Department of Public Health Medicine

Background: Measuring indicators for health promotion (HP) practice among healthcare workers is essential if health goals and objectives must be achieved. Such indicators provide connections between health policies and health outcomes; and ultimately add value to healthcare. This study identi ed indicators of health promotion among healthcare workers and compared them across levels of healthcare facilities in Nelson Mandela Bay Municipality, South Africa. Method: A cross sectional study involving 495 healthcare workers randomly sampled from 23 hospitals including primary, secondary, and tertiary level hospitals was conducted. Questionnaires were distributed to medical doctors, nurses, and allied health workers (AHW) such as social workers, physiotherapists, occupational therapists, and speech therapist. Questions (hereto referred to as dimensions) in the questionnaires were categorized to address Facility Related Indicators (FRI), Health worker related indicators (HRI) and Outcome related indicators (ORI). Descriptive and bivariate analysis were used to identify the indicators of HP among the three HCW groups from the three levels of health care. Indicators observed to be signi cant in the bivariate analysis were subjected to a multivariate analysis using the multinomial regression model. (p-value < 0.05). Results: Emerging Indicators were grouped into three categories: facility related indicators (FRI), healthcare workers' related indicators (HRI), and outcome related indicators (ORI). Four FRI dimensions were observed to be predictors of HP among doctors. Two dimensions were positively associated with HP practices while two others were negatively associated with HP practices among medical doctors and AHWs. On the other hand, seven HRI dimensions were signi cantly associated with HP among medical doctors and AHW. Furthermore, 5 outcome related indicator (ORI) dimensions were signi cant predictors of HP among medical doctors while only two dimensions were predictors of HP among AHW. The generalized Hosmer-Lemeshow Chi-square test showed that the models for the different HP indicators t the data. Conclusions: We identi ed indicators for measuring HP that can be applied at primary, secondary and tertiary hospitals in Nelson Mandela Bay Municipality, South Africa. These indicators which healthcare workers and health systems' managers in the study area should be aware of may be adapted for use in other areas. Background Worldwide, performance measurement of health promotion (HP) practice among healthcare workers (HCWs) is a contemporary theme in health systems (1, 2). However, there is no consensus on the approach for measuring HP practice among healthcare workers. For instance, existing HP indicators focus on speci c HP programmes and not on overall HP practices of healthcare workers (3, 4). Developing such indicators will provide the health system tools for assessing the effectiveness and quality of HP services by the HCWs. This will improve the performance of HCW to discharge HP services and ultimately reduce pressure at healthcare facilities as patients and the general community become empowered. Clearly de ned indicators are critical as instruments for methodical execution of HP practices. This enhances practice objectivity, improves understanding, decision making, ensures feedback on the way things are progressing and provide for prompt warning signs to authorities (5). Healthcare delivery faces signi cant challenges (6, 7) ranging from costs associated with healthcare to basic healthcare infrastructures. Globally, serious shortcomings have been documented across several domains in healthcare (8) and this may have long term effects on human health. Many low and middle income countries (LMIC) suffer from poor quality of care described by the World Health Organization (WHO) as worrisome particularly for Africa (9). In an analysis of healthcare services assessed against health outcomes, Africa scored an overall index of 0.48 (9) indicating that the continent utilizes only 48% of imaginable health services required for the health and well-being of its population. For instance, in Malawi, the healthcare delivery system is saddled with poor distribution of resources, disintegration of services and staff shortage (10). Similarly in Nigeria, the healthcare system is laden with poor service delivery and infrastructure (11). In South Africa, there is a strong commitment by the state to improve the healthcare delivery system evident from supportive policies and programmes implemented; and the funding invested (12-14). Despite these efforts, health outcomes remain polarised, unequal and unfair (12). Currently the country has a two-tiered system (15) that provides services to the population-the public and the private healthcare sectors. The public health care provides free health services and is fully funded by the state hence strongly overstretched. The private healthcare sector mainly provides services to wealthier and employed classes who subscribe to private health insurance schemes (16,17). This healthcare system has been described as one under increased strain as a result of overstretch of her HCWs capacity and operational resources (18). The success of any healthcare system is largely dependent on performance of HCWs, and worldwide, millions of patients visit the healthcare facilities daily to meet the HCWs for various health needs. Establishing a set of indicators for measuring HP practices among HCWs will enhance HP awareness and practice among the HCWs. Such HP indicators will provide HCWs with vital tools for systematically conducting follow-up and have an effective HP practices (3). These tools will assist in unravelling areas for improvement and intervention. Good sets of indicators will assist policy makers and stakeholders to monitor and evaluate HP practices of HCWs. Metrics for such measurement will require clear HP indicators and a framework that integrates relationships across the different elements of HP practices. This study identi ed selected measures or attributes for assessing HCWs HP practices and compared them across the various levels of healthcare in the Nelson Mandela Bay Municipality, South Africa. Method Study area The Nelson Mandela Bay Municipality (NMBM), is one of eight category A or metropolitan municipalities (19) in South Africa. NMBM is the largest of two Category A Metropolitan Municipalities in the Southern coast of the Eastern Cape Province (20).

Background Patients’ views and experiences in healthcare institutions provide a means of assessing the quality of services patients receive from healthcare workers (HCWs). However, the views of patients on the health promotion (HP) and disease prevention (DP) services offered by HCWs and the delivery mode have not been adequately studied. Aim This study assessed the views of patients on HP and DP services provided by various categories of HCWs. Setting The study was conducted at a tertiary hospital in the Nelson Mandela Bay Municipality, South Africa. Method An exploratory cross-sectional study was conducted among 500 patients. The questionnaire elicited responses from patients regarding the HP and DP services received from the different cadres of HCWs at three different admission phases: pre-admission phase (PAP), admission phase (ADP), and post-admission phase (POP). Descriptive, bivariate, and multivariate analysis was conducted. Results In the PAP, most patients (83.33%, n = 5; ...

Background Healthcare professionals (HCPs) play a pivotal role in ensuring access to quality healthcare of patients. However, their role in health promotion (HP) and disease prevention (DP) has not been fully explored. This study aimed at determining how training, attitude, and practice (TAP) of HCPs influence their practice of HP and DP. Methods Data on TAP regarding HP and DP were collected from 495 HCPs from twenty-three hospitals in the study area using a standardized questionnaire. Bivariate, univariate, and multivariate analyses were conducted to describe how the TAP of HCPs influence their HP and DP practices. The analysis was further desegregated at the three levels of healthcare (primary, secondary and tertiary levels). Results Most of the medical doctors 36.12% (n = 173), registered nurses 28.39% (n = 136), and allied health professionals (AHPs) 11.27% (n = 54) indicated the absence of coordinated HP training for staff in their facilities. Similarly, 32.93% (n = 193) of the HCPs, indicated having participated in HP or DP training. Among those that had participated in HP and DP training, benefits of training were positive behaviour, attributions, and emotional responses. When compared at the different levels of healthcare, enhanced staff satisfaction and continuing professional development for HP were statistically significant only at the tertiary healthcare level. Multivariate analysis showed a likelihood of reduced coordinated HP training for staff among medical doctors (Coef 0.15; 95% CI 0.07-0.32) and AHPs (Coef 0.24; 95% CI 0.10-0.59) compared to nurses. Furthermore, medical doctors (Coeff: 0.66; 95%

Background: Measuring indicators for health promotion (HP) practice among healthcare workers is essential if health goals and objectives must be achieved. Such indicators provide connections between health policies and health outcomes; and ultimately add value to healthcare. This study identi ed indicators of health promotion among healthcare workers and compared them across levels of healthcare facilities in Nelson Mandela Bay Municipality, South Africa. Method: A cross sectional study involving 495 healthcare workers randomly sampled from 23 hospitals including primary, secondary, and tertiary level hospitals was conducted. Questionnaires were distributed to medical doctors, nurses, and allied health workers (AHW) such as social workers, physiotherapists, occupational therapists, and speech therapist. Questions (hereto referred to as dimensions) in the questionnaires were categorized to address Facility Related Indicators (FRI), Health worker related indicators (HRI) and Outcome related indicators (ORI). Descriptive and bivariate analysis were used to identify the indicators of HP among the three HCW groups from the three levels of health care. Indicators observed to be signi cant in the bivariate analysis were subjected to a multivariate analysis using the multinomial regression model. (p-value < 0.05). Results: Emerging Indicators were grouped into three categories: facility related indicators (FRI), healthcare workers' related indicators (HRI), and outcome related indicators (ORI). Four FRI dimensions were observed to be predictors of HP among doctors. Two dimensions were positively associated with HP practices while two others were negatively associated with HP practices among medical doctors and AHWs. On the other hand, seven HRI dimensions were signi cantly associated with HP among medical doctors and AHW. Furthermore, 5 outcome related indicator (ORI) dimensions were signi cant predictors of HP among medical doctors while only two dimensions were predictors of HP among AHW. The generalized Hosmer-Lemeshow Chi-square test showed that the models for the different HP indicators t the data. Conclusions: We identi ed indicators for measuring HP that can be applied at primary, secondary and tertiary hospitals in Nelson Mandela Bay Municipality, South Africa. These indicators which healthcare workers and health systems' managers in the study area should be aware of may be adapted for use in other areas. Background Worldwide, performance measurement of health promotion (HP) practice among healthcare workers (HCWs) is a contemporary theme in health systems (1, 2). However, there is no consensus on the approach for measuring HP practice among healthcare workers. For instance, existing HP indicators focus on speci c HP programmes and not on overall HP practices of healthcare workers (3, 4). Developing such indicators will provide the health system tools for assessing the effectiveness and quality of HP services by the HCWs. This will improve the performance of HCW to discharge HP services and ultimately reduce pressure at healthcare facilities as patients and the general community become empowered. Clearly de ned indicators are critical as instruments for methodical execution of HP practices. This enhances practice objectivity, improves understanding, decision making, ensures feedback on the way things are progressing and provide for prompt warning signs to authorities (5). Healthcare delivery faces signi cant challenges (6, 7) ranging from costs associated with healthcare to basic healthcare infrastructures. Globally, serious shortcomings have been documented across several domains in healthcare (8) and this may have long term effects on human health. Many low and middle income countries (LMIC) suffer from poor quality of care described by the World Health Organization (WHO) as worrisome particularly for Africa (9). In an analysis of healthcare services assessed against health outcomes, Africa scored an overall index of 0.48 (9) indicating that the continent utilizes only 48% of imaginable health services required for the health and well-being of its population. For instance, in Malawi, the healthcare delivery system is saddled with poor distribution of resources, disintegration of services and staff shortage (10). Similarly in Nigeria, the healthcare system is laden with poor service delivery and infrastructure (11). In South Africa, there is a strong commitment by the state to improve the healthcare delivery system evident from supportive policies and programmes implemented; and the funding invested (12-14). Despite these efforts, health outcomes remain polarised, unequal and unfair (12). Currently the country has a two-tiered system (15) that provides services to the population-the public and the private healthcare sectors. The public health care provides free health services and is fully funded by the state hence strongly overstretched. The private healthcare sector mainly provides services to wealthier and employed classes who subscribe to private health insurance schemes (16,17). This healthcare system has been described as one under increased strain as a result of overstretch of her HCWs capacity and operational resources (18). The success of any healthcare system is largely dependent on performance of HCWs, and worldwide, millions of patients visit the healthcare facilities daily to meet the HCWs for various health needs. Establishing a set of indicators for measuring HP practices among HCWs will enhance HP awareness and practice among the HCWs. Such HP indicators will provide HCWs with vital tools for systematically conducting follow-up and have an effective HP practices (3). These tools will assist in unravelling areas for improvement and intervention. Good sets of indicators will assist policy makers and stakeholders to monitor and evaluate HP practices of HCWs. Metrics for such measurement will require clear HP indicators and a framework that integrates relationships across the different elements of HP practices. This study identi ed selected measures or attributes for assessing HCWs HP practices and compared them across the various levels of healthcare in the Nelson Mandela Bay Municipality, South Africa. Method Study area The Nelson Mandela Bay Municipality (NMBM), is one of eight category A or metropolitan municipalities (19) in South Africa. NMBM is the largest of two Category A Metropolitan Municipalities in the Southern coast of the Eastern Cape Province (20).

Background Patients' views and experiences in healthcare institutions provide a means of assessing the quality of services patients receive from healthcare workers (HCWs). However, the views of patients on the health promotion (HP) and disease prevention (DP) services offered by HCWs and the delivery mode have not been adequately studied. Aim This study assessed the views of patients on HP and DP services provided by various categories of HCWs. Setting The study was conducted at a tertiary hospital in the Nelson Mandela Bay Municipality, South Africa. Method An exploratory cross-sectional study was conducted among 500 patients. The questionnaire elicited responses from patients regarding the HP and DP services received from the different cadres of HCWs at three different admission phases: pre-admission phase (PAP), admission phase (ADP), and post-admission phase (POP). Descriptive, bivariate, and multivariate analysis was conducted. Results In the PAP, most patients (83.33%, n = 5; 87.85%, n = 217; and 76.14%, n = 150) seen by the rehabilitation health workers, medical doctors, and nurses respectively were empowered to manage their health. Patients attended to by nurses were 0.45 (95% CI 0.27-0.74) times less likely than those attended to by medical doctors to receive information that that will help them address the physical and environmental needs. In the ADP, patients attended to by nurses were less likely, compared to those attended to by medical doctors to be empowered to have good control over their health. In the POP, patients attended to by nurses are more likely to have their health behaviours change for better compared to those not seen by any HCW. Conclusion Patients attending tertiary hospital received greater HP and DP services during the PAP and ADP of patient care. Greatest influence for behavioural change of patients on HP and DP were achieved from the medical doctors, nurses and rehabilitation service staff. Improving structural factors may prove beneficial in enhancing patients' experience from all HCW groups and phases of patient care.

Background. Expanded HIV surveillance in TB patients forms part of the World Health Organization framework for strategic collaborative activity. Surveillance helps understand the epidemiology of the local dual epidemic and enables design of a tailored response to these challenges. Methods. We conducted an observational, cross-sectional study of anonymous unlinked HIV testing for 741 consecutive TB suspects attending an urban TB facility during a seven-week period in 2008. Results. A total of 512 patients were found to have TB. The mean age was 35.7 years, and 63% were male. The prevalence of HIV was 72.2% (95% CI: 68.2-75.9) in all TB cases, 69.8% (95% CI: 65.3-74.2) in pulmonary tuberculosis (PTB), 81.6% (95% CI: 72.9-90.3) in extrapulmonary disease, and 66.8% (95% CI: 60.7-72.9) in those without TB disease. HIV prevalence in TB patients was higher in females than males and in younger age groups (18-29 years). The sex ratio of PTB patients correlated with the sex ratio of the prevalence of HIV in the respective age groups ( < 0.05). Conclusion. The use of a rapid HIV test performed on sputum anonymously provides an opportunity for HIV surveillance in this high-burdened setting, which has the potential to lend valuable insight into the coepidemics.

e-Learning and other innovative open learning multimedia modalities of delivering education are being introduced to enhance learning opportunities and facilitate student access to and success in education. This article reports on a study that assessed students' readiness to make the shift from traditional learning to the technological culture of e-Learning at a university in Durban. A quasi-experimental study design was employed to assess such readiness in first year nursing students before and after an appropriate educational intervention. A modified Chapnick Readiness Score was used to measure their psychological, equipment and technological readiness for the change in learning method. It was found that, while students' psychological readiness for e-Learning was high, they lacked technological and equipment readiness. Although e-Learning could be used in nursing education, technological and equipment readiness require attention before it can be implemented effectively in this institution. Fortunately, these technical aspects are easier to resolve than improving psychological readiness.

Background. Human immunodeficiency virus type 1 (HIV-1)-specific CD8 1 responses contribute to the decline in acute peak viremia following infection. However, data on the relative immunogenicity of CD8 1 T-cell epitopes during and after acute viremia are lacking.

The mechanisms underlying HIV-1 control by protective HLA class I alleles are not fully understood and could involve selection of escape mutations in functionally important Gag epitopes resulting in fitness costs. This study was undertaken to investigate, at the population level, the impact of HLA-mediated immune pressure in Gag on viral fitness and its influence on HIV-1 pathogenesis. Replication capacities of 406 recombinant viruses encoding plasma-derived Gag-protease from patients chronically infected with HIV-1 subtype C were assayed in an HIV-1-inducible green fluorescent protein reporter cell line. Viral replication capacities varied significantly with respect to the specific HLA-B alleles expressed by the patient, and protective HLA-B alleles, most notably HLA-B*81, were associated with lower replication capacities. HLA-associated mutations at low-entropy sites, especially the HLA-B*81-associated 186S mutation in the TL9 epitope, were associated with lower replication capacities. Most mutations linked to alterations in replication capacity in the conserved p24 region decreased replication capacity, while most in the highly variable p17 region increased replication capacity. Replication capacity also correlated positively with baseline viral load and negatively with baseline CD4 count but did not correlate with the subsequent rate of CD4 decline. In conclusion, there is evidence that protective HLA alleles, in particular HLA-B*81, significantly influence Gag-protease function by driving sequence changes in Gag and that conserved regions of Gag should be included in a vaccine aiming to drive HIV-1 toward a less fit state. However, the long-term clinical benefit of immune-driven fitness costs is uncertain given the lack of correlation with longitudinal markers of disease progression.