Masters Degrees (Health Systems and Public Health)

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    Community poultry farmer knowledge, attitudes and practices contributing to antimicrobial resistance in high density areas of Bulawayo, Zimbabwe
    (Stellenbosch : Stellenbosch University, 2024-03) Ndlovu, Patience; Meintjes, Willem Albertus Jacobus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    ENGLISH SUMMARY: Background: Antimicrobial use in poultry poses a risk of resistance and transmission thereof to human populations, and poses a global public health risk. No previous studies considered Knowledge, Attitudes and Practices of community (backyard) poultry farmers in dense settlement areas in Zimbabwe Methods: We used self-administered questionnaires to assess knowledge, attitude and practice items in addition to general and demographic variables. We describe our findings and evaluate associations with practices. Results: Fifty-six participants completed questionnaires. A range of practices (good and bad) was reported. Practices with risk for antimicrobial resistance developing were associated with males, having previously experienced an incident of high mortality among the poultry, and if knowledge and attitude scores were low. Individuals trained by church organisations and practicing chicken farming as their only occupation was associated with good practices. Poor knowledge scores were predictive of poor practices in the study. The study also found that individuals who do chicken farming as their only occupation were more likely to adhere to international regulations than those who did it as a part time occupation. Factors associated with good practices were those that were trained by church organisations. Despite its limitations such as measurement bias, the study highlighted gaps in the one health concept which might reduce antimicrobial resistance in both clinical and community settings.
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    A descriptive study of clinicians’ experiences of giving feedback to final year medical students
    (Stellenbosch : Stellenbosch University, 2024-03) Mouton, Jannie; Blitz, Julia; Schmutz, A. M. S.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    ENGLISH SUMMARY: The translation of the science of learning to improve models of training should form part of the delivery of clinical services and the process of transforming health systems. Though good clinical teaching is at the centre of medical education, there are concerns about maintaining this in current pressured healthcare environments. Research revealed that feedback on student performance plays a crucial part of learning in the workplace and thus also as part of educational programs in health professions education. The importance of an educator’s role in feedback and how that role can improve achievement of learning outcomes via quality feedback have been reported. We are also reminded that experience-based learning of medical students plays an important role in competency-based medical curricula, and its value depends greatly on how clinicians and students use the exposure to achieve learning. Furthermore, it identified inadequate training in the giving of feedback as one of the key shortcomings of experience-based learning. Despite the importance of educators’, or in this case, clinicians’ roles in feedback and learning outcomes, my experience is that many of the clinicians, in our and in neighbouring training hospitals, have not been properly orientated or trained with regard to their responsibilities and simply had to assume this role of a clinician teacher as part of their duties. This experience is corroborated by research, who informs us that clinicians are sometimes unclear on how their teaching fits into the curriculum and that they feel unprepared for the tasks of giving feedback and of teaching and highlighted the need for faculty development of this area. The aim of this study, therefore, was to gain a better understanding of the perceptions of clinicians on giving feedback by exploring their experiences of doing this with final-year year medical students at rural teaching sites of Stellenbosch University, and in doing so, finding ways to improve the giving of feedback. This was an interpretivist study, generating qualitative data and using thematic analysis to analyse the data. This study was conducted at two rural district hospitals in the Western Cape (WC) Province of South Africa, namely that of Hermanus and Ceres, which form part of the LIC model of training of the Ukwanda Rural Clinical School of Stellenbosch University. Data was generated by conducting interviews with the clinicians, who are involved in teaching at these hospitals. Individual perspectives and experiences were explored by using a semi-structured interview schedule for the asking of the questions. Five overarching themes were developed from the findings of the study, and these highlight the important roles and responsibilities that both the clinical teacher and the student have in the feedback process, as well as the different aspects involved in the process of the giving of feedback itself. The overarching themes are the importance of relationship building between medical officer and student, the environment in which the feedback occurs, clinicians’ general experiences of feedback, more personal experiences of giving feedback and fifthly, considerations with regard to students, as the other party in the feedback process. Probably the most significant point that emerged was the importance of establishing a relationship between the medical officer and the student, and that connection between the two parties needed to take place before a relationship could be built. This was also crucial for the establishment of mutual trust and for feedback to translate into learning for the student. It was also revealed that this relationship or connection should entail a two-way discussion and was not a one-way monologue where the teacher or clinician just commented on what the student did wrong, as was very much a practice in the past. What was interesting was the various ways in which the process of feedback was described. According to some responses, the feedback process was something that should be specific and focused, but also should be carefully and skillfully done and therefore required thinking, preparation and more efficient orientation of the clinical teacher. It is well summarised in this quote: “Feedback should be a learning opportunity and not a scoring episode”. The need for training and capacity building for clinicians to improve the quality of the feedback they gave was another aspect that emerged almost unanimously from the data. The most prominent challenges identified in giving feedback that translated to learning were sufficient time and appropriate space to deliver the feedback. The envisaged contribution of the study is that gaining a better understanding of how clinicians experience giving feedback, could contribute towards planning and implementing appropriate training to improve the capacity of clinicians to provide feedback and therefore potentially improve quality of teaching and learning on this platform.
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    A survey of radiation protective equipment compliance amongst physicians performing fluoroscopy at Tygerberg Hospital
    (Stellenbosch : Stellenbosch University, 2023-12) Muller, Martin Carel; Meintjes, Willem Albertus Jacobus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    ENGLISH SUMMARY: Background: A high level of radiation protection equipment compliance is essential to protect physicians against ionizing radiation exposure. Initially, the majority of fluoroscopically guided interventional procedures were performed by radiologists, subsequently there have been a steady increase in physicians from other specialties employing procedural fluoroscopy. Compliance with the use of radiation protective equipment varies considerably in practise. Likely reasons could be differences in radiation safety training, variation in radiation safety knowledge and attitudes and practices inherent to different specialties. To better understand compliance with radiation protection equipment, the knowledge, attitudes, and usage patterns amongst exposed workers need critical examination. Objectives: The aim of the study was to determine factors associated with a low level of radiation protection equipment compliance amongst physicians performing fluoroscopically guided interventional procedures. Methods: A self-administered questionnaire was distributed to eligible subjects. Questions explored the following domains: demographic variables, radiation safety knowledge, attitudes towards radiation safety and practices associated with radiation protection equipment. Results: The proportion of subjects reporting compliant use of radiation protection equipment items were as follows: 8.4% for lead caps, 16.9% for eyewear, 3.3% for lead gloves, 56% for thyroid shields and 89.8% for lead aprons. For cap usage a low radiation safety knowledge level (OR=11.3, 95%CI=1.3-95.8; p = 0,049) and not supplying the item (OR = 5.8, 95%CI=1.1-30.2; p = 0,023) were associated with low compliance levels. Female gender (OR=5.1, 95%CI=1.2-21.9 p=0.028); radiology practice (OR=15.6, 95%CI=2.9-85.2; p=0,001); not supplying orthopods with eyewear (OR=22.5, 95%CI=2.7-189 p < 0,001) and less than 5 years of experience performing fluoroscopically guided interventional procedures (OR=8.1, 95%CI=1.8-36.5; p = 0.005) were identified as risk factors for low compliance with eyewear usage. Practising as an orthopod (OR=0.2, 95%CI=0-0.9 p=0.023) was identified as a protective factor against low compliance for eyewear. For thyroid shields female gender (OR=14.3, 95%CI=1.7-119.1; p = 0.003); not supplying orthopods with shields (OR=4.9, 95%CI=1.5-16.2, p < 0,001) and less than 5 years of experience performing fluoroscopically guided interventional procedures (OR=26.6, 95%CI=3.2-219.6, p < 0.001) were identified as risk factors. Practising as an orthopod (OR=0.1, 95%CI=0-0.3, p < 0.001) was identified as a protective factor against low compliance. No statistically significant associations were observed for low compliance in lead apron usage. Physicians with a low radiation safety knowledge of <40% (OR=11.3, 95%CI=1.3-95.8, p = 0.049) were 11.3 times more likely to be non-compliant with lead glove usage. Conclusions: The level of radiation protection equipment usage amongst the study population is far from desirable. Significant variation exists amongst subjects’ knowledge of radiation safety. Agreeable attitudes towards radiation safety practice were universally reported by subjects. Providing radiation protection equipment that fits the user is critical in addressing low compliance levels going forward.
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    Hospital cleaners’ knowledge, attitude and practices and the influence of training regarding cleaning roles in two government hospitals in the Erongo Region, Namibia
    (Stellenbosch : Stellenbosch University, 2022-12) Geurtze, Etheline Olivia; Begg, Kerrin; English, Rene; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    Introduction: Healthcare associated infections may arise following transfer of microorganisms from the hospital environment to patients. Effective cleaning and disinfection of hospital surfaces reduces the risk of pathogen transmission. This study explored the knowledge, attitudes and practises concerning their cleaning role and training influences of hospital cleaners at two governmental hospitals in the Erongo region, Namibia. Methods: A cross-sectional, mixed-methods design was used. Data were collected using a structured interviewer-administered questionnaire. Participants’ hospital cleaning knowledge, attitudes and practices were evaluated using quantitative analysis Open-ended questions explored their training experiences and thematic analysis was conducted. Results: Sixty-one hospital cleaners were interviewed. Eight participants (13,1%) received formal training. In terms of knowledge 68,9% knew they could carry germs without getting sick, and 55,7% reported that wearing gloves could sufficiently protect against germs. Sixty-five percent felt that they were not supported by other staff. In terms of practices, most of the reported challenges related to absence of necessary resources. Regarding the association between current knowledge, attitudes and practices and training, significant associations were shown for most measures. With regards to whether cleaners can protect themselves against germs without getting sick, and whether they can infect others with germs that they carry, knowledge levels were lowest for those with informal training (59,7%) and job-shadowing (60,1%) (p=0,01). Conclusion: This research study highlights limited formal training for hospital cleaners at two large Namibian hospitals, and demonstrates the need for formal training and better resource allocation of hospital cleaners who play a vital role in IPC and patient and healthcare worker safety.
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    The impact of COVID-19 on the cascade of care for tuberculosis : a systematic review
    (Stellenbosch : Stellenbosch University, 2022-09) Fapohunda, Tomiwa Temitayo; Chivese, Tawanda; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    ENGLISH SUMMARY: Background: Globally, the effect of the coronavirus pandemic on tuberculosis (TB) cascade of care is not well described. Objectives: To describe the impact of the 2019 coronavirus disease (COVID-19) pandemic on the TB care cascade, particularly on testing, case notifications and treatment of TB. Methods: In this systematic review, the Cochrane library, Scopus, CINAHL, Ebscohost, and PubMed databases were comprehensively searched from December 1st, 2019, the onset of the pandemic, till May 5th, 2022, without language restrictions. Eligible studies were observational studies documenting changes in the TB cascade of care one year before and one year during the COVID- 19 pandemic. The authors could not conduct a meta-analysis due to the expected differences in the contexts of the included studies, thus, a narrative synthesis was conducted. The Hoy et al.'s (2012) risk of bias tool was used for the quality assessment. Results: Twenty-seven studies from Asia, North America, Africa, South America, and Europe were included. TB screening suspected cases decreased between 1.3% and 49.5% (n= 5 studies), and multidrug resistance tuberculosis (MDR-TB) screening decreased by 17% in new patients and by 15% in existing patients (1 study). The diagnostic delay increased by11 and 45 days and 25.1% and 60% (2 studies), contact tracing decreased by 36.1% (1 study), case notification decreased between 2.9% and 63.3% (18 studies) and positivity rate increased between 0.1% and 4.5% (4 studies). General and community detection rates decreased by 11.8% and 44.7%, respectively (1 study), clinically diagnosed TB decreased between 10.4% and 46.0% (5 studies), presumptive TB diagnoses decreased between 12.8% and 45.6% (4 studies) and pulmonary TB diagnoses decreased between 20.0% and 50.7% (2 studies). Treatment enrolment decreased between 15.7% and 35.0% (4 studies), the diagnostic and treatment delay increased by 28 and 36 days, respectively, treatment completion decreased by 8.0% (1 study) and the treatment success rate decreased between 0.1% and 17.0% (7 studies). Conclusion: These results suggest that the pandemic likely had a detrimental impact on the TB care cascade. In future pandemics, stakeholders and governments must protect the care cascade of infectious diseases like TB and other diseases. The results of this study must be applied with caution since only observational studies, mostly without standardized population data, were included.