3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Factors affecting health-care seeking behaviour, and assessment of the population's perception of the major health problems in Gauteng province, South Africa 2013(2016) Abaerei, Admas AberaBackground: More than a billion people, mainly in low- and middle-income countries (LMICs), are unable to access needed health care services for a variety of reasons. Possible factors influencing health-care seeking behaviour are socio-demographic and economic factors such as age, sex, ethnicity, religion, education and employment; and income and expenditure levels, and other cultural or political factors. There are limited studies on health-care seeking behaviour especially of vulnerable populations such as immigrants in South Africa. Aim of the study: To assess factors associated with health care seeking behaviour, and to assess the population’s perception of major health problems and its determinants in Gauteng Province, South Africa in 2013. Methods: We conducted secondary data analysis of data from a Quality of Life (QoL) survey carried out by Gauteng City-Region Observatory (GCRO) to determine factors associated with health care seeking behaviour and perception of major health problems among adults living in Gauteng province. We used Coarsened Exact matching (CEM) to improve estimation of causal effects. A multiple logistic regression model was used to identify factors associated with health care seeking behaviour and multinomial logistic regression was employed to determine factors associated with perception of major health problems. Results: From a total of 27 490 participants interviewed, a total of 26 318 (95.7%) participants reported usually utilizing health care services while the remaining 4.3% reported not having sought health care services of any type, when they needed. In addition 141 (0.5%) reported having visited traditional healers when they are ill. Higher odds of reported health care seeking was associated with being white compared to being African (Odds Ratio (OR) =2.28 95% CI: 1.84 - 2.74; p<0.001); with having medical insurance compared to not having any (OR=5.41 95% CI: 4.06 - 7.23; p<0.001). In contrast, lower odds of seeking health care was associated with being an immigrant compared to being a citizen of Republic of South Africa (OR=0.61 95% CI: 0.53 - 0.70; p<0.001) and being employed compared to being unemployed (OR=0.84 95% CI: 0.72 - 0.97; p=0.02). the perception of major health problems was significantly associated with age, sex, population group and educational status. Conclusion: Age and sex of participants, population group, immigration status and presence/absence of health insurance were associated with health care seeking behaviour. There is a need to improve the quality of public health care services and perception towards them as improved IV health care quality increases the choice of health care provider relative to either going to traditional healers or self-treatment. Furthermore, health education and health promotion campaigns should focus on creating continuous awareness especially about chronic diseases and their risk factors.Item The experiences of patients receiving haemodialysis treatment in an open setting environment at an academic hospital in Johannesburg(2014-08-26) Khomba, Mayamiko MunthaliBACKGROUND: Patients receiving haemodialysis (HD) treatment experience a significant symptom burden and their needs are multifaceted. In HD unit, patients receive treatment in a diverse cultural and open ward setting. However, patients‟ experiences of receiving HD treatment in an open ward setting are not known. OBJECTIVES: The central aim of this study was to explore and describe the experiences of patients receiving HD treatment in an open setting environment at an academic hospital in Johannesburg. DESIGN: A qualitative, exploratory and descriptive study was conducted at a public, tertiary level academic hospital in Johannesburg after obtaining ethical approval from Wits University and relevant authorities. SETTING: The research setting for this study was an adult Chronic Renal Dialysis Unit. POPULATION: Sixteen adult (age 18 and above) patients receiving chronic HD treatment were recruited purposively in this study. INTERVENTIONS: An in-depth semi-structured interview was conducted either before or after receiving HD treatment, which was audio-recorded, transcribed then analysed by using Giorgi Phenomenological method. FINDINGS: A mood enhancer appeared a major theme as participants positively valued the open setting environment for their overall and psychological well-being. Participants expressed by being with others and sharing experiences, a sense of community likened to a family developed. Common to all participants‟ language was the use of the “we” in relation to being in the open setting environment. This expression of the “we” by participants was interpreted as a community concept. The use of “we” associated with the concept of community described as a space to which every patient receiving HD belonged. They described their experiences in a collective manner. This was evident in repetitive reference to their common space, being together, sharing experiences, and finding identity from one another, being understood and a sense of being protected with personal relations that extend beyond 10 years for some. This open space contributed to shaping their perception of body image and illness. The nurse‟s role in timeously providing HD care was appreciated by many. However, being exposed to multiple situations of chronic illness and treatment a sense of fear developed. Any negative event experienced, watched, observed, or heard in the HD unit triggered fear in the patients. Two common fears were of HD complications and the constant threat of death. Complications such as clotting, muscle cramps and collapsing because of hypotension as well as watching somebody dying on the machine were all reported in this study and so psychological counselling was felt to be very important. CONCLUSION The recommendations proposed in this study hopefully will assist HD staff to intervene and make adjustments to support patients‟ holistic needs. Further studies into patients receiving HD in open settings and mixed-gender space are required for diversity of experiences and knowledge from different settings. Keywords: Haemodialysis, hospital environment, open setting, patient experiencesItem Clinical outcomes and patient retention in the antiretroviral roll-out programme at Letaba Hospital, Limpopo Province, South Africa.(2014-04-24) Semenya, Matshehla Mary-Anne LebogangThe roll-out of antiretroviral drugs in South Africa started in March 2004. In Mopani district, a rural district of Limpopo Province, the roll-out programme commenced in October 2004. While many resources were invested in this program, no study has assessed the clinical outcomes in this rural district. In addition, most studies conducted in South Africa were conducted in urban and tertiary settings. Assessing clinical outcomes is important in determining whether the program is making the desired clinical difference in the lives of the patients and may serve as feedback into the program for quality improvement purposes. Methodology The study was a retrospective record review of patients who were initiated on antiretroviral (ARV) treatment between December 2007 and November 2008. A structured questionnaire was used to collect data from 124 patient’s files and data was collected up to November 2011. The data collected included patients’ socio-demographic characteristics, clinical outcomes (CD4 count, viral load, presence of opportunistic infections, adverse effects and hospital admissions recorded at 6, 12, 24 and 36 months), the number of patients who were still attending the ARV clinic at 36 months and the reasons why patients are no longer attending the clinic. Data was analysed with Epi-Info and STATA. Results Of the 124 patients, 69% were females, 28% males and 3% did not have their sex specified. The majority of the patients were between 30 and 49 years. There was a significant improvement in CD4 count and viral load between baseline and all timeperiods after the initiation of ARV treatment. The mean CD4 count at baseline was 128The roll-out of antiretroviral drugs in South Africa started in March 2004. In Mopani district, a rural district of Limpopo Province, the roll-out programme commenced in October 2004. While many resources were invested in this program, no study has assessed the clinical outcomes in this rural district. In addition, most studies conducted in South Africa were conducted in urban and tertiary settings. Assessing clinical outcomes is important in determining whether the program is making the desired clinical difference in the lives of the patients and may serve as feedback into the program for quality improvement purposes. Methodology The study was a retrospective record review of patients who were initiated on antiretroviral (ARV) treatment between December 2007 and November 2008. A structured questionnaire was used to collect data from 124 patient’s files and data was collected up to November 2011. The data collected included patients’ socio-demographic characteristics, clinical outcomes (CD4 count, viral load, presence of opportunistic infections, adverse effects and hospital admissions recorded at 6, 12, 24 and 36 months), the number of patients who were still attending the ARV clinic at 36 months and the reasons why patients are no longer attending the clinic. Data was analysed with Epi-Info and STATA. Results Of the 124 patients, 69% were females, 28% males and 3% did not have their sex specified. The majority of the patients were between 30 and 49 years. There was a significant improvement in CD4 count and viral load between baseline and all timeperiods after the initiation of ARV treatment. The mean CD4 count at baseline was 128 The roll-out of antiretroviral drugs in South Africa started in March 2004. In Mopani district, a rural district of Limpopo Province, the roll-out programme commenced in October 2004. While many resources were invested in this program, no study has assessed the clinical outcomes in this rural district. In addition, most studies conducted in South Africa were conducted in urban and tertiary settings. Assessing clinical outcomes is important in determining whether the program is making the desired clinical difference in the lives of the patients and may serve as feedback into the program for quality improvement purposes. Methodology The study was a retrospective record review of patients who were initiated on antiretroviral (ARV) treatment between December 2007 and November 2008. A structured questionnaire was used to collect data from 124 patient’s files and data was collected up to November 2011. The data collected included patients’ socio-demographic characteristics, clinical outcomes (CD4 count, viral load, presence of opportunistic infections, adverse effects and hospital admissions recorded at 6, 12, 24 and 36 months), the number of patients who were still attending the ARV clinic at 36 months and the reasons why patients are no longer attending the clinic. Data was analysed with Epi-Info and STATA. Results Of the 124 patients, 69% were females, 28% males and 3% did not have their sex specified. The majority of the patients were between 30 and 49 years. There was a significant improvement in CD4 count and viral load between baseline and all timeperiods after the initiation of ARV treatment. The mean CD4 count at baseline was 128 cells/mm3; it increased to 310 cells/mm3 at 6 months, 380 cells/mm3 at 12 months and 470 cells/mm3 at 24 months. By 6 months, 67% of the patients had achieved viral suppression, but at 24 months, patients started having viral rebound. During the study, 20 patients fell pregnant and four patients fell pregnant twice. Overall, pregnant patients had a significantly higher viral load compared to non-pregnant patients (p-values = 0.015 at 6 months, 0.002 at 12 months and 0.027 at 24 months). Seventy two percent of patients were retained in the program at 36 months. Of the 28% that were no longer attending the clinic, 11.3% were transferred to other institutions, 6.5% were down referred to clinics, 3.2% died, 3.2% defaulted and 3.2% were lost to follow-up. Conclusion This study shows that good clinical outcomes can be achieved within an antiretroviral rollout program in a rural hospital. The biggest magnitude of clinical benefits was observed in the first six months after the initiation of ARV treatment with threats of viral rebound thereafter. There was good patient retention at 36 months after initiation of ARV treatment and a significant difference in viral load between pregnant and non-pregnant patients. The high rate of unplanned pregnancy signifies the need to place closer attention to family planning among female patients on antiretroviral treatment.