Browsing by Author "Knight, Stephen Eric."
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Item 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.Item An analysis and evaluation of the child survival project in the uThukela district of KwaZulu-Natal.(2005) Pillay, J. D.; Knight, Stephen Eric.The uThukela District in the province of Kwazulu-Natal, Republic of South Africa, has been involved in improving Primary Health Care (PHC) in the district through evaluation surveys carried out at regular intervals during the past six years. World Vision's uThukela District Child Survival Project (TDCSP) began in November 16, 1999. This has been made possible by a Child Survival Grants Program from the Unites States Agency for International Development (USAID). In all previous surveys a 30-cluster sampling methodology was used to select individuals from the survey population. This time however, the Lot Quality Assurance Sampling (LQAS) methodology was used. The recent re-organization of the District into municipalities enabled each municipality to function as one Supervision Area (SA) or Lot. Even with a small sample size (in this case 24 per SA), poor health service performance could be identified so that resources are appropriately distributed. Furthermore, people from the community such as Community Health Workers (CHW) were involved in all phases of the study, including the manual analysis of the results, upon being trained appropriate. However, it is questionable as to how accurate and reliable such a manual analysis was. In this dissertation, the manual results of the study were evaluated by doing an electronic analysis. In addition, a more refined analysis of the data has been produced (e.g. population-weighted coverage, graphs and stratified analyses in some cases). From the comparisons made, it was concluded that the manual analysis was very similar to the electronic analysis and that differences obtained were not statistically significant. In addition, due to each municipality varying in population size, it was queried as to whether population-weighted results would produce a marked difference from the un-weighted, manual results. Again, the differences produced were in most cases not statistically significant. This concluded that the manual analysis carried out by the TDCSP team was accurate and that it is appropriate to use such results in determining individual municipality performance and overall District performance so that responsive action can then be taken immediately, without necessarily having to wait for electronic results.Item The application and use of the partogram in evaluating the Saving Mothers programme in South Africa in 2002.(2004) Mehari, Tesfai T.; Knight, Stephen Eric.The SA National Department of Health made maternal deaths notifiable in 1997. It also commissioned a National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) to confidentially investigate all maternal deaths, to write the "Saving Mothers Report" and to make recommendations based on the findings of the study. The Department of Health in 2003 commissioned an evaluation of the extent to which the 10 recommendations contained in the first "Saving Mother's Report" had been implemented. This rapid appraisal was carried out by Centre for Health and Social Studies (CHESS), University of Natal. A report 'The Progress with the Implementation of the Key Recommendations of the 1998 "Saving Mothers Report" on the Confidential Enquiry into Maternal Deaths in South Africa - A Rapid Appraisal," was published in 2003. The data collected on Recommendation 5 on the use of the obstetric partogram in 46 selected provincial hospitals in all the 9 provinces was only partially analysed in this report. This study reports on a secondary analysis of the 942 questionnaires that were completed on the use and application of the partogram in hospitals in South Africa. In the rapid appraisal experienced field workers evaluated the use of the partogram using a 36-point checklist. Provincial and national averages for each of these variables were calculated and hospitals were evaluated into how they performed according to these averages using Lot Quality Assurance Sampling methodologies. Using national and provincial averages, the hospitals in each province are compared with one another provincially and nationally. In addition, the application and use of partograms in areas and levels of hospitals are described. An attempt is made to show if there is relation between the number of deliveries and the recording of the partogram. The main findings were that, of all the provinces KwaZulu-Natal had the lowest number variables below the national average from the 36 variables used as a checklist. Eastern Cape and Limpopo had the highest number of variables below the national average. The hospital with the highest number below the national average is in the Eastern Cape. In the recording of the chart rural and level one hospitals are low in comparison with urban and level three hospitals. There was no relation in the recording of the chart and the number of deliveries.Item Assessing nursing students' readiness for e-learning.(2014) Coopasami, Marilynne.; Knight, Stephen Eric.Introduction e-Learning has been integrated and implemented in education and training to the level that it is now a well-established global practice. If used judiciously, e-Learning is a tool that enables active, individual and flexible learning. When integrated into medical education, it offers features that allow lecturers to be not merely content distributors, but also facilitators of learning. Aim The aim of this study was to assess the readiness of students to make the shift from traditional learning, to the technological culture of e-Learning. Methods An observational, cross-sectional, analytical study design was used and data was collected using a validated questionnaire. The sample comprised of all students enrolled in the first year nursing programme at the Durban University of Technology registered for anatomy and physiology in 2013. Informed consent was obtained from each participant prior to conducting the study. Results Three quarters (77/101 76%) of the participants were females. The psychological readiness score was noted to be high in the “could be worse” category (pre-72%, post- 64%). The technological readiness score was noted to be in the “dig deeper” category (pre- 58%, post- 65%) whilst the equipment readiness score fell in the e-Learning “not ready category” (pre- and post- 68%). Discussion The Chapnick Readiness Score Guide was used to analyse psychological, technological and equipment readiness. e-Learning has been identified as a multi-disciplinary field, which is dominated by information technology. Technological and equipment readiness factors of e-Learning are easier to resolve than the psychological readiness factor. Recommendations Although e-Learning could be a key tool in nursing education, a few factors require attention before it can be effectively implemented in this tertiary level education facility.Item Assessment of the therapeutic efficacy of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in northern KwaZulu-Natal.(2013) Vaughan-Williams, Charles Hervey.; Knight, Stephen Eric.Background Recent malaria epidemics in KwaZulu-Natal indicate that effective anti-malarial therapy is essential for malaria control. Although artemether-lumefantrine has been used as firstline treatment for uncomplicated Plasmodium falciparum malaria in northern KwaZulu- Natal since 2001, its efficacy has not been assessed since 2002. The objectives of this study were to quantify the proportion of patients treated for uncomplicated P. falciparum malaria with artemether-lumefantrine who failed treatment after 28 days, and to determine the prevalence of molecular markers associated with artemether-lumefantrine and chloroquine resistance. Methods An observational cohort of 49 symptomatic patients, diagnosed with uncomplicated P. falciparum malaria by rapid diagnostic test, had blood taken for malaria blood films and P. falciparum DNA polymerase chain reaction (PCR). Following diagnosis, patients were treated with artemether-lumefantrine (Coartem®) and invited to return to the health facility after 28 days for repeat blood film and PCR. All PCR P. falciparum positive samples were analysed for molecular markers of lumefantrine and chloroquine resistance. Results Of 49 patients recruited on the basis of a positive rapid diagnostic test, only 16 were confirmed to have P. falciparum by PCR. At follow-up, 14 were PCR-negative for malaria, one was lost to follow-up and one blood specimen had insufficient blood for a PCR analysis. All 16 with PCR-confirmed malaria carried a single copy of the multi-drug resistant (mdr1) gene, and the wild type asparagine allele mdr1 codon 86 (mdr1 86N). Ten of the 16 samples carried the wild type haplotype (CVMNK) at codons 72-76 of the chloroquine resistance transporter gene (pfcrt); three samples carried the resistant CVIET allele; one carried both the resistant and wild type, and in two samples the allele could not be analysed. ii Conclusions The absence of mdr1 gene copy number variation detected in this study suggests lumefantrine resistance has yet to emerge in KwaZulu-Natal. In addition, data from this investigation implies the possible re-emergence of chloroquine-sensitive parasites. Results from this study must be viewed with caution, given the extremely small sample size. Recommendations A larger study is needed to accurately determine therapeutic efficacy of artemetherlumefantrine and resistance marker prevalence. The high proportion of rapid diagnostic test false-positive results requires further investigation.Item The birth prevalence of congenital CMV infection in HIV-exposed newborns in Cape Town, South Africa : a pilot study. The "CYPREHEN" (Cytomegalovirus prevalence in HIV-exposed newborns) study.(2014) Manicklal, Sheetal.; Knight, Stephen Eric.; Boppana, Suresh B.Background Congenital cytomegalovirus infection (CMV) is a leading non-genetic cause of sensorineural hearing loss worldwide. The birth prevalence of congenital CMV infection correlates positively with the level of CMV seroimmunity in the adult population. In addition, women infected with Human Immunodeficiency Virus (HIV) constitute a special at risk subpopulation for the intrauterine transmission of CMV. Despite a high prevalence of both HIV and CMV, the birth prevalence of congenital CMV infection has not been assessed in sub-Saharan Africa. Purpose The purpose of the study was to determine the birth prevalence of congenital CMV infection among HIV-exposed newborns born in a public sector hospital in the Western Cape in 2012, during the era of prenatal antiretroviral therapy. Objectives The objectives of this study were: To determine the prevalence of congenital CMV infection among HIV-exposed newborns; To assess the predictors of congenital CMV infection transmission among HIV-infected women; and To inform the design of an analytic study to determine if newborn CMV screening should be implemented in this population. Study design An observational descriptive cross-sectional study design was used. Settings The study was conducted at Mowbray Maternity Hospital (MMH), which serves the Cape Town Metropole area. Study population The study population comprised infants born to HIV-infected mothers delivering at MMH. Study sample Non-probability convenience sampling was used to enroll 750 newborns. Methods HIV-infected mothers were recruited in the immediate postnatal period at a referral maternity hospital between April and October 2012. Maternal and infant clinical data and newborn oral swabs (saliva) were collected. Saliva was assayed by real-time PCR for CMV. Data were analysed using univariate and multivariate logistic regression analyses to determine specific demographic, maternal and newborn characteristics associated with congenital CMV infection. Results CMV was detected in 22/748 newborn oral swabs (2.9%; 95% Confidence Interval (CI), 1. 9%-4.4%). Maternal CD4 count less than 200 cells/μL during pregnancy was independently associated with congenital CMV infection (adjusted Odds Ratio (aOR) 2.9; 95% CI, 1.2-7.3). A negative correlation between CMV viral load in saliva and maternal CD4 count was observed (r = -0.495, n = 22, p = 0.019). Conclusions The birth prevalence of congenital CMV infection was high despite prenatal ARV prophylaxis, and was associated with advanced maternal immunosuppression.Item Case management and clinical outcomes of people living with HIV and admitted to a state-aided district hospital in Durban, South Africa in 2007.(2011) Sunpath, Henry.; Knight, Stephen Eric.Title: Case Management and Clinical Outcomes of People Living with HIV and Admitted to a State-aided District Hospital in Durban, South Africa in 2007. Introduction: A proportion of the many patients who have advanced AIDS in South Africa present for the first time requiring admission to hospital, the number of which are limited by the availability of beds. Novel ways were developed to offer subacute inpatient care at Siyaphila, a facility linked to McCord Hospital in Durban to provide expedited or immediate antiretroviral therapy (ART) (exposed) for patients with advanced disease before their discharge (ART group) . Different components of palliative care were offered for those who did not enter the inpatient ART programme or who were terminally ill (non-ART group) (non-exposed) . Aim: The aim of the study is to describe the clinical condition, inpatient case management and outcomes before discharge of people living with HIV admitted to Siyaphila in order to assist in developing appropriate protocols for inpatient care. Methods: This was an observational, analytic, cohort study using a convenience sample of all patients consecutively admitted to Siyaphila during nine months in 2006/2007. Prevalence of AIDS defining conditions at Siyaphila, time taken to progress from one stage of care to another and outcomes for the two groups before discharge were determined. Univariate and multivariate logistic regression analysis was performed on the ART group to identify risk factors for mortality before discharge. A comparison between the ART and non-ART group was also undertaken. Results: Among the cohort of 405 PLHIV enrolled at Siyaphila during the study period only 171 (42%) were initiated on ART immediately. In all patients, tuberculosis (251; 62%) was the most common opportunistic infection followed by cryptococcal meningitis (68; 17%) and Pneumocystis pneumonia (28; 7%). The mean baseline CD4 cell count was 84 celis/uL for the non-ART group and 55 celis/uL for the ART group. (p <0.01) The median time from initial admission until discharge was 13 days in the non-ART group and 18 days in the ART group. The mortality before discharge among the non-ART group was 24% compared to 6% among the ART group. (p =0.001). The median number of days before ART was initiated was 14 days. Immune reconstitution inflammatory syndrome was diagnosed in seven patients (4%) among the admissions but caused no deaths. In the multivariate analysis, the odds ratio for mortality for patients under 40 years was 0.1 (95% Confidence Interval: 0.01 - 0.9). Conclusions: Subacute care offered at Siyaphila provides an entry point into the ART programme for non-ambulatory patients who in the KwaZulu-Natal context have low ART uptake after discharge. The findings of this study should be adopted as the best clinical practice for PLHIV and AIDS admitted in the late stages of the disease. 0Nords 423) Title: Case Management and Clinical Outcomes of People Living with HIV and Admitted to a State-aided District Hospital in Durban, South Africa in 2007. Introduction: A proportion of the many patients who have advanced AIDS in South Africa present for the first time requiring admission to hospital, the number of which are limited by the availability of beds. Novel ways were developed to offer subacute inpatient care at Siyaphila, a facility linked to McCord Hospital in Durban to provide expedited or immediate antiretroviral therapy (ART) (exposed) for patients with advanced disease before their discharge (ART group) . Different components of palliative care were offered for those who did not enter the inpatient ART programme or who were terminally ill (non-ART group) (non-exposed). Aim: The aim of the study is to describe the clinical condition, inpatient case management and outcomes before discharge of people living with HIV admitted to Siyaphila in order to assist in developing appropriate protocols for inpatient care. Methods: This was an observational, analytic, cohort study using a convenience sample of all patients consecutively admitted to Siyaphila during nine months in 2006/2007. Prevalence of AIDS defining conditions at Siyaphila, time taken to progress from one stage of care to another and outcomes for the two groups before discharge were determined. Univariate and mUltivariate logistic regression analysis was performed on the ART group to identify risk factors for mortality before discharge. A comparison between the ART and non-ART group was also undertaken. Results: Among the cohort of 405 PLHIV enrolled at Siyaphila during the study period only 171 (42%) were initiated on ART immediately. In all patients, tuberculosis (251; 62%) was the most common opportunistic infection followed by cryptococcal meningitis (68; 17%) and Pneumocystis pneumonia (28; 7%). The mean baseline CD4 cell count was 84 celis/uL for the non-ART group and 55 celis/uL for the ART group. (p <0.01) The median time from initial admission until discharge was 13 days in the non-ART group and 18 days in the ART group. The mortality before discharge among the non-ART group was 24% compared to 6% among the ART group. (p =0.001). The median number of days before ART was initiated was 14 days. Immune reconstitution inflammatory syndrome was diagnosed in seven patients (4%) among the admissions but caused no deaths. In the mUltivariate analysis, the odds ratio for mortality for patients under 40 years was 0.1 (95% Confidence Interval: 0.01 - 0.9). Conclusions: Subacute care offered at Siyaphila provides an entry point into the ART programme for non-ambulatory patients who in the KwaZulu-Natal context have low ART uptake after discharge. The findings of this study should be adopted as the best clinical practice for PLHIV and AIDS admitted in the late stages of the disease. (Words 423)Item Comparing the outcomes of nurse initiated management of antiretroviral therapy in Tuberculosis - Human immunodeficiency Virus (HIV) co-infected patients Vs HIV mono-infected patients.(2016) Jithoo, Niraksha.; Knight, Stephen Eric.; Naidoo, Kogieleum.No abstract available.Item Effectiveness of early initiation of antiretroviral therapy in adults with HIV associated tuberculosis in Lesotho in 2012.(2015) Lenela, Maletsatsi.; Knight, Stephen Eric.Background Today Africa is confronted with a huge burden of Human Immunodeficiency Virus (HIV) associated tuberculosis (TB). In 2010, 77% of the TB in Lesotho was HIV associated. The problem is intensified by many factors, such as the timing of initiation of antiretroviral therapy (ART), separation of HIV and TB services that discourages people from seeking care and the policies governing the treatment of HIV and TB. Aim The aim of this study is to compare the effectiveness of late versus early commencement of ART in adults living with HIV associated TB in Lesotho in 2012. Method An observational, analytic cross-sectional study design was conducted. Three out of 17 hospitals were randomly selected and data for patients with HIV-associated TB who had completed TB therapy during the study period (January to March 2012) was extracted from the hospitals’ TB registers. Results Of the 247 adults living with HIV associated TB, 80 (32%) were started on ART early (4 weeks or less), 100 (41%) were started late (after 4 weeks) and 67 (27%) received no ART at all. The unadjusted results show that early initiators were 6 times more likely to have a successful TB outcome (OR 6.2: 95%CI: 3.7 to 27.5) relative to the group who had no ART. The difference was statistically significant (p<0.001). Interestingly those who commenced ART late also were six times more likely to have a successful TB outcome (OR 5.6: 95% CI: 2.8 to 11.2) relative to the group who had no ART. Discussion This study provides evidence that in Lesotho, early initiation of ART in adults living with HIV associated TB has not been fully implemented. Only a third were commenced on ART early after starting TB treatment. This study demonstrated however, that even those who commenced ART late performed much better than those who were not prescribed ART. This therefore highlighted that successful TB treatment outcomes were not dependent on when ART was initiated. Recommendations The Lesotho Ministry of Health should ensure early initiation of ART in people living with HIV associated TB in order to improve their TB outcomes.Item The epidomiology of childhood tubercolusis and clinical outcomes in South Africa 2008 - 2012.(2017) Smith, Jacqueline.; Knight, Stephen Eric.Tuberculosis (TB) in children, particularly in those under five years is regarded as an indicator of there being an infectious pool in the community. The World Health Organization (WHO) has focused on childhood tuberculosis, recognizing its contribution to the overall TB burden and to child survival. The Roadmap for Childhood Tuberculosis identifies the need to know the incidence of childhood TB in order to design and implement specific public health interventions to limit the spread of the disease and orientate health services in early TB detection, treatment and retention in care to prevent on-going transmission. Aim The aim of this research is to investigate the epidemiology of childhood TB in South Africa (SA) from 2008 to 2012 in order to inform TB control policy and practice. Methods An observational analytical cross sectional study design was used. The Electronic TB Register was used as the source of the data. Records from 1 January 2008 to 31 December 2012 were used. STATA and Excel were used to describe and analyse data. Results The proportion of children aged 0 to 14 years with TB in SA has fluctuated between 19.2% in 2008, reaching a high of 22.3% in 2009 and reducing to 18.8% in 2012. Testing children with TB for HIV has increased steadily from 17.9% in 2008 to 68.5% in 2012. The HIV prevalence in tested cases aged ten to fourteen years in 2012 was the highest at 42.6% with the lowest prevalence found in the zero to four year age group in 2012 of 16.7%. In analysing treatment outcomes, the children aged five to nine years had 21% (0.79) less risk of death compared to the children less than 5 years whereas the age group ten to fourteen had 1.33 times the risk of death.Item Estimation of childhood mortality in KwaZulu-Natal, 2001(2006) Hoque, A. K. M. Monjurul.; Knight, Stephen Eric.No abstract available.Item Evaluation of drinking water quality in Lake Mzingazi in Richards Bay.(2009) Mathenjwa, Cleopas Mzondeni.; Knight, Stephen Eric.Introduction Lake Mzingazi is the only suitable source of domestic water supply for the Richards Bay community. Rapid industrialisation in the city of uMhlathuze, accompanied by an influx of people, has resulted in informal settlement occurring around the lake. The uncontrolled activities of this development threaten to pollute the water source. Previous studies in1979 conducted by Council of Scientific & Industrial Research indicated that Lake Mzingazi water was still within acceptable limits in terms of the Department of Water Affairs & Forestry guidelines. The lake water quality was that of a Class I water resource, which is excellent for domestic use. Pollution of the lake can result from diffuse sources of pollution due to settlement of communities around it. Water purification costs could escalate thus forcing an increase in water tariffs. If pollution resulted in the lake being unable to be utilized, the Richards Bay community will be seriously affected, as it would necessitate the importing of water from distant regions. Either way, the expense of acquiring water would increase. All living organisms rely on adequate water for their survival. Worse still are human beings for their water should not only be adequate but should be of good quality to prevent health risks and even death. It is in view of these possibilities that the study was undertaken. Aim The aim of the study is to assess the extent of physical, chemical and biological pollution in Lake Mzingazi due to non-point sources and to recommend necessary protection measures that need to be implemented to prevent any negative health impact on surrounding communities. At present there are no restrictions and no protection of the lake from pollution except that no recreation is allowed into the lake at present. Methods Several objectives were set in order to focus on specific issues. One of the objectives was to inform the communities around the lake about the study. Sampling of the lake water was conducted monthly from June to November 2006 (using a boat). Pictures of areas around the lake were also taken for further analysis. At each sampling run, 36 samples were taken and delivered to a laboratory accredited by the South African National Accreditation Standards for analyses. Six sampling runs were completed. Secondary data for the period of 1998 to 2005 were obtained from uMhlathuze Municipality in order to establish pollution trends and for comparison purposes with the Department of Water Affairs and Forestry guidelines. Results The findings of the study revealed that the quality of the lake water is still within acceptable limits when compared with the Department of Water Affairs & Forestry guidelines; however, informal settlement threatens the future of the lake by encroaching into the lake banks. Discussion There is definitely a risk of pollution to Lake Mzingazi as long as there are no pollution prevention plans in place. Recommendations All data should be stored in a centralized information system to avoid losing valuable information. The Water Services Authority must develop and maintain a water quality-monitoring programme that will capture all changes occurring in the lake.Item Follow-up care of infants born in a prevention of mother-to-child transmission programme in an urban hospital in KwaZulu-Natal, South Africa.(2011) Chetty, Terusha.; Knight, Stephen Eric.Introduction. The Human Immunodeficiency Virus (HIV) is the main contributor to rising child mortality in South Africa. Although prevention of mother-to-child transmission programmes have been implemented in the country, little is known about the clinical and loss to follow-up outcomes of infants born to HIV-infected women attending these programmes. Purpose. The purpose of the study was to describe the clinical and loss to follow-up outcomes of HIV-exposed infants whose mothers had received antiretroviral therapy or prophylaxis during their pregnancy at the Prevention of Mother-to-Child Transmission programme at McCord Hospital. Furthermore, maternal socio-demographic characteristics associated with these outcomes were determined. Methods. An observational retrospective cohort study design was used. The study population consisted of infants whose mothers had received antiretroviral prophylaxis or therapy at McCord Hospital, and were delivered at McCord Hospital, and/or were brought back to McCord Hospital, following delivery from 1 May 2008 to 31 May 2009. Results. Data on 265 infants was analysed. Of the 220 infants who were tested, the HIV transmission risk was 2.7% (n=6; 95% Cl: 1.0% to 5.8%) at 6 weeks of age. Overall, 40.4% of infants in the cohort were lost to follow-up (n=105, 95% Cl: 34.4 to 46.6). In the multivariable model (n=253), late booking for first antenatal visit at or after 28 weeks of gestation (adjusted hazard ratio (AHR) 2.3; 95% Cl: 1.0 to 5.1, p=0.044) was a risk factor for loss to follow-up. Compared to having an emergency caesarean section, having an elective caesarean section (AHR 1.9; 95% Cl: 1.1 to 3.5) or normal vaginal delivery (AHR 2.5; 95% Cl: 1.4 to 4.5) was significantly associated with loss to follow-up of infants. Discussion. The substantial attrition of infants born to HIV-infected mothers in the Prevention of Mother-to-Child Transmission programme at McCord Hospital undermined the goals of the programme, and underestimated the effect of infectious disease morbidity, mortality and HIV transmission risk associated with these infants. Recommendations. Counselling mothers on the health benefits to their HIV-exposed infants of attending the follow-up clinic and tracing of infants who have been lost to follow-up is vital to the operational effectiveness of the Prevention of Mother-to-Child Transmission programme at McCord Hospital.Item Health care waste management in public clinics in the iLembe District : situational analysis and intervention strategy.(2007) Gabela, Sibusiso Derrick.; Knight, Stephen Eric.INTRODUCTION All waste generated at health care facilities in the past was regarded as hazardous and needed to be incinerated first before it was disposed. The purpose of this study was to investigate health care waste (HCW) management practices employed in public health clinics in the iLembe District, with a view of developing a HCW management intervention strategy. METHODOLOGY The study design was observational, descriptive, and cross-sectional. Data was collected using a structured individual questionnaire, which was administered to key informants from 31 rural and urban government fixed public clinics in the iLembe District Municipality. RESULT Thirty public clinics in iLembe district participated in the study. A total of 210 kg/day (0.06 kg/patient/day) of HCW was estimated to be generated in public clinics, 69% was health care general waste (HCGW) and 31 % was health care risk waste (HCRW). The district's generation rate was 0.04 kg/patient/day and 0.018 kg/patient/day, for HCGW and HCRW, respectively. The study found that HCW was improperly managed in the district. DISCUSSION The findings are different when compared to World Health Organisation norms and this was attributed to improper segregation of waste categories other than sharp waste, which was given special treatment. Factors such as the number of patients, size of the clinic, types of health care services rendered, and socio-economics status of the patient played a pivotal role in the waste volume generated. It is evident that no proper HCW management plan was being implemented in the district public clinics. CONCLUSION The management of health care risk waste is of great concern. There is a need for development of a health care waste management intervention strategy that must be implemented consistently and universally in the district. RECOMMENDATIONS It is recommended that a proper health care waste management intervention strategy be developed and implemented in the whole district. This strategy must incorporate training programmes and a waste management plan.Item Investigating the use of condoms among urban high school students in Asmara, Eritrea.(2004) Solomon, Zeweldi Tesfamariam.; Knight, Stephen Eric.No abstract available.Item Knowledge, attitudes, and beliefs of Emergency Care Practitioners to victims of domestic violence in the Western Cape.(2006) Naidoo, Navindhra.; Knight, Stephen Eric.; Martin, Lorna Jean.PURPOSE. Domestic violence has a significant prevalence in the world, and certainly in South Africa, yet Emergency Care Practitioner (ECP) training and practice does not have any particular focus on domestic violence intervention. The absence of any clear response protocol to domestic violence in a Health Professions Council of South Africa (HPCSA) regulated profession, suggests the reliance on health practitioner discretion in this regard. This is problematic as the profession is male dominated and focused on tertiary levels of care. ECP's may be positioned to screen for abuse early, yet there is no evidence of success or failure in this endeavour. This study aimed to ascertain what the prevailing ECP knowledge, attitudes and beliefs around domestic violence in the Western Cape are, so that any factors preventing or nurturing early identification and appropriate treatment of domestic violence may be mitigated or supported respectively. METHODS. Health Professions Council of South Africa (HPCSA) registered ECP's in the Provincial Government- Western Cape (PGWC)- Emergency Medical Service (EMS) Metropole region voluntarily completed a questionnaire. MAJOR RESULTS. Only 49% of respondents could correctly define domestic violence. ECP qualification was associated with domestic violence definition in that Basic ECP's were more likely to incorrectly define domestic violence than the advanced ECP's. Eighty-one percent of respondents recognized less than thirty domestic violence calls in the preceding six months. The majority of ECP's (89%) experienced no special handling of domestic violence victims. No significant association could be found (Chi-Square: p = 0.2298) between qualification and knowledge of domestic violence laws. An ECP's qualification is no predictor of his/her legal knowledge about abuse. Qualification could also not be positively associated with the referral of victims, although the majority of practitioners of all qualifications (78%), had only sometimes referred victims or not at all. The majority of respondents expressed inadequate assessment and management of domestic violence patients. The majority also indicated that their ECP training was inadequate in preparing them for domestic violence intervention. CONCLUSIONS DRAWN. The attitudes and beliefs of Emergency Care Practitioners elicited from this study suggest a poor level of understanding of the extent and nature of domestic violence. There is a probable low detection rate amongst the majority of ECP's. There exists harbouring of myths that may confound the implementation of a pre-hospital protocol for domestic violence management. There is an inadequacy of current ECP practice with respect to domestic violence crisis intervention with regards screening, management and referral. The EMS response to domestic violence should be congruent with an appropriate health sector response and should include universal screening (asking about domestic violence routinely); comprehensive physical and psychological care for those patients who disclose abuse; a safety assessment and safety plan; the documentation of past and present incidents of abuse; the provision of information about patients rights and the domestic violence act; and referral to appropriate resources. The ECP curriculum should emphasise the particular nature and treatment of domestic violence. The study supports the need for the introduction of a comprehensive ECP protocol, in training and in practice. This information should prove useful to all who attempt to design educational programmes and clinical strategies to address this public health issue.Item 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.Item Non-health system related factors affecting tuberculosis treatment outcomes : a case-control study Umgungundlovu Health District.(2012) Ndwandwe, Zanele S. I.; Knight, Stephen Eric.KwaZulu-Natal province records the highest number of tuberculosis cases diagnosed in the country, but less than 50% of these were cured in 2008, and fewer in those from rural areas and informal settlements where inadequate health care continues. HIV and AIDS associated tuberculosis frequently require labour-intensive methods of monitoring and combating for any success to be achieved. The socio-economic context wherein these diseases occur further limit their control. The low proportion of tuberculosis patients currently with successful treatment outcomes in Umgungundlovu Health District makes essential an in-depth investigation to establish the factors that are associated with these poor outcomes. This study investigates the factors affecting the current poor treatment outcomes in new patients with tuberculosis in a high disease burden district of KwaZulu-Natal in 2011. Methods A retrospective case-control study was conducted comprising 300 adult cases of tuberculosis who failed to complete 6 months of ambulant therapy and 300 frequency matched controls who completed therapy. A random sample of 15 primary health care clinics was selected from where consecutive cases and controls were selected with probability proportional to the number of tuberculosis patients seen at the clinic. Data was extracted from patient records and interviews. Processed data was analysed to identify risk associations using multivariate logistic regression. Results After adjusting for confounding statistically significant risk factors associated with poor tuberculosis treatment outcomes were unemployment (Odds Ratio (OR) 16.0; 95% CI: 6.7 to 37.8); living in a rural area (OR 14.3; 95% CI: 1.1 to 18), distance from home to clinic (OR 1.4; 95% CI: 1.3 to 1.6), living with HIV (OR 2.3; 95% CI: 1.1 to 4.7) and being very ill (OR -5.0; 95% CI: 2.1 to 11.9). Discussion The principal findings are that non-adherence to TB treatment is significantly associated with a number of non-health systems issues. Determinants of poor TB treatment outcomes in patients receiving six-month ambulatory care are diverse and multifactorial. After adjusting for confounding variables, unemployment, distance from patient home to the clinic, living with HIV and being very ill during TB therapy remained significantly associated with a poor TB treatment outcome. Conclusions Although determinants of poor tuberculosis treatment outcomes in patients receiving six-month ambulatory care are diverse and multifactorial, poor tuberculosis treatment outcomes are significantly associated with identifiable factors independent of the health system. Rigorous intervention strategies should prioritize at least these five major risk factors. Recommendations The TB control programme should go beyond the health systems issues to include inter-sectoral collaboration to address socio-economic and other non-health system barriers to adherence to TB treatment. Further research is recommended in this field.Item Perceived parental practices related to alcohol use by 16 to 18 year old adolescents in the public high schools in the Emawaleni District of KwaZulu-Natal.(2009) Ghuman, Shanaz.; Meyer-Weitz, Anna.; Knight, Stephen Eric.Introduction: A quantitative cross-sectional study was undertaken to assess whether parenting practices regarding alcohol use (as perceived by 16-18 year old adolescents) are determinants of alcohol use by the adolescents. Parental practices include supervision, emotional support and parenting alcohol socialization behaviours that could influence adolescents' alcohol use behaviour. Aim: The aim of the study was to investigate the influence of perceived parental practices and alcohol use behaviour among 16-18 year old adolescents in public high schools in the Emawaleni District, KwaZulu-Natal. Methods: A cross-sectional study design was used. Self-administered questionnaires provided data from 704 adolescents enrolled in public high schools Data were processed using SPSS 15.0. (SPSS Inc., Chicago, Illinois). Scale reliability analyses were conducted and frequencies on all items calculated. Chi-square tests were used to assess associations between adolescent alcohol use and demographic variables. Logistical regression analyses explored the associations between the different demographic variables, adolescents' perceptions of parental practices and alcohol use behaviours. Results: The results indicated that the most significant others that affect the adolescents' drinking behaviour are parents (51.3%) and peers (33.8%). It was revealed that peers (40.1%) and parents (12.9%) offered the first alcoholic drink to adolescents. Age of alcohol use initiation was found to be as early as 13 years. It was found that mothers who communicated the risks of drinking (84.2%), and it is also mothers (36.9%) who inform adolescents of safe drinking practices. Eighty-two percent of parents are aware of adolescents' whereabouts. Regarding peer connectedness, 86% of the adolescents who drank alcohol felt that they could depend on peers when drunk and 77% of adolescents reported that they discouraged their peers from getting drunk. The best predictors of adolescent alcohol use were: younger age, being male, race (White), religiosity, parental and peer alcohol use. Discussion: The evidence demonstrated a basic understanding of the processes by which parents influence adolescent alcohol use behaviours. Although the study showed a stronger parental protective factor than reported in other studies, the influence of the peers in the adolescents' development is also consistent with that of other studies. Recommendations: Adequate interventions for adolescents are urgently needed to improve parenting skills in order to prevent risky adolescent alcohol use behaviours.Item Pre-treatment preparation and loss-to-care of adults living with HIV from an antiretroviral therapy clinic in Durban, KwaZulu-Natal.(2011) Nixon, Krystal-Lee.; Knight, Stephen Eric.Introduction. The demand for comprehensive Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) services is greater than the available supply, particularly for the provision of antiretroviral therapy. The resulting bottleneck in service delivery has considerable implications for people living with HIV and for resource management. Aim. The purpose of this research was to investigate loss-to-care and associated variables of adult HIV-infected people who were eligible for antiretroviral therapy, from July 2004 to December 2007 at Sinikithemba HIV Clinic in Durban, KwaZulu-Natal. Methods. An observational descriptive and analytic cohort study design was used. Secondary data sourced from Sinikithemba were collated. All HIV-infected adults, 15 years and older when registered on the TrakCare database, who were eligible for antiretroviral therapy were included in the study. Data were extracted to describe the preparation of HIV infected adults who were eligible for antiretroviral therapy. Variables were first summarised and described before the confirmatory analytic steps were taken to measure associations at the p<0.05 significance level. Results. Of the 10 424 HIV-infected adults registered at Sinikithemba, 5470 (52%) were eligible for antiretroviral therapy from July 2004 to December 2007 and 2979 (54%) of these were lost to care prior to initiating antiretroviral therapy. Six exposure variables were significantly associated with this loss-to-care, (gender, baseline CD4 count, pre-eligibility care, antiretroviral therapy delay, preparation step and waiting time). These variables remained significantly associated with loss-to-care even after controlling for confounding with logistic regression. Discussion and Recommendations. With the rapid scale-up of antiretroviral therapy programmes, the outcome of those people living with HIV lost to care before commencing therapy have not been adequately documented. This large cohort enrolled over three-and-a-half years demonstrates that the loss-to-care prior to initiation of antiretroviral therapy is a significant problem that needs to be further investigated. Focusing retention strategies at the pre-antiretroviral therapy stage of HIV care will improve overall programme outcomes.