Browsing by Author "Zweigenthal, Virginia"

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    Adolescent girls’ perceptions of breastfeeding in two low-income periurban communities in South Africa
    (Routledge, 2019) Zweigenthal, Virginia; Strebel, Anna; Hunter-Adams, Jo
    In South Africa, exclusive breastfeeding rates are low, and rates of teenage pregnancy are high. Educational policy enables mothers’ return to school, which conflicts with policy emphasizing exclusive breastfeeding. We elicited adolescent women’s perceptions and experiences of infant feeding choices, and conducted six focus groups (N ¼ 57) in two periurban settlements. Participants knew arguments in favor of and against breast and formula-feeding, but in practice, mixed feeding occurred early after birth. While completion of high school was emphasized, exclusive breastfeeding was viewed as impractical. Congruent education policies and infant feeding policies/guidelines must address the constraints and contexts of adolescent mothers.
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    Assessing the impact of a waiting time survey on reducing waiting times in urban primary care clinics in Cape Town, South Africa
    (PAGEPress, 2017) Daniels, Johann; Zweigenthal, Virginia; Reagon, Gavin
    A waiting time survey (WTS) conducted in several clinics in Cape Town, South Africa provided recommendations on how to shorten waiting times (WT). A follow-up study was conducted to assess whether WT had reduced. Using a stratified sample of 22 clinics, a before and after study design assessed changes in WT. The WT was measured and perceptions of clinic managers were elicited, about the previous survey’s recommendations. The overall median WT decreased by 21 minutes (95%CI: 11.77- 30.23), a 28% decrease from the previous WTS. Although no specific factor was associated with decreases in WT, implementation of recommendations to reduce WT was 2.67 times (95%CI: 1.33-5.40) more likely amongst those who received written recommendations and 2.3 times (95%CI: 1.28- 4.19) more likely amongst managers with 5 or more years’ experience. The decrease in WT found demonstrates the utility of a WTS in busy urban clinics in developing country contexts. Experienced facility managers who timeously receive customised reports of their clinic’s performance are more likely to implement changes that positively impact on reducing WT.
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    Between HIV diagnosis and initiation of antiretroviral therapy: Assessing the effectiveness of care for people living with HIV in the public primary care service in Cape Town, South Africa
    (Wiley-Blackwell, 2011) Scott, Vera; Zweigenthal, Virginia; Jennings, Karen
    BACKGROUND: While much is written about the scale up of HIV counselling and testing (HCT) and antiretroviral therapy (ART), little research has been done on the expansion of routine preART HIV care. OBJECTIVE: To assess the quality of preART care in Cape Town and its continuity with HCT and ART. METHODS: The scale up of the HCT, preART and ART service platform and programmatic support in Cape Town is described. Data from the August 2010 routine annual HIV/TB/STI evaluation, from interviews with 133 facility managers and a folder review of 634 HCT s who tested positive and 1115 clients receiving preART HIV care are analysed. RESULTS: Historically the implementation and management of preART care has been relatively neglected compared with the scale-up of HCT and ART. The CD4 count was done on 77.5% positive HCT clients and 46.6% were clinically staged - crucial steps that determine the care path. There were: gaps in quality of care - 32.2% of women had a PAP smear; missed opportunities for integrated care - 67% were symptomatically screened for tuberculosis; and positive prevention - 48.3% had contraceptive needs assessed. Breaks in the continuity of care of preART clients occurred with only 47.2% of eligible clients referred appropriately to the ARV service. CONCLUSION: While a package of preART care has been clearly defined in Cape Town, it has not been fully implemented. There are weaknesses in the continuity and quality service delivered that undermine the programme objectives of provision of positive prevention and timeous access to ART.
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    Investigating the disjoint between education and health policy for infant feeding among teenage mothers in South Africa: a case for intersectoral work
    (BMC, 2022) Hunter‑Adams, Jo; Strebel, Anna; Corrigall, Joanne; Zweigenthal, Virginia
    Background: Many low-and-middle-income countries, including South Africa, have high rates of teenage preg‑ nancy. Following the World Health Organisation recommendations, South African health policy on infant feeding promotes exclusive breastfeeding until six months of age, with gradual weaning. At the same time, South Africa’s education department, in the interest of learners, promotes adolescents’ early return to school post-partum. Yet infant feeding at school is currently not perceived as a realistic option. Methods: Recognising his this policy tension, we aimed to explore how policies are interpreted and implemented by the health and education sectors through interviews with key informants who produce, interpret and implement these policies. Using an interview guide developed for this study, we conducted in-depth interviews with 24 health policy makers, managers in both sectors, school principals and nursing staf who manage adolescent mothers (aged 16-19) and their babies. Data was analysed using thematic analysis. Results: Informants from both sectors expressed discomfort at pregnant learners remaining in school late in preg‑ nancy and were uncertain about policy regarding when to return to school and how long to breast-feed. Educators reported that new mothers typically returned to school within a fortnight after delivery and that breastfeeding was not common. While health professionals highlighted the benefts of extended breastfeeding for infants and mothers, they recognised the potential confict between the need for the mother to return to school and the recommenda‑ tion for longer breastfeeding. Additionally, the need for ongoing support of young mothers and their families was highlighted. Conclusions: Our fndings suggest educators should actively encourage school attendance in a healthy pregnant adolescent until delivery with later return to school, and health providers should focus attention on breastfeeding for the initial 4-6weeks postpartum, followed by guided support of formula-feeding. We encourage the active engage‑ ment of adolescents’ mothers and extended families who are often involved in infant feeding and care decisions. Edu‑ cation and health departments must engage to facilitate the interests of both the mother and infant: some exclusive infant feeding together with a supported return to school for the adolescent mother