3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Factors influencing outcomes of severely injured children in a South African context(2017) Koekemoer, Heinrich PieterINTRODUCTION Paediatric trauma is a significant health burden and a leading cause of death among children in South Africa and globally. OBJECTIVE To determine the factors influencing the outcomes of severely injured children in a South African context. METHODS A retrospective study on factors influencing mortality in a paediatric cohort (≤ 14 years) admitted to the intensive care units of two hospitals in Gauteng, South Africa, from 1 January 2006 to 31 December 2013 after suffering major trauma (ISS>10). RESULTS The total cohort (n=166) consisted of public (n=125) and private (n=41) cohorts with actual death 15.7% (n=26) of the total cohort. There was a significant difference in probability of survival in survivors (92%) versus deaths (82%) (p=0.004). Factors that influenced the risk of mortality included time spent in the paediatric ICU [odds ratio of 0.706 (95% CI, 0.544- 0.915)] and whether a patient received public or private care [odds ratio of 5.43 (95% CI, 1.178-25.012)]. Both the Injury Severity Score (p=0.004) and Revised Trauma Score (p=0.034) systems played a significant role in the ability to predict mortality. CONCLUSION The outcome of severe paediatric trauma is influenced by multiple factors. The strongest predictors of mortality according to this study are time spent in PICU and the private health sector; numerous limitations of this study require replication with much larger data sets using paediatric specific trauma outcome scores.Item Mortality in paediatric burns victims: a retrospective review from 2009 - 2012 in a single centre(2016) Jugmohan, BenBackground. Childhood mortality is high in low- and middle-income countries. Burns are one of the five leading causes of childhood injury mortality in South Africa (SA). While there is an abundance of literature on burns in the developed world, there are far fewer publications dealing with childhood mortality related to burns in Africa and SA. Objective. To describe the mortality of children admitted to a dedicated paediatric burns unit, and investigate factors contributing to reducing mortality. Methods. A retrospective review was performed of patients admitted to the Johnson and Johnson Paediatric Burns Unit, Chris Hani Baragwanath Academic Hospital, Johannesburg, SA, between May 2009 and April 2012. Results. During the study period, 1 372 patients aged ≤10 years old were admitted to the unit. There were 1 089 admissions to the general ward and 283 admissions to the paediatric burns intensive care unit (PBICU). The overall mortality rate was 7.9% and the rate for children admitted to the PBICU 29.3%; 90.8% of deaths occurred in children aged ≤5 years. 89.5% of chidren admitted with an inhalational injury died. No child with a burn injury >60% of total body surface area (TBSA) survived. Conclusions. Our overall mortality rate was 7.9%, and the rate declined significantly over the 3-year study period from 11.7% to 5.1%. Age ≤5 years, the presence of inhalational injury, burn injury >30% of TBSA and admission to the PBICU were significant risk factors for mortality.Item Knowledge of and challenges experienced by health workers managing maternity patients in primary health care(PHC) clinics of Yobe State, Nigeria(2014) Ali, Abdullahi DanchuaThis study, entitled “Knowledge of and challenges of health workers managing maternity patients at PHC facilities of Yobe State, Nigeria,” had the following objectives: To describe the socio-demographic characteristics of the health workers in the Primary health care (PHC) facilities in the state. To determine the level of knowledge of the health workers regarding the management of maternity patients in Primary health care facilities in Yobe State. To determine the challenges experienced by the health workers in the Primary health care facilities in the state. The study was primarily aimed at exploring the health workers level of knowledge, skills and competencies in the management of maternity patients and their contributions towards the control and reduction of maternal mortality in the state. METHODS: A cross sectional survey study in PHC clinics of six selected local government areas of the state, namely Gujba, Geidam, Fune, Fika, Nguru and Jakusko local government areas. A total of 221 health workers (n=221) were interviewed using structured questionnaires, whilst 46 facility managers (n=46) were given self-administered questionnaires while on duty, and data were collected concurrently from clinic records. The data were cleaned, entered in to Epi info statistical software, imported and analysed using STATA. Descriptive and inferential statistics were used to interpret the outcomes of the analysis. RESULTS: More than half of the respondents were female (65.61%) with an average age of 33 years (SD± 8.1). Categories of the health workers who participated in the study were SCHEW, JCHEW, SSCE, TBAS, EHA/EHO and others who were not trained in any form as health workers, but were found running the affairs of maternity patients. More than 80% of the clinics did not have functional ambulances and there was gross inadequacy of basic services in most of the clinics; only 14 out of 46 clinics had portable water supply and electricity. There was a large seasonal turnout of patients in the clinics but poor patronage by maternity clients. The health workers in the maternity unit were found to be deficient in the knowledge, skills and competencies to manage maternity patients. Protocols were not followed (68.78%), some significant information about ante-natal care was not given to v clients and maternity clients were not adequately informed of some of the danger signs of pregnancy. There was a poor standard of institutional deliveries and the majority of the Health Workers had no training on EOC or conducting a clean and safe delivery. CONCLUSION: Examining the background of the current health workers in the primary health care facilities, the attainment of MDG 5 by 2015 will not be a reality, unless urgent measures are put in place, including large recruitment and motivation midwives, and deployment of these midwives to the rural health clinics. There is a need for the existing health workers to be supported by government and enrolled in short course training in Colleges of Midwifery to acquire the much needed skills and competencies for the care of maternity patients.