http://hdl.handle.net/10386/183 Sun, 19 May 2013 18:32:23 GMT 2013-05-19T18:32:23Z http://hdl.handle.net/10386/802 Title: Childhood immunization in Mmakaunyane village in the North West Province of South Africa Authors: Sehume, Kgomotso Lovey Abstract: ABSTRACT BACKGROUND AND OBJECTIVE: Immunization is one of the most cost effective preventative health care interventions that is available to communities; it has greatly reduced the burden of infectious diseases in childhood. Since the W orId Health Organization launched the expanded programme of immunization in 1974, routine childhood immunization is widely available and it forms an integral part of preventative healthcare. Unfortunately, many children lack access to this life saving health care intervention. Communities in poor, rural areas often lack access to basic services, including health care and immunization services. We studied immunization coverage in a poor, rural community in South Africa and further explored what factors put children in this community at risk for under-immunization. METHOD: This was a cross sectional study, in which the immunization status of children from birth to six years of age living in Mmakaunyane was assessed. The primary caregivers of these children were also interviewed to determine their knowledge, attitudes and their practices with regards to immunizations; they were further asked about their perception of healthcare service delivery in the village. Using a map of the village, it was divided it into 30 blocks with 4 clusters in each block. Field workers were looking for a maximum of 5 eligible children in each cluster. We used the Road to Health Card to check if immunization was complete for age according to the SA EPI. RESUL TS: There were 567 children enrolled in the study. The majority of the children were above 18 months of age (64.4%) We found that 92.1 % of children were in possession of a RHC. In total, 432 (76.2%) of the children were fully immunized for their age, 97 (17.1%) had incomplete immunizations and immunization status was unknown for 38 (6.7%). The primary caregiver for most of the children was the biological mother (85.5%). There was a low level of education amongst the primary caregivers with only 15.3% having completed matric or attained higher level of education. Caregiver knowledge of immunization was poor and only 21.1 % of caregivers correctly mentioned three diseases that can be prevented by immunization. The majority of the caregivers (96.0%) believed that immunizations help to keep children healthy. Approximately half (49.9%), of the caregivers perceived immunization service delivery in Mmakaunyane village to be good. Factors that were found to be associated with incomplete immunization included age of caregiver, gender of the child and knowledge of the caregiver on immunization. CONCLUSION: Only 76.2% of children were fully immunized for their age in Mmakaunyane village. This immunization coverage rate is less than the National target of 90% for all children aged one year. The proportion of children under one year of age that are fully immunized is higher than that of the whole group. This indicates that the older children have a lesser level of immunization coverage (>18 months: 74.2%). The major factors that were found to be associated with under-immunization include lack of knowledge about immunizations, older age of the caregiver as well as poor accessibility of health care services. Female children were also found to be at increased risk for under-immunization. Measures to improve immunization coverage in this community need to take all these factors into consideration Description: Thesis (M Med (Paediatrics and Child Health)-- University of Limpopo, 2011. Sat, 01 Jan 2011 00:00:00 GMT http://hdl.handle.net/10386/802 2011-01-01T00:00:00Z http://hdl.handle.net/10386/801 Title: The Association between iron deficiency anaemia and academic performance of children focusing on grade II pupils in the Winterveldt region, Tshwane North, South Africa Authors: Hlatshwayo, Bongiwe P. S. Abstract: ABSTRACT BACKGROUND AND OBJECTIVES: Iron deficiency anaemia (IDA) is the most common nutritional disorder in the developing world. A large number of children under the age of 5 years do not reach their developmental potential, IDA and iron deficiency being well documented risk factors. IDA has been shown to be an important cause for decreased attention span, reduced alertness and learning difficulties in both young children and adolescents. South Africa has a growing burden of anaemia and iron deficiency and the most affected areas are the poor communities. There is vast evidence on the negative effects of iron deficiency to a child's developing brain from studies done internationally but limited data on the subject in South Africa, despite the huge burden of iron deficiency. We investigated the association between IDA and school performance and intelligence and also determined the local prevalence of IDA in the Winterveldt region, North of Tshwane, South Africa. METHODS: Three primary schools from Winterveldt were sampled. All subjects with parental consent were screened for anaemia using Hemocue 201+ Hb meter (n=194). Blood for iron studies and CRP was collected on all anaemic pupils (n=75) to define IDA (Hb<I1.5g/dl, ferritin<12ug/L and CRP<10). Cases and controls were recruited after results using matching anthropometry at a 1:2 ratio (one case to two controls). A total of 90 pupils (30 cases & 60 controls) were compared using 2009 school reports. Analysis was done per subject using the national scoring system, where one means incompetent and four means excellent achievement. The Raven's Coloured Progressive Matrices (RCPM) was used as our psychometric test and scores were recorded as percentiles and interpreted by the educational psychologist who conducted the test. RESUL TS: Point prevalence of iron deficiency anaemia for the Winterveldt region was found to be 9.8%. The prevalence of under-weight was 19% and that of stunting 23% with no significant differences between cases and controls (P=0.368 for under-weight and p=0.863 for stunting). There was no statistically significant association between IDA and performance in mathematics (X2=1.34 and p=0.511). However, cases scored poorly in life skills (P=0.00017) and in literacy the test for level of significance approaches significance (P=0.071). There was also no statistically significant association between IDA and low scores on the RCPM test (X2=3.31 and p=0.65). CONCLUSION: The point prevalence was high compared to the national prevalence of IDA which is about 5%. This could be related to a number of factors including the socio-economic background of the pupils. Since dietary history and knowledge of fortified food was not investigated, we cannot draw conclusions on the cause of this high prevalence. The study also found that the general population was under-nourished, which is consistent with the poor socio¬ economic status of the study area. However, our participants were more under-weight and stunted when the data was compared with previous national surveys. The study found a negative correlation between IDA and two areas of academic performance which is consistent with international data. In mathematics however, we believe that the low curriculum standard in all South African schools affected the outcome. The results of the psychometric test were not consistent with international data where most studies showed a negative correlation between IDA and the Ravens Matrices. South African studies have demonstrated poor performance of black students on the Ravens Matrices when compared to other races and our results followed this trend as our scores were similar to most of the studies. Description: Thesis (M Med (Paediatrics and Child Health)) -- University of Limpopo, 2011. Sat, 01 Jan 2011 00:00:00 GMT http://hdl.handle.net/10386/801 2011-01-01T00:00:00Z http://hdl.handle.net/10386/800 Title: An Audit of preoperative evaluation of general surgery patients at Dr George Mukhari Hospital (DGMH), Ga-Rankuwa Authors: Mokgwathi, Gaorutwe Thomas Abstract: ABSTRACT INTRODUCTION: Preoperative evaluation of a patient is the fundamental component of anaesthetic practice. Poor documentation and record keeping on the preoperative evaluation (PEF) form is a big obstacle in attaining good practice and hence improving patient outcome following operative procedures. The aim of the study was to conduct an audit of the anaesthetic preoperative evaluation of general surgery patients at Dr George Mukhari hospital (DGMH), Garankuwa. METHODS: A sample size of 88 record files of general surgery patients who underwent elective surgery during 2008 at DGMH was analysed. The proportion of completeness of information recorded on the PEF used at DGMH was compared with a standardized PEF which uses the global quality index (GQI). RESULTS: Only 75 out of88 patients had PEF in their files. The Modified GQI scores for the sample of75 patients ranged between 33.3% and 100%. The mean Modified GQI score was 72.2 +/- SD 13.9%. The median was 73.3 %, while the lower quartile was 60% and the upper quartile was 80%. The GQI scores were low for the following criteria; 'preoperative diagnostic procedure' (46.7%), 'medications prescribed by surgeons' (46.7%), 'preoperative fasting status' (32%), and deficiency in 'patient's weight' (34.7%) and 'allergies' (34.7%) during the preoperative assessment. Only in 1.3% was the PEF filled completely in accordance with the Modified GQI score. CONCLUSION: The overall quality of the preoperative assessment was inadequate in a number of the ModifiedGQI scores criteria suggesting the need for improvement in preoperative assessment of patients by anaesthetists at this hospital to improve patient outcome. Description: Thesis (Anaesthesiology)) -- University of Limpopo, 2010. Fri, 01 Jan 2010 00:00:00 GMT http://hdl.handle.net/10386/800 2010-01-01T00:00:00Z http://hdl.handle.net/10386/791 Title: Ibuprofen, paracetamol and tilidine; their role in post tonsillectomy pain at Dr George Mukhari Hospital Authors: Makhafula, Lebone D. Abstract: Background: Tonsillectomy is one of the commonest operations performed by ENT surgeons. Pain, haemorrhage, delayed feeding and resumption of normal activities are common morbidities. Different groups of analgesics are used to reduce these morbidities. Objective: We examined the effectiveness of the use of three analgesics, some in combinations in reducing these morbidities. The primary outcome measures were pain, resumption of normal diet, resumption of normal physical activities and secondary haemorrhage. The secondary outcome was comparison of pain profile of children and adults. Methods: A prospective randomized double blind controlled study. Subjects were recruited and randomized into three study groups; group A (Paracetamol & Ibuprofen), group B (Ibuprofen) and group C (Paracetamol, Ibuprofen & Tilidine). A diathermy dissection technique was used on all patients in removing tonsils. Pain was measured using a patient morbidity scoring form (PMS) as well as the Smiley scale. The care givers for children and adult patients recorded all other events. Results: Sixty five patients were recruited, 30 were in group A, 20 in group B and 15 in group C. There were 36 females and 29 males. The youngest patient was 4 years of age and the oldest was 38 years. The mean number of days prior to resuming normal daily activities for groups A, B and C was 9.27, 10.60 and 7.67 respectively. Group C patients started their daily activities earlier than those in group B (p≤0.05). The average number of days to stop analgesic use was 12.3, 13.3 and 10.6 for groups A, B and C respectively. Patients in group C stopped using analgesics earlier than group B patients (p≤0.05). There was no statistically significant difference in PMS scores, resumption of normal diet, post-tonsillectomy haemorrhage as well as pain profiles of adults and children. Conclusion: Paracetamol-ibuprofen-tilidine combination appears to be more effective than either paracetamol-ibuprofen combination or ibuprofen in the first two weeks in the treatment of post tonsillectomy pain (p>0.05), however, further studies will have to be carried out to confirm this. Patients treated with a paracetamol-ibuprofen-tilidine combination appear to stop medication and return to their normal daily activities much earlier (p ≤ 0.05). Minor haemorrhage from the use of ibuprofen following tonsillectomy was not a cause for concern. Description: Thesis (M Med(Otorhinolaryngology)) -- University of Limpopo, 2011. Sat, 01 Jan 2011 00:00:00 GMT http://hdl.handle.net/10386/791 2011-01-01T00:00:00Z