3. Electronic Theses and Dissertations (ETDs) - All submissions
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/45
Browse
10 results
Search Results
Item An evaluation of a chronic disease outreach program (CDOP) - a primary care and tertiary care kidney and cardiovascular prevention, detection and management program(2011-02-01) Katz, Ivor JonathanBackground: Chronic diseases have increased worldwide. Despite the significant advances in medical science, the management of chronic diseases continues to be poor. To meet this challenge, we need to try to implement existing chronic illness models of prevention, early detection, and risk factor management. This is achievable in part by linking primary health care clinicians, such as primary health care nurses (PHCNs) and hospital-based medical specialists. This study evaluated a ‘real life’ chronic disease outreach program (CDOP), which assisted PHCNs with the early detection and management of chronic illnesses known to cause chronic kidney disease (CKD) and cardiovascular disease (CVD). PHCNs are critical in the management of chronic illnesses but they require ongoing support of and links with specialists. This will ensure that current guidelines reach the people receiving primary health care (PHC) and detection of those needing referrals. Aims: The study aimed to determine if CDOP was an effective method for the early detection and management of diabetic and hypertensive patients at high risk for complications like stroke, ischaemic heart disease and CKD. It also aimed to evaluate the PHCNs’ knowledge and motivation, and to elucidate the challenges facing the current health system in the management of patients with chronic conditions. Methods: Patients at risk for complications were enrolled for increased monitoring and clinical support and management, at 20 clinics in Soweto, South Africa (SA). CDOP used a paper-based support and patient care system, modelled on the Wagner Chronic Illness Care Model (CICM). The components for evaluation included: (i) Focus on monitoring functional and clinical outcomes (ii) Health system interventions, such as increased ‘decision support’ and the development of a ‘prepared motivated health care team’ and (iii) Enhancing PHCNs’ knowledge and motivation. The evaluation followed the various elements of the Wagner CICM, as well as drawing on the WHO Innovative Care for Chronic Conditions (ICCC) Framework. A cohort analysis of functional and clinical outcomes in enrolled patients was conducted. PHCN knowledge and motivation was assessed through self administered questionnaires. Health worker knowledge was evaluated through the use of case scenarios and multiple choice questions. On the theme of health worker motivation, Franco’s model, with Penn-Kekana’s adaptation, was used to develop the questions and analyse diary recordings. Diary recordings of PHCNs and meetings with regional and provincial health managers’ discussions were collected by CDOP staff during follow-up focus groups and feedback meetings. Diaries were analysed thematically. The CDOP evaluation is thus a triangulated analysis of clinical and functional outcomes, diary recordings, and the self-administered questionnaire. Results: The CDOP ran from 2003-2006, during which time 618 patients (61% females, 39% males) deemed at risk of CKD or CVD were enrolled; 55% had uncontrolled hypertension (HTN), 45% DM with HT and/or proteinuria. Patients were followed for 2 years. In total, 108 patients completed 2 years of follow up, most of whom were referred for specialist support (n=69, 11%), more intensive medication regimes or because were not available in the PHC system. Most did not require referral (515, 82%), 35 (6%) were referred but never arrived at the hospital and 6 (1%) died. Twelve percent had advanced CKD, 2% required dialysis, 6.9% required medications not available to primary care clinics, and 1% died. As a tool to detect those needing referral, the program was successful. The sensitivity and specificity for detecting those needing referral was 95% and 100%, respectively.. However, although PHCNs were able to detect high risk patients, not all those referred arrived at the hospital. Hypertension, blood glucose, cholesterol and proteinuria control significantly improved in those followed (p<0.01) over 2 years, but no improvement was noted with weight control. Importantly, proteinuria and kidney function, in patients with static stable renal function, measured by estimated GFR equations and urine dipstick or albumin creatinine ratio (ACR), did not worsen significantly. Of the remaining 510 patient enrolled but not followed up, 213 (35%) were reabsorbed into the routine clinics, and a further, 123 (20%) of patients enrolled were lost to follow up completely. The diary recording thematic analysis revealed the problem of poor patient follow up, attributed to the poor existing health system in the clinics, competing demands on PHCNs, staff shortages, high staff turnover, and the low motivation and morale of clinicians. The analysis of the health worker questionnaire showed improved motivation and statistically better knowledge in those PHCNs involved with CDOP compared to those who were not exposed to the program (p<0.0034). Conclusions: CDOP was successful in supporting PHCNs, detecting patients with advanced disease and ensuring their early referral. Such programs are able to correctly detect people with disease, but this is dependent on the health and program systems being intact. It also improved patient risk factor control in the sub-set of referred patients and impacted on PHCNs’ existing knowledge and motivation for caring for patients. Its weaknesses were related to the poor existing health systems and infrastructure, and the poor integration of chronic illness care in the region. The PHC clinics had poor follow up compared with that in the hospital setting. The study also revealed an overworked, poorly supported, and frustrated primary health care team. This was despite the fact that the PHCNs were willing and motivated to deliver a good service.Item UNESCO and its agencies' impact on cultural policy frameworks in Africa: a study of Mapungubwe World Heritage Site in South Africa(2009-04-06T11:49:34Z) Uche-Okeke, IjeomaABSTRACT UNESCO’s World Heritage Convention of 1972 has set the standard for the evaluation, preservation and conservation of World Heritage Sites (WHS) globally. The role and function of UNESCO in the cultural heritage sector in Africa, in particular cannot be denied. However, the World Heritage Convention (WHC) site management requirements for African States that are parties to the Convention, presents challenges in terms of implementation. This is due in most cases, to lack of infrastructure, deficient national policy structures, poor legislation, bad management and poor implementation. This is particularly the case in developing countries where governments are grappling with socio-economic and political challenges. Questions are raised about who has the right to define heritage, and what kinds of parameters are used to measure World Heritage of ‘‘universal’’ value. Is it appropriate for UNESCO to recommend a set of standards that have become a lens through which global cultural heritage policy is viewed and measured? What then are the implications for African sites for being listed as World Heritage, and what are their chances of competing in the global cultural arena based on the challenges mentioned above? This research report, through a study of the Mapungubwe Cultural Landscape in the Limpopo Province of South Africa, attempts to grapple with aspects of the questions raised above, and seeks to illustrate the challenges of managing a World Heritage Site. It highlights the gaps between WHC requirements, national cultural policy legislation, infrastructural and human resource incapacity, and implementation by the management at the Mapungubwe World Heritage SiteItem The perceptions of occupational social workers about how their service provision has been affected by HIV/AIDS in the workplace since 1995(2007-02-19T12:56:53Z) Maribe, KedisaletseThe study aimed at exploring the perceptions of occupational social workers on how their service provision has been affected by the HIV/AIDS pandemic. The focus was on whether they thought that the increasing prevalence of HIV/AIDS in the workplace had led to a shift in their service provision. That was done through: - An investigation of ways in which social worker’s service provision has had to be adjusted in the context of HIV/AIDS in the workplace. - An assessment of the extent to which occupational social workers perceive their HIV/AIDS services at macro level to be acknowledged as valuable by management and the workforce. - An exploration of perceptions of occupational social workers on how HIV/AIDS has affected their relationship with management The research was quantitative and qualitative in approach and the design used was descriptive. Various sectors like manufacturing, government departments, para-statal, military and finance that employ social workers were identified. A list of occupational social workers was obtained from the School of Social Work, University of the Witwatersrand and from the Gauteng EAP Association. A non-probability sample of twenty seven social workers participated in the study. Semi structured interviews lasting for approximately forty five minutes were used as a form of data collection. Data collected was analysed through simple descriptive statistics and development of core themes and common concerns. The findings indicated that most occupational social workers perceived their services not to have been affected by HIV/AIDS, management and employees to have regarded their HIV/AIDS macro practice as valuable and their relationship with management have not been affected negatively by HIV/AIDS.Item Relationship between woody biodiversity and use of non-timber forest products in the Savanna Biome of South Africa(2007-02-16T11:15:50Z) Dovie, Benjamin Delali KomlaThis study seeks to combine the knowledge of science and society to elicit the relationship between the harvesting of woody plant species and the local availability of woody species in South African savannas. Ten villages located in the former communal areas and homelands within three broad vegetation types (i.e., Mixed lowveld bushveld, Eastern thorn bushveld, and Natal lowveld bushveld) were studied. The study, conducted in the framework of the coupled human-environment system poses challenges to both scientists and managers (e.g., setting common goals). Data were collected using modified Whittaker plots (MWP) and focus group discussions (FGD), denoting ecology and society, respectively. There were nine 1000m² MWP plots sampled per village, each having nested 1m², 10m² and 100m² subplots. The FGD involved six groups of local people based on gender and age. The study revealed that the harvesting of woody plant species is a source of local disturbance to woody vegetation. Generally, there were more woody species in locations farther from settlements, having a mean of 41.97 ± 3.9, than for the intermediate (38.27 ± 5.6) and near locations (19.9 ± 4.2) within the 1000m² plots, the result of the reduction in species closer to settlements from higher harvesting levels. The larger sampling plot size of 1000m² of the MWP had the highest diversity, decreasing sequentially to the smallest scale (1m²). The density of the woody species was highest in the intermediate locations (517 ± 80 plants/ha), followed by the far and near, relative to the settlements. The Natal lowveld bushveld broad vegetation type had the highest mean density of trees (573 ± 71 trees/ha) compared to the Mixed lowveld bushveld (366 ± 64 trees/ha) and the Eastern thorn bushveld (312 ± 40 trees/ha). The stem diameters of trees were generally higher in the villages of the Mixed lowveld bushveld than the other two vegetation types. The study reaffirmed that anthropogenic disturbances within savannas impact vegetation and need to be studied concurrently with other disturbance factors (e.g., biotic and abiotic or environmental). The mean total coppice shoots of stumps within the 1000m² plots was relatively higher in the near locations (38.4%), than the far (33.0%) and intermediate (28.7%). This difference in coppicing shows that although near locations were less species rich, which is a result of disturbance, the growth of shoots may nevertheless be greater. Harvesting disturbance will possibly favour the regeneration of some species, as well as the maintenance of biodiversity. Whilst 135 woody species (from a total 191 from 42 plant families) sampled in the field were used by the local people, the community knowledge yielded almost twice as many (267 species, from 69 plant families). The ratio of mean useful woody species to total woody species remained relatively constant at about 1.0:1.1 from the near to far locations around the villages and accompanied by increased woody species diversity with distance from village. The MWP sampling yielded eight broad use categories (i.e., medicinal, wild edible fruits, fuelwood, housing and fencing poles, craft (e.g., carving), cultural, local beverages (e.g., alcohol)), and nine for the FGD (the eight for the MWP plus indigenous furniture). According to the local people, the highest number of species was used for medicine (27.8% of species), followed by fuelwood (19.2%) and wild edible fruits/seeds (19.1%). Over half of the species had multiple uses (i.e., three to eight uses), raising questions of possible threats to their persistence. Useful woody species were not restricted to any particular location or vegetation type. Large sized trees were subjected to even more uses than smaller trees, another source of conservation concern. Fifteen of the woody plant species are presently protected by law in South Africa (e.g., Adansonia digitata, Podocarpus latifolius, Mimusops caffra, Philenoptera violacea), while others are facing various forms of regional threats (e.g., Alberta magna, Catha edulis, Ocotea bullata). There is the need to popularise and make people (both local and outsiders) aware of the state of NTFP species, using local and village level information as an additional criterion for describing conservation threat (e.g., proposed “Locally Brown List” – Chapter 4). The older generation of local people were highly knowledgeable in terms of the woody species used for medicine, craft, fencing and housing poles, the middle aged in beverage making species, and the younger generation in fuelwood species. Overall, older males were highly knowledgeable of the useful species. The generally strong correlation (r = 0.99, p <0.0001) between the cumulative woody species diversity from field and community knowledge suggests the need to integrate data using multi-disciplinary approach and also to manage NTFP species. Although threat reduction assessments (TRA) and monitoring have previously been suggested, the participation of local people, harvesters and users will be crucial in making TRAs effective. In conclusion, the harvesting of NTFPs, and the impacts of the changes in the NTFP species on total diversity in savannas need to be understood in order to move towards a more holistic approach to conserving the woody species that may be at risk of extinction through harvesting. Disturbance criteria that describe harvesting levels should be set to guide research and management protocols. Finally, when discussing NTFPs and the species from which they are harvested, management should aim at incorporating all the factors that affect sustainability, such as land and resource tenure and local participation, the political economy, appropriate production and development cycles.Item Towards post-managerialism in higher education: The case study of management change at the University of The Witwatersrand 1999-2004(2006-11-16T11:37:25Z) Johnson, Bernadette JudithManagerialism and collegiality are employed in this thesis as constructs through which to make sense of the changing nature of management in a South African university. The rise and dominance of the managerialism discourse is examined with respect to organisational change and restructuring. As principally a qualitative research project, a single case study of the University of the Witwatersrand (Wits) is investigated using interviews, documentary analysis and focus group discussions as the main sources of data from 2001 to 2004. The study is exploratory and strives to establish how and why management has changed. It does so by investigating the underpinning changes in the organisational regime and the different levels of management; the role of the Senior Executive Team, the changing nature of the deanship and the head of school position as a consequence of the merger of departments and the creation of a school structure. Although management in higher education is recognised as having existed for as long as the establishments themselves, the thesis is concerned with the changes in power and authority of academic leaders, the struggle with their ‘lived’ tension between academic leadership or collegiality and managerialism and the implications of this for academic practice. The thesis illustrates that changes in management at Wits demonstrate efforts towards an era of post-managerialism, in this specific case best described as ‘contrived collegial managerialism’. The concept of ‘contrived collegial managerialism’ refers to how the domination of managerial practices from above has altered collegial relations from below. This has resulted in the weakening of academic leadership with profound implications for academic work and practice. Only through strengthened academic leadership at the different levels of university management and primarily school and disciplinary levels, can the university survive the indignities of the increasing corporatisation of its strategies, processes and management practices which constrain the opportunities for meaningful engagement and development of intellectual projects. It is only at disciplinary level, through strengthening the position of heads of department as academic leaders, that collegial relations can be developed and pressure towards upward accountability structures counteracted. Without this, the university risks being consumed by corporate practices at the expense of its unique quality and contribution to society, academic and intellectual advancement.Item Design and implementation of a fault management service for heterogeneous networks using Tina Network Resource architecture(2006-03-22) Parshotam, Chiba ChetanFaults are unavoidable and cause network downtime and degradation of large and complex communication networks. The need for fault management capabilities for improving network reliability is critical to rectify these faults. Current communication networks are moving towards the distributed computing environment enabling these networks to transport heterogeneous multimedia information across end to end connections. An advanced fault management system is thus required for such communication networks. Fault Management provides information on the status of the network by locating, detecting, identifying, isolating, and correcting network problems thereby increasing network reliability. The TINA (Telecommunication Information Networking Architecture) standards define a Network Resource Architecture (NRA) that provides a framework of a transport network that is capable of transporting heterogeneous multimedia media information across heterogeneous networks. TINA also defines a Management Architecture that follows the functional area organization defined in the OSI (Open Systems Interconnection) Management Framework, namely fault, configuration, accounting, performance, and security management (FCAPS). The aim of this project is to utilise the TINA NRA and Management Architecture concepts and principles to design and implement a distributed Fault Management Service for heterogeneous networks. The design presented here utilises TINA’s fault management specifi- cations, together with UML modelling tools to developed this Fault Management Service. The design incorporates the use of CORBA and SNMP to provide a distributed management functionality capable of providing fault management support across heterogeneous networks. The generic nature of the fault management service is tested on the SATINA Trial platform which consists of both an ATM network as well as an IP MPLS network. The report concludes that the Fault Management Service is applicable to any connectionoriented network that is modeled using the TINA NRA specification and principles.Item An evaluation of the key factors that influence a South African-based firm to implement environmental management(2006-03-22) Nel, HannelieInternational research indicates that the practice of environmental management may lead to profitability and competitive advantage for the firm. But this theory has not been tested in South Africa. This lack of empirical evidence led the researcher to the primary research question: does environmental management increase a firm’s profitability in South African-based firms? The secondary objective of the study is to determine which factors cause South African-based firms to implement environmental management strategies. Based on a comprehensive literature review, this study delineates the concepts environmental management and profitability and examines the causal relationship between the two factors. Data is collected from firms operating in ten sectors in South Africa using a cross-sectional online mail survey. A proposed research model and hypotheses are tested using confirmatory factor analysis and path analysis with latent variables. The SAS System is used for statistical analysis. The test of the structural model supports the proposed hypothesis that environmental management increases competitive advantage in South African-based firms. Environmental management, however, is limited to the minimization of natural resource consumption and competitive advantage is determined by the strength of the firm’s relationships with its stakeholders. In turn, top management positively influences the strength of these relationships. South African firms follow a strategy of pollution control as opposed pollution prevention. One of the main contributing factors to compliance with regulation in environmental management (as opposed to innovation) is the lack the technical skill and knowledge in both government and the manufacturing sector.Item An effective framework for total quality management in information systems building(2006-03-13) Masela, Piet TimothyBusiness processes in all sectors of the business community require information to achieve the missions of their organisations. The quality of the information is directly related to the quality of the application system which process or produce such information. During application systems development, the project manager should consciously gather the application owner’s quality requirements, and ensure that those requirements are built into the application which is delivered at the conclusion of the development project. The specified quality requirements should be measurable to ensure that their presence can be verified in the end product. This report uses quality attributes obtained from the International Standard (ISO) 9126 Software Evaluation Framework, to specify these requirements and to verify their achievement. This research found that there is a consensus among application system owners and project managers on the importance of quality attributes as an evaluation tool of the quality of an application system. In the quest for quality, the starting point should be gathering of quality requirements and their correct interpretation.Item Implementation of Tina service subscription information management using OBDMS(2006-03-13) Lee, JimmyThe next generation telecommunication networks will offer users a range of services. These future telecommunication services are envisaged to be tailored services that are customizable in order to satisfy specific requirements of a variety of customers. Service subscribers and users should be offered some direct control in managing their services. Customization in a multi-service environment introduces the requirement for multiple service profiles for each user. Having user service profiles enable universal service access. The current telecommunication service subscription model is no longer viable for the next generation or TINA-based services. This work proposes a subscription and service information management system that is integrated into the existing TINA-structured platform in the South African TINA (SATINA) Trial. The system developed here realizes the object-oriented TINA subscription information management model. The information model defines all the information and relationships required to handle users, subscribers and the subscription life cycle. The project employs the emerging Object Database Management System (ODBMS) to manage the object oriented telecommunication subscription data. ODBMS provides a powerful and efficient way to managed these object oriented information as information and the relationships are stored as they are used in the application. The proposed subscription and service information management system is a distributed application based on the widely used three-tier architecture model. The three-tier model enables distributed access to the centrally managed subscription and service information regardless of the implementation adopted. Visual modeling technique is used to develop the application and convey the design principles. Application of the subscription and service information management system in the service provider domain is demonstrated by the domain administrator’s usage of the system’s graphical management console. The integration of the information management system and the SATINA Trial’s service platform is indicated through the usage of the TINA compliant Online Subscription service.Item Telecommunications service accounting management based on TINA(2006-02-09) Chen, Chen-YuThe next generation telecommunication networks offers traditional voice type services as well as advanced data services, typically of the multi-media based type, on top of an open resource, heterogeneous network that delivers services with a specified level of quality of service (QoS). The need for a comprehensive telecommunications service accounting management system in the such Next Generation Network is envisaged as the traditional telecommunications billing system does not meet the accounting management requirements in such network. This report present the design and implementation of a service accounting management system based on the Telecommunications Information Networking Architecture (TINA). The service accounting management in TINA service environment, which allows the users to obtain multiple service with specified network connection QoS, is emonstrated on the South Africa TINA Trial platform, which provides a next generation service environment conceived by TINA. This work shows the generation and the flow of the service and network usage accounting information in the distributed processing environment.