Papers by Jakes Rawlinson
International Students' Meeting on Public Health, May 1, 2009
DOTS is being implemented in an attempt to address the resurgence of the TB epidemic and the emer... more DOTS is being implemented in an attempt to address the resurgence of the TB epidemic and the emerging MDR-TB epidemic in South Africa. DOTS focus on smear positive pulmonary TB patients, as they are the mainly responsible for feeding the epidemic in alliance with the HIV epidemic. TB smear microscopy is the advocated method for diagnosis and to monitor progress and treatment outcomes. As the development of an affordable and rapid diagnostic kit for on site use in less developed and resource poor settings through the WHO’s Diagnostic Initiative and other agents will probably not realise in the near future, TB smear microscopy for diagnosis and monitoring treatment outcomes is here to stay for the foreseeable future. To facilitate the implementation of DOTS, 13 new smear microscopy centres were established in the Northern Province in collaboration with the South African Institute of Medical Research since 1997. Extending the smear microscopy network without reducing the turn around ti...
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, Jan 24, 1984
South Africa experienced a severe drought in 1982/1983. In July 1983 certain rural communities we... more South Africa experienced a severe drought in 1982/1983. In July 1983 certain rural communities were identified which had recorded the most severe drought. Children were selected at random from these areas and compared against controls with regard to their respective weights and heights. On the basis of the predetermined sample sizes employed, no significant difference between the groups could be demonstrated. When compared with certain urban children attending crèches in Pretoria, there was also no significant difference. It is concluded that in July 1983 no crisis as regards the prevalence of acute malnutrition in children aged 1-5 years existed in the communities tested.
Journal of Advanced Nursing, 2009
Title. HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa. ... more Title. HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa. Aim. This paper is a report of a study exploring HIV/AIDS-related knowledge, attitudes, practices and perceptions of nurses in the largely black and rural Limpopo Province of South Africa. Background. Studies of HIV/AIDS knowledge, attitudes and practices among healthcare workers in developing countries have shown gaps in knowledge and fear of contagion, coupled with ambivalent attitudes in caring for patients with HIV/AIDS and inconsistent universal precautions adherence. Method. A cross-sectional study of a random sample of primary health care (PHC) (n = 71) and hospital nurses (n = 69) was carried out in 2005, using a questionnaire, focus groups and in-depth interviews.
This report outlines an effort to address the management of Multi-Drug Resistant (MDR) TB in Sout... more This report outlines an effort to address the management of Multi-Drug Resistant (MDR) TB in South Africa through the implementation of the DOTS Plus strategy. It is based on operational research, which was undertaken in the Lower Orange District of the Northern Cape Province between May 1999 and December 2000.
The report begins with a global overview of MDR TB, which is identified (together with the HIV pandemic) as a threat to international TB control efforts. Attention then moves to South Africa and an overview of current knowledge regarding MDR TB in the country is presented. It is argued that the DOTS Plus strategy (which is simply an integrated approach to the management of TB and MDR TB) is already being implemented in South Africa, and should receive additional attention and support.
The bulk of the report describes how the problem of MDR TB was addressed in a systematic and hopefully sustainable way in the Lower Orange District in context of the Northern Cape and the progress made at Westend Hospital. MDR TB emerged as a problem in the district following the implementation of a TB Control Programme based on DOTS. A high incidence of MDR TB was reported, but no systems were in place to quantify the problem, nor to manage individual patients or a system to address the problem of MDR TB as a whole.
A rapid appraisal was undertaken in 1998 to explore current practices around the management of MDR TB in the province. The appraisal confirmed the lack of a coherent or standardised system for managing the problem. The provincial Department of Health
indicated their support for the development of an overall system to address MDR TB based on the national MDR TB guidelines developed by the National TB Control Programme and adapted to local realities. A research proposal was developed and funding from the Department for International Development obtained.
During the twenty month period from May 1999 until December 2000, 129 patients with MDR TB were identified in the Lower Orange district. Fifty-seven patients had previously been diagnosed with MDR TB, but 72 cases were newly diagnosed. This
means that 47 cases of MDR TB per 100 000 people per year were identified in the district over the two year period. The impression of an extremely high incidence of MDR TB in the district was thereby confirmed. Most of the identified and traced ‘old’ cases were evaluated and restarted on treatment through the so-called “mop-up operation”, whilst newly diagnosed cases were identified by PHC workers and referred for assessment and management at the newly established specialist MDR TB clinic.
At the same time all aspects of MDR TB management were addressed in a systematic way. An MDR TB team was established in the district to drive the process and to ensure sustainability. An inpatient facility has been established (and it is hoped will be
converted to a MDR TB Unit soon) at the TB unit and regular MDR TB clinics established, with clear procedures for evaluation and management of patients. Issues related to the role of laboratories were clarified. A recording, reporting and monitoring system was put in place, as were procedures for tracing close contacts.
Emphasis was on monitoring outcomes and provisional results are available. 46% of new cases, but only 26% of old cases were cured. Ethambutol resistance proved much higher than had been anticipated, and outcomes for patients in this group were
particularly poor. Problems were encountered with ensuring a regular supply of Cycloserine, and the contribution of this to the poor outcome of MDR TB patients (with resistance to Ethambutol) is not known. Although the research and work focused on the Lower Orange District (and was also initiated at Westend Hospital), hopefully it will inform debates around the management
of MDR TB in South Africa and contribute to a more systematic and rational approach to the problem. The lessons which were learnt and the tools which were developed (included in the appendices) should prove useful to clinicians and managers when
establishing specialist MDR TB clinics whether at provincial, regional or district level.
Until recently, the National TB Control Programme’s position was that curing new smear positive patients must always remain the first priority of TB control efforts i.e. the implementation of DOTS. The reality of the emerging MDR TB epidemic cannot be ignored in South Africa and the high number of cases identified during the course of this study is alarming. Unless the problem is addressed, it is likely that the numbers will continue to increase and will constitute a significant threat to TB control efforts, increasing the mortality and morbidity associated with tuberculosis.
What is to be done? It is essential that an effective DOTS programme be in place before beginning a MDR TB treatment programme or be implemented as a simultaneous process. If this is not done, a poor TB control program would generate MDR TB cases more rapidly than a treatment program could treat. The suggestion from several quarters (including the WHO) is that DOTS Plus is the way forward. For South Africa, there is actually no other way to go, as it may become too difficult and expensive, if not impossible, to do so later on in resource poor settings. The TB
Research Programme and DOTS Plus Study Group led DOTS Plus Project funded by the World Health Organisation, has added a lot of momentum to the implementation of DOTS Plus in South Africa.
Journal of …, Jan 1, 2009
Title. HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa. ... more Title. HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa. Aim. This paper is a report of a study exploring HIV/AIDS-related knowledge, attitudes, practices and perceptions of nurses in the largely black and rural Limpopo Province of South Africa. Background. Studies of HIV/AIDS knowledge, attitudes and practices among healthcare workers in developing countries have shown gaps in knowledge and fear of contagion, coupled with ambivalent attitudes in caring for patients with HIV/AIDS and inconsistent universal precautions adherence. Method. A cross-sectional study of a random sample of primary health care (PHC) (n = 71) and hospital nurses (n = 69) was carried out in 2005, using a questionnaire, focus groups and in-depth interviews.
Aim. This paper is a report of a correlational study of the relationships between demographic var... more Aim. This paper is a report of a correlational study of the relationships between demographic variables, job satisfaction, and turnover intent among primary healthcare nurses in a rural area of South Africa.
Background. Health systems in Southern Africa face a nursing shortage fuelled by migration, but research on job satisfaction and turnover intent of primary healthcare nurses remains poorly described.
Method. A cross-sectional study with survey design was conducted in 2005 in all local primary healthcare clinics, including nurses on duty at the time of visit (n = 143). Scale development, ANOVA, Spearman’s rank correlation, and logistic
regression were applied.
Results. Nurses reported satisfaction with work content and coworker relationships and dissatisfaction with pay and work conditions. Half of all nurses considered turnover within two years, of whom three in ten considered moving overseas. Job
satisfaction was statistically significantly associated with tenure (P < 0.05), professional rank (P < 0.01) and turnover intent (P < 0.01). Turnover intent was statistically significantly explained by job satisfaction, age and education (P < 0.001), with younger and higher educated nurses being more likely to show turnover intent. Satisfaction with supervision was the only facet significantly
explaining turnover intent when controlling for age, education, years of nursing and unit tenure (P < 0.001).
Conclusion. Strategies aimed at improving job satisfaction and retention of primary healthcare nurses in rural South Africa should rely not only on financial rewards and improved work conditions, but also on adequate human resource management.
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Papers by Jakes Rawlinson
The report begins with a global overview of MDR TB, which is identified (together with the HIV pandemic) as a threat to international TB control efforts. Attention then moves to South Africa and an overview of current knowledge regarding MDR TB in the country is presented. It is argued that the DOTS Plus strategy (which is simply an integrated approach to the management of TB and MDR TB) is already being implemented in South Africa, and should receive additional attention and support.
The bulk of the report describes how the problem of MDR TB was addressed in a systematic and hopefully sustainable way in the Lower Orange District in context of the Northern Cape and the progress made at Westend Hospital. MDR TB emerged as a problem in the district following the implementation of a TB Control Programme based on DOTS. A high incidence of MDR TB was reported, but no systems were in place to quantify the problem, nor to manage individual patients or a system to address the problem of MDR TB as a whole.
A rapid appraisal was undertaken in 1998 to explore current practices around the management of MDR TB in the province. The appraisal confirmed the lack of a coherent or standardised system for managing the problem. The provincial Department of Health
indicated their support for the development of an overall system to address MDR TB based on the national MDR TB guidelines developed by the National TB Control Programme and adapted to local realities. A research proposal was developed and funding from the Department for International Development obtained.
During the twenty month period from May 1999 until December 2000, 129 patients with MDR TB were identified in the Lower Orange district. Fifty-seven patients had previously been diagnosed with MDR TB, but 72 cases were newly diagnosed. This
means that 47 cases of MDR TB per 100 000 people per year were identified in the district over the two year period. The impression of an extremely high incidence of MDR TB in the district was thereby confirmed. Most of the identified and traced ‘old’ cases were evaluated and restarted on treatment through the so-called “mop-up operation”, whilst newly diagnosed cases were identified by PHC workers and referred for assessment and management at the newly established specialist MDR TB clinic.
At the same time all aspects of MDR TB management were addressed in a systematic way. An MDR TB team was established in the district to drive the process and to ensure sustainability. An inpatient facility has been established (and it is hoped will be
converted to a MDR TB Unit soon) at the TB unit and regular MDR TB clinics established, with clear procedures for evaluation and management of patients. Issues related to the role of laboratories were clarified. A recording, reporting and monitoring system was put in place, as were procedures for tracing close contacts.
Emphasis was on monitoring outcomes and provisional results are available. 46% of new cases, but only 26% of old cases were cured. Ethambutol resistance proved much higher than had been anticipated, and outcomes for patients in this group were
particularly poor. Problems were encountered with ensuring a regular supply of Cycloserine, and the contribution of this to the poor outcome of MDR TB patients (with resistance to Ethambutol) is not known. Although the research and work focused on the Lower Orange District (and was also initiated at Westend Hospital), hopefully it will inform debates around the management
of MDR TB in South Africa and contribute to a more systematic and rational approach to the problem. The lessons which were learnt and the tools which were developed (included in the appendices) should prove useful to clinicians and managers when
establishing specialist MDR TB clinics whether at provincial, regional or district level.
Until recently, the National TB Control Programme’s position was that curing new smear positive patients must always remain the first priority of TB control efforts i.e. the implementation of DOTS. The reality of the emerging MDR TB epidemic cannot be ignored in South Africa and the high number of cases identified during the course of this study is alarming. Unless the problem is addressed, it is likely that the numbers will continue to increase and will constitute a significant threat to TB control efforts, increasing the mortality and morbidity associated with tuberculosis.
What is to be done? It is essential that an effective DOTS programme be in place before beginning a MDR TB treatment programme or be implemented as a simultaneous process. If this is not done, a poor TB control program would generate MDR TB cases more rapidly than a treatment program could treat. The suggestion from several quarters (including the WHO) is that DOTS Plus is the way forward. For South Africa, there is actually no other way to go, as it may become too difficult and expensive, if not impossible, to do so later on in resource poor settings. The TB
Research Programme and DOTS Plus Study Group led DOTS Plus Project funded by the World Health Organisation, has added a lot of momentum to the implementation of DOTS Plus in South Africa.
Background. Health systems in Southern Africa face a nursing shortage fuelled by migration, but research on job satisfaction and turnover intent of primary healthcare nurses remains poorly described.
Method. A cross-sectional study with survey design was conducted in 2005 in all local primary healthcare clinics, including nurses on duty at the time of visit (n = 143). Scale development, ANOVA, Spearman’s rank correlation, and logistic
regression were applied.
Results. Nurses reported satisfaction with work content and coworker relationships and dissatisfaction with pay and work conditions. Half of all nurses considered turnover within two years, of whom three in ten considered moving overseas. Job
satisfaction was statistically significantly associated with tenure (P < 0.05), professional rank (P < 0.01) and turnover intent (P < 0.01). Turnover intent was statistically significantly explained by job satisfaction, age and education (P < 0.001), with younger and higher educated nurses being more likely to show turnover intent. Satisfaction with supervision was the only facet significantly
explaining turnover intent when controlling for age, education, years of nursing and unit tenure (P < 0.001).
Conclusion. Strategies aimed at improving job satisfaction and retention of primary healthcare nurses in rural South Africa should rely not only on financial rewards and improved work conditions, but also on adequate human resource management.
The report begins with a global overview of MDR TB, which is identified (together with the HIV pandemic) as a threat to international TB control efforts. Attention then moves to South Africa and an overview of current knowledge regarding MDR TB in the country is presented. It is argued that the DOTS Plus strategy (which is simply an integrated approach to the management of TB and MDR TB) is already being implemented in South Africa, and should receive additional attention and support.
The bulk of the report describes how the problem of MDR TB was addressed in a systematic and hopefully sustainable way in the Lower Orange District in context of the Northern Cape and the progress made at Westend Hospital. MDR TB emerged as a problem in the district following the implementation of a TB Control Programme based on DOTS. A high incidence of MDR TB was reported, but no systems were in place to quantify the problem, nor to manage individual patients or a system to address the problem of MDR TB as a whole.
A rapid appraisal was undertaken in 1998 to explore current practices around the management of MDR TB in the province. The appraisal confirmed the lack of a coherent or standardised system for managing the problem. The provincial Department of Health
indicated their support for the development of an overall system to address MDR TB based on the national MDR TB guidelines developed by the National TB Control Programme and adapted to local realities. A research proposal was developed and funding from the Department for International Development obtained.
During the twenty month period from May 1999 until December 2000, 129 patients with MDR TB were identified in the Lower Orange district. Fifty-seven patients had previously been diagnosed with MDR TB, but 72 cases were newly diagnosed. This
means that 47 cases of MDR TB per 100 000 people per year were identified in the district over the two year period. The impression of an extremely high incidence of MDR TB in the district was thereby confirmed. Most of the identified and traced ‘old’ cases were evaluated and restarted on treatment through the so-called “mop-up operation”, whilst newly diagnosed cases were identified by PHC workers and referred for assessment and management at the newly established specialist MDR TB clinic.
At the same time all aspects of MDR TB management were addressed in a systematic way. An MDR TB team was established in the district to drive the process and to ensure sustainability. An inpatient facility has been established (and it is hoped will be
converted to a MDR TB Unit soon) at the TB unit and regular MDR TB clinics established, with clear procedures for evaluation and management of patients. Issues related to the role of laboratories were clarified. A recording, reporting and monitoring system was put in place, as were procedures for tracing close contacts.
Emphasis was on monitoring outcomes and provisional results are available. 46% of new cases, but only 26% of old cases were cured. Ethambutol resistance proved much higher than had been anticipated, and outcomes for patients in this group were
particularly poor. Problems were encountered with ensuring a regular supply of Cycloserine, and the contribution of this to the poor outcome of MDR TB patients (with resistance to Ethambutol) is not known. Although the research and work focused on the Lower Orange District (and was also initiated at Westend Hospital), hopefully it will inform debates around the management
of MDR TB in South Africa and contribute to a more systematic and rational approach to the problem. The lessons which were learnt and the tools which were developed (included in the appendices) should prove useful to clinicians and managers when
establishing specialist MDR TB clinics whether at provincial, regional or district level.
Until recently, the National TB Control Programme’s position was that curing new smear positive patients must always remain the first priority of TB control efforts i.e. the implementation of DOTS. The reality of the emerging MDR TB epidemic cannot be ignored in South Africa and the high number of cases identified during the course of this study is alarming. Unless the problem is addressed, it is likely that the numbers will continue to increase and will constitute a significant threat to TB control efforts, increasing the mortality and morbidity associated with tuberculosis.
What is to be done? It is essential that an effective DOTS programme be in place before beginning a MDR TB treatment programme or be implemented as a simultaneous process. If this is not done, a poor TB control program would generate MDR TB cases more rapidly than a treatment program could treat. The suggestion from several quarters (including the WHO) is that DOTS Plus is the way forward. For South Africa, there is actually no other way to go, as it may become too difficult and expensive, if not impossible, to do so later on in resource poor settings. The TB
Research Programme and DOTS Plus Study Group led DOTS Plus Project funded by the World Health Organisation, has added a lot of momentum to the implementation of DOTS Plus in South Africa.
Background. Health systems in Southern Africa face a nursing shortage fuelled by migration, but research on job satisfaction and turnover intent of primary healthcare nurses remains poorly described.
Method. A cross-sectional study with survey design was conducted in 2005 in all local primary healthcare clinics, including nurses on duty at the time of visit (n = 143). Scale development, ANOVA, Spearman’s rank correlation, and logistic
regression were applied.
Results. Nurses reported satisfaction with work content and coworker relationships and dissatisfaction with pay and work conditions. Half of all nurses considered turnover within two years, of whom three in ten considered moving overseas. Job
satisfaction was statistically significantly associated with tenure (P < 0.05), professional rank (P < 0.01) and turnover intent (P < 0.01). Turnover intent was statistically significantly explained by job satisfaction, age and education (P < 0.001), with younger and higher educated nurses being more likely to show turnover intent. Satisfaction with supervision was the only facet significantly
explaining turnover intent when controlling for age, education, years of nursing and unit tenure (P < 0.001).
Conclusion. Strategies aimed at improving job satisfaction and retention of primary healthcare nurses in rural South Africa should rely not only on financial rewards and improved work conditions, but also on adequate human resource management.