and analyse information for monitoring, evaluation and research in low-resource rural African settings. Methods To investigate this aim, data were gathered from the development, implementation and evaluation of four health surveys in South Africa. Two surveys were conducted with Birth to Twenty, a birth cohort of South African young adults living in Greater Johannesburg. These data were used to better understand the feasibility and data-quality implications of using mobile phones as a tool for the administration of ‘self-administered’ surveys. Two additional surveys, completed in KwaZulu-Natal province, evaluated the same themes of feasibility, acceptability and impact of data quality in mobile-phone-assisted personal (face-to-face) interviews (MPAPI). The first, conducted with 500 HIV-positive pregnant women in eight primary health clinics and 12 interviewers trained to use the mobile-phone survey software, was used to assess the feasibility and acceptability of MPAPI. The final survey compared the difference in data quality achieved by 100 interviewers using either pen and paper, or mobile phones to conduct a short health survey. De Leeuw's conceptual model was used to frame how mode characteristics influence data quality. Results Mobile-phone-assisted interviewing was found to have an impact on the data quality, feasibility and acceptability of health surveys. MPAPI was found to be similar in terms of accuracy and cost to small-scale paper-and-pen interviewing (PAPI) surveys. Time lines and accessibility were improved by the use of MPAPI. Mobile-phone-assisted self-interviewing (MPASI) surveys were found to have a lower survey response but a higher item-completion rate. Acceptability was found to be moderated by technological familiarity and the use patterns of mobile-phone features. Finally, conducting health research using mobile-phone interviews in South Africa was found to be feasible; to reduce the loss of questionnaires, and photocopying and data-entry costs; and to improve the speed at which data becomes available for analysis. Factors that mediated feasibility included the technical expertise of the project management and field staff, the technological know-how of participants, the comprehensiveness of the interviewer training, the mobile communication channel used (e.g., handset-agnostic SMS) and the presence or absence of an interviewer. Conclusion Under the right conditions, mobile-phone-assisted interviewing appears to be a feasible and practical tool for the rapid collection of health information, with data accuracy being the same or better than pen-and-paper interviews. It is argued that these benefits increase as the scale of the survey increases. Improved data can positively influence population health by providing decision makers with more rapid access to accurate data with which to monitor large-scale health systems. Small projects that do not require the rapid availability of data or where staff do not have the appropriate technical proficiencies would be better suited at present to more traditional survey data-collection techniques. Keywords: mobile phones; pervasive computing; mHealth; data collection; survey errorItem Whistle blowing in clinical research: some perspectives from good clinical practice and the role of research ethics committees(2011) Africa, Lorraine‘Whistle blowing’ means to blow a whistle calling attention to practices which an individual considers as immoral or illegal and harmful to the public. Some people think whistle blowing is a good or right act; others consider it wrong. There are numerous reports concerning blowing the whistle in scientific research. I place whistle blowing in the context of institutions, focusing on good clinical practice and Research Ethics Committees. Many research activities take place resulting in monetary and personal gain which may influence research conduct. I explore some issues in the development and organization of Research Ethics Committees, discuss the nature of whistle blowing and whistle blowers, and examine some whistle blowing incidents in scientific research. I conclude that although the function of Research Ethics Committees does not necessarily include mechanisms for whistle blowing, that this idea has merit and should be considered.