Browsing by Author "Govender, Srini"

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    An analysis of blood pressure measurement in a primary care hospital in Swaziland
    (AOSIS Publishing, 2014-12) Mlawanda, Ganizani; Pather, Michael; Govender, Srini
    Background: Measurement of blood pressure (BP) is done poorly because of both human and machine errors. Aim: To assess the difference between BP recorded in a pragmatic way and that recorded using standard guidelines; to assess differences between wrist- and mercury sphygmomanometerbased readings; and to assess the impact on clinical decision-making. Setting: Royal Swaziland Sugar Corporation Mhlume hospital, Swaziland. Method: After obtaining consent, BP was measured in a pragmatic way by a nurse practitioner who made treatment decisions. Thereafter, patients had their BP re-assessed using standard guidelines by mercury (gold standard) and wrist sphygmomanometer. Results: The prevalence of hypertension was 25%. The mean systolic BP was 143 mmHg (pragmatic) and 133 mmHg (standard) using a mercury sphygmomanometer; and 140 mmHg for standard BP assessed using wrist device. The mean diastolic BP was 90 mmHg, 87 mmHg and 91 mmHg for pragmatic, standard mercury and wrist, respectively. Bland Altman analyses showed that pragmatic and standard BP measurements were different and could not be interchanged clinically. Treatment decisions between those based on pragmatic BP and standard BP agreed in 83.3% of cases, whilst 16.7% of participants had their treatment outcomes misclassified. A total of 19.5% of patients were started erroneously on anti-hypertensive therapy based on pragmatic BP. Conclusion: Clinicians need to revert to basic good clinical practice and measure BP more accurately in order to avoid unnecessary additional costs and morbidity associated with incorrect treatment resulting from disease misclassification. Contrary to existing research, wrist devices need to be used with caution.
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    An assessment of organisational values, culture and performance in Cape Town's primary healthcare services
    (Medpharm Publications, 2013) Mash, R. J.; Govender, Srini; Isaacs, Abdul-Aziez; De Sa, Angela; Schlemmer, Arina
    Objectives: Improving the quality of primary health care in South Africa is a national priority and the Western Cape Department of Health has identified staff and patient experience as a key component. Its strategic plan, Vision 2020, espouses caring, competence, accountability, integrity, responsiveness and respect as the most important organisational values. This study aimed to measure the personal values of staff, as well as current and desired organisational values. Design: A cross-sectional survey used the cultural values assessment tool. Data were analysed by the Barrett Value Centre. Setting and subjects: Staff and managers at five community health centres in the Cape Town Metropole. Outcome measures: Personal values, current and desired organisational values, organisational entropy and organisational scorecard. Results: In total, 154 staff members completed the survey. Participants reported personal values that are congruent with a move towards more patient-centred care. The top 10 current organisational values were not sharing information, cost reduction, community involvement, confusion, control, manipulation, blame, power, results orientation, hierarchy, long hours and teamwork. Desired organisational values were open communication, shared decision-making, accountability, staff recognition, leadership development and professionalism. Organisational entropy was high at 36% of all values. Only teamwork and community involvement were found in both the current and desired culture. The organisational scorecard showed a lack of current focus on finances, evolution and patient experience. Conclusion: The organisational culture of the Metro District Health Services is currently not well aligned with the values expressed in Vision 2020, and the goal of delivering patient-centred care.
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    Auditing chronic disease care : does it make a difference?
    (AOSIS Publishing, 2015-06) Essel, Vivien; Van Vuuren, Unita; De Sa, Angela; Govender, Srini; Murie, Katie; Schlemmer, Arina; Gunst, Colette; Namane, Mosedi; Boulle, Andrew; De Vries, Elma
    Background: An integrated audit tool was developed for five chronic diseases, namely diabetes, hypertension, asthma, chronic obstructive pulmonary disease and epilepsy. Annual audits have been done in the Western Cape Metro district since 2009. The year 2012 was the first year that all six districts in South Africa’s Western Cape Province participated in the audit process. Aim: To determine whether clinical audits improve chronic disease care in health districts over time. Setting: Western Cape Province, South Africa. Methods: Internal audits were conducted of primary healthcare facility processes and equipment availability as well as a folder review of 10 folders per chronic condition per facility. Random systematic sampling was used to select the 10 folders for the folder review. Combined data for all facilities gave a provincial overview and allowed for comparison between districts. Analysis was done comparing districts that have been participating in the audit process from 2009 to 2010 (‘2012 old’) to districts that started auditing recently (‘2012 new’). Results: The number of facilities audited has steadily increased from 29 in 2009 to 129 in 2012. Improvements between different years have been modest, and the overall provincial average seemed worse in 2012 compared to 2011. However, there was an improvement in the ‘2012 old’ districts compared to the ‘2012 new’ districts for both the facility audit and the folder review, including for eight clinical indicators, with ‘2012 new’ districts being less likely to record clinical processes (OR 0.25, 95% CI 0.21–0.31). Conclusion: These findings are an indication of the value of audits to improve care processes over the long term. It is hoped that this improvement will lead to improved patient outcomes.
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    Community assault and non-community assault among adults in Khayelitsha: A case count and comparison of injury severity
    (Stellenbosch : Stellenbosch University, 2015-07) Forgus, Sheron; Delva, Wim; Hauptfleisch, Christine; Govender, Srini; Blitz, Julia; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences
    ENGLISH ABSTRACT: Background: Community Assault (CA) or vigilantism is rife in the township of Khayelitsha. Anecdotal evidence suggests that victims of CA are worse off than other assault cases. However, scientific data on the rate and severity of CA cases is lacking for South Africa. Aims and Objectives: To contribute to CA prevention and management strategies, by estimating the rate of CA among adults in Khayelitsha and comparing the injury severity and survival probability between cases of CA and other assault (non-CA) cases. Methods: We studied 4 health centres in Khayelitsha during July - December 2012. A consecutive case-series was conducted to capture all CA cases during this period and a retrospective folder review was performed on all cases of CA as well as on a control group of non-CA cases to compare injury severity and estimate survival probability. Results: One hundred and forty-eight adult cases of CA occurred (case rate 1.1/1000 person-years) over the study period. The Injury Severity Scores (ISS) in the CA group were significantly higher than in the non-CA group (P<0.001), with a median (Inter Quartile Range) ISS of 3 in CA cases (2-6) and 1 in non-CA cases (1-2). Comparison between the two groups showed that a GCS<15 (20.1% versus 5.4%), referral to the tertiary hospital (33.8% versus 22.6%), and crush syndrome (25.7% versus 0%) were all more common in CA cases. Survival probabilities were similar in both groups: 99.2% in the CA group versus 99.3% in the non-CA group. Conclusion: The rate of CA among adults in Khayelitsha is high, and the severity of injuries sustained by CA victims is substantially higher than in other assault cases.
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    Community oriented primary care
    (AOSIS Publishing, 2016) Govender, Srini
    ENGLISH SUMMARY : This review looks at two closely related books by the same author on community-oriented primary care (COPC). The review features two books by Tessa S. Marcus that are titled: "Community oriented primary care: L2 primary health" and "Community oriented primary care: origins and history" respectively.