Hepatitis B immunisation and immune status of nurses in a regional hospital in central South Africa.

BACKGROUND:  The hepatitis B virus (HBV) is one of the most important biological occupational hazards for healthcare workers. A high percentage of HBV infections are attributable to percutaneous occupational exposure. This study aimed to describe the HBV immunisation and current immune status of all the nurses employed in a regional hospital in central South Africa. METHODS:  A descriptive record review included all the nurses (N = 388) employed in a regional hospital in central South Africa from 01 January 2018 to 31 January 2020. A total of 289 health records were included in the study. Data were analysed using descriptive statistics. Logistic regression analysis was used to establish factors associated with full immunisation. RESULTS:  Most nurses were females (87.9%), working in medical (27.0%) wards. Only 20.4% of nurses received one dose of vaccine, while 51.2% received the three prescribed doses. However, 91.2% of nurses did not receive the vaccine at the correct intervals. Most of the tested nurses (71.0%) were immune. Immunisation status was significantly associated with religion (p  0.001) and schedule (p = 0.003). Nurses who were non-Christians were 35.9% less likely to be fully vaccinated compared to Christians. CONCLUSION:  Half of the nursing staff received three doses as prescribed. All nurses should receive the vaccine against HBV and their immune status monitored to minimise the risk of an infection. It is therefore recommended that proof of immunity should be a requirement.Contribution: This study found a high percentage of nurses with HBV antibodies, which will ensure workplace safety.

Chronic diseases of lifestyle curriculum: Students' perceptions in primary health care settings.

BACKGROUND: Community-based primary health care (PHC) forms the foundation of healthcare in South Africa. Medical programmes need to equip future health practitioners to face the challenges of the rising burden of chronic diseases of lifestyle (CDL) in different communities. Community-based education (CBE) contributes to developing knowledge, skills and attitudes appropriate to the challenges experienced in the PHC context. AIM: To explore medical students' perceptions of the current CDL curriculum and related programmes during CBE rotations. SETTING: The study was conducted among fourth- and fifth-year medical students at the University of the Free State, South Africa. METHODS: Focus group discussions were conducted and data were analysed thematically. RESULTS: Themes included perceptions of the CDL curriculum, relevance thereof for the PHC setting and barriers and challenges to implementing PHC programmes. This study identified foundational CDL content that needs to be incorporated or revisited at strategic points. Participants identified the need to contextualise educational programmes and focus on affordable, culturally acceptable and holistic healthcare prevention strategies. Barriers and challenges included high patient load, resource constraints, the lack of continuous care and focus on communicable diseases. Community-based education rotations were described as meaningful opportunities to develop professional attributes, competencies and skills. CONCLUSION: This study identified foundational concepts to consider at key points throughout the curriculum. Incorporating creative and reflective learning activities in CDL modules can prepare students for the realities of PHC settings.Contribution: This study provides insight into medical students' perceptions of the CDL curriculum and informs future curriculum content for CDL modules.

What is public health ethics for the geriatric community?

Background: A growing ageing community puts additional demands on the public health system. This will contribute to ethical consequences for the health care sector. A public health ethics framework can contribute towards addressing the ethical challenges faced by the geriatric community. Aim: This article intends to contribute to a public health ethics framework for the geriatric community from a South African perspective. Setting: Twenty-two participants from six geriatric institutions, two each in the three provinces, participated in the research. The provinces are the Free State, Northern Cape and North West. Methods: Fifteen statements were rated using a five-point Likert scale questionnaire. The statements were grouped into three indexes, namely what is ethics, what is public health ethics and what is public health ethics for the geriatric community? Results: Ethical behaviour is observable not only from person to person but also through systems, processes and practices. The need is to understand how to apply ethical principles to the working environment. A public health ethic can be understood from applied, professional and social ethics. Conclusion: Public health ethics is the application of health care principles through a professional ethic resulting in care and relationship-building. The core of what public health is should be the basis to identify a public health ethic where the focus is on the community and improvement of the quality of health and well-being of the community. Contribution: No evidence of a public health ethics framework for the geriatric community could be identified in South Africa.

Building blocks for a public health ethics framework for the geriatric community.

BACKGROUND: The elderly population is steadily growing in South Africa. However, there is limited strategic planning or policy initiatives to address this group's vulnerability resulting in several public health ethical issues that need to be considered and addressed. This article aims to develop a public health ethics framework for the geriatric community with the purpose to review ethical implications when working with the geriatric community. METHODS: The Q-methodology was selected for data collection. Fifteen statements were ranked by means of a five-point Likert-scale questionnaire. Twenty-two participants from six geriatric institutions participated in the ranking of the statements. RESULTS: The ranking of the statements confirmed the need for a public health ethics framework to provide guidance when working with the geriatric community and to evaluate decisions about geriatric care. Such a framework should be application-based and practice-oriented which can assist in addressing unfamiliarity with public health ethics in general and can extend the capacity for decision-making. The ranking of these statements contributed to the scope of the planned framework, by considering the vulnerability of healthcare practitioners (as community of practitioners) and the geriatric community as a basis from which to promote justice in public health programmes. CONCLUSION: Based on the ranking of statements, eight building blocks for a public health ethics framework were identified. The building blocks are imbedded in professional ethics and care ethics. The proposed framework can give rise to social justice in public health and the ability to evaluate what the ethical implications are for public health policies, programmes and interventions aimed at the geriatric community.

Obesity and sickness absenteeism among health workers in a private hospital in South Africa.

BACKGROUND: There is a worldwide trend among the general population including health workers to become more overweight and obese. Such obesity can reduce work ability as manifested through sickness absenteeism. The aim of this study was to describe the obesity among health workers in a private hospital in central South Africa, as measured by the body mass index (BMI) as well as the association of obesity and sickness absenteeism. METHODS: A cohort analytical study was conducted to describe changes in the BMI of employed health workers as well as the association of obesity and absenteeism in a private hospital in South Africa. The BMI measurement on employment, a repeat BMI at the time of the study as well as the sick leave days taken since employment of all health workers who had been employed for more than one year were analysed. RESULTS: Full time employees (n = 344) participated in the study of whom 33.7% were obese; 26.2% were overweight; 36.3% had normal weight and 3.7% were underweight at employment. On repeat BMI done in February 2016, 43.0% were obese; 27.6% were overweight; 28.2% had normal weight and 1.2% were underweight. There was no difference in the amount of sick leaves taken between the normal weight, overweight and obese groups. CONCLUSION: A trend among health workers to change to a higher BMI category during employment is concerning, but there was no statistically significant association between the different weight groups and sickness absenteeism. The negative impact of obesity on the productivity of workers cannot be ignored.

A Comparison of the Socio-Behavioral-Metabolic Risk Profiles and Associated Factors for Chronic Diseases of Lifestyle in Urban and Rural Communities in Central South Africa.

Background: The global escalating prevalence of lifestyle-related non-communicable diseases places a significant burden on health systems. Chronic diseases of lifestyle (CDL) are a group of diseases that share similar modifiable risk factors that can result in long-term disease processes. Considering the socio-behavioral-metabolic risk profiles of communities and risk factors predictive of the presence of CDL can assist in the development of focused and effective community-based prevention, intervention, and treatment programs for CDL. Aim: To determine the socio-behavioral-metabolic risk profiles and identify associated factors for the following CDL: obesity, cardiovascular disease, hypertension, and type 2 diabetes mellitus in rural and urban communities in central South Africa. Methodology: This cross-sectional study included adults aged 25-65 years in the rural Southern Free State and urban Mangaung. Social determinants, behavioral and metabolic risk factors, and inflammatory biomarkers for CDL were determined. Results: In total, 575 rural (mean age: 42 years; 71% female) and 429 urban (mean age: 44 years; 76% female) participants were included in the study. More than 20% of participants in both communities reported being previously diagnosed with cardiovascular diseases; with reported hypertension and diabetes mellitus more prevalent among rural participants. Insufficient intake of fruit and vegetables, alcohol use, and high blood pressure were among the top five risk factors in both communities. Physical inactivity ranked among the top two risk factors in the urban community; while alcohol and tobacco use was significantly higher in the rural community. Fibrinogen was the most prevalent inflammatory marker in both communities (32.9 rural vs. 48.3% urban). High sensitivity C-reactive protein (Hs-CRP), only available for rural participants, was high with increased levels in more than 80% of participants. In both communities, being female, having high blood pressure and increased fibrinogen levels were associated with obesity. Conclusion: This study illustrated the high prevalence of socio-behavioral-metabolic risk factors for CDL, and identified similarities and distinct differences in the risk profiles of rural and urban communities. Considering the CDL risk profiles of communities can assist in prioritizing health needs and contribute to the development of tailor-made community-based primary health care prevention, intervention, and health promotion programs.