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Biomedical subjects

Anthony B Zwi

Publications and source records attributed to Anthony B Zwi.

30 records · Page 2Linked to original sources
PubMed2002

Quality and equity of private sector care for sexually transmitted diseases in South Africa.

The private sector plays a major role in the delivery of health care in South Africa. Over the past two decades, the quality and equity of such provision has been questioned internationally. A study was conducted in Gauteng Province to explore these issues, using care for sexually transmitted disease (STD) as a case study. Private general practitioners (GPs) were interviewed by telephone. Each was presented with a set of STD syndromes and requested to describe how s/he would manage the patient, first if the patient was insured, then secondly if the patient was paying cash (uninsured). Reported prescriptions were costed and assessed for effectiveness against main causative pathogens using local standard clinical guidelines. Knowledge of recent developments in STD syndromic management and effectiveness of prescribed drugs was poor, especially for genital ulcer and pelvic inflammatory disease, and less than half the prescriptions overall were judged as effective. Although the effectiveness of prescriptions for insured and uninsured patients were similar, for most syndromes uninsured patients were offered significantly cheaper and less convenient antibiotic regimens. Effective regimens were also significantly more expensive than ineffective regimens. The results suggest that GPs' perceptions of patients' willingness or ability to pay for drugs have a bearing on quality of care. The paper concludes that STD patients who present to GPs are often offered poor quality of care, and the choice of inconvenient antibiotics impacts disproportionately on the poor. Improvements in the quality and equity of GP care will require interventions that address the factors that determine their behaviour.

Anti-Bacterial Agents↗
PubMed2002

Comparison of the effectiveness of major trauma services provided by tertiary and secondary hospitals in malaysia.

BACKGROUND: The effectiveness of trauma services provided by three hospitals operating at different levels of care, district general (DGH), tertiary care, and central tertiary, were compared in Malaysia. METHODS: Cases were recruited prospectively for 1 month. Outcome measures included death or, among survivors, disability at discharge. RESULTS: Leading causes of injuries were road traffic (72%), falls (9%), industrial (6%), and assaults (5%). Fifty-nine percent of cases were direct admissions and 41% were interhospital transfers. Of the 286 direct admissions, 12% arrived by ambulance and the remainder mostly by private car. For direct admissions, logistic regression identified an increased odds of dying associated with admission to DGH (compared with central tertiary) (odds ratio [OR], 9.8; 95% confidence interval [CI], 1.3-73.7), severe injuries (Injury Severity Score > 15) (OR, 33.1; 95% CI, 7.5-146.7), and older age (> or = 55 years) (OR, 10.8; 95% CI, 2.0-56.8). Disability at discharge was associated with being severely injured (OR, 6.4; 95% CI, 2.4-17.1). CONCLUSION: In this study in Malaysia, admission to DGH, older age, and severe injuries are associated with increased odds of fatality.

Adolescent↗
PubMed2002

Oceans of need in the desert: ethical issues identified while researching humanitarian agency response in Afghanistan.

This paper describes the interventions by the International Committee of the Red Cross to support a hospital in Afghanistan during the mid 1990s. We present elements of the interventions introduced in Ghazni, Afghanistan, and consider a number of ethical issues stimulated by this analysis. Ethical challenges arise whenever humanitarian interventions to deal with complex political emergencies are undertaken: among those related to the case study presented are questions concerning: a) whether humanitarian support runs the risk of propping up repressive and irresponsible governments; b) whether humanitarian relief activities can legitimately focus on a narrow range of interventions, or need to broaden to address the range of challenges facing the health system; and c) whether sustainability and quality of care should be routinely considered in such settings. The paper concludes by highlighting the value of case studies, suggesting mechanisms for extending transparency and accountability in humanitarian health interventions, and highlighting the need of contextualising humanitarian work if the interventions are to be successful.

Afghanistan↗
PubMed2002

[World report on violence and health].

In 1996, the World Health Assembly declared violence a major public health issue. To follow up on this resolution, on October 3 this year, WHO released the first World Report on Violence and Health. The report analyses different types of violence including child abuse and neglect, youth violence, intimate partner violence, sexual violence, elder abuse, self-directed violence, and collective violence. For all these types of violence, the report explores the magnitude of the health and social effects, the risk and protective factors, and the types of prevention efforts that have been initiated. The launch of the report will be followed by a 1-year Global Campaign on Violence Prevention, focusing on implementation of the recommendations. This article summarises some of the main points of the world report.

Humans↗
PubMedDate not supplied

Public health nurses' perspectives on collaborative partnerships in South Africa.

The importance of partnerships and collaborations between different stakeholders in order to achieve health objectives are increasingly recognized. This article aims to: (1) highlight the importance of establishing partnerships and coalitions to achieve health goals; (2) consider the benefits and costs of such collaborations; and (3) identify the conditions which facilitate effective partnerships, from the perspective of nurses working within collaborative ventures in South Africa. A survey of these nurses was undertaken to consider their perceptions of the likely returns from investments in collaborative working and the extent of the relationship between the participation incentives and difficulties encountered. By examining their perceptions to a number of facets of partnership fostering, the article has elaborated on the meaning of collaboration and its rationale, and highlighted the conditions necessary for the success of community partnerships (CPs). The study has also demonstrated the feeling that CPs are beneficial with increased satisfaction along many operational parameters. Working to a shared agenda requires a "give and take attitude" among the stakeholders, designed to produce an outcome that merges multiple and new insights and directions for action, as well as the combined power foundation to do so.

Community Health Services↗