Perceptions of people living in the catchment area of Madwaleni Hospital, South Africa regarding the health and social problems facing their community [Elektronische Ressource] / submitted by Carolin Winkel

Perceptions of people living in the catchment area of Madwaleni Hospital, South Africa regarding the health and social problems facing their community [Elektronische Ressource] / submitted by Carolin Winkel

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Perceptions of people living in the catchment area of Madwaleni Hospital, South Africa regarding the health and social problems facing their community D i s s e r t a t i o n to obtain the academic degree doctor medicinae (Dr. med.) at the Medical Faculty Carl Gustav Carus of the Dresden University of Technology submitted by Carolin Winkel born on 27. April 1983 in Berlin-Lichtenberg Dresden 2010 1. Reviewer: Prof. Dr. med. Dipl.-Psych. Joachim Kugler 2. Reviewer: Prof. Dr. med. Jörg Klewer Date of the dissertation defence: 07. December 2010 signed by: Prof. Dr. rer. nat. Henning Morawietz Chairman of the Doctorate Committee “…communities of the poor (are) in fact rich in potential and amply supplied with bright and creative people.” H. Jack Geiger Perceptions of people living in the catchment area of Madwaleni Hospital regarding the health and social problems facing their community Table of contents I Table of contents I Table of contents ...................................................................................................I II List of figures....................................................................................................... IV III List of tables...........................................................................................

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Perceptions of people living in the catchment area of Madwaleni Hospital, South Africa
regarding the health and social problems
facing their community
D i s s e r t a t i o n to obtain the academic degreedoctor medicinae(Dr. med.) at the Medical Faculty Carl Gustav Carus of the Dresden University of Technology submitted by Carolin Winkel born on 27. April 1983 in Berlin-Lichtenberg Dresden 2010
1. Reviewer: Prof. Dr. med. Dipl.-Psych. Joachim Kugler
2. Reviewer: Prof. Dr. med. Jörg Klewer Date of the dissertation defence: 07. December 2010
signed by: Prof. Dr. rer. nat. Henning Morawietz
Chairman of the Doctorate Committee
“…communities of the poor (are) in fact rich in potential
and amply supplied with bright and creative people.” H. Jack Geiger
Perceptions of people living in the catchment area of Madwaleni Hospital regarding the health and social problems facing their communityTable of contents
I
Table of contents
ITable of contents ...................................................................................................IIIList of figures....................................................................................................... IVIIIList of tables........................................................................................................ VIIVAcronyms ........................................................................................................... VII1Introduction ...........................................................................................................11.1Motivation and purpose of the study .....................................................................11.2Community Oriented Primary Care .......................................................................21.3Background: South Africa......................................................................................51.3.1Historical overview..........................................................................................51.3.2The Xhosa ......................................................................................................91.3.3Primary health care in South Africa ..............................................................111.4Background: HIV/AIDS........................................................................................141.4.1HIV/AIDS worldwide .....................................................................................141.4.2..............................................................................16HIV/AIDS in South Africa 1.4.3HIV/AIDS in Madwaleni ................................................................................171.5Aim and objectives of the study...........................................................................191.5.1Aim of the study ............................................................................................191.5.2Objectives of the study .................................................................................192Methods ..............................................................................................................202.1Study design........................................................................................................202.2Period of the study ..............................................................................................202.3Setting of the study..............................................................................................212.4Study population..................................................................................................242.5.........................................24Study samples, sampling methods and sample sizes 2.5.1Preliminary survey sample, sampling method and sample size ...................252.5.2Group 1 and 2 samples, sampling methods and sample sizes ....................252.5.3Group 3 and 4 samples, sampling methods and sample sizes ....................262.6Data collection methods and instruments ...........................................................282.6.1....28Data collection methods and instruments used in the preliminary survey 2.6.2Data collection methods and instruments used for the questionnaire-based structured interviews ..........................................................................292.6.2.1..........................................30Development process of the questionnaire 2.6.2.1.1Section 1: Community profile ............................................................302.6.2.1.2Sections 2 and 3: Health and social problems and needs ................312.6.2.2Description of the questionnaire...........................................................33
I
Perceptions of people living in the catchment area of Madwaleni Hospital regarding the health and social problems facing their communityTable of contents 2.6.2.3Xhosa version of the questionnaire ......................................................342.6.2.4......................................................34Administration of the questionnaire 2.7Pilot process........................................................................................................342.8Data collection procedure....................................................................................352.8.1Data collection procedure applied in the preliminary survey ........................352.8.2Data collection procedure applied for the questionnaire-based structured interviews......................................................................................................352.9Ethical considerations .........................................................................................362.10Data reliability and validity...................................................................................372.10.1Data reliability ...............................................................................................372.10.2..................................................................................................37Data validity 2.11Data analysis.......................................................................................................382.11.1Data analysis strategy in the preliminary survey ..........................................382.11.2Data analysis strategy for the questionnaire-based structured interviews ...392.11.3Data analysis strategy for the comparison of the Madwaleni community with the general South African population ....................................................413Results ................................................................................................................423.1..............................................................................42Madwaleni community profile 3.1.1Existing data about the Madwaleni community ............................................423.1.2Results from the questionnaire, section 1 – Madwaleni community profile ..533.1.2.1Sex .......................................................................................................533.1.2.2Age .......................................................................................................533.1.2.3Marital status and sexual behaviour.....................................................543.1.2.4Children ................................................................................................563.1.2.5Education .............................................................................................563.1.2.6Employment status...............................................................................583.1.2.7Household income................................................................................583.1.2.8Housing ................................................................................................623.1.2.9Water....................................................................................................643.1.2.10Sanitation .............................................................................................683.1.2.11Energy ..................................................................................................683.1.2.12Land .....................................................................................................733.1.2.13Access to health care and transport.....................................................753.1.3Comparison of the Madwaleni community with the general South African population .....................................................................................................783.2Results from the questionnaire, section 2 – Health and social problems facing the Madwaleni community ..................................................................................84
II
Perceptions of people living in the catchment area of Madwaleni Hospital regarding the health and social problems facing their community3.2.1Improvement of living conditions ..................................................................843.2.2.........................................................84Weightiest health and social problems 3.2.3Health problems ...........................................................................................853.2.4............................................................................................87Social problems 3.2.5..........................................................89Additional health and social problems 3.3Results from the questionnaire, section 3 – Relevant health education and disease prevention topics for the Madwaleni community....................................893.3.1Relevant health education and disease prevention topics ...........................893.3.2Additional health education and disease prevention topics ..........................914Discussion...........................................................................................................924.1The Strengths of the study ................................................................................1084.2Limitations of the study......................................................................................1095Summary...........................................................................................................1116References........................................................................................................115VAppendices ......................................................................................................... IX
III
Perceptions of people living in the catchment area of Madwaleni Hospital regarding the health and social problems facing their communityList of figures
II
List of figures
Figure 1-1: The COPC cycle................................................................................................4Figure 1-2: South African homelands (1979).......................................................................7Figure 1-3: Worldwide HIV prevalence rates (2007)..........................................................15Figure 2-1: Map of South Africa, indicating the Eastern Cape and Umtata (2007)............21Figure 2-2: Administrative structure of South Africa ..........................................................22Figure 2-3: Map of the Madwaleni area (2008)..................................................................23Figure 2-4: Description of the questionnaire......................................................................33Figure 2-5: Analysis strategies for the questionnaire.........................................................40Figure 3-1: Total population by age group – Eastern Cape and South Africa (2001) ........43Figure 3-2: Age groups of the Madwaleni community sample (N=199).............................53Figure 3-3: Marital states of the Madwaleni community members (N=200) ......................54Figure 3-4: Condom use amongst the sexually active Madwaleni community (N=169) ....55Figure 3-5: Location of the partners of the Madwaleni community members (N=171) ......55Figure 3-6: Highest level of education amongst the Madwaleni community (N=200)........57Figure 3-7: Literacy rates amongst the Madwaleni community members (N=198) ...........57Figure 3-8: Employment status of the Madwaleni community members (N=200) .............58Figure 3-9: Household sizes of the Madwaleni community sample (N=196).....................59Figure 3-10: Monthly household income of the Madwaleni community (N=197) ...............59Figure 3-11: Monthly incomes per capita of the Madwaleni community sample (N=193) .60Figure 3-12: Daily incomes per capita of the Madwaleni community members (N=193)...61Figure 3-13: Sources of household income of the Madwaleni sample (N=197) ................62Figure 3-14: Number of dwellings per household in the Madwaleni area (N=199)............63Figure 3-15: Number of rooms per Madwaleni household (N=199)...................................64Figure 3-16: Main sources of drinking water of the Madwaleni sample (N=200)...............65Figure 3-17: Fetching of drinking water in the Madwaleni area – Allocations (N=171)......65Figure 3-18: Fetching of drinking water in the Madwaleni area – Trips per day (N=166) ..66Figure 3-19: Fetching of drinking water in the Madwaleni area – Times per trip (N=171) .67Figure 3-20: Fetching of drinking water in the Madwaleni area – Litres per trip (N=167) ..67Figure 3-21: Toilet facilities used by the Madwaleni community members (N=198)..........68Figure 3-22: Electricity supply in the Madwaleni area (N=200) .........................................68Figure 3-23: Sources of energy for cooking in the Madwaleni community (N=200) ..........69Figure 3-24: Sources of energy for lighting in the Madwaleni area (N=200) .....................69Figure 3-25: Sources of energy for heating in the Madwaleni community (N=200)...........70Figure 3-26: Collection of wood in the Madwaleni area – Allocations (N=170) .................71Figure 3-27: Collection of wood in the Madwaleni area – Trips per week (N=165) ...........71
IV
Perceptions of people living in the catchment area of Madwaleni Hospital regarding the health and social problems facing their communityList of figures Figure 3-28: Collection of wood in the Madwaleni area – Times per trip (N=165).............72Figure 3-29: Goods owned by the sampled Madwaleni households (N=200) ...................73Figure 3-30: Land owned by the sampled Madwaleni community members (N=197).......73Figure 3-31: Use of owned land in the Madwaleni area (N=196) ......................................74Figure 3-32: Livestock owned by the Madwaleni community (N=198) ..............................74Figure 3-33: Closest clinics of the sampled Madwaleni community members (N=200) ....75Figure 3-34: Closest clinics in the Madwaleni area – Times to access (N=194) ...............76Figure 3-35: Closest clinics in the Madwaleni area – Ways of access (N=196) ................76Figure 3-36: Madwaleni Hospital – Times to access (N=172) ...........................................77Figure 3-37: Madwaleni Hospital – Ways of access (N=181) ............................................78
V
Perceptions of people living in the catchment area of Madwaleni Hospital regarding the health and social problems facing their communityList of tables
III
List of tables
Table 1-1: Madwaleni HIV/ARV programme statistics (2010) ...........................................18Table 2-1: Timeline of the study ........................................................................................21Table 2-2: Distribution of the Madwaleni HIV programme members (July 2007) ..............27Table 2-3: Distribution of the group 3 and 4 interviews .....................................................28Table 3-1: Mean and median age of the different sample groups .....................................53Table 3-2: Distribution of welfare grants in the Madwaleni area (N=198)..........................61Table 3-3: Distribution of dwellings in the Madwaleni area (N=199)..................................63Table 3-4: Livestock owned by the Madwaleni community (N=198)..................................75Table 3-5: Comparison of the Madwaleni community with the South African population ..83Table 3-6: Weightiest health problems of the Madwaleni community sample (N=200) .....85Table 3-7: Weightiest health problems of the four sub-samples (N=200)..........................86Table 3-8: Weightiest social problems of the Madwaleni community sample (N=200)......87Table 3-9: Weightiest social problems of the four sub-samples (N=200) .........................88Table 3-10: Relevant health education topics for the Madwaleni community (N=200)......90Table 3-11: Most relevant health education topics of the four sub-samples (N=200)........90Table 4-1: Weightiest problems of the Madwaleni community sample (N=200)..............102
VI
Perceptions of people living in the catchment area of Madwaleni Hospital regarding the health and social problems facing their communityAcronyms
IV
AHP AIDS ANC ANOVA ART ARV CHC CHW CIA COPC COPD CSG DG DHS
DOTS FAS FCH GCIS GDP HAART HBC HIV HIV+
MDR NHIS/SA NMAH OAP OPD OVC PART PEPFAR PHC PLWHA PMTCT SADHS SASSA
SPSS StatsSA STD STI TAC
Acronyms
Allied Health Professional
Acquired Immune Deficiency Syndrome
African National Congress
Analysis Of Variance
Anti-Retroviral Therapy/ -Treatment
Anti-Retroviral (Medication)
Community Health Centre
Community Health Worker
Central Intelligence Agency
Community Oriented Primary Care
Chronic Obstructive Pulmonary Disease
Child Support Grant
Disability Grant
Demographic and Health Surveys
Directly Observed Therapy-Shortcourse
Fetal Alcohol Syndrome
Foster Care Grant
Government Communication and Information Service
Gross Domestic Product
Highly Active Anti-Retroviral Therapy
Home-Based Care
Human Immuno-defiency Virus
Human Immuno-defiency Antibodies
Multi-Drug-Resistance/ -Resistant
National Health Information System of South Africa
Nelson Mandela Academic Hospital, Umtata
Old-Age Pension
Out-patients Department
Orphans and Vulnerable Children
Paediatric Anti-Retroviral Therapy
The U.S. Government’s President’s Emergency Plan for AIDS Relief
Primary Health Clinic
People Living with HIV/AIDS
Prevention of Mother-To-Child-Transmission
South African Demographic and Health Survey
South African Social Security Agency
Statistical Package for Social Sciences
Statistics South Africa
Sexually Transmitted Disease
Sexually Transmitted Infection
Treatment Action Campaign VII
Perceptions of people living in the catchment area of Madwaleni Hospital regarding the health and social problems facing their communityAcronyms
TB
TRC
UN
UNAIDS
UNICEF
VCT
WHO
ZAR
Tuberculosis
Truth and Reconciliation Commission
United Nations
Joint United Nations Programme on HIV/AIDS
United Nations Children’s Fund
Voluntary Counselling and Testing
World Health Organization
South African Rand
VIII