Sam Ntuli

Job satisfaction and turnover intent of primary healthcare nurses in rural South Africa: a questionnaire survey

AIM This paper is a report of a correlational study of the relationships between demographic variables, job satisfaction, and turnover intent among primary healthcare nurses in a rural area of South Africa. BACKGROUND Health systems in Southern Africa face a nursing shortage fuelled by migration, but research on job satisfaction and turnover intent of primary healthcare nurses remains poorly described. METHOD A cross-sectional study with survey design was conducted in 2005 in all local primary healthcare clinics, including nurses on duty at the time of visit (n = 143). Scale development, anova, Spearmans rank correlation, and logistic regression were applied. RESULTS Nurses reported satisfaction with work content and coworker relationships and dissatisfaction with pay and work conditions. Half of all nurses considered turnover within two years, of whom three in ten considered moving overseas. Job satisfaction was statistically significantly associated with unit tenure (P < 0·05), professional rank (P < 0·01) and turnover intent (P < 0·01). Turnover intent was statistically significantly explained by job satisfaction, age and education (P < 0·001), with younger and higher educated nurses being more likely to show turnover intent. Satisfaction with supervision was the only facet significantly explaining turnover intent when controlling for age, education, years of nursing and unit tenure (P < 0·001). CONCLUSION Strategies aimed at improving job satisfaction and retention of primary healthcare nurses in rural South Africa should rely not only on financial rewards and improved work conditions but also on adequate human resource management.

The role of heredity in pterygium development

Several risk factors, which include heredity, ultra-violet (UV) light and chronic inflammation, contribute to pterygium development. However, there is no report integrating these factors in the pathogenesis of pterygium. The aim of this review is to describe the connection between heredity, UV, and inflammation in pterygium development. Existing reports indicate that sunlight exposure is the main factor in pterygium occurrence by inducing growth factor production or chronic inflammation or DNA damage. Heredity may be a factor. Our studies on factors in pterygium occurrence and recurrence identify that heredity is crucial for pterygium to develop, and that sunlight is only a trigger, and that chronic inflammation promotes pterygium enlargement. We propose that genetic factors may interfere with the control of fibrovascular proliferation while UV light or (sunlight) most likely only triggers pterygium development by inducing growth factors which promote vibrant fibrovascular proliferation in predisposed individuals. It also just triggers inflammation and collagenolysis, which may be promoters of the enlargement of the fibrovascular mass. Pterygium probably occurs in the presence of exuberant collagen production and profuse neovascularisation.

Causes of Deaths in Children under-Five Years Old at a Tertiary Hospital in Limpopo Province of South Africa

Objective: Accurate and timely information on the causes of child deaths is essential in guiding efforts to improve child survival, by providing data from which health profiles can be constructed and relevant health policies formulated. The purpose of this study was to identify causes of death in children younger than 5 years-old in a tertiary hospital in South Africa. Methods: Death certificates from the Pietersburg/Mankweng hospital complex, for the period of January 1, 2008 through December 31, 2010, were obtained for all patients younger than 5 years and were retrospectively reviewed. Data were collected using a data collection form designed for the study. Information abstracted included: date of death, age, sex, and cause of death. Results: A total of 1266 deaths were recorded, the sex ratio was 1.26 boys per girl. About 611 (48%) of deaths were listed as neonatal deaths (0-28 days), 387 (31%) were listed as infant deaths (29 days-11 months), and 268 (21%) as children’s death (1-4 years). For neonates the leading causes of death were: prematurity/low birth weight, birth asphyxia and pneumonia. For the infant death group, the leading causes of death were pneumonia, diarrhea, and HIV/AIDS; and in the children’s group, the leading causes were injuries, diarrhea and pneumonia. There was no statistical significant difference in the proportions of causes of death based on the sex of children. Conclusion: The top 10 leading causes of death in children under-5 years old treated at Pietersburg/Mankweng Hospital Complex were in descending order: prematurity/low birth weight, pneumonia, diarrheal diseases, birth asphyxia, and severe malnutrition, HIV/AIDS, hydrocephalus, unintentional injuries, meningitis and other infections. These ten conditions represent 73.9% of causes of death at this facility. A mix of multi-faceted interventions is needed to address these causes of death in children.

Traditional eye medication and pterygium occurrence in Limpopo Province

BACKGROUND The relative importance of environmental and hereditary factors in the occurrence of pterygium in African blacks has not been reported. AIM To investigate the relative significance of factors associated with pterygium occurrence. METHODS This was a prospective case-controlled study where 150 pterygium patients and 150 controls participated. Interviews were conducted, eyes examined and multivariate analysis done. The families of 51 pterygium cases and 50 controls were examined for presence of pterygium. RESULTS Of 150 cases and 150 controls, 79 (52.6%) and 60 (40%) used traditional eye drops (odds ratio (OR) 2.03; p=0.009. Ten cases (6.6%) and 26 controls (17.3%) had unstable tear film (OR 0.30; p=0.007. Forty-six cases (30.6%) and 15 controls (10%) reported a positive family history (OR 3.93; p<0.001). Groups of 3 - 5 pterygium cases in a household occurred in 36 of 51 pterygium families (70.5%) v. 1 of 50 controls (2%). CONCLUSIONS Pterygium occurrence was associated with the use of traditional eye drops, a positive family history and having groups of diagnosed pterygium-affected relatives. However, unstable tear film seemed protective against pterygium occurrence.

An Investigation of the Stillbirths at a Tertiary Hospital in Limpopo Province of South Africa

Objective: To determine the stillbirth rate and identify the causal factors associated with it in a tertiary hospital. Methods: A retrospective review of records of women who had stillbirths at a tertiary hospital of the Limpopo Province was conducted. The study period was two years from January 1, 2009 to December 31, 2010. The hospital maternity registers were used to identify the women who gave birth during the study period. Data were collected using a data collection form designed for the study. The data collected included maternal age, parity, gestation, mode of delivery, obstetric complications, infant or foetal’s gender and weight; whether the birth was fresh stillbirth or macerated and cause of stillbirth. Results: There were 5597 deliveries during the two years period of the study. The hospital-based stillbirth rate was 38.4 per 1000 births, with 71% being macerated. The majority of women with stillborn infant in this study were in the age group (24%) 20-34 years, followed by (23%) aged 35 years and older. Nulliparity was associated with stillbirth. Unexplained intrauterine foetal death, hypertensive disease, placenta abruptio was the leading causes of stillbirth. Conclusion: In this study stillbirth rate seems to be unacceptably high, though less than those reported in other settings. The causal factors associated with it were identified as nulliparity, unexplained intrauterine foetal deaths, hypertensive disease, and placenta abruptio. Because of the high rate of stillbirths reported in this study, it is recommended that interventions be made to introduce fetal autopsies at the tertiary healthcare facilities and that an educational intervention aimed teaching pregnant women be instituted.

Relationships of heredity and dry eye with pterygia in black African patients

and a long duration of ultraviolet radiation has been reported to be responsible for its development. 5 The use of tobacco, 6 a poor tear film, 7 lower levels of education and skills, 6 ethnicity, 8 exposure to dust, 8 malnutrition 4 and chronic ocular surface inflammation 8 have been reported or proposed as associations with pterygium occurrence. The relative importance of these factors has not been described in rural black Africans. This report is confined to investigating possible genetic factors and dry eye, which were the main associations found. Ethical clearance was obtained from the institutional research ethics committees. We prospectively interviewed 71 patients and 71 age- and sex-matched controls in the Mankweng Eye Unit in Polokwane. Patients with ocular surface malignancy and pseudo-pterygium were excluded. Consent was obtained and participants were shown three photographs of eyes with pterygia (Fig. 1) and asked questions similar to those used in a previous study. 2 The patients were shown the photographs and asked if they had ever seen a person with such a growth on the eye. If they replied in the affirmative, they were asked if that person was a relative and if so what their relationship with the person was. Tear-film stability was assessed using a previously reported procedure; 7 after application of 5% fluorescein, the cornea was assessed for areas of dark spots or streaks in between the blinks. The mean age of the participants was 45 years (standard deviation 10.65), with a range of 22 - 65 years. There were nearly three times as many females as males in the series. There was a positive family history of pterygium in 36% of cases and 10% of controls. A positive history was almost 5 times as common in cases as in controls. This was statistically significant (p<0.05, chi-square test). The tear film was unstable in 7% of cases and 17% of controls. An unstable tear-film was 4 times more common in controls than in cases, and this was significant (p<0.05, chi-square test). A positive family history implies hereditary predisposition. 2 It was the only positive factor associated with the formation of pterygia in this study. In Australia 38% of patients admitted for pterygium surgery compared with 8 - 12% of controls admitted for other conditions had a family history of the growth. 9 In South Africa 30 - 35% of urban predominantly white individuals who had attended an ophthalmic practice because of pterygium had a positive family history. 2 An unstable tear film (dry eye) was not associated with pterygium in this study, and this lack of association has previously been reported

Risk factors for PTSD and depression in female survivors of rape.

Objective: To investigate association of the sociodemographic factors, characteristics of rape and social support to the development of depression and posttraumatic stress disorder at 6 months after the rape. Method: A cross-sectional survey with female survivors of rape was carried out in 3 provinces of South Africa 6 months after the rape. Results: One hundred female survivors s of sexual assault were interviewed. More than half (53%) were from Limpopo, 25% from Western Cape, and 22% from KwaZulu-Natal (KZN). 87% reported high levels of PTSD and 51% moderate to severe depression post rape. The major risk factors for PTSD and depression were the unmarried survivors of rape and those living in KZN. The female survivors of rape in KZN province were 7 times more likely to experience symptoms of depression compared to other provinces, while married/cohabiting female rape survivors were 6 times less likely to report symptoms of depression compared to the unmarried female rape survivors. Conclusion: These findings add support to existing literature on PTSD and depression as common mental health consequence of rape and also provide evidence that survivors’ socio- demographics—marital status, employment status—are significant contributors to the development of symptoms of depression and PTSD after rape. The results have research and clinical practice relevance for ensuring that PTSD and trauma treatment focuses on an in-depth understanding of the various aspects of the sociodemographic factors and rape characteristics that contribute to survivors’ mental state and how these compound stress and depression symptoms over time post rape victimization.

Midwifery workforce profile in Limpopo Province referral hospitals

Background In sub-Saharan Africa including South Africa, maternal mortality rates remain unacceptably high due to a shortage of registered nurses with advanced midwifery diplomas. Objective To determine the profile of registered nurses (RNs) involved in maternity care in public referral hospitals of the Limpopo Province, South Africa. Method A cross-sectional descriptive study was conducted in all maternity units of Limpopos public referral hospitals. The study population comprised of 210 registered nurses, who became the study sample. Data on their educational profile and work experience in midwifery was analysed using STATA version 9.0. Results The mean age of the 210 registered nurses was 44.5 ± 9.1 years (range 21 to 62). The majority (152/210; 70%) were 40 years and older, 56% (117/210) had been working for more than 10 years, and 63/210 (30%) were due to retire within 10 years. Only 22% (46/210) had advanced midwifery diplomas, i.e. after their basic undergraduate training. Only six (2.9%) of the RNs providing maternity care in these referral hospitals were studying for advanced midwifery diplomas at the time of the study. Conclusion This study demonstrated a shortage of registered nurses with advanced midwifery training/diplomas in referral hospitals of the Limpopo Province. This has a potentially negative effect in reducing the high maternal mortality rate in the province.

Causes of Death in Patients Treated at a Tertiary Hospital in the Limpopo Province: a Retrospective Study from 2008-2010

The aim of this study was to determine mortality rates and identify associated causes at a tertiary hospital situated in the Limpopo province of South Africa. Death notification forms from Pietersburg Mankweng Hospital Complex were retrieved and reviewed for the period 1 January 2008-31 December 2010 in this cross-sectional study. Data were collected using a data collection form designed for the study. There were 5 232 deaths, on which there was complete information for 5 147, which was then analysed. The average death rate was 6.8 deaths per 1 000 patients, based on the number of patients admitted during the study period. The age of the deceased ranged from 15-104 years, with a mean of 49.1 ± 18.6 years. While only 2.4% of deaths occurred in teenagers, over two thirds occurred in people aged 20-59 years. Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), cancer, cardiovascular disease, trauma and tuberculosis were the top five most common causes of death, and were responsible for 61.2% of all recorded deaths. Trauma was the most common cause of death in teenagers, and HIV/AIDS the most common cause in young adults and adults. Cardiovascular disease was the main cause of death in the elderly. Overall, the triple burden of infectious diseases, noncommunicable diseases (NCDs) and injury remain the leading causes of death in patients at the study site. Innovative injury prevention strategies and interventions to control the spread of infectious diseases are urgently required. Cancer screening services and culturally appropriate lifestyle programmes are needed to address NCDs.