A trend analysis of perinatal mortalities in Barberton Hospital between 2002 and 2016
- Authors: Modupe, Oluwarotimi Folorunsho
- Date: 2018
- Subjects: Newborn infants -- Mortality Perinatology
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/11254 , vital:37630
- Description: Background and aim: There is no doubt that the quantification of data on the new born is imperative towards the design of effective public health policy interventions. However, the trend in under-five mortality rates in Barberton Hospital is not recognised as no empirical investigation has been undertaken to ascertain its position in this regard. A trend analysis of infant and maternal deaths in will therefore shed light on possible factors influencing this trend. The specific objectives of this study were to examine the trend and causes of perinatal mortality in Barberton Hospital from 2002-2016. It was hypothesized that there would be a downward trend in the infant and maternal mortality rates in Barberton Hospital from 2002-2016, possibly as a result of improved medical care. Methods: This retrospective study was conducted in Barberton Hospital, located in the Umjindi sub-district in Mpumalanga Province. The data was drawn from the Perinatal Problem Identification Programme (PPIP) database. Pregnancy related deaths of women, and of children from birth to one year in Barberton Hospital from 1999-2014 were extracted. The population study consists of a record review of all infant and maternal deaths in Barberton Hospital from 2002-2016 and captured in the data on the PPIP. The University of Fort Hare ethical review committee approved the study protocol. In addition, permission to use the data was granted by the Mpumalanga Department of Health after applying for approval for use of the data for academic purposes. The data was then exported into an Excel format document and fed to Statistical Package for Social Sciences (SPSS) program to allow for a more detailed analysis. Results: Over the period under review (2002-2016), a total of 21151 babies were delivered, 20593 babies were alive at discharge, 221 babies died in the first 28 days of delivery, and 337 babies were stillbirths. 18577 were normal weight (≥2500gram), 1581 weighed 2000-2499 grams, 568 weighed 1500-1999grams, 286 weighed 1000-1499 and 139 weighed below 1000grams. All the women who gave birth over the period under review, 27.3percent tested positive to HIV, 40.3 percent tested negative. Of all women that tested positive, 80.2percent received any form of ART. For over half of women that received ART (n=2981), the type of ART they received is unknown. Most women whose baby died were young. One in five women did not have their age captured in the database indicating an important gap that need to be addressed in order to ensure integrity of the database. Of all the 558 perinatal mortality, 75.3 weighed below 2500 grams. Low birth weight is major risk factor for child mortality. Babies weighing less than 2,500 grams are 20 times more likely to die than heavier babies. For all the perinatal deaths, the majority of their mothers received antenatal care services. About 86.6percent were delivered at Barberton Hospital and only 1 child was delivered in transit to the hospital. Of all the 558 deaths, only 7.5 percent was multiple births. Of the 558 babies that died, only 39.6percent were born alive, 37.1percent was macerated stillbirths. The syphilis serology test indicated that most mothers tested negative. The HIV serology test indicated that 28percent of mothers tested positive. The hospital recorded a total of 337 stillbirths between 2002 and 2016. This accounts for 60.2percent of all perinatal mortality over the period. Of all stillbirths, 61.6percent was macerated stillbirths. Yearly analysis of stillbirth rate did not clearly indicate whether stillbirth rate is increasing or declining. Not less than 56 primary obstetric causes of perinatal deaths were identified in this study. Many perinatal deaths were unexplainable due to lack of post-mortem. Idiopathic preterm labour was the main primary obstetric cause of early (34.5percent) and late neonatal (38.9percent) deaths, and the next was labour related intrapartum asphyxia. Labour related intrapartum asphyxia also accounts for 6.8percent of all stillbirths. The main known primary obstetric cause of stillbirth in the Hospital was Proteinuric hypertension/hypertension disorders. Over 60percent of perinatal mortality in Barberton Hospital was due to associated maternal conditions. Only 10.9percent was due to fetal related conditions and 26.4percent was unexplained. Few deaths were due to health system failure and domestic violence. Spontaneous preterm labour (18.4percent), abnormal labour or uterine rupture (14.5percent), maternal hypertension (12.4percent), antepartum haemorrhage (10.2percent) were the main associated maternal conditions causes of perinatal mortality in Barberton Hospital. Similarly, Fetal abnormality and infections were the main associated fetal condition causes of perinatal mortality. Of all the babies that were alive at birth, 85.2percent died due to maternal related conditions. Most neonates died due to spontaneous preterm labour (43.5percent) and abnormal labour or uterine rupture (23.1percent). Maternal HIV, diabetics and syphilis only accounted for a few neonatal deaths. For stillbirth babies that were alive at admission, abnormal labour or uterine rupture (33.1percent) and antepartum haemorrhage (19.7percent) were the main causes of their death. Over 60percent of all of macerated deaths have unexplained causes. Maternal hypertension is the main known cause of macerated stillbirth. For stillbirths that were dead on admission, maternal hypertension (13.1percent), antepartum haemorrhage (26.2percent) and abnormal labour or uterine rupture were the main causes of deaths. The majority of perinatal deaths in the hospital were caused by intrauterine deaths (58.8percent). Extreme multi-organ immaturity (13.1percent), Hyaline membrane disease (7.2percent) and Hypoxic ischaemic encephalopathy (5.2percent) were among the main final causes of perinatal deaths. The main behavioural factor causing perinatal mortality in Mpumalanga province was non-use of antenatal care services. The majority of perinatal mortality (60.4percent) was due to health system related causes. Most perinatal deaths were due to poor management of cases and delayed referral. Conclusion: The findings indicate that while stillbirths have slightly declined, neonatal deaths have not declined over the period. Perinatal have slightly declined in the hospital. The findings of this study also indicate that the majority of perinatal deaths in the hospital were caused by idiopathic preterm labour, unexplained intrauterine deaths, hypertension, and intrapartum asphyxia. Patient and health system related factors contributed significantly to perinatal deaths in the hospital. There is a need for yearly analysis of PPIP data to track progress and identify area for continuous improvement in provision of quality obstetric services. A greater community awareness of risk factors for perinatal deaths and importance of early and regular take up antenatal care services is needed.
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- Date Issued: 2018
An assessment of quality health care in the operating theatres of Frere Hospital in the Eastern Cape
- Authors: Bennett, Fabion Charton
- Date: 2018
- Subjects: Medical care Surgical instruments and apparatus -- Safety measures
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/13425 , vital:39660
- Description: BACKGROUND: Operating theatres are one of most expensive resources in a hospital. The management of operating theatres is complex due to the conflicting priorities and preferences of all stakeholders. Operating theatres also pose one of the greatest medico legal risks to any hospital. This study was conducted at Frere Hospital in East London to assess the functioning of the operating theatre system. The focus of this study was on Pre-operative categorisation of emergency cases, the utilisation of the World Health Organisation Safety Checklist, compliance to the National Core Standards for Health, the effectiveness of governance and review processes, theatre staffing as well as theatre efficiency indicators (start time/tardiness, utilisation, turn-around time, re-admission to theatre rate, cancellation on day of procedure, slate under/over runs, Anaesthetic time as a percentage of theatre time). OBJECTIVE: The purpose of this study was to promote the adherence to the various operating theatre universal approaches by operating theatre staff with the goal of reducing costs and errors caused by poor quality in operating theatres and improving the overall health system. METHOD: In this research a convergent parallel mixed method research design was applied. The research was non-experimental and descriptive in approach, using a mixed method questionnaire, a structured open ended interview, a structured infrastructure assessment, a structured observation checklist and an audit of patient files for a review of emergency surgical cases. Data was collected during October 2016 and January 2017.The study population consisted of 13 operating rooms across 6 operating theatre suites, surgical management staff as well as clinical and nursing staff in the operating theatres at Frere Hospital in East London. RESULTS: The study showed opportunities for improvement in the overall management of the operating theatres to ensure efficient quality care; the data from the observations, questionnaires, interviews as well as the analysis of the efficiency indicators consistently showed that an effective process of operating theatre governance and performance is non-existent, the Pre- operative categorisation of emergency cases is inconsistently applied, the compliance to the principles of the World Health Organisation Safety Checklist Is very low, theatre nursing staff levels per case is low, staff are also demotivated and theatre efficiency indicators require improvement. During this study, the Paediatric theatre suite appeared to be well run and compliant with opportunity to increase theatre utilisation, the casualty theatre is underutilised and has potential to be utilised as an enabler to improve the efficiency of other theatres. The main theatre and endoscopy suites have opportunities to improve its compliance to universal operating theatre quality and efficiency standards, the Orthopaedics and Obstetrics theatre suites, however, require urgent improvement focus. DISCUSSION: According to the findings, a structured operating theatre governance and performance review processes should be implemented with the intention of ensuring consistency across the management of the 6 operating theatre suites in the hospital. A review of staffing allocation and relative task allocation should be conducted. Interventions should be implemented to increase utilisation rates, improve the pre-operative categorisation of emergency cases, improve the compliance to the principles of the World Health Organisation Safety Checklist, reduce case start time variance/tardiness, reduce cancellation on day of procedure, increase anaesthetic time as a percentage of theatre time by introducing pre- anaesthetic induction prior to the patient being wheeled into the operating room.
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- Date Issued: 2018
Analysis of the role of unions in health services delivery at Uitenhage district hospital
- Authors: Tshamase, Nozibele Yvonne
- Date: 2018
- Subjects: Public health Health services accessibility Labor unions
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/12348 , vital:39255
- Description: Purpose: According to Khan and Khan (2011:56), a trade union is an organization of employee tasked with activities which include negotiating on behalf of their members for “pay and conditions of employment”. Several authors have purported that these roles extend beyond ensuring not only that the rights of workers are not violated and that their working environment complies with health and safety standards, but also that unions may have an effect on management practices, generally and specifically, on efficiencies and performance (Zulu, 2009; McGuire, 2011; & Dhliwayo, 2012). Health care workers including professionals are organised by the unions in a bid to influence social and economic reforms in the South African democracy. The main aim of this study was to examine the role of public sector unions and how they exercise their functions in delivery of health services Method: A qualitative research method based on phenomenological and case approaches was applied. Semi-structured interviews with open ended questions were used to prompt discussions. Documents were used to obtain complementary data. Senior managers, middle managers, union/employee representatives and employees who are members of the unions in the district hospital of Nelson Mandela Bay health district constituted the target population. Purposive non-probability sampling, which was the preferred method for this study, yielded 16 participants. Results Analysis followed Creswell’s thematic analysis involving coding responses categorising them and identifying themes. This followed repeated and thorough listening to the recorded interviews and transcribing. Themes identified were organisational functioning in line with the service delivery context; worker’s rights protection; negotiating better service conditions; implementing legislation, policies and resolutions; union-management interaction; engaging in strikes and impact on services delivery. Conclusion and Recommendations: The study found that the presence of unions in health care services was necessary because there are various categories of employees – working class – whose interests must be served. The role of the unions leaned heavily towards protection of the rights of the workers. As far as the observation of legislation is concerned, the unions demonstrated knowledge of the legislation applicable to the health care personnel, that is, the BCEA, the LRA and the PSA. The study found that unions were a hindrance to health services delivery in their quest to exercise voice monopoly. The unions tended to exert undue influence on management resulting in lack of discipline and dereliction of duty. The strike actions compromised quality of health care and the rights of citizens to access health care. There was no active participation nor positive contributions in committees where advancement of service delivery standards were deliberated and promoted. Recommendations included training of shop stewards; capacitation and training of managers, and development and communication of departmental labour relations policies.
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- Date Issued: 2018
Assessment of the effect of the down-referral chronic medication distribution system on patients' adherence to chronic medication in the Buffalo City sub-district
- Authors: Ndwandwe, Miriam
- Date: 2018
- Subjects: Health services accessibility Pharmacology Patient compliance
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/13248 , vital:39626
- Description: The purpose of the study is to determine the effect of the down referral chronic medication distribution system on patient's adherence to chronic medicine in Buffalo City sub - district by ensuring that chronic patients receive their correct medication on time and in correct quantities every month so that they can take the medication as recommended by the health professional. Adherence to chronic medication lead to better health outcome and reduced hospital re-admission. A non-experimental and descriptive quantitative research methodology was used. A data abstraction form developed by the researcher was used to record data from the medical records of chronically ill patients. The results of the study revealed that most of the chronically ill patients who were admitted to hospital were not adherent to their chronic medication. Patients are non-adherent even if they have chronic medication with them. This was evident in the number of patients who do not remember how many days did they not take their treatment. Others indicated that they share their medication with other family members who suffer from the same chronic condition. The patients' lack of understanding of their chronic condition and the consequences of not taking medication as instructed by the health professional contribute to non-adherence. Strengthening of health promotion programmes to educate the patients about their chronic condition would improve adherence. Most of the chronic conditions are life-style modifiable diseases. Patients must be educated about the changes they can make to improve their quality of life.
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- Date Issued: 2018
Factors affecting patient perceptions od service delivery in Postmasburg Hospital in the Z.F. McGawu District, Northern Cape Province, South Africa
- Authors: Rakumakoe, Jacob Mogapi Chocky
- Date: 2018
- Subjects: Public health -- South Africa -- Northern Cape Medical care -- South Africa -- Northern Cape Health services accessibility
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/17805 , vital:41262
- Description: Background: There is a requirement to provide proper and safe quality service to patients, hence a view from patients was deemed important as it can help the hospital to improve services rendered to them. There were two Provincial assessments done on National Core Standards in Postmasburg Hospital (overall scores were 32percent in 2013 and 48percent in 2014) and on both occasions, the Hospital failed to comply with the assessments and the implication were a suspected negative impact on the Hospital service delivery. The repercussions could be that the hospital might not be certified or not funded through National Health Insurance following a national assessment if the status quo remains. Aim: The aim of the study was to describe the factors affecting patients’ perceptions of service delivery in order to inform health policy decisions to improve service delivery. Methodology: A quantitative descriptive design was used to collect data on 133 adult patients admitted for a minimum of three days in the different hospital wards. Participants were administered a structured pre-tested questionnaire to collect data relating to their employment status, the number of hospital admissions and the reason for hospital admission. Results: About 41.4percent of participants were neutral or not sure whether the nurses/doctors came often to the ward where they were admitted. The majority (51.9percent) were neutral or not sure whether the quality of food in the hospital was good; 53.4percent expressed uncertainty concerning the adequacy of benches/chairs in the hospital for patients to sit while waiting to be seen by the health worker; and 55.6percent participants were neural or not sure whether the ward/room had enough space for consulting. Asked whether the hospital was user-friendly to disabled persons, 53.4percent participants were not sure. About 43.6percent participants expressed uncertainty regarding the registration satisfactory nature of the procedures in the hospital; the water cleanliness for patients in the hospital (42.1percent); whether their privacy was respected by all the staff within the hospital (51.9percent); permission to be examined and treated (51.1percent); the nurse/doctor who treated them being polite (53.4percent); and the nurse/doctor who treated them being able to answer all their questions about their illness (56.8percent). On whether they will visit the hospital again, 49.6percent participants were uncertain. The majority (69.7percent) agreed that all prescribed medicine was available in the hospital; the staff explained to them on how to use the medicine/pills (67percent); and they were told on how to store their pills/medication (47percent). Gender, education and employment status of the participants affect exactly one dimension each. Females, those with secondary education and employed were more satisfied on the respective dimensions. Conclusion: Patient involvement is an essential feature in healthcare services. Patients influence outcome quality through compliance, defining the right symptoms and physically experiencing treatment. Patient perceptions and satisfaction with service delivery is a multi-dimensional concept that should be studied by operationalising it within its context. Consequently, a conceptual model to understand and measure patient perception and satisfaction of service delivery and care quality in hospital health care services is proposed.
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- Date Issued: 2018
The perceptions of professional nurses about the introduction of the National Health Insurance in a private hospital in Gauteng
- Authors: Molokomme, Victoria Khabonina
- Date: 2018
- Subjects: Health insurance Hospitals Primary health care
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/13057 , vital:39444
- Description: The National Health Insurance is a relatively new concept in South Africa currently being piloted to ensure that all citizens have access to quality and affordable health care regardless of their socio-economic status. This study was prompted by concerns regarding the introduction of the NHI and its implications on the South African health system. Therefore it seeks to determine the professional nurses concerns about the introduction of the NHI in a private hospital in Gauteng and to describe recommendations based on these perceptions. This study used a qualitative, exploratory and descriptive design. Data was collected using a semi-structured individual interview schedule. The sample was purposive consisting of professional nurses employed in a private hospital in Gauteng. Thematic data saturation determined the number of professional nurses interviewed. Data analysis was done with the aid of Creswell’s theory (2014:1996). Ethical considerations were observed and trustworthiness maintained. The results of the study outlined that professional nurse’s perception about the NHI is centred on equal distribution of health services to benefit all South Africans. However, concerns were based on its financial implications for those mandated to pay towards the fund. The feasibility of its implementation in the midst of staff shortage, inadequate resources and its impact on the public health sector was seen as a major challenge. The notion of a joint effort between public and private health sector in creating one health system was anticipated by most participants. The NHI implementation raised concerns about the impact it will have on the private sectors viability in the future. Professional nurse’s non-involvement in policy making, poor communication, lack of transparency, concerns about governance and management were perceived to be stumbling blocks towards efficient and effective implementation of the NHI.
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- Date Issued: 2018
Towards the development of a conceptual framework for hospital performance assessment of a South African public hospital in the Eastern Cape province
- Authors: Wagner, Rolene Margaret
- Date: 2018
- Subjects: Public hospitals Hospital care Hospitals -- Administration
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/12249 , vital:39223
- Description: An integrated conceptual framework for measuring and comparing the performance of a South African teaching hospital in the Eastern Cape Province with other hospitals, is not available. The aim of this study was therefore to contribute to the development of a conceptual framework for assessing the performance of a SA public hospital in the Eastern Cape Province. The systematic literature review included all black and grey literature that relate to one of the two main themes- the purpose of measuring hospital performance and the methodology of assessing hospital performance. Relevant studies were identified through a Google search using the following descriptors: “Hospital Performance”, and “Hospital Performance Assessment”. There were 369 scholarly articles with the exact descriptors anywhere in the article with 59 articles released during the period 2012 to 2016. Ultimately, 7 articles met all the inclusionary criteria and described enterprise wide assessments of hospital performance. Other relevant articles, inclusive of grey literature, are included. Two of the studies in Morocco and Costa Rica were systematic reviews of hospital performance and covered the period 2000-2011. The Botswana case study assessed the use of the WHO PATH tool to measure the performance of its public hospitals. The Iranian, United States and Malaysian studies reflected on single aspect measures of hospital performance such as efficiency; the effect of weighting hospital performance indicators for patient harm on hospital profiles and payment; and Bed Occupancy rates, respectively. The review of the challenges associated with developing a hospital performance assessment framework was not found to be as useful as the other articles. The WHO PATH tool provides a high level integrated conceptual framework for measuring and comparing the performance of a South African teaching hospital in the Eastern Cape Province with other hospitals. This, however, needs to be adapted to the South African context with specific indicators being selected by local stakeholders that will promote best possible patient outcomes and a positive experience of patient-centred care at effective and efficient public health facilities. Lessons can be drawn from other countries’ experiences that have implemented hospital performance assessments and tested specific performance indicators.
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- Date Issued: 2018
Women's knowledge and attitudes towards discontinuation of the Long-acting reversible contraceptive (Implanon) in Buffalo City Municipality, South Africa
- Authors: Mrwebi, Khungelwa Patricia
- Date: 2018
- Subjects: Contraceptives Birth control Women's health services
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/11206 , vital:37231
- Description: Unintended pregnancy remains a public health concern worldwide despite the availability of many contraceptives options. The South Africa Government introduced Implanon —a Long-acting Reversible Device— with aim to cost effectively prevent unplanned pregnancy. There are concerns that the implementation of this contraceptive option was without prior piloting to test for level of acceptance and attitude towards this contraception. Also, there is paucity of evidence on knowledge of women and their attitude to implanon as well as duration of use and reasons for discontinuation of implanon in South Africa. The present study address this gap by assessing the women’s knowledge of and attitude to implanon as well as reasons for implanon discontinuation in Buffalo City Municipality in South Africa. This prospective observational study administered a pre-validated questionnaire to 189 women who had removed implanon in the reproductive health clinic in one regional hospital and a primary health centre in Buffalo City Municipality. Descriptive statistics were used to analysis the study data. The average duration for implanon use among the participants was 11.2 months. Most participants had poor knowledge of implanon and implanon knowledge was significantly associated was with age. Most participants opined that implanon use is associated with heavy bleeding (60.7), irregular frequent bleeding (84.3percent), and weight gain (67percent). The main reason for implanon discontinuation was its side effects (71.3 percent). Other reasons for discontinuation of implanon are poor or wrong positioning (3.2percent), want to become pregnant (4.3percent). Some participants discontinued implanon because they were on treatment; 24 participants on ARV drug, one on antipsychotic drugs, and one on TB drugs. Experience of heavy bleeding (39.9percent) was the most stated side of implanon leading to implanon discontinuation. The study concluded that women, even though adopted implanon, lack knowledge of implanon mechanism of action and side effects. Poor knowledge of implanon side effects could explain its early discontinuation among women in South Africa. Provider should prioritise comprehensive counselling of clients on implanon side effects and mechanism of action in order to realise the benefit of implanon in this population.
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- Date Issued: 2018