Epidemiology and Biostatistics

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    Cost and impact of scaling up interventions to save lives of mothers and children: taking South Africa closer to MDGs 4 and 5
    (2015) Chola, M; Pillay, Y; Barron, P; et al
    BACKGROUND:South Africa has made substantial progress on child and maternal mortality, yet many avoidable deaths of mothers and children still occur. This analysis identifies priority interventions to be scaled up nationally and projects the potential maternal and child lives saved. DESIGN: We modelled the impact of maternal, newborn and child interventions using the Lives Saved Tools Projections to 2015 and used realistic coverage increases based on expert opinion considering recent policy change, financial and resource inputs, and observed coverage change. A scenario analysis was undertaken to test the impact of increasing intervention coverage to 95%. RESULTS:By 2015, with realistic coverage, the maternal mortality ratio (MMR) can reduce to 153 deaths per 100,000 and child mortality to 34 deaths per 1,000 live births. Fifteen interventions, including labour and delivery management, early HIV treatment in pregnancy, prevention of mother-to-child transmission and handwashing with soap, will save an additional 9,000 newborns and children and 1,000 mothers annually. An additional US$370 million (US$7 per capita) will be required annually to scale up these interventions. When intervention coverage is increased to 95%, breastfeeding promotion becomes the top intervention, the MMR reduces to 116 and the child mortality ratio to 23.
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    Does moonlighting influence South African nurses' intention to leave their primary jobs?
    (2014) Rispel, L; Chirwa, T; Blaauw, D; et al
    BACKGROUND: Staff retention and turnover have risen in prominence in the global discourse on the health workforce. Moonlighting, having a second job in addition to a primary job, has not featured in debates on turnover. OBJECTIVE: This paper examines whether moonlighting is a determinant of South African nurses' intention to leave their primary jobs. DESIGN: During 2010, a one-stage cluster random sample of 80 hospitals was selected in four South African provinces. On the survey day, all nurses working in critical care, theatre, emergency, maternity, and general medical and surgical wards completed a self-administered questionnaire after giving informed consent. In addition to demographic information and information on moonlighting, the questionnaire obtained information on the participants' intention to leave their primary jobs in the 12 months following the survey. A weighted analysis of the survey data was done using STATA(®) 13. RESULTS: Survey participants (n=3,784) were predominantly middle-aged with a mean age of 41.5 (SD±10.4) years. Almost one-third of survey participants (30.9%) indicated that they planned to leave their jobs within 12 months. Intention to leave was higher among the moonlighters (39.5%) compared to non-moonlighters (27.9%; p<0.001). Predictors of intention to leave in a multiple logistic regression were moonlighting in the preceding year, nursing category, sector of primary employment, period working at the primary job, and number of children. The odds of intention to leave was 1.40 (95% CI: 1.16-1.69) times higher for moonlighters than for non-moonlighters. The odds ratio of intention to leave was 0.53 (95% CI: 0.42-0.66) for nursing assistants compared to professional nurses and 2.09 (95% CI: 1.49-2.94) for nurses working for a commercial nursing agency compared to those working in the public sector.
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    Impact of AIDS care and level of burnout among nurses in selected hospitals in Limpopo Province, South Africa
    (2013) Ingumbor, J O; Davhana-Maselesele, M
    South Africa has one of the worst AIDS epidemics in the world and nurses bear the brunt of caring for people living with HIV and AIDS (PLWHA). This situation exacerbates the existing challenge of nursing staff shortage in South Africa as a whole and more profound in rural areas. Despite this, there is limited information on the nature and magnitude of the impact of caring for PLWHA on nurses in rural South Africa. This study therefore investigated the impact of AIDS care and the level of burnout and symptoms of depression among nurses in rural areas. One hundred and seventy four nurses involved in the care of people living with AIDS participated in the study. A structured interview guide was used as the instrument for data collection. The instrument incorporated the AIDS Impact Scale (AIS), Maslach Bumoql Inventory (MBI), Beck Depression Inventory (BDI) and the participants’ demographic and professional profiles. The study participants were conveniently drawn from five randomly selected hospitals in Limpopo Province. We found that the participants’ level of physical and emotional exhaustion were positively associated with age and years of experience respectively. Personal accomplishment was also associated with level of training and qualification. AIS items contributed more to the prediction of physical and emotional exhaustion when compared to their contribution to the prediction of depersonalization and personal accomplishment. The AIS items contributed over 40% to the prediction of emotional exhaustion. The stigma related AIS items were the contributors to the variation in depersonalization. This study therefore re-emphasizes the need to address social stigma, develop psycho-social support programmes and promote social incentives and recognition of the role of nurses in AIDS care.