ETD Collection

Permanent URI for this collectionhttps://wiredspace.wits.ac.za/handle/10539/104


Please note: Digitised content is made available at the best possible quality range, taking into consideration file size and the condition of the original item. These restrictions may sometimes affect the quality of the final published item. For queries regarding content of ETD collection please contact IR specialists by email : IR specialists or Tel : 011 717 4652 / 1954

Follow the link below for important information about Electronic Theses and Dissertations (ETD)

Library Guide about ETD

Browse

Filters

2016 - 20182

Settings

Subject: search.filters.subject.Infection

Search Results

Now showing 1 - 2 of 2
  • No Thumbnail Available
    Item
    Analysing the national notifiable diseases surveillance system in South Africa
    (2018) Benson, Frew Gerald
    Background Outbreaks of infectious diseases contribute to premature mortality and underscore the importance of effective disease surveillance and response systems. There is limited knowledge on the performance of the South African notifiable disease surveillance system (NDSS). Objective The aim of this PhD study was to analyse the NDSS of South Africa. The specific objectives were to: analyse key informants’ perspectives on system attributes of the National NDSS; analyse the NDSS attributes through comparing notifications with laboratory surveillance; determine the factors influencing provider compliance with the NDSS; and make policy recommendations to improve the effectiveness of the NDSS. Methods This thesis combined a novel comparative analysis of laboratory and notification records for three tracer conditions of measles, meningococcal meningitis, and typhoid with two cross-sectional, analytical studies among NDSS key stakeholders (n=169) and health care providers (n=1050) respectively. STATA® 14 was used to conduct quantitative, statistical analyses. Results The key stakeholders’ survey had an 84% response rate: 25% perceived the system to be acceptable; 51%, flexible; 45%, timely; 61%, useful; and 74%, simple. Stakeholders with more experience were less likely to perceive the NDSS as acceptable (OR 0.91, 95 % CI: 0.84–1.00, p = 0.041); those in disease detection were less likely to perceive it as timely (OR 0.10, 95 % CI: 0.01–0.96, p = 0.046) and those participating in National Outbreak Response Team were less likely to perceive it as useful (OR 0.38, 95 % CI: 0.16–0.93, p = 0.034). vii For all three diseases, fewer cases were notified than laboratory confirmed. Completeness for the laboratory system was higher for measles (63% vs. 47%, p<0.001) and meningococcal meningitis (63% vs. 57%, p<0.001), but not for typhoid (60% vs. 63%, p=0.082). Stability was higher for the laboratory (all 100%) compared to notified measles (24%, p<0.001), meningococcal meningitis (74%, p<0.001), and typhoid (36%, p<0.001). Representativeness was also higher for the laboratory (all 100%) than for notified measles (67%, p=0.058), meningococcal meningitis (56%, p=0.023), and typhoid (44%, p=0.009). The sensitivity of the NDSS was 50%, 98%, and 93%, and the PPV was 20%, 57%, and 81% for measles, meningococcal meningitis, and typhoid, respectively. The response rate for the health care provider (HCP) survey was 90%. In the year preceding the survey, 58% diagnosed a notifiable disease; 92% of these HCPs reported the disease, but only 51% notified correctly to the Department of Health. Factors influencing notification were HCPs perceptions of workload (OR 0.84, 95% CI 0.70 - 0.99, p=0.043) and that notification data are not useful (OR 0.84, 95% CI 0.71 - 0.99, p=0.040). Conclusion The NDSS in South Africa performed poorly on most of the system attributes. In addition, HCP compliance with the NDSS was suboptimal. The study generated new knowledge on the performance of the NDSS in South Africa, which should inform the revitalisation and reforms of the system.
  • No Thumbnail Available
    Item
    Neonatal mortality at Leratong Hospital
    (2016) Moundzika-Kibamba, Jean-Claude
    Background: Leratong Hospital is a regional hospital in the West Rand of Johannesburg, South Africa. Statistics from maternity in 2008 showed high utilisation rates for delivery services at Leratong but a study on neonatal mortality was not yet done. It was therefore essential to measure and analyse the causes of new-born deaths so as to have policies to advance neonatal care. Objectives: To determine the neonatal mortality rate (NMR), the major neonatal causes of death and the occurrence of avoidable health factors. Methods: This was a prospective review of the clinical records of the 46 neonates who died within the 3 month period (15th April 2013 to the 15th July 2013). Data was obtained from neonatal admission and death registers. Information on the number oflive births was obtained from labour ward registers. Delegation books for nurses were checked to determine the number of nursing staff per shift as well as their allocation in different rooms. Neonate's age, birth weight, gender, race, place of origin, reason for admission and cause of death, were analysed. Health factors examined were access to high care services and to the neonatal ICU, number of staff on duty and the use of treatment guidelines. Questionnaires were used to collect information, and the consent to use clinical records was obtained from the mothers. Descriptive statistics were used to describe the frequencies and percentages of variables. Logistic regression of variables was applied to predict mortality. Results: The overall neonatal mortality rate at Leratong Hospital was lower than the rates found in South Africa and other studies in sub-Saharan Africa. Almost 37% of neonates died within 24 hours of admission. The three most common causes of death were: prematurity (39%), perinatal asphyxia (26%) and infection (20%). More than sixty per cent of deaths occurred in the admission room. Three-quarters of neonates who died (74%) were low birth weight neonates. A critical staff shortage (nurse: neonate rati02.: 1:10) was the most common modifiable factor (63% of deaths). Thirty seven per cent of neonates were denied access to ICU. The significant predictors of neonatal death were being born preterm (OR: 3.1, 95% CI 1.7-6.0), extremely low birth weight (OR: 27.5,95% CI 8.2-92.6), very low birth weight (OR: 5.0, 95% CI 2.1-12.3) and birth by caesarean section (OR: 3.2, 95% CI 1.6-6.2). Conclusions: The study found the neonatal mortality rate at Leratong Hospital in 2013 to be lower than rates recorded in South Africa. Our results showed that the most common causes of neonatal mortality were similar to those in other hospitals in sub-Saharan Africa and in South Africa. A high number of neonatal deaths were avoidable by providing high care services (including NCP AP and surfactant) and adequate number of nurses trained in newborn care in the admission room, improving access to neonatal ICU, early detection of perinatal asphyxia and improved neonatal resuscitation, and the supervision of medical doctors.