Community perspectives on HIV, violence and health surveillance in rural South Africa: a participatory pilot study
Community perspectives on HIV, violence and health surveillance in rural South Africa: a participatory pilot study
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DOI：
10.7189/jogh.06.010406
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发表时间：
2016-06-01
影响因子：
7.2
通讯作者：
Byass, Peter
中科院分区：
文献类型：
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作者：
Hullur, Nitya;D'Ambruoso, Lucia;Byass, Peter
南非面临着复杂的疾病负担，包括传染性和非传染性疾病、伤害和人际暴力以及孕产妇和儿童死亡率。收入和机会的不平等将疾病负担推向弱势群体，卫生系统努力应对这种情况。在这方面，迫切需要进行保健规划，以考虑到边缘化群体的需要。这项研究的目的是制定一个程序，在南非东北部农村地区已建立的阿金库尔卫生和社会人口监测站，征求当地社区对两个主要死亡原因（艾滋病毒/艾滋病和暴力攻击）的看法，以及对卫生监测作为产生当地卫生信息的手段的看法。方法采用社区参与式研究（CBPR）的方法，以3个村为单位，每村8人，进行一系列的讨论，以确定艾滋病和暴力侵害致死的原因、治疗方法和存在的问题。还讨论了监测系统，并提出了建议。讨论叙述的主要数据源，使用框架analysis.Results的研究确定了一系列的社会和卫生系统的问题，包括危险的性健康行为，根深蒂固的传统做法，酒精和药物滥用，不稳定的关系，债务的因果关系。与会者还解释了如何在诊所，不敏感的工作人员和有偏见的司法系统的病人保密性受损的治疗和报告这两种情况的问题。对卫生监督的看法是积极的。建议，以加强已经运作良好的系统有关保持保密性和敏感性，并扩大辅助careobligations.Conclusion讨论提供了信息，无法从其他来源的社会和卫生系统的过程中，通过获得高质量的医疗保健是在这种情况下的限制。在此基础上，正在进行常规卫生和社会保障系统中的进一步CBPR，以扩大研究人员、社区和卫生当局之间的伙伴关系，将证据与行动手段联系起来。
Background South Africa faces a complex burden of disease consisting of infectious and non-communicable conditions, injury and interpersonal violence, and maternal and child mortality. Inequalities in income and opportunity push disease burdens towards vulnerable populations, a situation to which the health system struggles to respond. There is an urgent need for health planning to account for the needs of marginalized groups in this context. The study objectives were to develop a process to elicit the perspectives of local communities in the established Agincourt health and socio-demographic surveillance site (HDSS) in rural north-east South Africa on two leading causes of death: HIV/AIDS and violent assault, and on health surveillance as a means to generate information on health in the locality. Methods Drawing on community-based participatory research (CBPR)methods, three village-based groups of eight participants were convened, with whom a series of discussions were held to identify and define the causes of, treatments for, and problems surrounding, deaths due to HIV/AIDS and violent assault. The surveillance system was also discussed and recommendations generated. The discussion narratives were the main data source, examined using framework analysis.Results The groups identified a range of social and health systems issues including risky sexual health behaviors, entrenched traditional practices, alcohol and substance abuse, unstable relationships, and debt as causative. Participants also explained how compromised patient confidentiality in clinics, insensitive staff, and a biased judicial system were problematic for the treatment and reporting of both conditions. Views on health surveillance were positive. Recommendations to strengthen an already well-functioning system related to maintaining confidentiality and sensitivity, and extending ancillary care obligations.Conclusion The discussions provided information not available from other sources on the social and health systems processes through which access to good quality health care is constrained in this setting. On this basis, further CBPR in routine HDSS to extend partnerships between researchers, communities and health authorities to connect evidence with the means for action is underway.