Browsing by Author "Jinabhai, Champaklal Chhaganlal."

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Adapting the WHO Health Promoting Hospitals strategy for South African hospitals : an evaluation.
(2008) Geddes, Rosemary Veronica.; Jinabhai, Champaklal Chhaganlal.; Knight, Stephen Eric.
Objective To conduct an evaluation of the pilot implementation of the World Health Organization Health Promoting Hospitals initiative and its self-assessment tool in public hospitals in KwaZulu-Natal in 2004/2005 Study design This evaluation utilised a cross-sectional design that incorporated both qualitative and quantitative research methods. Main measures Throughout the Health Promoting Hospital pilot project the opinions and responses of those with a legitimate interest in the initiative were monitored. Data collection methods utilised in this evaluation included participant observation, the World Health Organisation metaevaluation questionnaire, records of workshops and feedback meetings and secondary analysis of all data collected by the six pilot hospitals during the implementation of the project in KwaZulu-Natal. Results Major constraints were found to be time, human and financial resources, lack of training and expertise and insufficient support for the project. The self-assessment tool was found to be insufficiently adapted and not all outcomes were found to be reliable and useful. Despite this, institutional staff found the Health Promoting Hospital project to be capacity building and morale boosting. Relationships between health service levels improved. All hospitals who participated recommended that other hospitals become Health Promoting Hospitals. Conclusion If the World Health Organisation Health Promoting Hospital initiative with its selfassessment tool is to be rolled out to the rest of KwaZulu-Natal province, then substantial changes have to be made to the process. Amongst these are: further adaptation of the selfassessment tool, improved methods of data collection, provision of sufficient resources and increased and sustained provincial support for the project. In addition it is imperative that outcome and impact evaluations be done.
Adherence-monitoring practices by private healthcare sector doctors managing HIV and AIDS patients in the eThekwini metro of KwaZulu-Natal.
(MedPharm, 2009) Naidoo, Panjasaram.; Taylor, Myra.; Jinabhai, Champaklal Chhaganlal.
Background: The danger of poor adherence to treatment by patients with HIV infection is that poor adherence correlates with clinical and virological failure. Understanding how private-sector doctors monitor adherence by their HIV-infected patients could assist in developing interventions to improve adherence by these patients. Information about such practices amongst private-sector doctors in the province of KwaZulu-Natal, however, is limited. This study was, therefore, undertaken to assess the private-sector doctor adherence-monitoring practices of HIV-infected patients in the eThekwini metro of KwaZulu-Natal. Methods: A descriptive cross-sectional study was undertaken amongst private general practitioners (GPs) and specialists managing HIV/AIDS patients in the eThekwini metro. Anonymous semi-structured questionnaires were used to investigate adherence-monitoring practices by these doctors and their strategies to improve adherence. Results: A total of 171 doctors responded, with over 75% in practice for over 11 years and 78.9% indicating that they monitored adherence. A comparison between the GPs and the specialists found that 82.6% of the GPs monitored adherence compared with 63.6% of the specialists (p = 0.016). The doctors used several approaches, with 60.6% reporting the use of patient self-reports and 18.3% reporting the use of pill counts. A total of 68.7% of the doctors indicated that their adherence monitoring was reliable, whilst 19.7% indicated that they did not test the reliability of their monitoring tools. The most common strategy used to improve adherence by their patients was through counselling. Other strategies included alarm clocks, SMSs, telephone calls to the patients, the encouragement of family support and the use of medical aid programmes. Conclusions: Private-sector doctors managing HIV/AIDS patients in the eThekwini metro of KwaZulu-Natal do monitor adherence and employ strategies to improve adherence.
An analysis of health inspection as a component of school health service, in Kwazulu-Natal.
(2000) Memela, Daphne Thembile.; Jinabhai, Champaklal Chhaganlal.
Introduction In 1996 there were 1,847,440 pupils in 4007 primary schools in KwaZulu-Natal (KZN) who were targeted for school Health Inspection (HI). In the same year there were only 95 school health teams who were visiting schools for HI. The School Health Service (SHS) had been running on a racial basis since the Apartheid era of government, and needed to be reviewed in order to measure its effectiveness and to make it relevant to the new government and its new health policies. Purpose To review HI as a key component of School Health Services (SHS) and make recommendations to improve it's impact on the health of the school child and on health promotion in schools. Objectives To describe the structure, process, output and outcome of HI in KZN; to measure the impact of HI on the health of school children; and to calculate the SHS consultation cost and compare it with other primary health care services. Methodology A cross sectional study involving 21 schools covered by the SHS and 5 schools not covered by SHS was undertaken. The study area was KZN and the sample area was Indlovu region. All health authorities and racial groups participated in the study. Results A total of 212 children and 129 parents were interviewed. Of the children interviewed, 156 pupils (73.5%) had been involved in HI and 56 (26%) had not. The average nurse/pupil ratio was 1:49301. HI coverage was 62%. Of the 156 pupils examined, 108 were referred and 53% of them went for treatment. 93 % of parents interviewed gave a positive comment on HI and 24.8 % of them did not know their children's problems before they were informed by the SHN. Std. 5 pupils interviewed before and after HI were compared and it was found that 57% from the after-HI group went for treatment for their health problems compared to 53% before HI. Subjective feelings improved from 15% pain before HI to 0% after HI. Conclusion HI had a positive influence on encouraging pupils to seek recommended treatment and this is likely to improve their health.
Caesarean section rates at the Standerton Hospital, 2004-2007.
(2011) Dlamini, Sibongile Margaret.; Jinabhai, Champaklal Chhaganlal.
Introduction Increased use of caesarean section (CS) as a mode of delivery is of concern for maternal and child health in many countries. The World Health Organization (WHO) has set guideline of population caesarean section rate between 5% - 15% for CS deliveries. Accordingly the South African National Department of Health (NDOH) has set a national target for district hospitals, that no more than 10% of all deliveries should be by CS. Standerton District Hospital experienced a sudden increase in the caesarean section rate (CSR), from 17.5% in 2004 to 30.8% in 2007. The reasons for this increase are not known. Purpose of the study This study aims to investigate factors which contributed to the sudden increase of CSR from 17.5% in 2004 to 30.8% in 2007 at Standerton District Hospital, Gert Sibande District Mpumalanga. Method A retrospective record review of 790 women who delivered at Standerton District Hospital by caesarean section from January 2004 to December 2007 was done. Fifty percent of the total number of records for each year was retrieved and to achieve this every second record was selected from the maternity and theatre registers for patients who have undergone CS. Systematic sampling selection of records of all women who have undergone CS was conducted during the identified period. Data on patient demographics, the reasons for the CS, the maternal and neonatal outcomes achieved, antenatal care profile, the employment status and the responsible medical practitioner were extracted from existing records maintained by the hospital. Analysis ascertained factors associated with increased CSR. Results The Caesarean section rate at Standerton District Hospital has increased annually since 2004. The factors contributed to the increase include medical indications, clients who are primigravida and the less experienced community service doctors who performed the CS. There was no evidence that education, high income clients, or maternal request contributed to the increase of Caesarean Section rate (CSR). The outcome of mother and baby were positive except for 1% of babies who were not alive. Robson’s group classification (classification system which defines 10 groups of women according to obstetric record, category of pregnancy, the presence of previous uterine scar, the course of labour, delivery and gestational age), revealed that groups two and four played a major role. Conclusion CSR has increased over the years and strategies needs to be developed to reduce this by having experienced doctors supervising community service doctors, training of professionals working in maternity and monitoring of labour by midwives. Recommendation Standerton District Hospital management should intensify recruitment and retention of experienced medical officers, train additional midwives on advanced courses, intensify ante natal care, establish a high risk clinic at the hospital, review hospital policies on maternal care and monitoring of compliance to mother and baby’s national and provincial policies.
Developing a provincial epidemiologic and demographic information system for health policy and planning in Kwazulu-Natal.
(2000) Buso, D. L.; Jinabhai, Champaklal Chhaganlal.; Naidoo, Kogieleum.
Since 1994, a turning point in the history of South Africa (SA), significant changes were made in the delivery of health services by the public sector, provincially and nationally. The process of change involved making important decisions about health services provision, often based on past experience but ideally requiring detailed information on health status and health services. For an example, Primary Health Care (PHC) was made freely accessible to all citizens of this country. Many studies on the impact of free PHC in the country have shown increased utilization of these services.40 In the context of HIV/AIDS and its complications and other emerging health conditions, reasons for this increased utilization may not be that simple. I17, II8. Parallel with increased utilisatIon has been uncontrollable escalation of costs in the Department of Health (DoH), often resulting in ad-hoc and ineffective measures of cost-containment.40. For these and many other reasons of critical importance to public health services management, the issue of health information generally, and epidemiological inforn1ation in particular, should be brought higher on the agenda of health management. Public health services management is about planning, organization, leading, monitoring and control of the same services.2 Any public health plan must have a scientific basis. In order to achieve rational planning of public health services in the province, adequate, up to date, accurate information must be available, as a planning tool. Health information is one of key resources and an essential element in health services management. It is a powerful tool by which to assess health needs, to measure health status of the population and most importantly, to decide how resources should be deployed.5 Trends in the health status of the population are suggested by the White Paper for transforn1ation of Health Services (White Paper), to be important indicators of the success of the Reconstruction and Development Programme (RDP), the country's programme of transformation. 37,39 It is within that context that the KwaZulu-Natal-Department of Health (KZN-DoH) resolved to establish an Epidemiology/Demographic Unit for the province, to assist management to achieve the department's objectives of providing equitable, effective, efficient and comprehensive health services. 37,89 Purpose: To develop a provincial Epidemiological-Demographic Inforn1ation System (EDIS) that will consistently inforn1 and support rational and realistic management decisions based on accurate, timely, current and comprehensive infom1ation, moving the DoH towards evidence based policy and planning. Objectives: To provide an ED IS framework to : .develop provincial health policy .assist management with health services planning and decision-making .ensure central co-ordination of health information in order to support delivery of services at all levels of the health system . . monitor implementation and evaluation of health programmes . ensure utilization of information at the point of collection, for local planning and interventlon. Methods: A rapid appraisal of the existing Health Information System (HIS) in the province was conducted from the sub-departments of the DoH and randomly selected institutions. A cross-sectional study involving retrospective review of records from selected hospitals, clinics and other sources, was conducted. The study period was the period between January 1998 to December 1998. Capacity at district and regional levels on managing health information and epidemiological information in particular, was reviewed and established through training progranmles. Results: The rapid appraisal of existing HIS in the province revealed a relatively electronically well resourced sub-department of Informatics within the KZN-DoH, with a potential to provide quality and timely data. However, a lot of data was collected from both clinics and hospitals but not analyzed nor utilized. Some critical data was captured and analyzed nationally. There was lack of clarity between the Informatics Department staff responsible for collecting and processing provincial data and top management with regards each other's needs. Demographics: The demographic composition and distribution profile of the KZN population showed features of a third world country for Blacks with the White population displaying contrasting first world characteristics. Socio-Economic Profile: The majority of the population was unemployed, poor, illiterate, economically inactive, and earning very low income. The water supply, housing and toilet facilities seemed adequate, but in the absence of data on urban/rural distinction, this finding needs to be interpreted with caution Epidemiology: All basic indicators of socio-economic status (infant, child, neonatal mortality rates) were high and this province had the second poorest of the same indicators in the country. Adult and child morbidity and mortality profiles of the province, both at clinics and district hospitals were mainly from preventable conditions. Indicators on women and maternal health were consistent with the socio-economic status of this province; and maternal mortality rate was high with causes of mortality that were mainly preventable. The issue of HIV / AIDS complications remains unquantifiable with the limited data available. HIV is a serious epidemic in KZN and this province continues to lead all the provinces in the country, a prevalence of 32 % in 1999.86 Health Services Provision: Inmmnization coverage was almost 50% below the national target and drop out rate was very high. Termlinations of Pregnancies (TOP) occurred mainly among adult, single women, and the procedure done within the first trimester and requested for social and economic reasons. Provincial clinics (mainly fixed) and hospitals provide family planning and Ante Natal Care (ANC) services to the majority of pregnant women in the province. Conclusion : KZN is a poor province with an epidemiological profile of a country in transition but predominantly preventable health conditions. The province has a potential for producing high quality health information required for management, planning and decision making. It is recommended that management redirects resources towards improving PHC services. Establishment of an Epidemiology Unit would facilitate the DoH's health services reforms, through provision of comprehensive, accurate, timely and relevant health information .
Epidemiological and clinical status of South African primary school children : investing in the future.
(2001) Jinabhai, Champaklal Chhaganlal.; Coovadia, Hoosen Mahomed.
The physical, psychological and social development of school children has been neglected - partly because they were seen as healthy "survivors" of the ravages of childhood illnesses, and partly because of the way in which health services are organized (such as the traditional under-five maternal and child health (MCH) services and the curative PHC clinic services). From the age of five years children undergo rapid and profound bio-psycho-social development, to emerge in adolescence as the next generation of leaders and workers. Securing their future growth and development is vital for any society to be economically and socially productive. A substantial body of national and intemational literature has recognised the detrimental impact of helminthic infections and micronutrient deficiencies on the physical and psychological health and development of school children; which requires appropriate nutritional interventions. Concern has been expressed that these adverse biological, physical and social deprivations have a cumulative impact on several dimensions of children's growth. Most important, apart from stunting physical growth, is the inhibition of educational development of school children. Recent evidence strongly suggests a powerful interaction between physical and psychosocial growth and development of children. Inhibition of either component of a child's well-being has adverse implications. Conversely, investments in the physical and psychological development of children are likely to generate substantial health and educational benefits and are a worthy investment to secure a healthy future generation. In summary, there are a number of reasons for, and benefits of, investing in school-based health and nutrition interventions. They are likely to improve learning at school and enhance educational outcomes; create new opportunities to meet unfulfilled needs; redress inequity; build on investments in early child development and promote and protect youth and adolescent development. Health and nutrition interventions such as school feeding programmes, micronutrient supplementation and deworming aim to improve primary outcomes of macro and micro-nutrient deficiencies, parasitic and cognitive status; as well as secondary outcomes of developing integrated comprehensive school health policies and programmes. This rationale served as the conceptual framework for this study. This theoretical framework views improvements of the health, nutritional, cognitive and scholastic development status of school children as the primary focus of policies, strategies and programmes in the health and education sector. This focus constitutes the central core of this thesis. Optimum social development requires investments in both the health and educational development of school children, so as to maximise the synergies inherent in each sector and to operationalise national and international strategies and programmes. As part of the larger RCT study a comprehensive nutritional, health and psychological profile of rural school children was established through a community-based cross-sectional study. Eleven schools were randomly selected from the Vulamehlo Magisterial District in southern KwaZulu-Natal (KZN). Within each school, all Standard 1 pupils, aged between 8 - 10 years, were selected giving a final study sample of 579 children. Some of the observed prevalence's were stunting (7.3%), wasting (0.7%), anaemia (16.5%) (as measured by haemoglobin below 12 g/dl), vitamin A deficiency (34.7%) (as measured by serum retinol below 20 ug/dl) and serum ferritin below 12ng/ml (28.1%). This study established that micronutrient deficiency, parasitic infestations and stunting remain significant public health problems among school-aged children in South Africa. Combining micronutrient supplementation and deworming are likely to produce significant health and educational gains. To determine the impact of single and combined interventions (anthelminthic treatment and micronutrient supplements) on nutritional status and scholastic and cognitive performance of school children, a double-blind randomised placebo controlled trial was undertaken among 579 children 8-10 years of age. There was a significant treatment effect of vitamin A on serum retinol (P<0.01), and the suggestion of an additive effect between vitamin A fortification and deworming. Vitamin A and iron fortification also produced a significant treatment effect on transferrin saturation (P<0.05). Among the dewormed group, anthelminthic treatment produced a significant decrease in the prevalence of helminthic infections (P<0.02), but with no significant between-group treatment effect (P>0.40). Scholastic and cognitive scores and anthropometric indicators were no different among the treated or the untreated children. Fortified biscuits improved micronutrient status among rural primary school children; vitamin A combined with deworming had a greater impact on micronutrient status than vitamin A fortification on its own; while anthelminthic treatment produced a significant reduction in the overall prevalence of parasite infection. The prevalence's of Ascaris lumbricoides, Trichuris trichiura and Schistosoma haematobium declined significantly sixteen weeks post-treatment. The levels of both prevalence and intensity in the untreated group remained constant. The cure rates over the first two weeks of the study were 94.4% for Ascaris lumbricoides, 40% for Trichuris trichiura, and 72.2% for Schistosoma haematobium. The benefits of targeted school-based treatment in reducing the prevalence and intensity of infection supports the South African government's focus of using school-based interventions as part of an integrated parasite control programme. These strategies and programmes were found to be consistent with the recommendations of WHO and UNICEF. The nutritional transition facing developing and middle-income countries also has important implications for preventive strategies to control chronic degenerative diseases (Popkin B, 1994; WHO 1998; Monyeki KO, 1999). This descriptive study, comparing BMI data of school children over three time periods, found a rising prevalence of overweight and obesity among South African school children. Obesity as a public health problem requires to be addressed from a population or community perspective for its prevention and management. Environmental risk factors such as exposure to atmospheric pollution remain significant hazards for children. Lead poisoning is a significant, preventable risk factor affecting cognitive and scholastic development among children. The prevalence of elevated blood lead (PbB) levels in rural and semi-urban areas of KwaZulu-Natal (KZN) as well as the risk factors for elevation of PbB among children in informal settlements were examined. This study investigated over 1200 rural and urban children in two age groups: 3-5 and 8-10 years old. Average PbB level in peri-urban Besters, an informal settlement in the Durban metropolitan region, was 10 ug/dl with 5% of the children showing PbB level of greater than 25 ug/dl. By comparison, average PbB value in Vulamehlo, a rural area located 90-120 km from Durban, was 3.8 ug/dl and 2% of the children's PbB levels were greater than 10 ug/dl. Since the cognitive and scholastic performance of school children was a primary outcome measure in this study, it was important to explore other factors that influenced this variable. The performance scores of all four tests in the battery, among the cohort of a thousand rural and urban children, were in the lower range. The educational deficit identified in this test battery clearly indicates the impact of the inferior "Bantu" educational system that African children have experienced in South Africa. Aspects of the School Health Services that were investigated in this descriptive study included the services provided and their distribution; assessment of health inspection; health education and referral processes undertaken by the School Health Teams; perceptions of managers, providers and recipients of the service; as well as the costs of the provision of the service in KwaZulu-Natal. In KwaZulu-Natal, there were School Health Teams In all the 8 health and education regions in the province. In total, there were 95 teams in the province, consisting of nearly 300 staff members. The School Health Teams were involved in a wide range of activities - 74% of all teams were involved in health inspection and 80% were involved in health education. The total annual cost of delivering School Health Services in the province in 1995 was estimated to be approximately R8 750 000. Given the rise of HIV and AIDS in the province, School Health Services need to play a central role not only in prevention, but also in assisting with the acceptance of HIV-positive children within schools. It is recommended that the current and future draft SHS policy guidelines be approved by the relevant authorities for immediate implementation. Districts should consider developing "Health Promoting Schools", with School Health Teams being a central resource. This thesis has explored several aspects of the epidemiological profile of school children in rural and urban settings in KwaZulu-Natal. It has established that school children are exposed to a range of risk factors ranging from nutritional deficits, parasitic infections, atmospheric lead poisoning and a rising prevalence of overweight. All of these risk factors may compromise their physical, psychological and social development. A number of health interventions have been identified, which have the potential to address these problems. Such investments are essential to secure the health of future generations.
Evaluation of the clinical and drug management of HIV/AIDS patients in the private health care sector of the eThekwini Metro of KwaZulu-Natal : sharing models and lessons for application in the public health care sector.
(2010) Naidoo, Panjasaram.; Jinabhai, Champaklal Chhaganlal.; Taylor, Myra.
Introduction: South Africa is currently experiencing one of the most severe AIDS epidemics in the world with South Africa‘s public sector under great stress and under-resourced whilst there exists a vibrant private healthcare sector. Private healthcare sector doctors have a pivotal role to play in the management of HIV and AIDS infection. However not much is known about the extent of private healthcare sector doctor involvement in the management of HIV and AIDS patients. In addition these doctors need to have an accurate knowledge of the management of the infection, and a positive attitude towards the treatment of persons with HIV and AIDS. With the availability of antiretroviral drugs only since around 1996, many of the doctors who were trained prior to 1996 would not have received any formal training in the management of HIV and AIDS patients, further it is very important that these doctors constantly update their knowledge and obtain information in order to practise high-quality medicine. Although private sector doctors are the backbone of treatment service in many countries, caring for patients with HIV brings a whole new set of challenges and difficulties. The few studies done on the quality of care of HIV patients, in the private sector in developing countries, have highlighted some problems with management thus it becomes important to ascertain these doctors‘ training needs together with where these doctors source information on HIV/AIDS to stay updated. In South Africa two thirds of the doctors work in the private sector. To address some of the resource and personnel shortages facing the public sector in South Africa, partnerships between the public and private sectors are slowly being forged. However, little is known about the willingness on the part of private sector doctors in the eThekwini Metro of KwaZulu-Natal, to manage public sector HIV and AIDS patients. Though many studies have been undertaken on HIV/AIDS, fewer have been done in the private sector in terms of the management of this disease which includes doctors‘ adherence monitoring practices, their training needs and sources of information and their willingness to manage public sector patients. A study was therefore undertaken to assess the involvement of private sector doctors in the management of HIV, their training needs and sources of HIV information, the quality of HIV clinical management that they provided, together with their strategies for improving adherence in patients. Further the study assessed factors that affect adherence in patients attending private healthcare, and finally investigated whether private sector doctors are willing to manage public sector HIV infected patients. A literature review of the barriers that prevent doctors from managing HIV/AIDS patients was also undertaken. Method: A descriptive cross sectional study was undertaken using structured self reported questionnaires. All private sector doctors practising in the eThekwini Metro were included in the study. The study was divided into different phases. After exclusions a valid sample of 931 participants was obtained in Phase 1. However only 235 of these doctors indicated that they managed HIV infected patients, of which only 190 consented to be part of Phase 2 of the study. In Phase 2 the questionnaires were administered by trained field workers to the doctors after confirming doctors‘ consent. The questionnaires were thereafter collected, the data captured and analysed using SP55 version 15. Results: Although 235 (71.6%) doctors managed HIV and AIDS patients, 93 (28.4%) doctors did not, and of the latter 48 (51.61%) had not encountered HIV and AIDS patients, twenty five (26.88%) referred such patients to specialists, six (6.45%) cited cost factors as reasons for not treating such patients, whilst twelve (12.90%) doctors, though they indicated that there were other reasons for not managing HIV infected patients, did not specify their reasons. Two doctors (2.15%) indicated that due to inadequate knowledge they did not manage HIV and AIDS patients. Significantly younger (recently qualified) doctors rather than older (qualified for more years) doctors treated HIV/AIDS patients (p<0.001). Most doctors (76.3%) expressed a need for more training/knowledge on the management of HIV patients. Eighty five doctors (54.5%) always measured the CD4 count and viral load levels at diagnosis. Both CD4 counts and viral load were always used by 76 doctors (61.8%) to initiate therapy. Of the doctors 134 (78.5%) initiated therapy at CD4 count < 200cells/mm3. The majority of doctors prescribed triple therapy regimens using the 2 NRTI +1 NNRTI combination. Doctors who used CD4 counts tended to also use viral load (VL) to assess effectiveness and change therapy (p<0.001). At initiation of treatment 68.5% of the doctors saw their patients monthly and 64.3% saw them 3-6 monthly when stable. The majority of the doctors (92.4%) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME), textbooks, pharmaceutical representatives, workshops, colleagues and conferences were identified as other sources of information, while only 35.7% of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9% versus 72.7%; p < 0.05) and conferences (48.6% versus 78.8%; p < 0.05) as sources of HIV information. Of the respondents, 78.9% indicated that they monitor for adherence. Comparison of GPs and specialists found that 82.6% of the GPs monitor for adherence compared to 63.6% of the specialists. (p=0.016). Doctors used several approaches with 60.6% reporting the use of patient self reports and 18.3% pill counts. Doctors (68.7%) indicated that their adherence monitoring is reliable, whilst 19.7% stated they did not test the reliability of their monitoring tool. The most common strategy used to improve adherence of their patients was by counseling. Other strategies included alarm clocks, SMS, telephoning the patient, encouraging family support and the use of medical aid programmes. One hundred and thirty three (77.8%) doctors were willing to manage public sector HIV and AIDS patients, with 105 (78.9%) reporting adequate knowledge, 99 (74.4%) adequate time, and 83 (62.4%) adequate infrastructure. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. Another reason cited by five doctors (3.8%) who were unwilling was the distance from public sector facilities. Of the 33 specialist doctors, 14 (42.4%) indicated that they would not be willing to manage public sector HIV and AIDS patients, compared with only 24 (17.4%) of the 138 GPs (p < 0.01). There was no statistical difference between adherence to treatment and demographics of the respondent patient such as age, gender and marital status. In this study 89.1% of patients were classified as non-adherent and reasons for non-adherence included difficulty in swallowing medicines (67.3%) (p = 0.01); side effects (61.8%) (p = 0.03); forgetting to take medication (58.2%) (p = 0.003); and not wanting to reveal their HIV status (41.8%) (p = 0.03). Common side effects experienced were nausea, dizziness, insomnia, tiredness or weakness. Reasons for taking their medicines included that tablets would save their lives (83.6%); they understood how to take the medication (81.8%); tablets would help them feel better (80.0%); and that they were educated about their illness (78.2%). All participants that were on a regimen that comprised protease inhibitors and two NRTIs were found to be non-adherent. Conclusion: All doctors in the private healthcare sector were not involved in the management of HIV/AIDS patients. Doctors indicated that they required more training in the management of HIV/AIDS patients. However private sector doctors in the eThekwini Metro do obtain information on HIV from reliable sources in order to have up-to-date knowledge on the management of HIV-infected patients, with the majority of private sector doctors being compliant with the current guidelines, hence maintaining an acceptable quality of clinical health care. These doctors do monitor for adherence and employ strategies to improve adherence in their patients who do have problems adhering to their treatment due to various factors. Many private sector doctors are willing to manage public sector HIV and AIDS patients in the eThekwini Metro, potentially removing some of the current burden on the public health sector.
Evaluation of the clinical management of HIV-infected patients by private sector doctors in the eThekwini Metro, KwaZulu-Natal.
(MedPharm, 2009) Naidoo, Panjasaram.; Esterhuizen, Tonya.; Jinabhai, Champaklal Chhaganlal.; Taylor, Myra.
Background: Although private sector doctors are the backbone of treatment service in many countries, caring for patients with HIV entails a whole new set of challenges and difficulties. The few studies done on the quality of care of HIV patients, in the private sector in developing countries, have highlighted some problems with management. In South Africa, two-thirds of doctors work in the private sector. Though many studies on HIV/AIDS have been undertaken, few have been done in the private sector in terms of the management of this disease. Therefore, a study was undertaken to evaluate the clinical management of HIV-infected patients by private sector doctors. Methods: A descriptive cross-sectional study was undertaken in the eThekwini Metro in KwaZulu-Natal, South Africa, with 190 private sector doctors who, in the first phase of the study, indicated that they manage HIV and AIDS patients and would be willing to participate in the second phase of the study. The HIV guidelines of the Department of Health and Human Services and the South African National Department of Health were used to compare the treatment of HIV patients by these doctors. Results: Eighty-five doctors (54.5%) always measured the CD4 count and viral load levels at diagnosis. Both CD4 counts and viral load were always used by 76 doctors (61.8%) to initiate therapy. Of the doctors, 134 (78.5%) initiated therapy at CD4 count < 200 cells/mm3. The majority of doctors prescribed triple therapy regimens using the 2 NRTI + 1 NNRTI combination. Doctors who utilised CD4 counts tended to also use viral load (VL) to assess effectiveness and change therapy (p < 0.001). At initiation of treatment, 68.5% of the doctors saw their patients monthly and 64.3% saw them every three to six months, when stable. Conclusion: The majority of private sector doctors were compliant with current guidelines for HIV management, hence maintaining an acceptable quality of clinical healthcare.
An evaluation of the implementation and capacity of hospital boards at district hospitals in KwaZulu-Natal in 2008.
(2009) Human, Hans Jacob.; Jinabhai, Champaklal Chhaganlal.
Introduction Hospital boards are vital structures that represent the needs and aspirations, of the community that hospitals serve. Aim This study aims to determine whether district-level hospital boards in KwaZulu-Natal (KZN) are equipped to support hospital management in the effective and efficient delivery of hospital services. Methods A quantitative, descriptive and cross-sectional health systems research study has been used. Thirty-two (32) of the thirty five (35) district hospitals in KZN participated in the study. Nineteen (19) chairpersons of hospital boards (CHB) and twenty-four (24) chief executive officers (CEO’s) were telephonically interviewed using a structured but open-ended questionnaire. Ordinary board members at eleven district hospitals were interviewed over a period of four (4) months using an interview schedule. Minutes of fifty-eight (58) board meetings were scrutinised to establish what items were discussed at board meetings and how matters were dealt with. Hospitals were excluded from the study after five (5) failed attempts to involve them in the study. Results Hospital boards in KwaZulu-Natal (KZN) are interim structures. The role and responsibilities of hospital board members are unclear and their supervision is inadequate. Their commitment and ability to function is limited and they are not representative of the community that they serve. There is a lack of clarity as to the real purpose of hospital boards. Training, orientation and induction of new members are weak. There was little evidence about how boards provide feedback to the community and health users. Conclusion Hospital boards will function adequately once legislative regulations have been passed, clear policies finalised and appointed board members are adequately trained and capacitated. Recommendation The KZN Department of Health should promulgate legislation that will govern hospital boards, appoint permanent hospital boards, develop policies and training manuals and capacitate board members on an on-going basis.
An HIV/AIDS prevention intervention among high school learners in South Africa.
(2008) Frank, Serena V.; Taylor, Myra.; Jinabhai, Champaklal Chhaganlal.
Introduction Nearly half of all new HIV infections worldwide occur in young people aged 15-24 years. Risky sexual behaviours may lead to the development of lifelong negative habits like having multiple partners, thereby placing young people at risk of a broad range of health problems, including HIV/AIDS. Prevention is therefore critical and includes changing behaviours that are risky, such as the early age of sexual initiation, having many sexual partners and non-use of condoms. The study aimed to evaluate whether a theory based HIV/AIDS intervention, 'Be A Responsible Teenager' (B.A.R.T.), could produce behaviour change among high school learners in South Africa. Methods A pre-test /multiple post-test intervention study was undertaken. All Grade 10 learners (n = 805) from all three public high schools in Wentworth were included in the study. Eleven teachers were interviewed from these schools. Learners completed a questionnaire at baseline (Tl), immediately post intervention 1 (T2), post intervention 2 (T3) and after a period of seven months (T4). The B.A.R.T.intervention was implemented in the intervention schools while the control group did not receive any intervention. Qualitative data was analyzed according to themes, while quantitative data was analyzed cross sectionally and longitudinally. Results Teachers reported many obstacles in implementing the HIV/AIDS Life Skills' curriculum, including the poor quality of training and inadequate resources in schools. Further, learners practised high-risk sexual behaviours. Gender differences in sexual behaviour were reported with males predominately practising higher risk behaviours than females.The B.A.R.T. intervention did show changes in behaviour for alcohol use at last sex and for the determinants knowledge, attitudes, beliefs, self-efficacy and intentions to practise safer sex respectively, over time. However, the intervention didnot positively impact abstinence behaviours, condom use and the reduction in partners. Further, subjective norms did not change. Conclusion The major obstacles to AIDS prevention include the current practices of risky sexual behaviours including age mixing, early sexual initiation, multiple partners, forced sex and receiving money or gifts for sex among others. Social norms as potrayed by parents, peers and religious groups play a pivotal role in promoting protective sexual behaviours. The role of gender and the gaps in LHAP (Life Skills' HIV/AIDS programme) also require urgent attention.
Identification of sources from which doctors in the private sector obtain information on HIV and AIDS.
(MedPharm, 2009) Naidoo, Panjasaram.; Jinabhai, Champaklal Chhaganlal.; Taylor, Myra.
Background: Doctors need to constantly update their knowledge and obtain information in order to practise high-quality medicine. Antiretroviral drugs have been available only since around 1996, therefore many of the doctors who were trained prior to 1996 would not have received any formal training in the management of HIV and AIDS patients. Where doctors source their general medical knowledge has been established, but little is known about where doctors source information on HIV/AIDS. This study investigated where private sector doctors from the eThekwini Metro obtain information on HIV and AIDS for patient management. Methods: A descriptive cross-sectional study among 133 private general practitioners (GPs) and 33 specialist doctors in the eThekwini Metro of KwaZulu-Natal, South Africa, was conducted with the use of questionnaires. The questionnaires were analysed using SPSS version 15. A p value of < 0.05 was considered statistically significant. Results: The majority of the doctors (92.4%) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME), textbooks, pharmaceutical representatives, workshops, colleagues and conferences were identified as other sources of information, while only 35.7% of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9% versus 72.7%; p < 0.05) and conferences (48.6% versus 78.8%; p < 0.05) as sources of HIV information. More than 90% of doctors reported that CME courses contributed to better management of HIV and AIDS patients. Conclusion: Private sector doctors in the eThekwini Metro obtain information on HIV from reliable sources in order to have up-to-date knowledge on the management of HIV-infected patients.
The impact of Laduma, a health education intervention, on the knowledge, attitudes, beliefs, and practices regarding sexually transmitted infections among secondary school learners in KwaZulu-Natal.
(2005) Shamagonam, James.; Jinabhai, Champaklal Chhaganlal.; Reddy, S. P.
Purpose To evaluate the impact of Laduma, a health education intervention, on the knowledge, attitudes, beliefs and practices regarding sexually transmitted infections among secondary school learners in KwaZulu-Natal. Objectives The objectives of the study were to determine knowledge, attitudes, beliefs, perceptions and practices of secondary school learners regarding sexually transmitted infections at baseline and post-exposure to Laduma; assess intended behaviour change regarding sexually transmitted infections and condom use as well as the awareness of skills to achieve such behaviour; assess learners' perceived vulnerability to sexually transmitted infections; assess comprehension, acceptability and appeal of the photonovella among learners and to assess whether learners can identify with the characters and situations in the photo-novella. Design This was an experimental study design. Setting Nineteen randomly selected secondary schools in the Midlands district of KwaZulu-Natal. Subjects Grade 11 learners, n = 1168, from randomly selected schools that were further randomised into intervention and control groups. Outcome Measures The learners had to complete three sets of questionnaires that elicited information about their biographical profile, knowledge, attitudes, beliefs, perceptions and practices regarding sexually transmitted infections, intention to change their behaviour with regard to sexually transmitted infections and condom use, as well as their skills to achieve such behaviour, their perceived vulnerability to sexually transmitted infections and their perceptions of Laduma. All of these outcomes were assessed at baseline (Tl), following the learners' exposure to Laduma (T2, three weeks after the baseline), as well as six weeks later (T3) in the case of the intervention group. With respect to the control group they had to answer the baseline questionnaire on all three occasions. Results The mean age of the respondents was 16.8 years with almost two thirds of the learners being between the ages of 15 - 18 years. Seventy percent were primarily Zulu speaking. Learners reported feeling personally scared of getting a sexually transmitted infection with 17.8% responding that they thought they could get a sexually transmitted infection in the next two years. There was a significant gender difference between male and female learners in their topics of communication to friends, parents and partners regarding HIV/AIDS, condom use, having sex or not having sex (p < 0.01). Although learners had adequate knowledge about the spread of sexually transmitted infections at baseline, the mean scores for the spread for the group exposed to Laduma differed significantly from the mean scores of the control group, both immediately after the intervention (p < 0.01) and six weeks thereafter (p < 0.001). Learners in the intervention group responded more positively towards condom use at time 2 (T2) than the control group and maintained this change six weeks later. Sexual activity and condom use at time 3 (T3) was not influenced by the intervention but was significantly predicted by past sexual activity (p< 0.001) and past condom use (p < 0.001) respectively. At time 3 (T3) significantly more learners in the intervention group intended to have sex with a condom (65.1 %) compared to the control group (52.3%, p < 0.05). Overall learners had a positive response to Laduma and appreciated it as a health education intervention. Conclusion and Recommendation The findings of this study provided important information about adolescent sexuality on a range of outcomes related to knowledge, attitudes and sexual behaviour. The findings also provided information on learners' gender differences about what they communicate and to whom, as well as their sexual behaviour. After a single reading of Laduma learners showed an increase in knowledge about the spread of sexually transmitted infections, a change in their attitude to condom use as well as an increased intention to practice safer sex. Laduma did not influence communication about sexually transmitted infections, sexual behaviour nor condom use. These are complex behaviours and indicate that interventions focussing on preventive sexual behaviour need to move beyond awareness and information dissemination towards being more intensive and skills focussed. Such interventions need to address the gaps between knowledge and practice and be facilitated in a context that supports such implementation. The specific recommendations made from the findings of this study therefore include, the development of a systematic health promotion programme that addresses the issues related to personal vulnerability, knowledge related to treatment of and protection against sexually transmitted infections as well as skills that promote safer sexual choice.
Incidence of HIV infection in rural KwaZulu-Natal in the context of the epidemiology and impact of HIV/AIDS in South Africa.
(2007) Gouws, Eleanor.; Abdool Karim, Salim Safurdeen.; Jinabhai, Champaklal Chhaganlal.
South Africa has had one of the fastest growing HIV epidemics in the world and almost 30% of women attending public antenatal clinics (ANC) are currently infected with the virus. But as the epidemic is starting to level off and antiretroviral therapy (ART) is becoming increasingly available, few methods exist to determine the impact of ART or other interventions on the epidemic in South Africa. This thesis explores the epidemiology and dynamics of HIV infection and investigates the potential impact of ART. Methods Total and age-specific prevalence data are analysed in time and space and are used to investigate patterns of infection in men and women, urban and rural, and low and high risk populations. Dynamical models are developed to estimate incidence from age-specific prevalence and trends over time and are compared to laboratory-based estimates of recent HIV sero-conversion. Incidence is estimated in different populations in South Africa. A dynamical model is developed to estimate the impact of ART on the future course of the HIV epidemic. Results HIV prevalence varies geographically and by age, sex and race. The average female-tomale HIV prevalence ratio is 1.7 and prevalence peaks at an older age among men than women. The age at which prevalence peaks among women has increased from 23.0 to 26.5 years between 1995 and 2002. Four patterns of infection are identified: among pregnant women attending ANCs, among men and women in the general population, and among migrant workers. HIV incidence among ANC attendees peaked in the mid to late 1990s (at 6.6% per year nationally) with variation between provinces. Current estimates of HIV prevalence and incidence among the general population in South Africa (aged 15-49 year) are 18.8% and 2.4% per year, respectively. Age-specific incidence estimates from dynamical models and laboratory methods are in good agreement provided the window period for the laboratory method is increased. Over the next ten years the provision of ART could avert 1 to 1.5 million deaths depending on whether it is provided when the CD4 cell count falls to 200 or 350 cells/ul. By 2015 about 1.1 million people will be receiving ART but this will have little impact on the incidence of HIV and scaling up of prevention efforts remains urgent. Conclusions The thesis explores some of the determinants and patterns of HIV prevalence and incidence in South Africa in order to find better ways to manage the epidemic of HIV, monitor changes and evaluate progress in control efforts. In order to fight the epidemic we need to mobilize the best possible science in support of those people and communities affected by the epidemic.
Mortality trends at Benedictine Hospital, Nongoma, KwaZulu-Natal 1995- 2001.
(2003) Kaufmann, Kenneth W.; Knight, Stephen Eric.; Jinabhai, Champaklal Chhaganlal.
This epidemiological study is a longitudinal descriptive review of the mortuary register at Benedictine Hospital, with an analysis of the trends which emerge. The descriptive component describes mortality at Benedictine Hospital during the years 1995- 2001. It describes both the actual numbers of deaths which occurred according to each sex and age group, and the causes of death as recorded in the mortuary register. The purpose of this study was twofold. First it was desired to raise AIDS awareness in the district by examining the effects of the AIDS epidemic on mortality. Second as the new district health system was being established, it was desired to develop a baseline of mortality information to be utilized for management in the Nongoma Local Municipality. In the trend analysis component of the study, first, it is assumed that most of the deaths occurred at Benedictine Hospital as it is the only health facility which handles severe illness in the Nongoma Local Municipality; therefore the number of deaths within the hospital and the population of Nongoma were used to calculate Age Specific (ASMRs) and Cause Specific Mortality Rates (CSMRs). Secondly an analysis of the age and sex distribution of deaths, ASMRs, the distribution of causes of death, and CSMRs was done. Two research questions were posed. The first research question was, has there been any change in the age distribution of death? It was demonstrated that while there was an 80% increase in the number of deaths, and although deaths increased in every age group except for the neonatal group, 80% of the increase was in the young adult ages particularly in the 20 through 39 years old age groups. By 2001 these groups were recording the largest number of deaths, 179 male deaths and 133 female deaths in the 30 through 39 years old group. Also the ASMRs of young adults had increased three to four times. The second research question was, has there been any change in the distribution of causes of death? It was demonstrated that the infectious diseases which caused the largest numbers of deaths, pulmonary tuberculosis caused 353 deaths, pneumonia 250, gastroenteritis acute and chronic 203, retro-viral disease 66, and meningitis 59, were six of the top seven causes of death in 2001. Chronic gastroenteritis, retro-viral disease, and meningitis had strengthened their position moving from the second ten into the top seven. Only trauma which was in the top five was not an infectious disease. Infectious diseases increased their share of the burden of disease from 36% in 1995 to 57% in 2001. While CSMRs for trauma and the type II non-communicable diseases were basically stable or falling, those of the infectious diseases increased three to four times. It is estimated that because the mortality pattern is similar to that of AIDS deaths in South Africa and Zimbabwe, that because it is young adult mortality that has increased and that it is infectious diseases which have increased that about 50% of mortality in Nongoma is due to AIDS. Recommendations are put forward as to how to disseminate this information and also how to institute a system to carry on monitoring mortality in Nongoma.
An overview of occupational health in the Durban Metropolitan area.
(1981) Jinabhai, Champaklal Chhaganlal.
No abstract available.
Rates and causes of child mortality in rural KwaZulu-Natal.
(2007) Garrib, Anupam Virjanand.; Herbst, Abraham J.; Jinabhai, Champaklal Chhaganlal.; Knight, Stephen Eric.
Background Recent gains in child survival are being threatened by the RN epidemic. Monitoring child mortality rates is essential to understanding the impact of the epidemic, but is constrained by a lack of data. A community-based survey was used to determine child mortality rates in a rural area with high RN prevalence, located in the Rlabisa subdistrict of the KwaZulu-Natal Province, South Africa. ii. Methods The study was conducted between 1 January 2000 and 31 December 2002 on deaths in children under the age of 15 years. Children were followed up through 4-monthly home visits. Cause of death was ascertained by verbal autopsy. Rates were calculated using Poisson methods. iii. Results Infant and under-5 mortality ratios were respectively, 59.6 and 97.1 deaths per 1000 live births. Infant and under-5 mortality rates were, respectively, 67.5 and 21.1 deaths per 1000 child-years. RN/AIDS was attributed to 41% of deaths in the under-5 age group, with a mortality rate of 8.6 per 1000 person years. Lower respiratory infections caused an estimated 24.9 deaths per 1000 person years in children under 1 year of age. iv. Discussion In rural South Africa, infant and child mortality levels are high, with RN/AIDS estimated as the single largest cause ofdeath. Improving the coverage of interventions known to impact on child mortality is required urgently.
The respiratory health status of adults who spent their developing years in a polluted area in South Africa : a historical cohort study.
(2004) Oosthuizen, Maria Aletta.; Jinabhai, Champaklal Chhaganlal.; Terblanche, Aletta Petronella Susarah.
No abstract available.
Role and contribution of private healthcare sector doctors in the management of HIV-infected patients in the eThekwini Metropolitan area of KwaZulu-Natal.
(MedPharm, 2007) Naidoo, Panjasaram.; Jinabhai, Champaklal Chhaganlal.; Taylor, Myra.
Private healthcare sector doctors have a pivotal role to play in the management of HIV and AIDS infection. These doctors need to have an accurate knowledge of the management of the infection, and a positive attitude towards the treatment of persons with HIV and AIDS. This study investigated the extent of private healthcare sector doctor involvement in the management of HIV and AIDS patients and their training needs. Across sectional descriptive study of private general practitioners and specialists was undertaken in the eThekwini Metro of KwaZulu-Natal. Structured self-report questionnaires were sent to 931 private healthcare sector doctors. Of the 331 (35.6%) responses received, three doctors did not complete the questionnaire, 235 (71.6%) doctors managed HIV and AIDS patients, but 93 (28.4%) doctors did not; of these, 48 (51.61%) had not encountered HIV and AIDS patients, 25 (26.88%) referred such patients to specialists, six (6.45%) cited cost factors as reasons for not treating such patients, whilst 12 (12.90%) doctors, though they indicated that there were other reasons for not managing HIV-infected patients, did not specify the reason. Two doctors (2.15%) indicated that due to inadequate knowledge they did not manage HIV and AIDS patients. Most doctors, 151 (63.5%), managed between 1-20 patients, whilst 19 (8%) managed more than 200 patients. The mean number of years since doctors had qualified was 22.02 (SD 10.58). Significantly more younger (recently qualified) doctors than older (qualified more years) doctors treated HIV/AIDS patients (p<0.001). Most doctors (76.3%) expressed a need for more training/knowledge on the management of HIV patients in areas such as overall HIV care (59%), antiretroviral therapy (53%), side effect management (39%) and therapeutic monitoring (35%); 194 (62.2%) doctors indicated their willingness to participate in a post graduate diploma in HIV and AIDS management. These results suggest that increased private sector doctor involvement in the treatment of HIV/AIDS patients needs to be facilitated. Addressing doctors’ training needs could contribute to achieving this.
The role of IgG and its subclasses in byssinosis.
(2002) Hunter, Garth Andrew.; Jinabhai, Champaklal Chhaganlal.; Coertze, D.
A case control study was performed in 6 cotton mills in KwaZulu-Natal, South Africa. The study used questionnaire and pulmonary function testing results to categorise respiratory symptoms in 52 exposed symptomatic, 30 exposed asymptomatic and 46 unexposed control subjects. These categorisation results were used to explore the relationship between serum IgG subclasses and cotton-specific IgG to byssinosis. No definitive relationships between the serum IgG subclasses and clinical and functional symptoms of byssinosis were found . Whereas, exposed symptomatic (22.72 mg All) subjects had significantly higher (P = 0.01) mean specific IgG concentrations than exposed asymptomatic (15.02 mg All) or unexposed control (13.08 mg All) subjects. A pathoaetiological or marker-aetiological role is indicated for specific IgG in the development of byssinosis. The findings of this research challenged the status quo in terms of the accepted aetiological pathways of byssinosis. In turn the acceptance of a different aetiological pathway provided a possible answer to the varying presentation of the disease and by implication contested the current definition of byssinosis.
Tuberculosis among health care workers in hospitals in the Ethekwini Municipality of KwaZulu-Natal.
(2006) Naidoo, Saloshni.; Jinabhai, Champaklal Chhaganlal.
Tuberculosis is a disease of global importance and remains the leading cause of death in the developing world. In South Africa a weak notification system and poor occupational health services for health care workers has resulted in little information being available about the incidence of tuberculosis and the groups at highest risk of contracting tuberculosis amongst health care workers, the clinical presentation and management of workers infected with tuberculosis. The purpose of this study was to describe the incidence of tuberculosis, and the clinical and public health aspects of the management of tuberculosis among health care workers in eight public sector hospitals in the Ethekwini Municipality of KwaZulu-Natal. Data was collected through a retrospective review of hospital records for the study period January 1999 to June 2004. Study findings: Five hundred and eighty three (N=583) health care workers were diagnosed with tuberculosis for the period under review. The mean age of the HCWs was 38 years (95% Cl: 37-39). The mean cumulative incidence for the study period was 1040/100 000 HCW population (95% Cl: 838-1242). The mean cumulative incidence of TB was highest in males (1544/100 000 HCW population; 95% Cl 1228 -1859), the age group 25 to 34 years (1043/100 000 HCW population; 95% CI: 650 -1436) and in paramedical staff (1675/100 000 HCW population; 95%CI: 880-2470). The majority of health care workers presented with pulmonary tuberculosis (77%, n=322) and 3% (n=13) had multidrug resistant tuberculosis. Successful treatment outcomes were achieved in 63% (n=334) of health care workers. Only one hospital has a work place policy with regard tuberculosis in health care workers. Compensation for this occupational disease was sought as follows. Submissions of a first medical report were made in 107 (18%) of the 583 health care workers. In the 107 cases initially reported submission of progress reports (n=75; 70%) and final reports (n=60; 56%) decreased considerably. In conclusion, the incidence of tuberculosis in health care workers has increased annually since 1999 and the treatment outcomes among health care workers do not reach the targets set by the National Tuberculosis Control Programme. Recommendations based on the study findings include establishing a uniform provincial policy for the prevention and reduction of tuberculosis infections among health care workers for implementation in hospitals; the implementation of a medical surveillance system for health care workers with respect to tuberculosis and a provincial training programme for staff on the clinical and administrative management of TB in health care workers.