The acceptability of a donor human milk bank and donated human milk among mothers in Limpopo Province, South Africa.

Breastfeeding is a crucial public health approach that reduces infant morbidity and mortality by providing essential nutrients and antibodies, and breast milk is easily digested. Breastfeeding and donated milk serve as a preventative measure against necrotising enterocolitis. Additionally, they protect against viruses and nosocomial sepsis. When a birthing parent's own milk is unavailable, alternative enteral nutrition for preterm or low-birth-weight infants is either donor human milk (DHM) or artificial formula. This study aimed to understand mothers' acceptance of the donor human milk bank (DHMB) and DHM. A qualitative phenomenological study was conducted in Limpopo Province, South Africa. The study used purposive sampling to select 23 mothers in postnatal and neonatal wards. Data collection was via in-depth interviews using a semistructured interview guide. Manual data analysis using an interpretative phenomenological analysis (IPA) framework was used to coding. Concepts were grouped to generate themes. Three themes and nine subthemes were generated: (1) DHMBs (2) cultural perspective of DHMB, and (3) health considerations of DHM. Participants were unaware of the DHMB. Hesitancy in accepting DHM due to fear of contracting HIV was observed. Cultural beliefs are an influencing factor for use, while donation was driven by altruistic reasons, preventing waste, helping others and having previously benefited from DHM. The study found that mothers are willing to donate human milk. Willingness to donate can be increased by raising awareness about DHMB and addressing culture and safety concerns at antenatal clinics.

Stakeholders' views on the utility and employment strategies of clinical associates.

BACKGROUND: Clinical associates (ClinAs) were introduced into the South African healthcare system to increase the numbers of skilled health professionals. Little is known on how they are viewed. This study explored stakeholder views on the utility and employment strategies of ClinAs in the public sector. METHODS: A mixed-methods design was used. An online survey was used to collect data from operational stakeholders, while online interviews explored strategic stakeholders' views. RESULTS: Forty-five operational stakeholders participated. The view of ClinAs' contribution to the joint management of four common health conditions was strong (91% - 96%). The poorest agreement was their perceived contribution to maternal health (38%). There was a strong agreement (mean = 6.13, s.d.: 0.94) that conditions of ClinAs practice are met. Clinical associates were viewed as being able to work with others (mean = 6.11, s.d.: 0.98) and contribute to service improvement (mean = 6.47, s.d.: 0.62). There was a low agreement regarding the positive impact of recruitment (mean = 2.93, s.d.: 1.99) and retention strategies on ClinAs (mean = 2.75, s.d.: 1.51). The six key strategic stakeholders ascribed the slow progress made in career development, career progression, post creation and professional autonomy to the uncertainty regarding the scope of practice and perceived lack of support. CONCLUSION: The utility of ClinAs to provide health services in the public sector is clear, and their contribution is valued. The lack of progress around many of the human resource issues is a constraint that needs a champion if this cadre is to fully realise their potential.Contribution: Clinical associates are valued at service delivery level, but appear overlooked higher up.

Inter-rater agreement of scores to assess quality of care in public sector primary health care facilities - A pattern of performance.

PURPOSE: To determine if the scores obtained from the Ideal Clinic Assessment Tool (ICAT) used to assess the quality of care in public Primary Health Care facilities in South Africa showed inter-rater agreement between self-assessments, district peer reviews and cross-district peer reviews. The ICAT scores obtained in the three types of reviews were paired as follows: self-assessments/district peer reviews, self-assessment/cross-district peer reviews and district/cross-district peer reviews. The global scores and averages of the Vital elements for the three paired reviews for 587 facilities across the country were compared using Bland-Altman plots. RESULTS: The Bland-Altman plots showed no inter-rater agreement between the global scores and averages of the Vital elements for the facilities in any of the paired reviews (n = 1 761 reviews). Similarly, there was no inter-rater agreement between the global scores of the three paired reviews in any of the nine provinces in the country. CONCLUSION: There is still a need to continue to conduct both district and cross-district reviews despite the substantial cost of doing so. Further studies are required to determine what factors contributed to the disagreement in scores between the different types of reviews despite the preparatory training of reviewers.

The clinical outcomes of patients with diabetes and hypertension in a peri-urban area, Johannesburg, South Africa.

AIM: To describe the clinical outcomes of patients with type 2 diabetes (DM2) and hypertension (HT) who received treatment and care at a specialized primary healthcare facility. METHODS: A cross-sectional study was conducted and data retrieved from 349 patient's records. The clinical outcomes were linked to individual risk factors and demographic profiles. Patients with HT who had at least four blood pressure (BP) measurements and patients with DM2 who had at least two HbA1c measurements in a 12-month period were included. RESULTS: More females had controlled HT than males. There was no sex difference observed for the control of DM2. Patients with HT visited the clinic for a median period of 96 days (IQR 35-257). Among 59.1% (n = 159) patients who achieved at least one controlled BP measurement, 64.2% (n = 102) had a controlled BP at the last visit. Patients with DM2 visited the clinic for a median period of 851 days (IQR 449.5-1254). From a total of 34 patients (43.5%) who achieved at least one controlled HbA1c measurement, 55.9% (n = 19) had a controlled HbA1c at the last visit. CONCLUSION: Despite the difference in patient profiles, more than half of the patients who received specialised DM2 and HT care managed to achieve BP and HbA1c control.

Trends in practice intentions and preferences of clinical associate students: Implications for training and health services in South Africa.

BACKGROUND: The University of Pretoria (UP) had its first intake of Bachelor of Clinical Medical Practice (BCMP) students in 2009. The objectives of this study were to examine the trends in geographical practice intentions and preferences of the first nine cohorts of BCMP students. We also assessed sector and level of care preferences of six BCMP cohorts. METHODS: Cross-sectional studies were conducted 2011, 2014 and 2017. First-, second- and third-year UP BCMP students were invited to complete a electronic questionnaire. Our analyses consisted of calculating proportions for the practice intentions and preferences for each surveys, and performing multiple logistic regression on the aggregated date to determine their associations with sociodemographic and training characteristics. RESULTS: The proportion of participants intending to practise as a clinical associate in a rural area in South Africa directly after graduating was 62.5% in the 2014 survey and 69.7% in the 2017 survey, compared to 59.6% in the 2011 survey. The majority in all three surveys (53.4% in 2011, 56.6% in 2014 and 59.8% in 2017) indicated a preference for rural practice. Both rural practice intention and rural practice preference were found to be significantly associated with respondent's self-description of having lived most of her/his life in a rural area, and rural district hospital exposure during training. In 2014 and 2017, approximately two-thirds of the participants selected a public sector option as their most preferred work setting. District hospitals were the most preferred setting of 30.3% participants in 2014 and 32.0% in 2017. CONCLUSION: Most participants across the three surveys intended to work in rural settings. Considering that this could provide a sustainable solution to the shortage of health care workforce in rural areas, policy makers in both higher education and health need to promote and ensure the viability of the training of this category of health care providers.

The ability of primary healthcare clinics to provide quality diabetes care: An audit.

BACKGROUND: In South Africa, much of diabetes care takes place at primary healthcare (PHC) facilities where screening for diabetic complications is often low. Clinics require access to equipment, resources and a functional health system to do effective screening, but what is unknown is whether these components are in place. AIM: The aim of this study was to assess the capacity of primary care clinics in one district to provide quality diabetes care. SETTING: This study was conducted at the Tshwane district in South Africa. METHODS: An audit was done in 12 PHC clinics. A self-developed audit tool based on national and clinical guidelines was developed and completed using observation and interviewing the clinic manager and pharmacist or pharmacy assistant. RESULTS: Scales, height rods, glucometers and blood pressure machines were available. Monofilaments were unknown and calibration of equipment was rare. The Essential Drug List was the only guideline consistently available. All sites reported consistent access to medication, glucose strips and urine dipsticks. All sites made use of the chronic disease register, and only 25% used an appointment system. No diabetes-specific structured care form was in use. All facilities had registered and enrolled nurses and access to doctors. Availability of educational material was generally poor. CONCLUSION: The capacity to deliver quality care is compromised by the poor availability of guidelines, educational material and the absence of monofilaments. These are modifiable risk factors that could be resolved by the clinic managers and staff development educators. However, patient records and health information systems need attention at policy level.

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.

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.

Household conditions, eczema symptoms and rhinitis symptoms: relationship with wheeze and severe wheeze in children living in the Polokwane area, South Africa.

BACKGROUND: This is the fifth study that applied the International Study of Asthma and Allergies in Childhood (ISAAC) methodology in the Southern African Development Community (SADC region). However, it is the first ISAAC study that focused on 6- to 7-year-old children living in South Africa and that also investigated the association between potential risk factors and asthma symptoms. Objective To assess the 12-month prevalence of wheeze and severe wheeze along with their potential risk factors. Setting Within a 60-km radius from the Polokwane city centre, Limpopo Province. METHODS: The survey was conducted during August 2004 and February 2005. Parents/guardians of 6- to 7-year-old children completed the questionnaires in English, Afrikaans or North-Sotho. However, the statistical analyses were restricted to the North-Sotho group (n = 2,437). RESULTS: The 12-month prevalence rates of wheeze and severe wheeze were 11.2% and 5.7%, respectively. The 12-month prevalence rates of eczema symptoms and rhinoconjunctivitis symptoms were 8.0% and 7.3%, respectively. Living in a rural area significantly decreased the likelihood of wheeze by 31%. Exposure to environmental tobacco smoke at home and the presence of eczema symptoms and rhinoconjunctivitis symptoms increased the likelihood of wheeze by 77%, 104% and 226%, respectively. Only the presence of rhinoconjunctivitis symptoms increased the likelihood of severe wheeze by 107%. CONCLUSION: Wheeze appears to be an emerging public health problem in the Polokwane area. Hopefully, detailed analytical intervention studies will further explicate these results in the near future.

Association between children's household living conditions and eczema in the Polokwane area, South Africa.

The aim of the study was to determine the 12-month prevalence of eczema symptoms (ES), the prevalence of ever having had eczema (EE), and potential risk factors among 6-7-year-old children within a 60km radius of Polokwane city centre, Limpopo Province, South Africa. This study applied the International Study of Asthma and Allergies in Childhood (ISAAC) Phase III protocol. It was conducted during August 2004 (winter) and February 2005 (summer). Among the 2437 participants, the 12-month prevalence of ES (17%) was much lower than the prevalence of EE (38%). The multivariate logistic regression model revealed that the likelihood of having ES was significantly increased by 43% in rural areas, and by 54% when exposed to environmental tobacco smoke (ETS) at home. The model also revealed that the likelihood of EE significantly increased with ETS exposure at home (37%), and by the use of coal, paraffin, gas and/or electricity for cooking (28%). Living in a formal house significantly decreased the likelihood of EE by 23%. Eczema appears to be a substantial public health problem in the Polokwane area. It is hoped that future studies will scrutinize these results in more detail, to inform and influence policy decisions, and form a basis for a health-promotion intervention in the community.

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 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.

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.