3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Pre-hospital trauma care: training and preparedness of, and practices by, medical general practitioners in Limpopo Province.(2009-09-17T09:28:15Z) Risiva, ObbyTrauma is a pandemic that has a significant negative impact on the lives of its victims and national economies. This descriptive study was conducted on 103 private medical general practitioners in Limpopo Province. Ethical approval for the study was obtained from the University of the Witwatersrand Committee for research on Human Subjects (Medical). Approval protocol number M050230. The aim of the study was to determine the state of pre-hospital trauma care: training and preparedness of and practice by private medical general practitioners (GPs) in Limpopo Province. Data was collected by means of an anonymous, confidential, self-administered questionnaire. The objectives were to determine demographic features of the respondents; determine the status of emergency pre-hospital trauma training, preparedness and practice amongst the respondents; and to determine their incentives and disincentives to trauma medicine training, preparedness and practice in Limpopo province. The response rate was 36%. Fifty five per cent (55%) of the respondents had received trauma training since they commenced work as GPs. The proportion of GPs who said that they received trauma training while working in hospitals casualty departments was 52%. The number of respondents who completed ATLS was 24 (23%). Five (21%) of those who had completed ATLS updated their qualifications during years 2001 to 2005. Of the GPs surveyed 46% were not aware of ATLS course offered by the College of Emergency Care at Polokwane City. The majority of the respondents graduated as medical practitioners from the university of Pretoria (38%) and MEDUNSA (31%). But undergoing trauma management training was not associated with the medical schools from which 4 respondents graduated as medical practitioners (p=0.767; Fisher’s exact=0.827; Pearson chi2 = 4.9075). The medical schools from which respondents graduated as medical practitioners was also not related to the amount of private medical practice that comprised emergency care (p= 0.372). Undergoing trauma training was not associated with the age of a GP (p value= 0.120; Fisher exact=0.127). Sex was not found to be associated with trauma training (p=0.895; Fisher exact=1.000). Sex also had no link to the proportion of medical practice comprising emergency care (p-value=0.153; Fisher ‘s exact=0.214; Pearson Chi2). Even though location of GP’s practice was reported to be both an incentive and disincentive to trauma management training it was found not to be associated with trauma management training (p=0.393; Fisher exact=0.426; Pearson chi2 =1.5687) There was no association between location of GP’s practice and preparedness for trauma management. The exception to the finding was in terms of availability of chest drains where the p-value was 0.001. It was found that 31% of respondents who indicated that they had chest drains were based in rural areas while about 6% were practicing in urban areas. Availability of morphine and other analgesics (p-value=0.025, Fisher’s exact=0.038, Pearson Chi2 (1)=5.0165) were associated with preparedness for trauma. There was no association between type of GP practice and trauma management training (Pearson Chi2 (2) =2.1242. p- value = 0.346. Fisher’s exact = 0.429). Almost 95% of those who stated that they spent at least 50% of their time in private general medical practice were full-time. Being in full-time private general medical practice did not necessarily translate into a higher proportion of the practice that comprised trauma care. It was found that 64% of the respondents who were in full-time private general medical practice had an emergency trauma care burden of less than 10% compared to 36% that had a proportion of 10% and more. Amongst part-time practitioners the percentage of those whose burden of trauma care was less than 10% was equal to that of those with 10% and more. The findings implied lack of an association between time spent in private general medical practice and proportion of the practice that constitutes trauma care (p=0.621). The commonest method of updating trauma management skills was through personal study (37% of respondents) followed by attendance of trauma meetings (24% of respondents). Trauma trained GPs tended to have a higher proportion of their practices that comprised emergency trauma care (p-value = 0.030; Fisher’s exact =0.050) than those who had not. The frequently used sources of trauma management information were personal experience (58%) of the respondents followed by continuing medical education (50% of respondents). Almost 50.8% of the respondents reported that they were fairly skilled to manage in a pre-hospital setting various types of injuries. Minor soft tissue injuries were the type of trauma that 68% of the respondents said that they could manage excellently. Incentives factors to both trauma training and practice were high trauma prevalence (33.3% of respondents-training: and 20.7% of respondents-practice); performance improvement (20% of respondents-training: 12.1% of respondents respectively-practice); adequate and managed trauma care facilities (17% of respondents-training: 10.4% of respondents-practice); trauma care support (6.7% of respondents-training: 6.9% of respondents-practice); the need to improve trauma knowledge and skills (17% of respondents-training: 17.2% of respondents-practice) and; strategic GP practice location (7% of respondents-training: 6.9% of respondents-practice). Major disincentives to both trauma training and practice were lack of time for trauma care (28.9% respondents-training: 14.9% respondents practice); unsupportive staff (10% respondents-training: 14.9% respondents-practice); perceived high cost of trauma care and poor rewards (15.6% respondents-training: 11.7% respondents-practice); substandard and inaccessible trauma care facilities (15.6% respondents-training: 24.5% respondents-practice); under-utilized trauma knowledge and skills (6.7% respondents-training: 4.3% respondents-practice); 6 restrictive healthcare regulations and policies (2.2% respondents-training: 2% respondents-practice); and low number of trauma patients seen (11.1% respondents-training: 3.2% respondents-practice). In terms of preparedness for trauma the respondents were ill-prepared for trauma as evidenced by insufficient trauma equipment and drugs. Whereas almost all the respondents (frequency 102 or 99%) had stethoscopes only 7% had cricothyrotomy set. Only 18% of them had needle with one-way valve and chest drains. The trauma drug that appeared to have been the most widely stocked was adrenaline with a frequency of 96 or 93%. It was followed by aspirin with a frequency of 95 or 92%. Ketamine and zidovudine were drugs that were least stocked by the respondents. Their frequencies were 27 or 26%) and 33 or 32% respectively. The other equipment that was infrequently available at GPs’ rooms was goggles (frequency 46%) suggesting poor adherence to safety measures. There were low levels of preparedness to manage trauma patients independently with 43% reporting that they could independently adhere to universal safety measures. Whereas 52% of the respondents stated that they had received training in CPR 54.5% stated that they were equipped and prepared to open and protect the airway; 43% could independently provide adequate breathing while 45% of them could restore and maintain sufficient circulation, indicating a need to improve levels of CPR training. It was recommended that more general practitioners in Limpopo province should be trained and involved in trauma care. It was further recommended that awareness should be raised about the ATLS offered at the College of Emergency Care in Polokwane City. Further research is needed to explore how trauma trained GPs could be better equipped, prepared and supported in the management of trauma. There was also a need to address the disincentive factors to trauma training, preparedness and practice while strengthening the incentives. Given the critical shortage of advanced emergency practitioners (such as paramedics) in Limpopo province, there was perhaps a need to consider how GPs, with their 7 advanced medical qualifications and strategic positioning within communities, could be better deployed in pre-hospital trauma care.Item Socio-cultural and behavioral determinants of condom use among youths in Limpopo Province, South Africa(2008-07-15T13:38:59Z) Chandiwana, Nomathemba ChiwonesoIntroduction South Africa is one of the countries hardest hit by HIV/AIDS. Of particular concern, new infections among young people, especially young women and girls are on the rise. Despite widespread awareness and prevention campaigns, the prevalence of HIV and deaths caused by AIDS are still on the increase, whereas condom use particularly in rural areas remains low. Consistent condom use is central to the prevention of unwanted pregnancies, HIV and other STIs, yet young men and women alike are hesitant to use condoms because of threats to their relationships, cultural roles and at times economic survival. Purpose The purpose of this study is to identify socio-cultural and behavioral factors that influence condom use among youths in Limpopo province, South Africa. This adds to a growing body of knowledge on the determinants of condom use and how they might shape effective HIV prevention programs. Objectives 1. To conduct a secondary data analysis that examines the determinants of condom use, for men and women separately in relation to the following factors: Socio-demographic characteristics- age, education, marital status, migration and iv socio-economic status Sexual behavior characteristics- partnership type (spousal, non spousal, or both), age at sexual debut, number of lifetime sexual partners, contraceptive use (females only) and HIV-status Socio-cultural characteristics - perceived risk of HIV infection, condom self efficacy (males only), partner communication on sex, condoms, HIV and other STI’s, beliefs on gender norms, attitudes towards gender violence, knowledge on HIV/AIDS and HIV/AIDS related stigma To compare the results of this analysis to other national studies on condom use among young people. To use the results of this analysis to make recommendations to improve HIV control in rural South Africa.Methods This study is a secondary analysis of data collected from a sample of 2236 sexually active young people aged between 14-35 years in Limpopo province, South Africa. The data used in this study is part of a wider public health intervention, the Intervention with Micro-finance for AIDS and Gender Equity (IMAGE) study. STATA 8.0 was used to analyze data in bivariate and multivariate analyses to assess determinants of consistent condom use and condom use at last sex for males and females separately as the patterns of associations are likely to differ between them. Results Overall condom use in this population was low: less than a quarter of respondents used condoms consistently and less than one third of men and women used condoms at last sex. This is especially true of females, married couples and those who have multiple partners. In multivariate analysis, significant predictors of consistent condom use for both sexes included good communication, older age at sexual debut, low risk perception of HIV infection, progressive attitudes towards gender violence and high HIV-related stigma. High condom self-efficacy, defined as the intention to pick up or purchase condoms with the intention of use, was the most powerful predictor of both condom use indices among males. Among females only, having fewer than three lifetime sexual partners was positively associated with using condoms consistently. Lastly, females who used condoms as their main method of contraception were up to 20 times more likely to use them consistently and at last sex. Conclusions HIV prevention programmes in this population should focus on delaying sexual debut, increasing perceived risk of HIV infection, encouraging partner communication, making condoms more easily accessible to young men and addressing gender inequalities. Furthermore, the dual protection offered by condoms against unwanted pregnancies and against HIV and other STI’s should be emphasized in this population as it plays an important role in the prevention of HIV.