Health SA Gesondheid - Volume 10, Issue 4, December 2005

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Tans word gehoorsifting van babas toenemend uitgevoer as gevolg van navorsingsbewyse wat die dramatiese voordele van vroeë identifikasie van gehoorverlies (voor die ouderdom van ses-maande) aantoon. Die Suid-Afrikaanse Raad vir die Gesondheidsberoepe het onlangs 'n verklaring oor gehoorsifting gepubliseer waarin hulle drie kontekste vir sodanige sifting aanbeveel: gesonde-baba-sale, by ontslag uit Neonatale Intensiewesorgeenhede (NISE), of by Moeder en Kind Gesondheidsorgklinieke (MKG). Die gesondebaba-eenhede en NISE is gevestigde siftingskontekste wat internasionaal erken word terwyl MKG-klinieke nog nie voorheen as gehoorsiftingskonteks ondersoek of beskryf is nie. Die doel van hierdie studie was om die konteks en interaksieprosesse gedurende 'n siftingsprogram vir babas by MKG-klinieke in 'n Suid-Afrikaanse gemeenskap te beskryf om vas te stel of die klinieke 'n gepaste omgewing vir hierdie programme daarstel. 'n Verkennende beskrywende navorsingsontwerp met 'n kwalitatiewe metodologie is gebruik om die konteks en interaksieprosesse wat gedurende die gehoorsiftingsprogram by twee MKG klinieke in die Hammanskraal gemeenskap ervaar is te beskryf. Vyf veldwerkers wat die siftingsprogram by die klinieke toegepas het, het hul ervarings oor 'n vyf-maande-tydperk gedokumenteer deur van sistematiese veldnotas en kritiese refleksies gebruik te maak. Die resultate toon aan dat die twee MKG-klinieke oor potensiaal beskik om 'n toepaslike gehoorsiftingskonteks vir babas te wees ten spyte van voortdurende kontekstuele struikelblokke wat kenmerkend is van primêre gesondheidsorgklinieke in ontwikkelende gemeenskappe in Suid-Afrika. Interaksie tussen veldwerkers, verpleegkundiges en sorggewers het daarop gedui dat konstante dienslewering, die daarstel van 'n oop kommunikasiekanaal, en basiese respek, effektiewe vroeë gehoorsifting kan verseker. MKG-klinieke toon belofte as 'n praktiese kontekstuele oplossing om wydverspreide gehoorsifting in Suid-Afrika te realiseer. End

Infant hearing screening has become increasingly widespread as research evidence a dramatic benefit when early identification of hearing loss occurs before six-months of age. The Health Professions Council of South Africa (HPCSA) has recently published a hearing screening position statement recommending infant hearing screening in three contexts: the well-baby nursery, at discharge from the neonatal intensive care unit (NICU), and at Maternal and Child Health (MCH) clinics. The well-baby nursery and NICUs are established and internationally recognised screening contexts abundantly reported on whilst MCH clinics have not been investigated as screening contexts previously. The objective of this study was therefore to describe the context and interactional processes during an infant hearing screening programme at MCH clinics in a South African community to ascertain whether clinics provide a suitable milieu for hearing screening programmes. An exploratory descriptive design implementing a qualitative methodology was selected to describe the context and interactional processes experienced during an infant hearing screening programme at two MCH clinics in the Hammanskraal community. Five fieldworkers conducting the screening programme at the clinics documented experiences using systematic field notes and critical reflections for a fivemonth period. The two MCH clinics investigated proved to be suitable contexts to screen infants for hearing loss despite prevailing contextual barriers that are characteristic of primary healthcare clinics in developing contexts of South Africa. Interactional processes between fieldworkers, nursing staff and caregivers revealed that collaborative partnerships fostered by consistent service delivery, maintenance of an open channel of communication and basic courteousness, facilitated an effective initial infant hearing screening at the two clinics. MCH clinics demonstrate promise as a practical contextual solution to achieve widespread screening coverage in South Africa. End

'n Kwantitatiewe nie-eksperimentele en verkennende studie is onderneem om te bepaal wat die bydrae van die kliniese verpleeginstrukteur is om kritiese denke by die studentverpleegkundige in Namibië te ontwikkel. Die studie is in die opleidingshospitale van Namibië, naamlik Windhoek, Oshakati en Onandjokwe Staatshospitale uitgevoer. Kliniese verpleeginstrukteurs van alle dissiplines is by die studie ingesluit. Voorts het studentverpleegkundiges in hulle tweede, derde en vierde jaar van voorgraadse verpleegstudie aan die navorsing deelgeneem. In die studie is bevind dat, alhoewel kliniese verpleeginstrukteurs in die opleidingshospitale van Namibië van hulle verantwoordelikheid bewus is, hulle nie op die ontwikkeling van kritiese denke by die studentverpleegkundiges van Namibië fokus nie. 'n Behoefte aan 'n indiensopleidingsprogram is geidentifiseer om die ontwikkeling van kritiese denke, in beide die verpleeginstrukteur en die studentverpleegkundige te bevorder, was geïdentifiseer. End

A quantitative, non-experimental and exploratory study was undertaken to determine the contribution by the clinical nurse instructor to develop critical thinking skills of student nurses in Namibia. The study was conducted at the training hospitals of Namibia, namely Windhoek, Oshakati and Onandjokwe State hospitals. Clinical nurse instructors from all disciplines were included in the study, as well as student nurses in their second, third and fourth year of undergraduate nursing study. The findings of the study revealed that, although the clinical instructors in the training hospitals of Namibia are aware of their responsibility, they do not focus on the development of critical thinking of student nurses in Namibia. A need for in-service programmes to emphasise the development of critical thinking skills of both clinical nurse instructors and student nurses was identified. End

Mediese en sielkundige gesondheidsorgberoepslui word toenemend daarvan bewus dat doeltreffende behandeling in kultureel diverse gemeenskappe sensitiwiteit teenoor die pasiënt se kulturele oortuigings en gebruike vereis (Davidhizar & Giger, 2001:2; Foley & Wurmser, 2004:2; Hickson & Christie, 1989:162; Mkize, 2003:4; Narayanasamy, 2003:1). In dié verband stel hierdie artikel die Suid-Afrikaanse Tradisionele Geloofskaal (SATBS) voor as 'n meetinstrument om kultuurkongruente versorging te bevorder, nie net in die mediese veld nie, maar ook in psigoterapie en sielkundige voorligting. Hierdie skaal meet die mate waarin swart Suid-Afrikaners trou bly aan tradisionele oortuigings en gebruike. Ten einde betroubaarheid- en geldigheidsdata te bekom, is 64 tweedejaarstudente ewekansig geselekteer op die Oosrandse kampus van die Universiteit Vista. Die betroubaarheid van die SATBS is vasgestel deur die berekening van interitemkorrelasies. 'n Betroubaarheidskoëffisiënt, of indeks van interne konsekwentheid van 0.91 (Cronbach alpha) is na die eerste iterasie verkry. Om kriteriumverwante geldigheid vas te stel, is dieselfde steekproef gebuik om die SATBS met ondersoek oor die graad van enkulturasie ("Degree of Enculturation Survey" - DES) te vergelyk. 'n Geldigheidskoëffisiënt van 0.7899 is verkry, wat 'n hoë indeks van kriteriumverwante geldigheid aandui. Die vraelys meet dus wat dit ten doel het om te bepaal. End

Medical and psychological health care professionals are becoming increasingly aware that effective treatment in culturally diverse societies requires sensitivity to the patient's cultural beliefs and customs (Davidhizar & Giger, 2001:2; Foley & Wurmser, 2004:2; Hickson & Christie, 1989:162; Mkize, 2003:4; Narayanasamy, 2003:1). To this end this article introduces the South African Traditional Belief Scale (SATBS) as an instrument to enable culturecongruent care, not only in the medical field, but also in psychotherapy and counselling. This scale measures the extent to which black South Africans adhere to traditional beliefs and customs. To obtain reliability and validity data, 64 second-year students were randomly selected at the East Rand campus of Vista University. The reliability of the SATBS was established by calculating inter-item correlations. A reliability coefficient, or index of internal consistency of 0.91 (Cronbach alpha) was obtained after the first iteration. In order to establish criterion validity, the South African Traditional Belief Scale was validated against the Degree of Enculturation Survey (DES) by using the same random sample. A validity coefficient of 0.7899 was obtained which indicates a high index of criterion validity. The questionnaire therefore measures what it purports to assess. End

Huishoudelike geweld is 'n wydverspreide probleem in Suid-Afrika. Die Departement Verpleegkunde van die Universiteit van Wes-Kaapland het die uitdaging vir die ontwerp van 'n module oor die hantering van Geslagsgegronde Geweld (GGG) vir die opleiding van sensitiewe, kundige en vaardige gesondheidspersoneel aanvaar. Die doel van hierdie artikel is om die professionele en persoonlike ontwikkeling van verpleegstudente in hierdie program op grond van hulle diensleweringservaring te beskryf. Hierdie uiteensetting is gebaseer op die ontleding van die beskrywings van die studente se reflektiewe joernale en 'n fokusgroepbespreking, en dui aan dat studente kritiese denkvaardighede aangeleer het, begrip ontwikkel het ten opsigte van die ondersteunende rol wat professionele gesondheidspersoneel kan speel deur die ontwikkeling van vaardighede soos omgee en voorspraak, en dat hulle 'n verbintenis tot siviele interaksie samewerkingsverhoudings sal bevorder. Van die lesse wat uit hierdie ervaring geleer is, sluit in realistiese beplanning ten opsigte van doelwitte, tydskedules, beskikbare bronne sowel as versekering van die ondersteuning van kollegas vir die effektiewe implementering van die program. End

Domestic violence is a pervasive problem in South Africa. The School of Nursing at the University of the Western Cape has responded to the challenge of training sensitive, knowledgeable and skilled health personnel by developing a Management of Gender-Based Violence (GBV) module. The purpose of this paper is to describe the professional and personal development of nursing students in this programme through their service-learning experience in the GBV module based on the analysis of the description of the students' reflective journals, group project reports and a focus-group discussion as the primary data sources. Analysis showed that students gained critical thinking skills and developed an understanding of the supportive role health professionals can play through developing skills of caring, advocacy and a commitment to civic engagement, which promotes collaborative relationships. Some of the lessons learnt from this experience include realistic planning in terms of outcomes, time frames, and available resources as well ensuring support from colleagues for the effective implementation of the programme. End

Globalisering behels 'n toename in ekonomiese, tegnologiese en kulturele uitruiling vanaf ekonomies-dominante na ekonomies minder-dominante samelewings. Talle beginsels onderliggend tot globalisering is in teenstelling met tradisionele waardes. Globalisering kan ook die marginalisering van kwesbare gemeenskappe vererger. In teenstelling hiermee, kan globalisering ontwikkelende en onderontwikkelde gemeenskappe help om te ontsnap uit 'n siklus van onderontwikkeling, armoede, onvoldoende toegang tot gesondheidsorg en swak gesondheid. Gesondheidsorgdeskundiges kan meewerk om die voordele van globalisering te optimaliseer ter bevordering van gesondheid en die ontwikkeling van gemeenskappe. Dit vereis 'n herkonseptualisering van hulle rolle en die aard van opvoedkundige programme vir gesondheidsorg. Die outeur bespreek die hoofkenmerke van globalisering, en die implikasies daarvan vir ontwikkelende lande en tradisionele lewenswyses. Die rol en verantwoordlikhede van gesondheidsdeskundiges word uitgespel. End

Globalisation entails a rapid increase in economic, technological and cultural exchange, which flows from economically and technologically dominant nations to less dominant nations. Many of the underlying principles of globalisation are contradictory to traditional values. Globalisation could aggravate marginalisation of vulnerable communities in Africa. On the other hand globalisation is regarded to provide developing and under-developed nations an opportunity to escape from a cycle of under-development, poverty, inadequate access to health care, and ill health. Health care professionals could contribute towards optimising the benefits of globalisation towards enhancing health and development in their communities. This requires that they reconceptualise their roles and the nature of health sciences education programmes. The author discusses the main characteristics of globalisation, and its implications for developing countries and traditional lifestyles. End

'n Dwarssnit, beskrywende en vergelykende studie met verwysing na bekende risikofaktore vir cholera het in die KwaZulu-Natal Provinsie tussen November en Desember 2001 plaasgevind om 'n vergelyking te maak tussen gesondheidsdistrikte wat deur cholera geteister word en distrikte wat nie deur cholera geteister word nie. Ewekansige groepe van 979 en 441 deelnemers is onderskeidelik uit die ongeaffekteerde en geteisterde gesondheidsdistrikte gekies. Beide groepe deelnemers in die studie het dieselfde digtheid ten opsigte van ouderdom, geslag en geletterdheid gehad. Uit 979 persone wat nie met cholera besmet was nie het 72% toegang tot kraanwater gehad, 10% van wateropgaartenks gebruik gemaak en 10% het dam- of rivierwater gebruik. Vyftig persent het geweet hoe om gebruik te maak van middels soos JIK, 75% het water vir drinkwater gekook en 70% het toegang tot geslote toilette gehad. Uit 441 persone besmet met cholera het 54% toegang tot kraanwater gehad, 3% het van watertenks gebruik gemaak, 38% het dam- of rivierwater gebruik, 38% het kennis van watersuiwering met behulp van middels soos JIK beskik, 66% het gekookte water gebruik en 51% het geslote toilette gebruik. Uitslae van die binêre logistieke regressie-analise toon dat cholera aansienlik beïnvloed word deur nie drinkwater te kook nie, 'n gebrek aan kennis van metodes vir watersuiwering, 'n tekort aan toegang tot kraanwater, asook 'n gebrek aan goeie persoonlike gesondheidssorg. Dit word dus aanbeveel dat gesondheidsbevordering- en opvoedingsprogramme in cholerageteisterde gesondsheidsdistrikte geimplementeer moet word en dat primêre gesondheidsorgbeginsels en gemeenskapsgebaseerde benaderings in hierdie programme in gedagte gehou moet word. End

This study was a cross-sectional, descriptive and comparative study conducted in the province of KwaZulu-Natal in the months of November and December 2001 in order to make a comparison between health districts stricken with cholera and districts not stricken with cholera with regards to well-known risk factors for cholera. Random samples of 979 and 441 participants were drawn from health districts that were not stricken with cholera and health districts that were stricken with cholera respectively. The two groups of participants in the study had similar distributions of age, gender and literacy rate. Out of the 979 people that were not stricken with cholera, 72% of them had access to tap water, 10% owned water tankers, 10% used dam or river water, 50% knew how to purify water by use of disinfectants such as JIK, 75% practised boiling drinking water, 70% used protected toilets. Out of the 441 people that were stricken with cholera, 54% of them had access to tap water, 3% owned water tankers, 38% used dam or river water, 38% knew how to purify water by use of disinfectants such as JIK, 66% practised boiling drinking water, 51% used protected toilets. Results from the binary logistic regression analysis showed that cholera sickness was significantly influenced by failure to boil drinking water, lack of knowledge of water purification methods, lack of access to tap water, as well as failure to practice proper personal hygiene. A recommendation is made to implement health promotion and education programmes in health districts stricken with cholera using primary health care principles and community-based approaches. End

Metielfenidaat word hoofsaaklik vir aandag-gebrek-hiperaktiwiteitsindroom in kinders gebruik. Die primêre doel van die studie was om die voorskryfpatrone van metielfenidaat van 'n mediese hulpfonds-pasiëntpopulasie in 'n privaatsektor te ondersoek en om die resultate met dié van vorige studies te vergelyk. 'n Studie oor die gebruik van geneesmiddels is uitgevoer. Data is van 'n Suid-Afrikaanse mediese hulpfonds-administreerder verkry. Rekords van voorskrifte vir 2002 van 115 pasiënte wat metielfenidaat ontvang het, is retrospektief ontleed. Bykans 'n driekwart (73.0%) van die pasiënte was mans en 79.1% van die pasiënte was 18 jaar of jonger. Die gemiddelde ouderdom van die pasiënte was 15.6 (SD=10.8) jaar. Sewentien pasiënte was 30 jaar of ouer. Twee-derdes van die voorskrifte (67.3%) was vir metielfenidaat 10 mg (die innoveerderproduk), 20.7% was vir die 20 mg stadig-vrystellende innoveerderproduk en die res was voorskrifte vir die 10 mg generiese ekwivalent wat onlangs bekend gestel is. Pasiënte het gemiddeld 4.0 (SD=3.3) voorskrifte vir metielfenidaat gedurende die jaar ontvang. Die gemiddelde Voorgeskrewe Daaglikse Dosis (VDD) vir metielfeniaat was 15.4 (SD=7.6) mg. Verdere studies word aanbeveel, veral met betrekking tot die lewenskwaliteit van pasiënte vóór en nadat hulle metielfenidaat gebruik het. Die impak van metielfenidaat op die akademiese prestasie van pasiënte behoort ook gekwantifiseer te word. End

Methylphenidate is primarily used for attention deficit hyperactivity disorder (ADHD) in children. The primary aim of the study was to investigate the prescribing patterns of methylphenidate of a medical aid patient population in a private sector and to compare the results with previous studies. An exposure cohort drug utilisation study was conducted. Data were obtained from a South African medical aid administrator. Prescription records for 115 patients who received methylphenidate during 2002 were retrospectively analysed. Nearly three-quarters (73.0%) of the patients were males and 79.1% of patients were 18 years or younger. The average age of patients was 15.6 (SD=10.8) years. Seventeen patients were 30 years or older. Two-thirds of prescriptions (67.3%) were for methylphenidate 10 mg (the innovator product), 20.7% were for the 20 mg slow-release innovator product and the rest were prescriptions for the recently introduced 10 mg generic equivalent tablet. Patients received on average 4.0 (SD=3.3) prescriptions for methylphenidate during the year. The average Prescribed Daily Dose (PDD) for methylphenidate was 15.4 (SD=7.6) mg. Further studies are recommended, especially into the quality of life of patients before and after receiving methylphenidate. The impact of methylphenidate on the academic performance of patients should also be quantified. End