District Hospital In KwaZulu-Natal Research Articles

A Survey of Telemedicine Use by Doctors in District Hospitals in KwaZulu-Natal, South Africa.

There is anecdotal evidence of informal telemedicine activity in KwaZulu-Natal (KZ-N), South Africa. Aim: To determine the current extent of telemedicine in district hospitals in KZ-N; the range of clinical activities and technologies used; additional services needed; current knowledge and practice regarding legal, ethical, and regulatory issues; and the need to formalise telemedicine activities. Method: A cross-sectional survey of telemedicine use by 143 doctors working at 22 District hospitals in KZ-N. Results: Most doctors (96%) participated in some form of telemedicine across a spectrum of disciplines, but more than half did not consider their activities to constitute telemedicine. To meet their needs, doctors have started their own informal services with colleagues, using mostly instant messaging and chat groups (WhatsApp). Some doctors indicated the need to formalise these services and establish additional services. Few doctors were aware of the national telemedicine guidelines and the required written informed consent for telemedicine was seldom obtained. This could have serious legal, regulatory, and ethical implications. Conclusions: Practical clinical and technical guidelines and standard operating procedures need to be developed with the active participation of the clinical workforce. These should encourage innovation and greater use of telemedicine, including the use of instant messaging apps.

An Audit and Survey of Informal Use of Instant Messaging for Dermatology in District Hospitals in KwaZulu-Natal, South Africa.

Background. In KwaZulu-Natal (KZ-N), South Africa, recent reports have indicated that spontaneous use of smartphones has occurred, providing access to specialist dermatological care to remote areas. This informal use has raised a number of practical, legal, regulatory, and ethical concerns. Aim. To assess the nature and content of WhatsApp messages sent to dermatologists, to determine the referring doctors’ reasons for, and satisfaction with, their interactions, as well as their knowledge of legal, regulatory, and ethical requirements. Methods. A retrospective study of WhatsApp messages between referring doctors and dermatologists, as well as a cross-sectional survey of doctors working at district hospitals in KZ-N who used IM for teledermatology. Results. Use of IM (primarily WhatsApp) for teledermatology was almost universal, but often not considered ‘telemedicine’. Few referring doctors were aware of South Africa’s ethical guidelines and their requirements, and few of those who did followed them, e.g., the stipulated and onerous consent process and existing privacy and security legislations. No secure methods for record keeping or data storage of WhatsApp content were used. A desire to formalize the service existed. Conclusions. Based upon these findings, it was proposed that a number of described steps be followed in order to formalize the use of IM for teledermatology.

Using an action learning methodology to develop skills of health managers: experiences from KwaZulu-Natal, South Africa

BackgroundStrong management skills are key to improving performance of health systems. Action learning, a technique to develop management skills, has been used successfully with health managers but not usually among lower level managers or in low and middle-income countries (LMICs).MethodsThis study uses a qualitative approach to explore experiences, successes and challenges of using an action learning approach to improve skills of managers in neonatal units in KwaZulu-Natal (KZN), South Africa. Eight action learning groups were convened with neonatal unit managers from all 39 district hospitals in KZN, each group had 4–6 participants. Meetings were conducted by a facilitator trained in action learning techniques, and groups met a minimum of ten times over a one-year period. After completion of the intervention, 14 in-depth interviews were conducted with purposively selected action learning participants. Data was transcribed and analysed using framework analysis.ResultsNeonatal unit managers found that action learning generated a sense of empowerment in their abilities, trust and confidence among participants was nurtured, problem solving and critical thinking skills were developed, and a continuous support system was created. The action learning process led to several positive changes in neonatal units, which enhanced the quality of care for patients. A number of challenges were also identified, mainly relating to administrative issues such as the provision of a skilled facilitator, permission to attend action learning meetings and logistical issues, including transport and other financial implications.ConclusionsThis paper illustrates that action learning can be an effective and practical method to support public health workers to manage their health units despite the challenges associated with the method. Time, energy and financial resources used to facilitate action learning for this cadre of health workers is rewarded by improved skills of managers and better quality of care for patients.

First experiences of accrediting district hospitals for excellence in newborn care in KwaZulu-Natal, South Africa: Successes and challenges

Objective: Providing quality health care is what all health facilities seek to achieve. Accreditation of health services are used to assess and improve the quality of health care in different settings. This study describes experiences of developing and conducting accreditation for excellence in newborn care in district hospitals in KwaZulu-Natal (KZN), South Africa following a 3-year programme of support to all nurseries in KZN.Methods: A facility review was conducted in district hospitals in KZN to evaluate the quality of care provided to newborn babies to accredit hospitals in newborn care. Multiple tools were used to assess different components of care from different perspectives, including record reviews, assessment of staff skills and interviews with mothers. Awarding accreditation was based on scores achieved in various domains, which contributed to an overall score. Compliance with key priority indicators was required for accreditation to be awarded.Results: Overall scores for accreditation ranged between 57%-93%. Mothers reported high levels of satisfaction with care received. Record reviews identified shortfalls in care provided, and skills assessments showed poor resuscitation skills in labour wards in some hospitals. Of 39 district hospitals, eight were awarded silver and five were awarded gold accreditation status.Conclusions: This accreditation of newborn care provides a workable model for undertaking accreditation in district hospitals and can be used by managers to identify and address shortfalls in care. Regular accreditation would support ongoing quality improvement (QI) in neonatal care and such a process could be applied to other aspects of care in health facilities.

Maternal HIV infection and preterm delivery outcomes at an urban district hospital in KwaZulu-Natal 2011

Background: The seroprevalence of human immunodeficiency virus (HIV) in pregnant women attending public facilities in KwaZulu-Natal province in 2011 was 37%, the highest in South Africa. An association between the HIV status of the pregnant women and preterm delivery, with associated poorer clinical outcomes, has been reported in many studies. The aim of this study was to explore the relationship between preterm delivery and maternal HIV infections at an urban district hospital in KwaZuluNatal in 2011.Method: The associations and outcomes of preterm deliveries at a high patient load urban district hospital were determined using a retrospective cohort study.Results: Of the 250 consecutively enrolled patients, 23 women (9%) [95% confidence interval (CI): 5.90–13.50] delivered 25 preterm infants. Ninety-two women (37%) (95% CI: 30.80–43.10) were found to be HIV positive, of whom 13 (14%) (95% CI: 7.70– 23.00) delivered preterm neonates, compared to 10 of the 158 women (6%) (95% CI: 3.10–11.30) of the HIV-negative mothers. HIV-positive mothers were significantly more likely (~ 4 fold) to have preterm deliveries than their HIV-negative counterparts, following multivariable adjustment [odds ratio (OR) 4.09, 95% CI: 1.37–12.17] (p 0.010). Hypertension was the only other risk factor to remain significantly associated with preterm delivery following multivariable adjustment (OR 0.07, 95% CI: 0.02–0.28) (p 0.001).Conclusion: The risk of preterm delivery is elevated in HIV-infected pregnant women. HIV-positive pregnant women should be targeted for improved antenatal care and intensive counselling.

Internship training adequately prepares South African medical graduates for community service – with exceptions

The 2-year internship period for medical graduates began in South Africa in 2005 and has never been formally evaluated. This study assessed the perceptions of community service medical officers (COSMOs) working at district hospitals (DHs) in KwaZulu-Natal (KZN) to determine whether the 2-year internship programme had adequately prepared them for community service (CS). A cross-sectional descriptive study was conducted regarding the perceptions of COSMOs working at 22 district hospitals in KZN. Data were collected in July 2012, using a questionnaire based on the core skills and knowledge detailed in the Health Professions Council of South Africa intern log book. All eight domains were self-assessed and a score of 4 out of 5 indicated an ability to work independently. Of the COSMOs, 78% (60 out of 89) completed the questionnaire. Most felt well-prepared for CS in all disciplines, but critical gaps in knowledge and skills were identified in paediatrics, orthopaedics, anaesthetics and obstetrics. In addition, 75% of respondents (45 out of 60) expressed a need for additional training in the disciplines of ear, nose and throat (ENT), urology, ophthalmology and dermatology. The 2-year internship has provided the basis for independent medical practice in DHs. However, certain critical skill gaps need urgent attention, particularly in obstetrics and anaesthesia. Areas of weakness in ENT, urology, ophthalmology and dermatology could be addressed by including these specialities as a compulsory rotation in surgery, medicine or family medicine during internship training.