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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.
Paediatric admissions to hospitals in the Cape Town Metro district: A survey
A Westwood, M Levin, J Hageman
South African Journal of Child Health , 2012,
Abstract: A point prevalence survey of 381 paediatric medical inpatients in the 11 public hospitals in Cape Town in November 2008 showed that 70% of them were in central hospitals, with 39.4% requiring level 3 (sub-specialist) care. Numbers of children in hospital and their levels of health care requirement did not vary by sub-district of residence. Seventy-seven per cent of patients were under 5 years of age; 5% were teenagers. Few patients changed level of care during admission, but 10% did not need to be in hospital at the time of review. Median length of stay was 4 days, with children with level 3 needs having the longest lengths of stay. An under-provision of level 1 beds was demonstrated. HIV infection had been identified in 12% of admissions. While children with level 3 problems were well catered for in terms of bed provision, level 1 and step-down/home care provision were deficient or inefficiently utilised.
Housing Cape Town’s Forgotten Dead: Conflict in the Post-apartheid Public Sphere1
L Green, N Murray
Africa Development , 2010,
Abstract: On 28 May 2008, the Cape Town Partnership Company Executive Officers’s newsletter reported on an ‘Interfaith ceremony at Prestwich Place [sic]’ to ‘consecrate’ a new ossuary building recently completed in Cape Town’s central business district. The announcement placed the Ossuary alongside other Partnership initiates and events such as the Harvest Festival, the Creative Cape Town initiative, and the upgrading of the Cape Town Station and the Grand Parade managed through the Partnership and the City Improvement District. The building of the Ossuary is intended to memorialise and bring closure to the contestations over the re-emergence of burial spaces in the city that have taken place in Cape Town since 2004. Presented as a successful ‘partnership’ between the Prestwich Place Project Committee, the City of Cape Town, the South African Heritage Resources Agency, the District Six Museum and Heritage Western Cape, this symbolic act of closure has been hailed a breakthrough in terms of heritage practice by practitioners and city officials alike. In this paper we visit the space of the Ossuary and its associated exhibition in the city, and reflect on the relationship between life space and burial space in Cape Town. Following the official path of the exhibition we pause to attach our own notes – a series of fragmentary interventions which trouble the smooth surface of containment. We use the experience of walking to reflect on the architecture of closure.
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
Safety and efficacy of procedural sedation and analgesia (PSA) conducted by medical officers in a level 1 hospital in Cape Town
G Wenzel-Smith, B Schweitzer
South African Medical Journal , 2011,
Abstract: Objectives. To study the efficacy and safety of procedural sedation and analgesia (PSA) administered by medical officers (MOs) without formal anaesthetic training. Methods. A retrospective descriptive study in the Emergency Department (ED) of False Bay Hospital (FBH), situated in the southern suburbs of the Cape Town Metro Health District. The study included all patients who received PSA at FBH between 1 March 2007 and 31 August 2009. Variables recorded included age, gender, physical status as determined by the American Society of Anesthesiologists (ASA status), procedure, fasting and intoxication status, PSA medications, adverse effects, rescue manoeuvres performed, if any, and time to discharge. Analysis was largely descriptive and clinical and demographic data are presented as means (standard deviations), medians, ranges and proportions as appropriate. Success of sedation and incidence of adverse effects are presented as proportions. Results. Of 166 patients, 140 (84.3%) showed a good level of sedation, 14 (8.4%) were inadequately sedated, 5 (3%) were too deeply sedated but showed no signs of respiratory compromise, and 7 (4.2%) developed respiratory side-effects. Respiratory complications were treated with simple airway manoeuvres; no patient required intubation or experienced respiratory problems after waking up. There was no significant difference in the risk of adverse effects between the fasted and non-fasted groups. Mildly intoxicated patients who received PSA were at a higher risk of adverse effects. Conclusion. PSA can be administered safely by medical officers. Future research should expand on PSA research in this setting and focus on safety and patient satisfaction.S Afr Med J 2011;101:895-898.
Costs of measures to control tuberculosis/HIV in public primary care facilities in Cape Town, South Africa
Hausler,Harry Peter; Sinanovic,Edina; Kumaranayake,Lilani; Naidoo,Pren; Schoeman,Hennie; Karpakis,Barbara; Godfrey-Faussett,Peter;
Bulletin of the World Health Organization , 2006, DOI: 10.1590/S0042-96862006000700014
Abstract: objective: to measure the costs and estimate the cost-effectiveness of the protest package of tuberculosis/human immunodeficiency virus (tb/hiv) interventions in primary health care facilities in cape town, south africa. methods: we collected annual cost data retrospectively using ingredients-based costing in three primary care facilities and estimated the cost per hiv infection averted and the cost per tb case prevented. findings: the range of costs per person for the protest interventions in the three facilities were: us$ 7-11 for voluntary counselling and testing (vct), us$ 81-166 for detecting a tb case, us$ 92-183 for completing isoniazid preventive therapy (ipt) and us$ 20-44 for completing six months of cotrimoxazole preventive therapy. the estimated cost per hiv infection averted by vct was us$ 67-112. the cost per tb case prevented by vct (through preventing hiv) was us$ 129-215, by intensified case finding was us$ 323-664 and by ipt was us$ 486-962. sensitivity analysis showed that the use of chest x-rays for ipt screening decreases the cost-effectiveness of ipt in preventing tb cases by 36%. ipt screening with or without tuberculin purified protein derivative screening was almost equally cost-effective. conclusion: we conclude that the protest package is cost saving. despite moderate adherence, linking prevention and care interventions for tb and hiv resulted in the estimated costs of preventing tb being less than previous estimates of costs of treating it. vct was less expensive than previously reported in africa.
Breastfeeding policies and practices in health care facilities in the Western Cape Province, South Africa
D.B Marais, H.E Koornhof, M.L du Plessis, C.E Naude, K Smit, E Hertzog, R Treurnicht, M Alexander, L Cruywagen, I Kosaber
South African Journal of Clinical Nutrition , 2010,
Abstract: The Baby-Friendly Hospital Initiative (BFHI) is a global effort to improve the role of maternity services and to enable mothers to breastfeed their infants, thus ensuring the best start in life for their infants. The foundation for the BFHI is the Ten Steps to Successful Breastfeeding (BF). It has been shown, however, that the selective implementation of only some of the steps may be ineffective and discouraging to successful BF practices. An initial study was therefore conducted to assess the extent of the implementation of the Ten Steps in both public and private maternity facilities. Poor performance for some steps led to a follow-up study to investigate the knowledge and attitudes of health care workers (HCWs) and mothers alike and to evaluate the exclusive BF (EBF) practices of mothers attending private BF clinics. Both studies followed descriptive, cross-sectional designs and were set in the Cape Metropole in the Western Cape. Twenty-six maternity facilities participated in the initial study, for which observation lists were completed and verified by interviewer-administered questionnaires to both HCWs and mothers. Eighteen private BF clinics participated in the follow-up study, which included observations and interviewer-administered questionnaires to 25 HCWs and 64 mothers. During the initial study, lower mean scores were noted for Steps 1, 2, 6 and 10. The overall implementation of the Ten Steps was average. The findings highlighted the importance of the establishment and implementation of BF policies, of appropriate and continuous BF training and better referral systems to ensure initiation and establishment of early BF, EBF practices and support on an ongoing basis to ensure the best start in life for infants.
Effectiveness of prenatal screening for Down syndrome on the basis of maternal age in Cape Town
MF Urban, C Stewart, T Ruppelt, I Geerts
South African Medical Journal , 2011,
Abstract: Objective. The prenatal screening programme for Down syndrome (DS) in the South African public health sector remains primarily based on advanced maternal age (AMA). We assessed the changes over time and effectiveness of this screening programme within a Cape Town health district. Methods. Retrospective analysis of the Groote Schuur Hospital Cytogenetic Laboratory and Pregnancy Counselling Clinic databases and audit of maternal delivery records at a primary health care facility. Results. The number of amniocenteses performed for AMA in consecutive 5-year periods reduced progressively from 786 in 1981 - 1985 to 360 in 2001 - 2005. Comparing prenatal with neonatal diagnoses of DS, the absolute number and the proportion diagnosed prenatally have remained relatively constant over time. The Pregnancy Counselling Database showed that, of 507 women receiving genetic counselling for AMA in 2008 - 2009, 158 (31.1%) accepted amniocentesis – uptake has reduced considerably since the early 1990s. The audit of women delivering at a primary care facility found that only 10 (16.4%) of 61 AMA women reached genetic counselling in tertiary care: reasons included late initiation of antenatal care and low referral rates from primary care. Conclusion. Prenatal screening and diagnosis for DS based on AMA is working ineffectively in the Cape Town health district assessed, and this appears to be representative of a broader trend in South Africa. Inclusion of fetal ultrasound in the process of prenatal screening for DS should be explored as a way forward.
D.B. Saddington
Akroterion , 2012, DOI: 10.7445/46-0-123
Abstract: The South African Cultural History Museum in Cape Town is well known for its fine collections, not least those of Greek and Roman antiquities.2 On my last visit to Cape Town I was surprised to see something in the museum which I had not noticed before, a Latin inscription attached to the wall. There are of course very few ancient Latin inscriptions in South Africa.
Knowledge and attitudes of nursing staff and mothers towards kangaroo mother care in the eastern sub-district of Cape Town
N Solomons, C Rosant
South African Journal of Clinical Nutrition , 2012,
Abstract: Objectives: To determine the knowledge and attitude of nursing staff and mothers towards kangaroo mother care (KMC) in the eastern sub-district of Cape Town. Design: A cross-sectional descriptive study. Setting and subjects: A multi-stage sample of 30 kangaroo care mothers admitted to the Helderberg District Hospital (HDH); six nurses from the HDH; and nine nurses from the seven antenatal clinics that the mothers attended. The respondents were interviewed using a pretested questionnaire. Outcome measures: Knowledge, attitudes and acceptability of KMC. Results: Data were analysed using CDC Epi Info version 3.3.2, and Microsoft Excel software programmes. The majority of the mothers (83.3%) did not have prior knowledge of KMC. Sixty per cent of the nursing staff did not have any KMC training. The majority of the mothers were committed to KMC, were satisfied with the results (with regard to the weight gain of the infant), and indicated that they would continue to practise KMC at home. The majority of the hospital nursing staff was very positive toward KMC, and agreed that it was beneficial to both mother and infant. Conclusion: Most of the mothers lacked prior knowledge of KMC, and were only informed about it when they were admitted to the KMC ward. All of the nursing staff who were engaged in KMC (n = 15) had a positive attitude towards it.
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