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An evaluation of University of Cape Town medical students’ community placements in South Africa  [PDF]
Claudia S. Naidu,Virginia Zweigenthal,James Irlam,Leslie London
African Journal of Primary Health Care & Family Medicine , 2012,
Abstract: Background: Fourth-year medical students at the University of Cape Town (UCT) work closely with stakeholders in community teaching sites to conduct community-based research projects and follow-up health promotion interventions during their Public Health training.Objectives: This study evaluated the placements as a learning experience from the perspectives of past students and community stakeholders.Methods: A total of 32 projects were randomly selected out of 232 projects undertaken during 2006, 2008 and 2009. Two students and a stakeholder involved with each project were sampled. A standardised survey was emailed to students and in-depth interviews were held with stakeholders.Results: Fifty two per cent of 64 students and 57% of 25 stakeholders responded. Most students felt that the placements enhanced their academic experience and confidence in research skills, and were an effective form of learning. Perceived challenges included time constraints and, for a minority, inadequately prepared settings and stakeholders. Stakeholders felt that the placements empowered the communities and prepared students for the realities of working as a medical professional. They viewed students as a valuable resource and believed that student projects addressed important community myths and health problems. Recommendations from students and stakeholders included more time for the Public Health block, followup interventions for greater continuity, and better alignment of projects with stakeholder programmes.Conclusion: The evaluation reveals both the importance and challenges of community placements and identifies areas of improvement. Despite the limited duration of the placements, they offered valuable community-based learning experiences for the students and worthwhile benefits for the communities.
A survey of hypertensive practices at two community health centres in Cape Town
B Rayner, M Blockman, D Baines, Y Trinder
South African Medical Journal , 2007,
Abstract: Background. Control of hypertension remains an elusive goal, but doctors' non-compliance with guidelines, patient attitudes and adherence to treatment, and poor delivery of care at clinics are important contributing factors. Objectives. To determine the overall quality of hypertensive care, and compliance with current hypertension guidelines at community health centres (CHCs) in the Western Cape. Methods. Consecutive patients attending hypertension clinics at two CHCs were selected to participate. A questionnaire was designed to determine patient demographics, doctors' compliance with hypertension guidelines, factors leading to treatment non-adherence, and delivery of care. Accuracy of blood pressure (BP) recording was evaluated by comparing the clinic BP with that measured using an approved manometer. Results. One hundred and sixty-one patients were evaluated, 100 from CHC 1 and 61 from CHC 2. There was no difference in both control systolic and diastolic BP measured by the hypertension nurse (147.9 v. 144.8 mmHg, p = 0.45, and 89.3 v. 85.6 mmHg, p = 0.14) respectively. All clinic BP readings were recorded to the nearest 10 mmHg mercury. The difference in both systolic and diastolic BP > 10 mmHg between the clinic and control BP was significantly greater at CHC 2 than CHC 1 (28% v. 56%, p = 0.005, and 43% v. 64%, p = 0.007) respectively. Overall, 39.8% of patients had a systolic and diastolic BP < 140 and < 90 mmHg. The mean number of antihypertensive drugs was 2.4 per patient. The use of non-steroidal antiinflammatory drugs (NSAIDs) and tricyclic antidepressants was high at both centres, and few patients underwent basic investigations, lifestyle interventions, risk stratification or global cardiovascular risk reduction. Conclusions. 39.8% of patients achieved a BP < 140/90 mmHg. There is significant scope for improvement in prescription of medication, application of uniform lifestyle changes, and avoidance of NSAIDs and tricyclic antidepressants. Major deficiencies were identified in BP measurement, assessment of target organ damage, risk stratification and the reduction of overall cardiovascular risk. South African Medical Journal Vol. 97 (2) 2007: pp. 280-284
Primary health eye care knowledge among general practitioners working in the Cape Town metropole
M Van Zyl, N Fernandes, G Rogers, N Du Toit
South African Family Practice , 2011,
Abstract: Aim: The main purpose of this study was to determine whether general practitioners (GPs) in the Cape Town metropole have sufficient knowledge to diagnose and treat primary care ophthalmic conditions correctly, and to assess their own perceptions of their levels of knowledge. Secondary objectives included identifying the need for courses to improve the ophthalmic knowledge of GPs and assessing whether there is a need to revise the undergraduate curriculum in ophthalmology in general. Method: A cross-sectional survey was done. A questionnaire of 10 primary care level ophthalmology questions, including a self-assessment section, was sent to each of 140 randomly chosen GPs in Cape Town. Results: A response rate of 79.2% was obtained. Respondents included graduates from all eight medical schools in South Africa. Most of the responding GPs were practising for more than 10 years (78.2%). The mean test score was 52.5% (standard deviation [SD]: 22.2). The mean self-rating was 51.9% (SD: 14.5). There was no statistically significant difference between the test score and the self-rating score (p = 0.5840). Responding GPs felt that there is a need for ophthalmology up-skilling courses and 99.9% of them would attend such courses. Also, 82% of GPs felt that primary care doctors, not optometrists, should deliver primary eye care. Conclusion: GPs appear to lack sufficient knowledge to manage primary health eye care problems, presumably due to a lack of adequate training in the field. Clinical up-skilling courses are needed to improve core knowledge in ophthalmology.
Improving the annual review of diabetic patients in primary care: an appreciative inquiry in the Cape Town District Health Services
R Mash, NS Levitt, U Van Vuuren, R Martell
South African Family Practice , 2008,
Abstract: Background: Diabetes is a common chronic disease in the Cape Town District Health Services and yet an audit of diabetic care demonstrated serious deficiencies in the quality of care. The Metro District Health Services (MDHS) decided to focus on improving the annual review of the diabetic patient. The MDHS provides primary care to the uninsured population of Cape Town through a network of 45 Community Health Centres (CHC). Methods: An appreciative inquiry was established amongst the staff responsible for diabetic care at the 15 CHCs that had newly appointed facility managers. The inquiry completed three cycles of action-reflection over a period of one year and included training in clinical skills as requested by the participants. At the end of the inquiry a consensus was reached on the learning of the group. Results: This consensus was expressed in the form of 11 key themes. CHCs that reported success with improving the annual re-view formed chronic care teams that met regularly to discuss their goals, roles and to plan improvements. These teams developed more structured and systematic approaches to care, which included the creation of special clubs, attention to the steps in patient flow and methods of summarising and accessing key information. These teams also appointed specific champions who would not rotate to other duties and who would provide continuity of leadership and organisation. These teams also supported continuity of relationships, clinical management and organisation of care. Teams involved the community and local non-profit organisations, particularly in the establishment of support groups that could disseminate medications and build health literacy and self-efficacy. Some teams emphasised the need to also care for the carers and to not just focus on workload and output indicators. More suc-cessful CHCs also grappled with balancing of the workload, quality of care and waiting times in a way that improved all three in an upward spiral. Patient satisfaction, staff satisfaction and clinical outcomes were seen as interlinked. There was a need to plan methods for empowering patients and build self-efficacy through a variety of facility- and community-based as well as individual- and group-orientated initiatives. Training in clinical skills was requested for foot and eye screening. Feedback was given to the MDHS on the need to improve referral pathways and access to preventative services such as dieticians, podiatrists and vascular surgery. Finally, the inquiry process itself together with the annual audit supported organisational learning and change at the facility level. Conclusion: Improving the annual review has more to do with the organisation of care than gaps in knowledge or skills that can be addressed through training. While such gaps do exist, as shown by the training around foot screening, the main focus was on issues of leadership, teamwork, systematic organisation, continuity, staff satisfaction, motivation and the balancing
Use of dietary supplements, and awareness and knowledge of the recommended fruit and vegetable intakes and consumption of health food store customers in the Cape Town city bowl
M Braun, I Venter
South African Journal of Clinical Nutrition , 2008,
Abstract: Objectives: The objectives of this study were to determine the dietary supplement use and demographic characteristics of customers visiting health food stores in the Cape Town city bowl, and to determine their awareness and knowledge of the recommended fruit and vegetable intake servings and their fruit and vegetable consumption. Design and setting: A self-administered questionnaire was completed by customers visiting two health food stores in the Cape Town city bowl. Subjects: Participants were recruited systematically. One hundred and sixteen of the 146 invited customers participated in the survey (79.5%), but the sample consisted of 112 because four questionnaires were not completed fully. Results: The majority of the sample (81.3%) used supplements, and 79.1% of these were regular users. The demographics of the sample and of the supplement users were mainly female and white, with a higher education, and a younger age. Vitamin (63.2%), mineral (42.5%) and herbal (42.5%) supplements were consumed most. The two main reasons for use were to supplement the diet (68.1%) and to prevent disease (59.3%). A third of the sample (33.0%) was aware of the “5-a-day” concept, while only 21.4% understood the concept. Knowledge of the recommended daily fruit (92.0%) and vegetable (47.3%) intake servings was higher than the awareness of the “5-a-day” concept, although only 65.2% and 14.3% of the respondents consumed the recommended daily servings of fruit and vegetables respectively. Conclusions: The demographic profile of the supplement users was similar to that reported in other studies. Knowledge of the recommended daily fruit and vegetable intake servings was higher than the consumption behaviour, as fewer servings were consumed than were indicated should be consumed, especially regarding vegetable intake. More respondents who were aware of the “5-a-day” concept were consuming the recommended intake of five fruit and vegetables servings daily. SAJCN Vol. 21 (4) 2008: pp. 323-330
Awareness, knowledge, understanding and readiness to adopt bioactive food ingredients as part of functional food consumption by health-conscious consumers of the City of Cape Town
K O'Connor, I Venter
Journal of Family Ecology and Consumer Sciences /Tydskrif vir Gesinsekologie en Verbruikerswetenskappe , 2012,
Abstract: Functional foods (and dietary supplements) containing bioactive food ingredients are more likely to be adopted by consumers who are aware of, have knowledge and an understanding of these ingredients. The first aim of this survey was to determine the consumer awareness, knowledge and understanding of ten bioactive food ingredients. As a second aim, associations between the consumer awareness, knowledge and understanding of each bioactive food ingredient and the consumer interest in, and knowledge of, food and nutrition, and health and wellness were determined. Consumer interest and knowledge are fundamental factors supporting consumer adoption of new products. Representing the health-conscious consumer 139 gymnasium/fitness centre subscribers and/or dietary supplement users from two middle-to-upper socio-economic sub-councils of the City of Cape Town Metropolitan Municipality voluntarily participated. The top five bioactive food ingredients recognised by the respondents were omega-3 fatty acids (97,1%), antioxidants (87,1%), probiotics (84,9%), soy protein (83,5%) and beta-carotene (68,3%). Omega-3 also produced the highest percentage of respondents with understanding of it as ingredient. Significant differences (p < 0,05) between the awareness, knowledge and understanding of omega-3 by the respondents and their perceived interest in, and knowledge of, food and nutrition, as well as health and wellness, were found. This placed omega-3 fatty acids closest to product adoption and consumption and differentiated it from soy protein and beta-carotene which were not found to be significantly (p > 0,05) associated with any of these factors.
Local-level mortality surveillance in resource-limited settings: a case study of Cape Town highlights disparities in health
Groenewald,Pam; Bradshaw,Debbie; Daniels,Johann; Zinyakatira,Nesbert; Matzopoulos,Richard; Bourne,David; Shaikh,Najma; Naledi,Tracey;
Bulletin of the World Health Organization , 2010, DOI: 10.1590/S0042-96862010000600013
Abstract: objective: to identify the leading causes of mortality and premature mortality in cape town, south africa, and its subdistricts, and to compare levels of mortality between subdistricts. methods: cape town mortality data for the period 2001-2006 were analysed by age, cause of death and sex. cause-of-death codes were aggregated into three main cause groups: (i) pre-transitional causes (e.g. communicable diseases, maternal causes, perinatal conditions and nutritional deficiencies), (ii) noncommunicable diseases and (iii) injuries. premature mortality was calculated in years of life lost (ylls). population estimates for the cape town metro district were used to calculate age-specific rates per 100 000 population, which were then age-standardized and compared across subdistricts. findings: the pattern of mortality in cape town reflects the quadruple burden of disease observed in the national cause-of-death profile, with hiv/aids, other infectious diseases, injuries and noncommunicable diseases all accounting for a significant proportion of deaths. hiv/aids has replaced homicide as the leading cause of death. hiv/aids, homicide, tuberculosis and road traffic injuries accounted for 44% of all premature mortality. khayelitsha, the poorest subdistrict, had the highest levels of mortality for all main cause groups. conclusion: local mortality surveillance highlights the differential needs of the population of cape town and provides a wealth of data to inform planning and implementation of targeted interventions. multisectoral interventions will be required to reduce the burden of disease.
Adverse social, nutrition and health conditions in rural districts of KwaZulu-Natal and the Eastern Cape provinces, South Africa.
S Schoeman, M Faber, V Adams, C Smuts, N Ford-Ngomane, J Laubscher, M Dhansay
South African Journal of Clinical Nutrition , 2010,
Abstract: Objective: This study determined the socio-demographic, nutritional and health status of children and their caregivers in two rural districts in KwaZulu-Natal (KZN) and one rural district in the Eastern Cape (EC), South Africa. Design: A cross-sectional survey was conducted. Setting: The study population resided in Umkhanyakude (sub-district Jozini) and Zululand (sub-district Pongola) in KZN, and in OR Tambo (sub-district Nyandeni) in the EC province. Subjects: Children 0 to 59 months old (Umkhanyakude n = 398; Zululand n = 303; OR Tambo n = 364) and their caregivers were included. Methods: Structured interviewer-administered questionnaires were conducted and height and weight were measured. Results: Households in OR Tambo had less access to services (tap water 3%, toilets 33%), compared to Umkhanyakude (tap water 50%, toilets 82%) and Zululand (tap water 74%, toilets 98%). Wood was the main energy source used to cook food in all three districts (> 75%). Grants were a main source of income (Umkhanyakude and Zululand 61%; OR Tambo 55%). Many households obtained vegetables from their own garden (Umkhanyakude and Zululand 30%; OR Tambo 70%). The households that reportedly had enough food available at all times (Umkhanyakude and Zululand 25%; OR Tambo 17%), were in the minority. The diarrhoea prevalence reported by the caregivers was high (Umkhanyakude 35%; Zululand 24%; OR Tambo 24%). The prevalence of stunting was higher for children older than 12 months and varied between 22 and 26%. The prevalence of overweight among children 0 to 23 months exceeded the prevalence of underweight. The prevalence of overweight and obesity among caregivers was high (Umkhanyakude 42%; Zululand 60%; OR Tambo 56%). Conclusion: Concerted efforts are needed to address the adverse social, nutrition and health conditions in these districts
Making COD statistics useful for public health at local level in the city of Cape Town: utilidad para la salud pública a nivel local en Ciudad del Cabo
Bradshaw,Debbie; Groenewald,Pamela; Bourne,David E; Mahomed,Hassan; Nojilana,Beatrice; Daniels,Johan; Nixon,Jo;
Bulletin of the World Health Organization , 2006, DOI: 10.1590/S0042-96862006000300016
Abstract: objective: to review the quality of the coding of the cause of death (cod) statistics and assess the mortality information needs of the city of cape town. methods: using an action research approach, a study was set up to investigate the quality of cod information, the accuracy of cod coding and consistency of coding practices in the larger health subdistricts. mortality information needs and the best way of presenting the statistics to assist health managers were explored. findings: useful information was contained in 75% of death certificates, but nearly 60% had only a single cause certified; 55% of forms were coded accurately. disagreement was mainly because routine coders coded the immediate instead of the underlying cod. an abridged classification of cod, based on causes of public health importance, prevalent causes and selected combinations of diseases was implemented with training on underlying cause. analysis of the 2001 data identified the leading causes of death and premature mortality and illustrated striking differences in the disease burden and profile between health subdistricts. conclusion: action research is particularly useful for improving information systems and revealed the need to standardize the coding practice to identify underlying cause. the specificity of the full icd classification is beyond the level of detail on the death certificates currently available. an abridged classification for coding provides a practical tool appropriate for local level public health surveillance. attention to the presentation of cod statistics is important to enable the data to inform decision-makers.
Making COD statistics useful for public health at local level in the city of Cape Town: utilidad para la salud pública a nivel local en Ciudad del Cabo  [cached]
Bradshaw Debbie,Groenewald Pamela,Bourne David E,Mahomed Hassan
Bulletin of the World Health Organization , 2006,
Abstract: OBJECTIVE: To review the quality of the coding of the cause of death (COD) statistics and assess the mortality information needs of the City of Cape Town. METHODS: Using an action research approach, a study was set up to investigate the quality of COD information, the accuracy of COD coding and consistency of coding practices in the larger health subdistricts. Mortality information needs and the best way of presenting the statistics to assist health managers were explored. FINDINGS: Useful information was contained in 75% of death certificates, but nearly 60% had only a single cause certified; 55% of forms were coded accurately. Disagreement was mainly because routine coders coded the immediate instead of the underlying COD. An abridged classification of COD, based on causes of public health importance, prevalent causes and selected combinations of diseases was implemented with training on underlying cause. Analysis of the 2001 data identified the leading causes of death and premature mortality and illustrated striking differences in the disease burden and profile between health subdistricts. CONCLUSION: Action research is particularly useful for improving information systems and revealed the need to standardize the coding practice to identify underlying cause. The specificity of the full ICD classification is beyond the level of detail on the death certificates currently available. An abridged classification for coding provides a practical tool appropriate for local level public health surveillance. Attention to the presentation of COD statistics is important to enable the data to inform decision-makers.
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