Jacqueline Elizabeth Wolvaardt

A Process and Outcomes Evaluation of the International AIDS Conference: Who Attends? Who Benefits Most?

The objective of the study was to conduct a process and outcomes evaluation of the International AIDS Conference (IAC). Reaction evaluation data are presented from a delegate survey distributed at the 2004 IAC held in Thailand. Input and output data from the Thailand IAC are compared to data from previous IACs to ascertain attendance and reaction trends, which delegates benefit most, and host country effects. Outcomes effectiveness data were collected via a survey and intercept interviews. Data suggest that the host country may significantly affect the number and quality of basic science IAC presentations, who attends, and who benefits most. Intended and executed HIV work-related behavior change was assessed under 9 classifications. Delegates who attended 1 previous IAC were more likely to report behavior changes than attendees who attended more than 1 previous IAC. The conference needs to be continually evaluated to elicit the required data to plan effective future IACs.

Household Conditions, Eczema Symptoms and Rhinitis Symptoms: Relationship with Wheeze and Severe Wheeze in Adolescents Living in the Polokwane Area, South Africa

Objective. Determine the prevalence and risk factors of wheeze and severe wheeze in 13-to 14-year-old children. Methods. The study was conducted August 2004 to February 2005 in the Polokwane area, South Africa. Results. The 12-month prevalence rate was 18.9% for wheeze and 9.2% for severe wheeze (n = 3,926). The presence of other allergic symptoms and industrial activities appear to increase the likelihood of wheeze, even more so for severe wheeze. Socioeconomic-related factors appear to have a protective effect on wheeze. Conclusions. Wheeze appears to be a substantial public health problem in the Polokwane area.

A blank page: feedback from first referral hospitals to primary health care clinics

Background: Primary care practitioners depend on the feedback from hospitals in order to care for returning patients effectively. Lack of such feedback from the hospitals leads to frustration, poor efficiency and care that it is not cost effective. This study examined the presence and adequacy of written feedback from first referral hospitals to primary health clinics (PHC) in the Metsweding district, Tshwane, South Africa. Methods: A retrospective descriptive stratified cluster study was done by reviewing 863 patient records selected randomly from referred patients between 1 January 2010 and 31 December 2011 in 6 of the 11 clinics. The clinics were stratified according to type of setting and 6 clinics sampled proportionately. Results: Of the 858 referrals only 5.4% (n = 46) had feedback letters. Details of the patient were listed in 35 (76.0%) of the feedback letters. There were no contact details for the referring institution or practitioner in almost half of the feedback letters (41.8%; n = 19). Most did not mention the symptoms (87%; n = 40) or signs (89.2%; n = 41) but the majority (58.6%; n = 27) recorded the condition or diagnosis of the patient. The follow-up instructions were documented in 30 letters (65.2%). Conclusions: The low rate of return feedback letters appears to be a commonplace experience and this study both quantifies the extent of this problem and highlights the weaknesses in the letters themselves. The findings reinforce the experiences of practitioners in PHCs and have practical implications for hospital doctors and district hospital managers who wish to strengthen the health system.

Patient safety culture in a district hospital in South Africa: An issue of quality

Background The Nursing Act 33 of 2005 holds nurse practitioners responsible for all acts and omissions in the delivery of quality patient care. But quality patient care is influenced by a number of factors beyond the control of nurse practitioners. Patient safety culture is one such factor and is seldom explored in hospitals in developing countries. This article describes the patient safety culture of a district hospital in South Africa. Objectives The study identified and analysed the factors that influence the patient safety culture by using the Manchester Patient Safety Framework at the National District Hospital, Bloemfontein, Free State Province. Method A descriptive cross-sectional study was conducted and included the total population of permanent staff; community service health professionals; temporarily employed health professionals and volunteers. The standard Manchester Patient Safety Framework questionnaire was distributed with a response rate of 61%. Results Less than half of the respondents (42.4%; n = 61) graded their units as acceptable. Several quality dimensions were statistically significant for the employment profile: overall commitment to quality (p = 0.001); investigating patient incidents (p = 0.031); organisational learning following incidents (p < 0.001); communication around safety issues (p = 0.001); and team working around safety issues (p = 0.005). These same quality dimensions were also statistically significant for the professional profiles. Medical doctors had negative perceptions of all the safety dimensions. Conclusion The research measured and described patient safety culture (PSC) amongst the staff at the National District Hospital (NDH). This research has identified the perceived inadequacies with PSC and gives nurse managers a clear mandate to implement change to ensure a PSC that fosters quality patient care.

Clinical mentoring to improve quality of care provided at three NIM-ART facilities: A mixed methods study

Background The South African Department of Health implemented the nurse-initiated management of antiretroviral treatment (NIM-ART) programme as a policy to decentralise services. Increasing access to ART through nurse initiation results in significant consequences. Aim This study evaluated the quality of care provided, the barriers to the effective rollout of antiretroviral services and the role of a clinical mentor. Setting The study was conducted at three NIM-ART facilities in South Africa. One clinic provided a high standard of care, one had a high defaulter rate, and at the third clinic, treatment failures were missed, and routine bloods were not collected. Methods A mixed methods study design was used. Data were collected using patient satisfaction surveys, review of clinical records, facility audits, focus group interviews, field notes and a reflection diary. Results NIM-ART nurses prescribed rationally and followed antiretroviral guidelines. Mortality rates and loss to follow-up rates were lower than those at the surrounding hospitals, and 91.1% of nurse-monitored patients had an undetectable viral load after a year. The quality of care provided was comparable to doctor-monitored care. The facility audits found recurrent shortages of essential drugs. Patients indicated a high level of satisfaction. Salary challenges, excessive workload, a lack of trained nurses and infrastructural barriers were identified as barriers. On-going mentoring and support by a clinical mentor strengthened each of the facilities, facilitated quality improvement and stimulated health workers to address constraints. Conclusion Clinical mentors are the key to addressing institutional treatment barriers and ensuring quality of patient care.

The bottom line : tailoring a public health elective to students' needs

Context and setting . Academics face difficulties when trying to include public health in the medical curriculum. The first hurdle is an already overloaded curriculum and the second the marginal interest in the healthy on the part of those who are mainly concerned with the ill. One overlooked potential opportunity for inclusion in the curriculum is the elective and, in particular, the self-constructed elective of third-year medical students at the University of Pretoria. Why the idea was necessary . Not only does public health have to compete with the powerful clinical interests among students, but students are also not in a position to identify opportunities in the community that could offer meaningful learning opportunities for an elective in public health. What was done . An action research study design used an online survey to explore the factors that students take into account when constructing an elective experience. These factors determined the final design of a public health elective which was subsequently advertised to third-year medical students at the University of Pretoria as a possible option. Results and impact . Disappointingly, no student enrolled for the elective. Subsequent investigation of students’ actual choices resulted in a deeper understanding of students’ unvoiced needs. It would appear that a successful public health elective needs to be like a mini-skirt - long enough to cover the subject, but short enough to hold interest. Academics considering innovations in public health could benefit from this complexity in design.