Magister Public Health - MPH (Public Health)

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Factors associated with adherence to anti-retroviral therapy in katima mulilo hospital, Namibia
(University of the Western Cape, 2012) Olabanji Nelson; Dr. Van Wyk Brian
Drug prescribing practices among primary healthcare providers in a local government area of northwestern Nigeria
(University of the Western Cape, 2011) Olalere Oguntunde,; Bradley Hazel
Background: Drugs are essential components of the health system and their rational use is vital to delivering quality and efficient healthcare services. However, inappropriate prescribing is a common rational drug use problem globally, particularly in developing countries including Nigeria. Despite measures to address this problem, inappropriate drug use continues to be a major public health problem in Nigeria. Aim: This study assessed rational drug use (RDU), with a focus on rational prescribing and factors affecting it, among primary healthcare providers working in primary healthcare facilities of a LGA in Northwestern Nigeria. Methods: The study was a cross sectional descriptive study and it included retrospective review of patient encounters and interviews with prescribing healthcare providers in sampled health facilities. Stratified random sampling method was used to select 20 public primary healthcare facilities and 30 patient encounters were drawn by systematic random sampling from each facility. One hundred and sixty three prescribing healthcare providers in the health facilities were also included in the study. Adapted WHO's drug use study tools and a structured self administered questionnaire were used to collect data. Data were analysed using Statistical Package for Social Sciences (SPSS Version 17) software and presented as contingency table with chi square test used to test for relationship between variables with statistical significance taken at p < 0.05. Ethical approval was obtained from the University of the Western Cape Research Ethics Committee and Kaduna State Ministry of Health, and permission from local stakeholders. Confidentiality of individual patients, healthcare providers and health facilities data was maintained. Results: The prescribing staff at the selected facilities were predominantly Nurses/Midwives and community health assistants with SCHEWs constituting the majority (60.8%). More than half (54.4%) of providers did not know about the concept of RDU. Similarly, the computed knowledge score of RDU revealed that the majority (74.4%) had poor knowledge of the concept. Knowledge was significantly associated with duration of service, providers' previous training in rational drug use and professional status (p<0.05), with the CHOs having better knowledge of RDU compared with other professional cadres. High antibiotic use (68.3% in retrospective review and 82.9% in survey) and injection use (9.5% in retrospective review and 12% in survey) were found in the study with significant proportions of providers admitting that all cases of URTI should receive antibiotics (72.3% ) and that patients could be prescribed injections if they requested for it (35.3%). The Standing Order was the main source of information for the majority (50.6%) of providers and it served as the major influence affecting prescribing practices. Conclusion: This study revealed a poor understanding and knowledge of RDU among healthcare providers. High antibiotic and injection use also reflected providers' poor attitude to rational prescribing of these commodities. To improve prescribing practices at the PHC level, adequate staff skill mix, including physicians should be established. Since RDU knowledge was associated with prior training, curriculum development towards RDU and opportunities for in-service training should be provided to build prescribers capacity, in addition to instituting a system of rational drug use monitoring. Further research into rational drug use among different cadres of PHC healthcare providers is also recommended.
Evaluation of the effectiveness of the partnership for reviving routine immunization in Northern Nigeria programme in Jigawa State, Nigeria
(University of the Western Cape, 2012) Adedayo, Adegbenga Ominiabohs; Ehimario, Igumbor; Segun, Oguntoyinbo
The weak routine immunization activities in Nigeria have led to an upsurge of vaccine preventable diseases such as poliomyelitis in the northern parts of the country. This made the federal government to intensify efforts to improve routine immunization activities with various intervention programmes over the years. This commitment of the federal government towards improving routine immunization as a way to promote infant and child survival led to the partnership between the UK. Department for International Development (DFID) to support the launching of Partnership for Reviving Routine Immunization in Northern Nigeria (PRRINN) programme in 2006. The programme, implemented in the northern states of Jigawa, Katsina, Y obe, and Zamfara was intended to augment other federal government immunization intervention efforts in improving routine immunizations services. After five years of programme implementation, assessment of the effectiveness of PRRINN had not be undertaken using a survey based immunization coverage to establish how well the primary objectives of the programme are being met in terms of improving routine immunization.
Barriers to effective partner notification amongst Patients with sexually transmitted infections at a Health center in Windhoek district, Namibia.
(University of the Western Cape, 2011) Shonhiwa Shepherd Ushe; Schaay Nichola
The notification and treatment of sexual partner(s) is a key element in the prevention and control of sexually transmitted infections (STIs). Partner notification interrupts the chain of STI transmission, prevents STI complications and long-term sequelae in the sexual partner(s), and also prevents re-infection of the treated index patient. Partner notification is a recognized component of the syndromic management of STIs in Namibia and yet the partner notification rates in the country remain low - as low as 7% in the district of Windhoek currently. In this district, which has the highest number of STIs cases in Namibia, the specific factors that hinder partner notification have not yet been documented. This study sought to investigate the perceived and experienced barriers to partner notification amongst STI patients attending an urban primary health center in the district. An explorative, qualitative study with eight patients (four males and four females), aged 16 years and over, who presented with a new/recurrent episode or a STI follow up was conducted. The participants were purposively selected with the aid of the deputy nurse in charge of the health center after agreeing to take part in the study. The patients were asked about what they felt were personal, partner-relationship and health services related factors that hindered partner notification. Three health workers working at the health center served as key informants and were asked about barriers to partner notification based on their experience of delivering preventative and curative STI - related services over the past three or more years.
Factors that influence intention to stay amongst health workers in Kabaya, Rwanda
(University of the Western Cape, 2012) Melence , Gatsinda; Schneider , Helen
Adequate human resources for health playa crucial role in improving access to services and quality of care. Human resources for health are often inequitably distributed between rural and urban areas within countries. In Rwanda, almost 88% of physicians and 58% of nurses in the country work in urban areas, despite the fact that 82% of the population lives in rural areas. Kabaya is located in a remote rural area in Ngororero District; its health facilities consist of one hospital and four health centers. Living and working conditions are poor for health .This study aimed to assess factors that influence the intention to stay in Kabaya amongst health workers currently in Kabaya's health facilities. The specific objectives were to analyze the associations between the following factors and intention to stay among health workers in Kabaya: socio-demographic and job characteristics; working and living conditions; and financial and non-financial incentives.
Factors affecting the implementation of the family life and HIV/AIDS education curriculum in junior secondary schools in Abuja, Nigeria
(University of the Western Cape, 2011) Oyewale Bimpe Aderinre; Mohamed Suraya
The Family Life and HIV I AIDS Education (FLHE) curriculum was introduced into Junior Secondary Schools (JSS) in Nigeria to provide young people with life skills and knowledge essential for protecting themselves from HIV I AIDS. However, coverage of schools with the FLHE curriculum implementation is low. The purpose of this study was to determine the factors that affect the implementation of the FLHE curriculum in JSS in Abuja, Nigeria. This study was a quantitative descriptive cross-sectional survey. The study population were teachers from public JSS implementing the FLHE curriculum in Abuja, among whom 300 teachers selected using systematic random sampling constituted the sample size. A close-ended anonymous questionnaire was administered to the research respondents as a self-administered questionnaire in English Language in their schools. A total of 300 questionnaires were administered of which 251 completed questionnaires were returned and analysed. Data analysis was undertaken using SPSS version 17 and included frequency distribution, mean score and standard deviation (univariate analysis), and cross tabulations of dependent variable (teaching of FLHE curriculum) and independent variables (awareness of HI VIA IDS policy and government directive; level of knowledge of the FLHE curriculum; level of comfort to teach FLHE curriculum; religious belief and affiliation; and cultural values of respondents). Chi-square tests and p-values were calculated to determine relationship between variables. The majority (72%) of teachers in this study were aware of the National HIV/AIDS Policy and the government directive to mainstream topics in the FLHE curriculum into existing subjects (78%). Just above one-third (36%) of the teachers had ever seen a copy of the HIV/AIDS policy and knew all the content of the policy. The study revealed that only 5% of the teachers in schools implementing the FLHE curriculum had sufficient level of knowledge of the FLHE curriculum. Majority of the teachers (71 %) knew the content of only one (HIV infection) out of the five themes in the curriculum, and 4 out of 5 of the teachers were comfortable in teaching the curriculum to students. Throughout this study, the autonomy of the respondents and dignity were respected; and their participation was voluntary. There was full disclosure of the purpose of the study.
Factors associated with exclusive breastfeeding in Kwekwe district, Zimbabwe
(University of the Western Cape, 2011) Nduna, Themba; van Wyk, Brian
Evidence on the benefits of breastfeeding for child survival, growth and development is published extensively. Breastfeeding is an "unequalled" way of providing ideal food to infants and young children to promote good health, growth, development and to attainment of their full potential. Despite initiatives and programmes to promote uptake of exclusive breastfeeding, this practice remains sub-optimal in Zimbabwe. This study explored factors that influence breastfeeding decisions and practices based on mothers' own breastfeeding experiences. Methodology This study employed a phenomenological research design. Information collected from mothers using in-depth interviews was triangulated with that from key informants. Interviews were audio-tape recorded and transcribed verbatim in Ndebele and then translated to English. Thematic analysis was used to compare various accounts from study participants to identify similar and related themes. Findings Mothers could not differentiate exclusive breastfeeding from predominant and partial breastfeeding. Barriers to exclusive breastfeeding were: (i) Poor understanding of exclusive breastfeeding and its benefits; (ii) Use of herbal infusions; (iii) Practice of giving babies water; (iv) Perceived insufficient breastmilk production; (v) Myths and misconceptions; (vi) Breast conditions; (vii) Tradition (viii) the HIV epidemic; and (ix) Employment. Enabling factors were: (i) Adequate food for the lactating mother; (ii) Family support; (iii) Support from husband; and (iv) Knowledge of the benefits of exclusive breastfeeding.
An assessment of attrition and retention of adherence support workers in Ndola district of Zambia
(University of the Western Cape, 2011) Jackson, Okuku; Lehmann-Grube, Uta
Community health workers called Adherence Support Workers (ASWs) involved in antiretroviral therapy (ART) adherence management in Ndola district of Zambia are dropping out of work. For this reason this study sought insight into the factors determining attrition and retention of ASWs in Ndola district. It describes the characteristics of ASWs, including age, sex and marital status, and explores key factors influencing their attrition/retention, paying attention to reasons motivating their decision to become ASWs, the challenges they face in fulfilling their roles and their experience of training, supervision and support received. The study is descriptive in design and a quantitative survey which used semi-structured questionnaires to collect data from 35 active ASWs and 12 who had dropped out, and who were attached to 10 ART clinics and hospitals supported by the Zambia Prevention, Care and Treatment Partnership (ZPCT). Participants were recruited using purposive and snowball sampling techniques. Using the ZPCT data base, ASWs in the district were identified and approached at the facilities where they work. Those difficult to reach were traced through their colleagues (ASWs) and reached by telephone.
A study to understand the barriers and facilitating factors for accessing health care amongst adult street dwellers in New Delhi, India.
(University of the Western Cape, 2011) Prasad , Vandana
Urban health policy has remained a neglected area in India. The homeless remain the most deprived, neglected and stigmatized group amongst the urban poor. While they suffer from a large burden of disease, there are a variety of reasons that prevent them from accessing the available health care services - particularly in the public health sector. Some interventions by concerned non-governmental organisations have attempted to circumvent the barriers to health care access faced by the homeless but these have not been well documented or assessed. This study seeks to establish both the barriers and facilitating factors for access to health care and health care seeking amongst adult street dwellers in an area of New Delhi which is known for a high concentration of homeless persons. Using a qualitative approach 18 adult street dwellers (both male and female) were individually interviewed - along with 6 key informants working in the public and non-governmental health sector. This was accompanied by a process of participant-observation. The results were analyzed by identifying recurrent themes associated with barriers and facilitating factors for access to health care by the homeless, following which a set of recommendations related to the homeless, have been developed so as to inform those working in the public health sector. In terms of ethics, informed consent was taken from each interviewee and they were explicitly given the option not to participate without adverse consequences to themselves. If any participant was found with acute health problems immediate assistance was facilitated. The study reveals a number of barriers faced by the homeless in attempting to access health care services. While minor ailments are taken care of by local private practitioners, they need to access public health care services for major problems. There they encounter many barriers due to the lack of money, delays and being shunted from place to place. Moreover, they are not able to get admission for reasons such as lack of address and the lack of an attendant. Facilitating factors include assistance for transportation, facilitation of admissions, arranging money for out of pocket expenditures on drugs and consumables, arranging blood and providing after-care. The role of social contacts in enabling access is also demonstrated through this study.
An assessment of equity in geographical allocation of resources relative to need, in public primary healthcare services in the Northern Cape in South Africa
(University of the Western Cape, 2004) Philip, Ajith John
South Africa has one of the most unequal societies in the world with regard to income, gender, socio-economic status and the distribution of key social services. Much of these inequalities, which are also reflected in its health sector and the general health status of its different population groups, can be attributed to the discrimination and systematic disadvantaging of certain race groups under the apartheid rule. Many researchers have highlighted and raised concern about these substantial disparities in allocation of resources between provinces. In spite of efforts by the post apartheid government to reduce such inequities, these geographic disparities still exist not only between provinces, but also within provinces. Government resource allocation decisions are largely geographically based and the fiscal federalism, currently used in South Africa has been recognised in many ways for its incompatibility of promoting equity across national sectors. Though inter-provincial allocation of health budgets are set through the medium term fiscal framework process and are monitored for equity, most provinces still use historical budgets when making resource allocations at the district level, resulting in many rural areas and health districts being under- resourced. In a country like South Africa with gross inequities in health, equity in geographical allocation of resources can only be achieved through vertical equity, by preferential allocation of resources based on increased need. This descriptive study uses routinely available data to compare health expenditure to health needs in measuring the inequities in financial and human resource allocation, relative to need, between districts in the Northern Cape. By identifying the dependent population and then areas of increased need through the use of different indicators weighted according to their costs and burden on health services, it estimates a composite measure of need for a health district. This measure of composite need is then compared with the expenditure per district to measure the distance from equity for each district. The study also estimates the equitable number of professional nurses per district in proportion to the dependent population and also assesses the inequities in distribution of professional nurses between districts.
Effectiveness of task shifting in antiretroviral treatment services in health centres, Gasabo District, Rwanda
(University of the Western Cape, 2012) Kabeja, Adeline
In the context of human resource crisis in African countries, the World Health Organization has proposed task-shifting as an approach to meet the ever-increasing need for HIV/AIDS care and treatment services. Rwanda started the process of task shifting towards nurse-based care in ART services in June 2010. After one year of implementation, a need to determine whether task shifting program has been implemented as intended and if it achieved its primary goal of increasing accessibility of people living with HIV to ARV therapy and improving nurse capacity in HIV patient care was imperative. A multi-method program evaluation study design, combining cross sectional, retrospective review and retrospective cohort sub-studies were used to evaluate the implementation, maintenance processes and outcomes of task shifting in 13 Health Centres (HCs) located in the catchment area of Kibagabaga District Hospital, in Rwanda. The study population consisted of HCs providing task shifted care (n=13), nurses working in the ART services of the 13 HCs (n=36), and more than 9,000 patients enrolled in ART care in the 13 HCs since 2006. All 13 HCs and 36 nurses were included in the evaluation. Routine data on patients enrolled in the pre-task shifting period (n=6 876) were compared with the post task shifting period (n=2 159), with a specific focus on data in the 20-months periods prior to and after task shifting. A cohort of patients 15 years and older, initiated onto ART specifically by nurses from June to December 2010 was sampled (n=170) and data extracted from patients medical files. Data collection was guided by a set of selected indicators. Three different data collection tools were used to extract data related to planning, overall programmatic data and individual data from respectively, the program action plans/reports, HIV central databases and patients medical files. Descriptive analysis was performed using frequencies, means and standard deviations (SD). The paired and un-paired t-tests were used to compare means, and chi-square test was used to compare categorical variables. To compare and to test statistical difference between two repeated measurements on a single sample but with non-normally distributed data, Wilcoxon signed rank test was used. To judge if current task shifted care is better, similar or worse than non-task shifted care, comparisons were made of program outputs and outcomes from the central database prior to and after the period of task shifting, and also with the cohort of nurse initiated patients. Results showed that 61% of nurses working in the ART program were fully trained and certificated to provide ART. Seven out of 13 HCs met the target of a minimum of 2 nurses trained in ART service delivery. Supervision and mentorship systems for the 13 HCs were well organized on paper, although no evidence documenting visits by mentors from the local district hospital to clinics was found. In term of accessibility, the mean number of patients newly initiated on ART per month in the HCs increased significantly, from 77.8/month (SD=22.7) to 93.9/month (SD=20.9) (t test (df=38), p=0.025). A small minority of patients was enrolled in late stages of HIV, with only 15% of the patient cohort having CD4 counts of less than 100 cell per microlitre at initiation on ART. The baseline median CD4 cell count was 267.5 cells per microlitre in the cohort as a whole. With respect to quality of care, only 8.8% of patients in the cohort had respected all appointments over a mean follow up period of 17.2 months; and although follow up CD4 counts had been performed on the majority of patients (80%), it was done after a mean of 8.5 months (SD=2.7) on ART, and only a quarter (24.7%) had been tested by 6 months (as stipulated by guidelines). From central ART program data, a small but significant increase of patients on 2nd line drugs was observed after implementation of task shifting (from 1.98% to 3.00%, chi-square=13.26, p<0.001), although the meaning of this shift is not entirely clear. The median weight gain was 1 kg and median CD4 increase was 89.5 cells per microlitre in the cohort after 6 months of receiving task shifted care and treatment. These increases were statistically significant for both male and female patients (Wilcoxon signed rank test, p<0.001). With regard to loss to follow up, only three of the 170 patients in the cohort followed up by nurses had been lost to follow-up after a mean of 17.2 months on treatment. The routine data showed a decrease of patients lost to follow up, from 7.0% in the pre-task shifting period to 2.5% in the post-task shifting period. In general, the mortality rate was slightly lower in the post-task shifting period than in the pre-task shifting (5.5% vs 6.9% respectively), although this was not statistically significant (chi-square=2.4, df=1, p=0.1209). This study indicates that, after over one year of implementation of task shifting, task shifting enabled the transfer of required capacity to a relatively high number of nurses. In an already well established programme, task shifting achieved moderate improvements in uptake (access) to ART, significant reductions in loss to follow up, and good clinical outcomes. However, evaluation of process quality highlighted some concerns with respect to adherence to testing guidelines on the part of providers and follow up visits on the part of patients. Improvements in processes of monitoring and follow up are imperative for optimal mid-term and long-term task shifting in the ART program.
Exploring the perceptions of mental health among young black isiXhosa-speaking people living in Nelson Mandela Bay
(University of the Western Cape, 2025) Tsotsa, Asisipho
Background: The presence of mental disorders during earlier years of life is a strong predictor for mental health problems in adulthood. Despite the multiple risk factors that can precipitate the onset of a mental disorder in young people, only 37.2% of young people who report depressive symptoms seek treatment. Black youth are at severe risk of mental illness because of their compounded risk factors. Health-seeking behaviour is influenced by awareness of mental health services and perceptions and beliefs regarding mental health. Aim: This study explored the perceptions, beliefs and attitudes of young Black isiXhosa-speaking people living in Nelson Mandela Bay toward mental health and illness, and examined how these perceptions, along with awareness of existing mental health services, influence help-seeking behaviour. Methodology: A descriptive qualitative design was employed. Data were collected through twenty (20) semi-structured individual interviews, two (2) focus group discussions, and one key informant interview, using purposive and snowball sampling. Participants were isiXhosa-speaking youth aged 18–34 years residing in Nelson Mandela Bay. Data were analysed manually using thematic coding analysis, guided by the Health Belief Model to interpret perceived susceptibility, barriers and benefits related to mental health and help-seeking. Ethical standards were maintained throughout the research process and ethical approval was received through the University of the Western Cape Biomedical Research Ethics Committee (BM24/10/10). Results: Four key themes emerged: (1) youth’s understanding of mental health and illness; (2) beliefs and attitudes towards mental health and illness (3) participants’ personal experiences with mental health issues; and (4) social and structural influences on mental health. Spiritual frameworks of understanding mental health and illness often took precedence over biomedical ones. Stigma, limited literacy and resource barriers reduced help-seeking, although participants expressed willingness to seek care when services were accessible and culturally sensitive. Perceptions of mental health among isiXhosa-speaking youth are deeply shaped by sociocultural and economic contexts. Conclusion: Efforts to strengthen youth mental health must integrate culturally responsive, faith-inclusive and community-based approaches that promote literacy, accessibility and trust in care.
Cash transfers and child health: understanding the barriers and facilitators to early application and receipt of the child support grant in Langa Township, Cape Town
(University of the Western Cape, 2026) Maxhakana, Inathi
The Child Support Grant (CSG) is increasingly a social protection instrument of choice aimed at alleviating child poverty and malnutrition in South Africa, with over 13 million children as beneficiaries of the Child Support Grant (CSG). Timely receipt of the grant, within the first three months of birth, is needed for the CSG to be protective against stunting(Aguero et al., 2006). Late application for the Child Support Grant (CSG) remains a significant issue, even 25 years after the grant's establishment. Despite national uptake rates consistently hovering around 80%, take up for children younger than 1 is still low at less than 50%, with the majority of mothers still applying for the CSG late after delivery. This study aimed to explore the reasons behind this late application and understand the contributing factors. The study employed a qualitative exploratory approach to conduct interviews and focus group discussions with 30 mothers/primary caregivers who are 18 years and above with children under 6 years, who have applied and received CSG. . Fifteen in-depth interviews and 2 Focus Group Discussions (FGDs) were conducted to gain a greater understanding, at individual and community level. The age of mothers was stratified according to different age groups (18-24; 2531; 32-38; 39-45;>45). These mothers/primary caregivers were sampled from a longitudinal birth cohort study that ran for 6 years (2016 to 2022) in Langa, Western Cape. The data were analysed using thematic content analysis, and used to formulate themes.
Understanding reasons for treatment defaulting among mental health patients at a district hospital in Mossel Bay, South Africa
(University of the Western Cape, 2025) Jacobs, Heinerich Elroy
The number of patients who received a selective serotonin re-uptake inhibitor within the Mossel Bay Sub-District in the last four years (2020 – 2023) ranged from 2500 – 3500 annually. In 2020, the number of patients on mental health treatment within the Sub-District was 3510, and it decreased to 2500 in 2023, mostly because of treatment defaults. This statistic shows that there is a significant need for intervention in the mental health sphere within the Mossel Bay District. Treatment default by mental health care users is a challenge in the Mossel Bay area and this study sought to understand the reasons for treatment defaulting at Mossel Bay Hospital, Western Cape Province, South Africa.
The prevalence and risk factors associated with pulmonary arterial hypertension among HIV-infected individuals in a tertiary hospital in Durban
(University of the Western Cape, 2025) Gwala, Thembelihle Roseline
Human Immunodeficiency Virus (HIV) infection continues to be a major global public health burden and a risk factor for developing pulmonary arterial hypertension (PAH). Africa carries the largest burden of HIV globally. However, data summarizing the epidemiology of PAH remains unclear. The lungs are often affected by disorders associated with HIV-infection. HIV-infected individuals are at an increased risk of developing PAH and dying from the condition compared to the general population. This study aims to determine the prevalence of PAH, and the risk factors associated with it in individuals living with HIV in a healthcare facility in Durban between 2022 and 2023
Implementing the ideal hospital programme in two rural district hospitals in the West Coast District, Western Cape Province, South Africa: A qualitative study of staff perspectives
(University of the Western Cape, 2025) Cillié, Johanna Jacomina
South Africa's constitution guarantees the right to health and embeds regulations to ensure the delivery of quality healthcare. The National Ministry of Health proposed the National Health Insurance (NHI) Bill in 2012 to support universal health coverage. The National Department of Health established the Office of Health Standards Compliance in 2013 to enforce compliance with the National Core Standards and to provide high-quality healthcare, even though the National Core Standards were promulgated only in 2015. Inspection tools based on the National Core Standards were finalized only in 2018. The Ideal Hospital Programme was introduced in 2018 with its own set of tools to enhance hospital service delivery and to prepare for the implementation of NHI and compliance with the Office of Health Standards Compliance assessments. The COVID-19 pandemic disrupted the Ideal Hospital Programme, resulting in slow progress and poor assessment results. None of the seven district hospitals in the Western Cape's West Coast District met the requirements of the Ideal Hospital Programme during the 2023-24 self-assessments, with outcomes for all seven district hospitals being unsatisfactory, highlighting implementation and sustainability challenges. Concerns about sustainability and the lack of research to support learning and improvement for the Ideal Hospital Programme were raised in a workshop held in June 2024. This situation prompted a research examination of the Ideal Hospital Programme's current state in the West Coast District of the Western Cape and the experiences of staff implementing the programme.
Assessment of knowledge, attitudes, and practices of contraceptive use among college students at a tertiary institution in Harare, Zimbabwe
(University of the Western Cape, 2025) Mutirikwi, Givemore
Contraceptive utilization among young adults remains a cornerstone of sexual and reproductive health and rights (SRHR). In Zimbabwe, young adults—including university students—remain vulnerable to unintended pregnancies and sexually transmitted infections due to persistent gaps in contraceptive knowledge, misconceptions, and barriers to access. Understanding contraceptive knowledge, attitudes, and practices (KAP) within university settings is therefore essential for informing targeted reproductive health interventions. This study assessed contraceptive KAP and associated determinants among students at the University of Zimbabwe, with emphasis on predictors of optimal contraceptive behaviour.
Factors associated with precancerous cervical lesions in HIV-positive women: a retrospective cross-sectional study at a clinic in Eswatini
(University of the Western Cape, 2025) Matsenjwa, Gcinekile
Women living with HIV (WLHIV) are at increased risk of developing precancerous cervical lesions due to immunosuppression and persistent high-risk human papillomavirus (HPV) infection. Cervical cancer remains the fourth most common cancer among women globally, with a disproportionate burden in sub-Saharan Africa. Eswatini faces a dual burden of high HIV prevalence and cervical cancer incidence, yet screening uptake remains low. Limited research has examined the relationship between antiretroviral therapy (ART), immune status, and precancerous cervical lesions among WLHIV in the country. This study aimed to determine the prevalence of precancerous cervical lesions and identify associated factors among WLHIV attending a clinic in Mbabane, Eswatini
Barriers in implementing quality improvement initiatives amongst health care workers at a regional hospital, eSwatini
(University of the Western Cape, 2025) Ngwenya Juliet Siphiwe
The quality and safety of healthcare depend on the capacity of healthcare professionals to continuously implement quality improvement (QI) processes in service delivery. However, QI initiatives often fail to be fully integrated into daily practice due to barriers that hinder effective implementation. This sought to identify and describe factors influencing the uptake and implementation of quality standards among healthcare workers, with the goal of informing strategies to close the gap between expected and actual performance. A descriptive cross-sectional study was conducted at Raleigh Fitkin Memorial Hospital (RFMH), a regional hospital in Manzini, eSwatini guided by the Theoretical Domains Framework (TDF). A stratified systematic sampling method with proportional allocation was used to select 134 healthcare workers across medical, nursing, and allied cadres. Data were collected through a validated self-administered questionnaire distributed both electronically and in hard copy. The instrument contained structured Likert-scale items and open-ended questions assessing individual, organisational, and contextual barriers to QI implementation. Data were analysed using excel to generate descriptive statistics, supported by qualitative thematic insights from open-ended responses. From the findings, it was revealed that although most participants understood QI concepts and recognised their importance, practical application remained imperfect. For example, 77.8% of respondents reported clarity of roles, and the belief in QI’s value was strong, with 90.4% acknowledging its positive impact. Moreover, organisational endorsement of QI was relatively high (83.7%), but financial limitations (21.5%) and moderate self-efficacy (60%) hindered effective implementation. Major barriers included insufficient resources, weak day-to-day management support, inadequate training, low confidence in QI delivery, and limited peer collaboration. Staff thus believed QI enhances patient outcomes but felt constrained by poor organisational systems and perceived lack of active management engagement. The study concludes that, for these barriers to be addressed, it requires a stronger leadership engagement, adequate resourcing, continuous in-service training, and the integration of QI activities into routine hospital operations. Strengthening mentorship, communication, and feedback mechanisms is also essential for sustaining QI practices.
An exploration of the challenges hindering implementation of learning programmes at special care centres
(University of the Western Cape, 2024) Emmanuel, Anthea; Carelse, Shernaaz
The high demand for special care centres for children with severe to profound intellectual disabilities (CSPID) in the Cape Metropole, led to several special care centres (SCCs) emerging in recent years. However, implementing the learning programmes (LPs) in SCCs pose problems regarding the quality of care and the well-being of CSPID. This qualitative case study aimed to understand the challenges that hinder the implementation of LPs provided by special care centres for CSPID. Using a combination of an exploratory and descriptive design, a developmental perspective was employed to investigate this phenomenon. The study population was transversal outreach teams (educational psychologists, physiotherapists [psysio], occupational therapists [OT], speech-language therapists, and learning support educators), programme implementers, caregivers and centre managers, who form a multidisciplinary team employed at special care centres in the Cape Metropole, the study setting. Purposive sampling was used to select 31 participants. Three focus groups were conducted with three to six participants per group, involving caregivers, programme implementers and CSPID teams while individual semi-structured interviews were conducted with the managers of the selected SCCs in the Metropole. Thematic analysis was conducted to develop themes and sub- themes. Ethics approval was obtained from the Humanities and Social Sciences Research Ethics Committee at the University of the Western Cape, and permission to conduct the study was granted from the Western Cape Department of Education and the selected SCCs.

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