School of Nursing & Public Health

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An overview of occupational health in the Durban Metropolitan area.
(1981) Jinabhai, Champaklal Chhaganlal.
No abstract available.
Challenges facing a community health physician in Bophuthatswana.
(1981) Matjila, Maila John.
No abstract available.
A review of child health care in the Durban Metropolitan area.
(1981) Ramiah, Kowselia Ramaswami.
No abstract available.
Indicators of maternal child health.
(1981) O'Dowd, Patricia Bridget.
The introduction outlines the reasons for the priority of maternal and child health emphasizing the relatively simple resources required. The aims of such programmes must be identified and the results measured so that services can be monitored and evaluated. Categories of measurement are defined and indicators of maternal child health identified within these categories. A chapter is devoted to an outline of the principal non-medical determinants based on material from the Inter-American Investigation of Childhood Mortality. The significance of the principal indicators viz. the perinatal mortality rate, the infant mortality rate, the maternal mortality rate and growth and development data are compared. Chapter lV presents a report of a questionnaire study into local indices viz. Stillbirth rates, Caesarean Section rates and Maternal Mortality rates. The uptake of certain clinic services was also determined. Differences between groups and possible reasons for these are discussed. The final chapter points out the need for accurate birth and death registration and a reliable health information system and suggests methods for achieving this. Recommendations are made for upgrading the collection of data and for improving maternal and child health by research and peripheralization of services.
The epidemiology of parasuicide at RK Khan Hospital.
(1984) Bhamjee, M.
It was suspected that about 2 cases of parasuicide were admitted daily to RK Khan Hospital and this suspicion was confirmed by this study. Most of the cases were female, and in the 15 - 24 year age group. Patients were admitted mainly in the evenings and on Sundays. The majority earned less than R500 per month and were mainly manual-skilled and semi-skilled workers predominantly from Chatsworth. Non-violent means were the common mode of parasuicide, the causes being family, marital and romantic problems. The hospital social worker dealt with the cases and referred patients to relevant organisations outside the hospital for management. Certain patients were referred to the Psychiatric Outpatient Clinic at the Hospital as there was no resident psychiatrist.
The health needs and priorities of a semi-urban African community.
(1984) Shasha, Welile.
This commentary is essentially a report on various aspects of assessment of health needs and priorities in a peri-urban black community (mainly African) situated near Pinetown. The study was initially conducted under the auspices of the Pinetown Health Department, and the main findings are as follows (a) The geographical area of Mariannhill II Location includes what the local people call "Impola" and "Tshelimnyama", and sustains a population of 3 000 persons on some 500 hectares. (b) The origins of the population have been found, contrary to popular belief, to be 92% urban and semi-urban, and only 8% rural. (c) Demographic characteristics are those of an established stable community with a high mortality rate and high fertility (135 livebirths per 1 000 women aged 15 - 49 years per annum). The sex ratio is 99.4 males per 100 females, and there are no migratory characteristics. (d) The average number of individuals per household is 9, with a lot of overcrowding per room (not quantified). Of 1 346 adults of working age 43.68% are unemployed. (e) Morbidity and mortality studies conducted both at the level of the community and hospital revealed that children under the age of one year had the most sickness episodes, while the age groups 6.1 to 18 years had the least. (f) The disease profile is that of a typical third world developing country, with predominance of infections, accidents and physical violence. (g) Diarrhea disease constituted about 11% of the profile and was significantly associated with the water source for the household. (h) The most important cause of the 33 deaths reported over a one year period is motor vehicle accidents and physical violence (33.3%). (i) The major health resource is the local St Mary's Hospital with a 55% uptake of sickness episodes from the community. Nearly half of these ended up as in-patients. (j) 60% of children under the age of 6 years were estimated to have been fully immunized, and virtually all of it had been done by the hospital. (k) Community opinion on their problems and needs overwhelmingly pointed at water, clinic and lack of transport facilities as urgent matters. However, careful assessment of community concern pointed to the threat of removal as the most important single community problem, with implications for housing and all the other perceived problems. The majority of the people looked up to the Catholic Mission as a possible source of help to resolve the problem of availability of water. (l) As the study was initiated with a view to interventive strategies, the main findings are discussed against a background of information distilled from several literary sources, and recommendations for action are advanced. (m) Lastly, the most important problem in data collection has been that of inaccessibility of the Pinetown register of births and deaths to the Pinetown Medical Officer of Health. We regret the difficulty, but we hope to update our study when the problem has been overcome.
Community awareness of GOBI-FFF and its implementation in two urban communities
(1985) Dada, Ebrahim.
The health picture in the developing world is still very bleak. The varlOUS Black populations of South Africa (be they Africans, Indians or Coloureds) are part of this developing world. In a total world population of 4,607 million (of which 75 % are in the developing world); there are 10.3 million annual infant deaths (0-11 months) (of which 97 % are ln the developing countries); and 4.3 million annual child deaths (1-4 years) (of which 98 % are in the developing countries).*l The infant mortality rate (IMR) (infant deaths per 1,000 live births) in 1980 for the developing countries as a whole, and for Southern Africa specifically is 100; as compared to the IMR of 20 for developed countries. South Africa has an IMR of 90 (1982). However, a few relatively simple and inexpensive methods could enable parents themselves to bring about a revolution ln child survival and development. The idea that could make this revolution possible is primary health care. The vehicles that could make this revolution achievable are the spread of education, communications and social organization. The techniques which could make this revolution affordable even with very limited resources, are growth monitoring, oral rehydration therapy, breast-feeding and immunization (GOBI). These four principle life line techniques are low-cost, available now, achieve rapid results and a l most universally relevant. They involve people in taking more responsibility for their own health, and thus promote primary health care. In combination they offer an even greater degree of protection against the synergistic alliance of malnutrition and infection which is the central problem of child health and child development today. *3 In addition, three other changes-female education, family spacing and food supplementation (FFF) are also among the most powerful levers for raising the level of child survival and child health. Although more costly and more difficult to achieve, these changes in the lives of women are of such potential significance that they must also now be count ed among the breakthrough in knowledge which could change the ratio between the health and wealth of nations. *3 However, against this information is the stark reality that only up to 15 % of the world's families are using oral rehydration therapy (ORT), the revolutionary low-cost technique for preventing and treating diarrhoeal dehydration, the biggest single killer of children in the world. *4 This then rai ses the vital question that although the potential for child survival and a healthy and normal child development is there, to what extent is the average mother aware of and implementing these cost-effective methods of GOBI-FFF in her own situation? These questions are thus addressed in this study in an African and an Indian urban communities ln Natal/Kwa Zulu.
The prevalence of obesity and associated medical conditions in an urban Indian general practice.
(1986) David, C. A. D.
The prevalence of obesity and associated medical conditions amongst Indian patients attending an urban Indian general practice in Phoenix was investigated. Data were collected using standardized questionnaires and checklists. All obese patients, 18 years of age and older, who attended the Researcher's general practice were interviewed and examined, personally, by the Researcher. The study was conducted over a period of three months. In respect of identifying medical conditions associated with obesity, information from patients' records in the Researcher's general practice was utilized and where this was not available, a questionnaire to identify the aforementioned medical conditions, was administered to the patient. Data were collected, entered onto a collation sheet and analysed manually. The prevalence rate of obesity for males and females was found to be 4% and 13% respectively. The majority (88%) of obese subjects were married and were housewives. A large number (81%) had received a low level of education. The majority (91%) did not smoke. Most (95%) did not consume any alcohol. The majority of obese subjects (70%) came from families consisting of between four and seven persons. Most were in the third and fourth decades of their lives (65%), and engaged in very little physical activity. The majority (70%) had a diet consisting mainly of carbohydrates, especially refined carbohydrates. Dyspnoea was the most commonly occurring medical condition in these subjects (32%). Next ranked osteoarthrosis (23%); then varicose veins (10%); depression (10%); hypertension (9%); anxiety (6%); diabetes niellitus (4%); flat feet (2%); hernia (2%) and ischaemic heart disease (2%). Obesity is associated with much morbidity. Efforts should be directed towards preventive measures as well as identifying and treating those obese persons who are at risk of developing obesity - associated diseases.
Dietary factors in overweight adults.
(1986) Smith, R. J.
The often stated inability of many patients to lose weight or maintain weight reduction is a common complaint heard in general practice and the dietary reasons underlying the problem was studied. The study was carried out in a suburban general practice , and it was found that there is a high degree of dietary ignorance and dietary indiscretion in overweight people. This would therefore account in the majority of cases for the claims made by patients that they eat very little and yet cannot lose weight. Overweight/obesity is of multi-factoral aetiology and the dietary aspect plays a major role. Thus recommendations have been made to endeavour to correct the problem at general practice level, by supplying a protocol in an approach to weight control management and at a community level by the introduction of a comprehensive and multifaceted health programme aimed at education and implementation of good dietary behaviour.
A review of dispensing in South Africa.
(1986) Cassimjee, Mohammed Hoosen.
The dispensing Medical Practitioner has become topical since 13B4 . Dn this issue, much confusion and ignorance prevails, both amongst members of the medical and allied professions and in the public mind. This study was undertaken to demonstrate some aspects of dispensing of medicines in South Africa and to cansider the implications arising out of the application of legislation governing such dispensing of medicines by family practi tioners. The main objectives of this study were: CaD To identify and ascertain the opinions and policies of all those who are involved and concerned with the dispensing of medicines. Cb) To determine the implications of all the legislation governing the dispensing of medicines on: 1. patient care 2. the dispensing of medicines by doctors Cto their patients}. Information was gathered from a questionnaire sent to service/ consumer groups; from literature review of journals; publications and gazettes; and from legal consultations. The results of the study indicated that: C13 Professional Associations such as, Medical Association of South Africa, the Pharmaceutical Society as well as statutory bodies such as the South African Medical and Dental Council and the Pharmacy Council are concerned with issues such as 'trading in medicine ' and 'profiteering '. Inadequate patient care resulting from the physical, financial and economic hardships suffered by a majority of patients are issues which appear not to have been addressed by these bodies. CE) The fundamental issues of "what is in the best interest of the patient " appears to be ignored in legislation pertaining to dispensing. C33 Dispensing to patients became difficult due to the impractical stringent restrictions imposed by the legislation governing dispensing of medicines. C4D The dispensing of medicines by a doctor is less timB consuming, more convenient and cheaper for the patient as well as for the Sick Benefit Funds. The results were discussed with respect to their theoretical and practical implications and the conclusion reached was that the dispensing legislation presently designed for first world communities, became totally impractical when applied to third world communities, and that most doctors dispense medicines in response to the needs of the individual communities they service. Further research possibilities and recommendations were suggested in order to gain a greater understanding of the dispensing issue, which hopefully will assist to improve the quality of health care and also ensure the best possible advantage for the patient.
Alcohol use and the availability of supportive services in a white urban community.
(1986) Miller, Atholl Jonathan.
This study identifies the alcohol intaKe patterns of 274 white patients attending an Urban General Practice. The average consumption rate was 6.5 drinKs per person per weeK (d/p/w). 40X of the surveyed group did not consume any alcohol. The drinkers averaged 11 dIp/wo 72X of the males drank and 501: of the females dranK. 4.31: of the population surveyed were drinking more than 28 dIp/wo Marital status made no real difference to consumption rates but unemployment (16 d/p/w) and being a manual labourer (11.7 d/p/w) did. People who had lost either their occupation (11.7 d/p/w) or a close family member (9.3 d/p/w) in the preceeding year had higher than average (6,5 d/p/w) consumption levels and these were increased further if they had identified an alcohol abuser in their family. This study also identifies the useful supportive services available to this particular community and its health care worKers with a brief discussion of the type of service prOVided and method of access to the service. The appendix contains a list of the services with the relevant address. telephone number and where possible the name of a contact person.
Survival and rehabilitation following acute stroke.
(1986) Dewar, Sandra Ruth.; Arbuckle, Derek Dennis.; Bill, Pierre Louis Alfred.
The outcome of acute stroke in 210 White adult patients admitted to Addington Hospital, Durban in 1983 and 1984 was investigated by means of retrospective case-note review. In addition, the level of functional independence of 35 people who, at the time of this study, were survivors of an initial acute stroke was assessed through household survey. The study was considered relevant and worthwhile for several reasons: 1. Stroke is an important contributor to morbidity and mortality in Whites in South Africa, however, l i t t l e information is available in respect of the outcome of sufferers of stroke who were admitted to the study hospital. 2. Knowledge of the needs of survivors of acute stroke is necessary if appropriate health care is to be provided. 3. Few community studies have been done in South Africa in which the status of stroke survivors has been established. The principle aims of the study were therefore: 1. To establish the survival of patients with acute stroke who were admitted to the study hospital. 2. To determine in survivors of an initial stroke their residual functional loss and hence to identify the supportive health care needs of this group. The most important findings of the study were as follows: 1. Of the 286 stroke admissions identified through the hospital's medical record retrieval system, stroke diagnosis according to the study definition could be confirmed in only 210 (73.4%) cases due to misplaced files or miscoded diagnoses. The need for improvement in the method of recording, storing and retrieving of patient information is indicated by these findings. The overall hospital fatality rate for stroke was 54%. Mortality was highest in the first week after admission (71%). The number of males and females, in respect of whom a final diagnosis of stroke was attributed, was almost equal. A significant difference (p < .000 2) in respect of age was noted between the sexes. The mean age of onset of stroke was 62.9 and 70.0 years for males and females respectively. The major diagnostic categories (haemorrhagic or occlusive) of stroke could only be ascertained in respect of 30% of cases. This was due to incomplete recording of clinical findings, and possibly, due to the absence of resident brain-scanning facilities at the time. Analysis of the results of the household interviews indicated that:-( I ) Of the 35 patients interviewed 13 (37%) were found to be fully independent in self-care and were mobile outside of the home. (ii) The patients' potential for improvement in an appreciable number of cases had been under-estimated by the hospital staff. Patient adjustment following hospital discharge appeared adversely affected by.-(i) Inadequate preparation for discharge, especially where patients were returning to their own homes. (ii) Inadequate explanation given to patients and their families of the meaning and implications of stroke. (iii)The non-involvement of the family during the period of hospitalization. (iv) The absence of appropriate follow-up after discharge. Stroke onset was a traumatic experience in all cases. Amongst the most important reasons given for reduced life-satisfaction post stroke were confinement to the home, reduced independence and unresolved loss (eg death of spouse, forced retirement). 8. In some cases it was f e l t that social isolation, general ill-health and old age were more significant problems in the lives of patients than the stroke itself. The advent of stroke merely exaggerated these problems. 9. The advantage of administering a standardized functional assessment at intervals during the rehabilitation of the patients became increasingly clear as the study progressed. It is proposed that functional assessment be considered as important as clinical assessment in the management of stroke patients. 10. Recommendations have been submitted concerning rehabilitation and the provision of supportive services for stroke patients. As the role of the nurse in short and long-term care is central to successful stroke outcome, emphasis has been placed on her role in the team. The main conclusions formulated in the study were:-1. Mortality from stroke is high but in survivors an appreciable proportion maintained functional independence. 2. Preparation of patients and their families is important to adjustment following discharge from hospital. 3. Supportive services are important to the maintenance of the stroke patient in the home environment. 4. A team approach, consisting of a wide range of health professionals is appropriate to the management of stroke. 5. Functional assessment is an important component of the clinical examination and should be done prior to discharge and subsequently at regular intervals to assess the patient's competence to exist in the current domestic environment.
Primary health care needs of an urban and a rural African community.
(1986) Ngubane, B. S.; Arbuckle, Derek Dennis.
No abstract available.
Health care of the geriatric Indian population of Port Shepstone.
(1986) Naidoo, D. M.
No abstract available.
Profile of sexually transmitted diseases at Addington Hospital, Durban.
(1986) Govind, Uttam.
During the period January 1985 to December 1985, 537 consultations were undertaken at the Special Clinic at Addington Hospital, 483 of these were specifically for venereal disease. The male to female ratio was 2.2:1. The majority of the patients treated were Coloureds. Most of the patients were in the age group of 20-35 years. The majority of the patients were unemployed. Gonorrhoea was diagnosed in 25.13% of the patients, followed by latent syphilis 19.52%. Chancroid was the commonest cause of genital ulceration and was diagnosed in 10.4% of the study population. N. Gonorrhoea was isolated in 42 patients; 40.5% of the isolates were resistant to penicillin, 66.6% to cotrimaxozole and 30.9% to ampicillin. The organism was sensitive to chloromycetin, erythromycin and tetracycline in most cases. All the penicillin resistant strains were sensitive to spectinomycin.
Attitudes of African males to contraception.
(1986) Luthuli, H. V.; Arbuckle, Derek Dennis.; Naidoo, K.
The attitude of the African male to contraception and the role he plays in the acceptance of contraceptives by his racial group is presented. Over a period of one month the researcher interviewed 220 African males at a primary care private practice. In this study 186 (85%) were aware of contraceptives and 34 (15%) had no knowledge of contraception; 111 (60%) were married and 75 (40%) were unmarried. The 26 - 35 year age group were the most familiar with contraception (57%). The unemployed were the least users of contraceptives (8%), whereas 69% of the professional group were using contraceptives. The average ideal family size of the group was 4 children. No significant cultural barriers to contraception were found. Religion was found to have little effect on contraceptive practice by the African male. Fifty-three percent of the Urban dwellers were using contraceptives compared with only 30% of the Rural inhabitants. Modern methods of contraception are not yet sufficiently known by the African male to be useful to him. Health workers should educate the African male in matters of contraception to achieve the desired objectives of family planning campaigns among this racial group.
Outpatient catchment populations of hospitals and clinics in Natal/KwaZulu.
(1987) Dada, Ebrahim.
Catchment populations and cross-boundary flow characteristics of health facilities in Natal and KwaZulu have not previously been determined. As this information is essential to objective health service planning the present study was undertaken. Utilization. cross-boundary flow and catchment populations were determined in 1986 for each hospital and clinic in Natal and KwaZulu. All of the 61 hospitals and 178 clinics in Natal and KwaZulu which are operated by the public sector were included in the study. The ratio of clinics-to-hospitals was 2.9 1. The overall average population per hospital and clinic was 106775 and 36591 respectively. The size of the catchment populations of hospitals varied from 334972 to 272 and of clinics from 253159 to 877. Factors associated with these variations are discussed. Inter-regional cross-boundary flow of patients varied appreciably. The greatest influx of patients was experienced by the Durban sub-region where the teaching hospital is situated while the greatest influx of patients was experienced in the Port Shepstone sub-region. Attendance rates per person per annum. according to racial group, were 0.9, 2.1, 1.7 and 0.8 respectively for Blacks, Coloureds, Indians and Whites. Recommendations in respect of the distribution of health facilities and the routine collection and use of health information relevant to the management process are submitted.
Occupational health in South Africa.
(1987) Kistnasamy, Malcolm Barry.
Occupational health is concerned with health in its relation to work and the working environment. This study was undertaken to present an overview of occupational health in South Africa, with national and international perspectives on the discipline, in the light of : (a) the recent commissions of enquiry into aspects of occupational health in South Africa (b) the development of the national and self-governing states (c) new strategies by the authorities in the form of decentralization and deregulation. Information on the health profile of its workers, current legislative and service provisions and on policies for economic development and urbanization is vital for health administrators, occupational health and safety practitioners and policy makers. Data was collected through the use of literature surveys and postal questionnaires to the various interested persons and groups involved with occupational health. The findings reveal that (a) an inadequate occupational health policy exists in that the responsibilities of government(s), employers, workers and health professionals are not defined (b) there is an absence of an organizational and service framework for an occupational health system in South Africa although the morbidity and mortality data are significant (with their concomitant economic and social consequences) (c) there is a lack of financial and human resources for the practice of occupational health in South Africa. Recommendations are made taking into account the developed and developing components of South Africa.
Quality of paediatric care at King Edward VIII hospital.
(1987) Will, R. G.
The purpose of health service research is to produce knowledge that will contribute to the improvement in the delivery of health care and it is in this spirit that this study of the quality of paediatric care at King Edward VIII Hospital was undertaken. The main method utilized was an evaluation of aspects of the process of care of selected conditions, as measured against a predefined set of standards. This was accomplished by a retrospective review of patient records. Assessments were also made of the utilization of the Department's services, manpower and equipment. The surveys conducted involved the Outpatient's Department, the General and the Neonatal Wards of the Paediatric Department of the King Edward VIII Hospital, Durban. The Hospital Administration's routine and computerized data were also analyzed. Among the findings was that the routinely collected data is inadequate,providing only limited information for management purposes. The assertion that the utilization of the Department is high was confirmed, as was the claim that some resources are inadequate to cope with increasing demand. Many factors contribute to this, including high bed occupancy, high patient to doctor ratios, and several factors outside of direct hospital control (primary care services). The general clinical care of patients is high, but particular aspects were found to be in need of attention; for example, the metabolic and fluid management of the ill young patient and medical records in general. Immediate and long-term recommendations pertaining to the Paediatric Department and the Administration are presented.
The prevalence of infertility in women attending a general practice in Katlehong.
(1987) Mgiba, Phosakufa Wilson.
A study to determine the prevalence of infertility in females in a patient population attending a general practice in Katlehong was done over seven weeks in 1985. In this study 40.6% out of a total of 143 patients interviewed were found to be infertile. Contributing factors to infertility included an advanced age of patients and use of intra-uterine contraceptive devices. Pelvic inflammatory diseases, fibroid uteri, fixed retroverted uteri and a poor socio-economic status of patients were also found to be associated with infertility. The above factors associated with infertility in females are discussed and recommendations directed to the reduction of infertility are submitted.

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