Knowledge, Understanding and Satisfaction with the Implementation of the Performance Management System at a District Hospital in the Madibeng Subdistrict, South Africa.

The Performance Management and Development System (PMDS) is an essential asset in aligning the strategic objectives of both the National and Provincial departments of health with the individual targets and Key Responsibility Areas (KRAs) of the individual employees working in these departments. The system is not without challenges. The sources of contention can be with the rewards mechanism of the system, bias in the application of the system and the incorrect use of the system for punitive measures. The objective of this study was to determine the perceived knowledge, understanding and satisfaction levels of employees at Brits District Hospital regarding the PMDS. Another objective was to provide an intervention targeting the knowledge and understanding of the key concepts of the system. A quantitative cross-sectional and longitudinal action research method was applied by tracking the responses of 64 healthcare workers three times, firstly in a questionnaire and then in an intervention checklist. The respondents were selected via proportionate stratified sampling. Data were analysed via STATA statistical software package 13.0. The respondents had a poor knowledge and understanding of how to score the PMDS. The respondents where highly dissatisfied with the development of their weaknesses and the recognition of their strengths. Training needs to be prioritized on both the PMDS and the employees' areas of weakness affecting their performance toward their assigned Key Responsibility Areas. Employees need to be recognised for areas in which they show strength.

Influence of patients' living conditions on tuberculosis treatment outcomes in a South African health sub-district.

BACKGROUND: Tuberculosis (TB) remains a serious public health concern because it continues devastating communities. This survey was conducted in the sub-district 2 of the Tshwane health district, South Africa. It aimed at determining the influence of patients' living conditions on TB treatment outcomes. Human immunodeficiency virus (HIV) status, food security and exposure to cigarette smoke were considered as living conditions; and cure, death, default, failure and relapse were considered TB treatment outcomes. METHODS: Record review using the Aitahealth database, clinic registers as well as a piloted, structured and administered questionnaire. RESULTS: Convenience sampling applied; 180 respondents were obtained. Tuberculosis respondents with negative HIV status had a cure rate of 67.3% whilst those with positive HIV status had 37%. Tuberculosis respondents with good food security had 45.9% of cure rate. Tuberculosis respondents exposed to cigarette smoke had a death rate of 65.2%, while respondents not exposed to cigarette smoke showed 75% of cure rate. CONCLUSION: HIV status, food security and exposure to cigarette smoke, as components of living conditions, showed an association with TB treatment outcomes in the selected sample; in the sense HIV infection reduced the cure rate, increased the death and default rates of TB patients in the same sample. Good food security increased the cure rate of TB patients, but exposure to cigarette smoke decreased the cure rate and increased the death rate amongst respondents having TB treatment in the current survey.

Alcohol use amongst learners in rural high school in South Africa.

BACKGROUND: Drinking behaviour by adolescents is a significant public health challenge nationally and internationally. Alcohol use has serious challenges that continue to deprive adolescents of their normal child growth and development. Drinking is associated with dangers that include fighting, crime, unintentional accidents, unprotected sex, violence and others. AIM: The aim of the study is to investigate drinking patterns, and factors contributing to drinking, amongst secondary school learners in South Africa. METHOD: The sample included 177 male (46.6%) and 206 female (53.4%) respondents in the age range from 15­23 years, selected by stratified random sampling. RESULTS: The results indicated that 35.5% of male and 29.7% of female respondents used alcohol. Both male and female respondents consumed six or more alcohol units (binge drinking) within 30 days; on one occasion the consumption was 17.5% and 15.9% respectively. It was found that alcohol consumption increases with age, 32.2% of 15­17 year-olds and 53.2% of 18­20 year-olds consumed different types of alcohol. It was deduced that 28.9% respondents reported that one of the adults at home drank alcohol regularly, and 9.3% reported that both their parents drank alcohol daily. It was found that 27.6% of the respondents agreed that friends made them conform to drinking. The tenth and eleventh grade reported 15.2% of male and 13.9% of female respondents were aware that alcohol can be addictive. CONCLUSION: This study found that age, gender, parental alcohol use and peer pressure were found to be the major contributing factors to alcohol use amongst learners Prevention campaigns such as introducing the harmful effects of alcohol use amongst learners are of utmost importance in reducing alcohol use amongst learners in South Africa.

Screening and brief interventions for hazardous and harmful alcohol use among hospital outpatients in South Africa: results from a randomized controlled trial.

BACKGROUND: High prevalence rates of hazardous and harmful alcohol use have been found in a hospital outpatient setting in South Africa. Hospital settings are a particularly valuable point of contact for the delivery of brief interventions because of the large access to patient populations each year. With this in mind, the primary purpose of this randomized controlled trial is to provide screening for alcohol misuse and to test the effectiveness of brief interventions in reducing alcohol intake among hospital outpatients in South Africa. METHODS: The study design for this effectiveness study is a randomized controlled trial with 6- and 12-month follow-ups to examine the effects of a brief alcohol intervention to reduce alcohol use by hazardous or harmful drinkers in a hospital setting. Outpatients were screened for alcohol problems, and those identified as hazardous or harmful drinkers were randomized into an experimental or control group. The experimental group received one brief counselling session on alcohol risk reduction, while the control group received a health education leaflet. RESULTS: Of the 1419 screened for alcohol misuse who agreed to participate in the trial 392 (27.6%) screened positive for hazardous or harmful use on the Alcohol Use Disorder Identification Test (AUDIT) (score 7/8-19) and 51 (3.6%) had an AUDIT score of 20 or more. Among the 282 (72%) hospital outpatients who also attended the 12-month follow-up session, the time effects on the AUDIT scores were significant [F (1,195 = 7.72), P < 0.01] but the intervention effect on the AUDIT score was statistically not significant [F (1,194 = 0.06), P < 0.804]. CONCLUSION: Given the lack of difference in outcome between control and intervention group, alcohol screening and the provision of an alcohol health education leaflet may in itself cause reduction in drinking. TRIAL REGISTRATION: PACTR201110000319392.

Screening and brief interventions for hazardous and harmful alcohol use among university students in South Africa: results from a randomized controlled trial.

The aim of this study was to assess the effectiveness of Screening and Brief Intervention (SBI) for alcohol problems among university students in South Africa. The study design for this efficacy study is a randomized controlled trial with 6- and 12-month follow-ups to examine the effects of a brief alcohol intervention to reduce alcohol use by hazardous and harmful drinkers in a university setting. The unit of randomization is the individual university student identified as a hazardous or harmful drinker attending public recruitment venues in a university campus. University students were screened for alcohol problems, and those identified as hazardous or harmful drinkers were randomized into an experimental or control group. The experimental group received one brief counseling session on alcohol risk reduction, while the control group received a health education leaflet. Results indicate that of the 722 screened for alcohol and who agreed to participate in the trial 152 (21.1%) tested positive for the Alcohol Use Disorder Identification Test (AUDIT) (score 8 or more). Among the 147 (96.7%) university students who also attended the 12-month follow-up session, the intervention effect on the AUDIT score was -1.5, which was statistically significant (P = 0.009). Further, the depression scores marginally significantly decreased over time across treatment groups, while other substance use (tobacco and cannabis use), self-rated health status and Posttraumatic Stress Disorder (PTSD) scores did not change over time across treatment groups. The study provides evidence of effective brief intervention by assistant nurses with hazardous and harmful drinkers in a university setting in South Africa. The short duration of the brief intervention makes it a realistic candidate for use in a university setting.

Screening and brief intervention for alcohol problems in Dr George Mukhari Hospital out-patients in Gauteng, South Africa: a single-blinded randomized controlled trial protocol.

BACKGROUND: For alcohol drinkers in South Africa it has been found that annual consumption per drinker is among the highest in the world. High prevalence rates of hazardous and harmful alcohol use have also been found in a hospital out-patient setting in South Africa. Hospital settings are a particularly valuable point of contact for the delivery of brief interventions because of the large access to patient populations each year. With this in mind, the primary purpose of this randomized controlled trial is to provide screening for alcohol misuse and to test the efficacy of brief interventions in reducing alcohol intake among hospital out-patients in South Africa. METHODS/DESIGN: The study design for this efficacy study is a randomised controlled trial with 6- and 12-month follow-ups to examine the effects of a brief alcohol intervention to reduce alcohol use by problem drinkers in a hospital setting. The unit of randomisation is the individual out-patient identified as a medium risk drinker attending Dr George Mukhari Hospital. Out-patients will be screened for alcohol problems, and those identified as medium risk drinkers will be randomized into an experimental or control group. The experimental group will receive one brief counselling session on alcohol risk reduction, while the control group will receive a health education leaflet. DISCUSSION: The trial will evaluate the impact of alcohol screening and brief interventions for patients with alcohol problems in a hospital out-patient setting in South Africa. The findings will impact public health and will enable the health ministry to formulate policy related to brief alcohol interventions, which will result in reduction in alcohol use. TRIAL REGISTRATION: PACTR201110000319392.

Prevalence of alcohol use and associated factors in urban hospital outpatients in South Africa.

The aim of this study was to assess the prevalence of alcohol use and associated factors among outpatients in an urban hospital in South Africa. The sample included 1,532 (56.4% men and women 43.6%) consecutively selected patients from different hospital outpatient departments. Results indicate that 41.2% of men and 18.3% of women were found to be hazardous drinkers, and 3.6% of men and 1.4% of women meet criteria for probable alcohol dependence or harmful drinking as defined by the Alcohol Use Disorder Identification Test (AUDIT). Two in five patients (40.5%) were hazardous or harmful drinkers and/or had anxiety or depression. Logistic multiple regression found that for men tobacco use and not having been diagnosed with diabetes and for women tobacco use and having been diagnosed with migraine headache was associated with hazardous and harmful drinking. Although the study is cross-sectional, it does identify groups that may be at high risk of alcohol misuse and for whom intervention is urgent. Because prevalence of hazardous and harmful alcohol use is high in this population, routine screening should be introduced in hospital out-patient settings.