https://ir.unisa.ac.za/handle/10500/14520 2026-09-17T22:49:01Z https://ir.unisa.ac.za/handle/10500/33052 Development of guidelines for the utilization of health management information system for quality immunization service in Ethiopia Feleke Fanta Tassew Health Management Information System (HMIS) is a major source of information for estimating immunisation service coverage; however, most studies argue that the Routine Health Management Information System (RHIS) inherently produces poor-quality data, which deters its wider use. Some literature asserts that no data from any source can prove the best quality; rather, using available information to provide quality service can sustain information use, thereby achieving higher data quality. This, in turn, promotes usability; nevertheless, the nexus between quality improvement and information use is not yet established. This study was intended to develop guidelines to improve HMIS use for quality immunisation service. The Performance of Routine Information System Management-Model For Improvement (PRISM-MFI) framework, guided by an explanatory sequential design, informed the mixed-methods data collection, analysis, and interpretation. The study was conducted in 42 health facilities in Addis Ababa, Ethiopia, enrolling 412 participants among health and HMIS workers. A multistage cluster, stratified with Probability Proportion to the Size (PPS) sampling, was used. Data collected through a self-administered questionnaire were entered and cleaned with EpiInfo version 7.2.5 and thoroughly analysed using SPSS for Windows 28. Qualitative strand applied Nested Criterion sampling. Data collected from nine focus group interviews composed of Information Technicians (HITs), health professionals, and health managers. Each of the categories had three groups interviewed using a thematic guide, audio recordings, and notes were manually transcribed, and codes and themes were subsequently generated using the software ATLAS.ti version 24, and were detail-analysed applying a descriptive qualitative design. Integration of findings from two studies; used a narrative joint display table to generate meta-inferences. The result revealed weak data management and data quality, hence the need to use information to ensure quality immunisation services. RHIS processes are affected by the use of hybrid, disaggregated data tools, redundant entry into the District Health Information System (DHIS2), and parallel reporting; they fail to systematically assess data quality, perform timely analysis, and interpret gaps and mitigation plans. The feedback mechanism is not constructive. The system update neglects frontline staff participation, worsening the complexity of forms, DHIS2 software, and indicators. Subpar HMIS staffing, training resources, and data use for budgeting and staff appraisal negate accountability. Data demand prioritises monitoring program output over improving service quality. Health staff lack selfreliance in interpreting and using data to evidence the design and implementation of quality initiatives. In sum, information is underused for immunisation planning, resource optimisation, supportive supervision, and community engagement in services. The interlinked guidelines were developed to address current challenges in data quality assurance and in the use of information to improve immunisation service quality. 2025-12-01T00:00:00Z https://ir.unisa.ac.za/handle/10500/32989 Midwives' Understanding of Cardiotocography Monitoring and Interpretation in a Selected District Hospital at Lepelle-Nkumpi Local Municipality, Limpopo Province Sekgoka, Matimu Pollet Cardiotocography (CTG) is a device used during antenatal and intrapartum care to monitor the foetal well-being and identify foetuses at risk of hypoxia. Midwives in antenatal and labour wards ought to be knowledgeable and competent in the monitoring and interpretation of cardiotocography as a clinical skill in order to deliver positive foetal outcomes. This study’s purpose was to determine the midwives’ knowledge and understanding in the preparation, monitoring and interpretation of the cardiotocography as a clinical skill in a selected district hospital at the Lepelle-Nkumpi Local Municipality, Limpopo Province. The study employed a quantitative research approach in conjunction with the descriptive design to acquire data from 18 purposively sampled midwives involved in the monitoring and interpretation of the cardiotocography at the selected district hospital. Data were collected by means of non-participant observation using a checklist and a self-administered questionnaire. The Stata version 19.5 SE was utilised for data analysis with assistance of a statistician. While some of the participants demonstrated basic knowledge on the indication and purpose of the cardiotocography, the majority failed to correctly interpret and record the findings of the cardiotocography in monitoring pregnant women’s progress. The participants reported several challenges that included deficient in-service training, demanding workloads, and inadequate cardiotocography machines. Participants recommended increased staff complements in order to alleviate the problem of midwife shortages and work pressure, institutionalisation of a well-managed cardiotocography tracing paper procurement, and regular workshops on cardiotocography monitoring. 2025-12-08T00:00:00Z https://ir.unisa.ac.za/handle/10500/32987 Guideline for implementation of Jacobson’s progressive muscle relaxation technique as non-pharmacological management of hypertension at selected hospitals in Arsi Zone, Oromia Regional State, Ethiopia Aliye Kediro Adem Hypertension is a leading cause of premature cardiovascular deaths and is rising in low- and middle-income countries like Ethiopia. Relaxation-based stress management can lower blood pressure, yet Jacobson’s Progressive Muscle Relaxation remains under-researched as a non-pharmacologic therapy in Ethiopia. The study aimed to identify the prevalence, associated factors of hypertension and evaluate Jacobson’s Progressive Muscle Relaxation for lowering blood pressure in adult hypertensive patients at Arsi Zone hospitals and formulated guidelines for its use as a non-pharmacological strategy in hypertension management. A multi-phase sequential mixed-methods design was employed, integrating cross-sectional analysis, a quasi-experimental study, and guideline development among adult patients in Arsi Zone hospitals, carried out across three distinct phases. Phase I included 840 participants. Phase II involved 102 participants, with 51 in the pre-test group and 51 in the post-test group. In Phase III, guidelines were developed based on findings from earlier phases, existing literature, the researchers’ reflections, and expert input. Data were analysed using Statistical Package for the Social Sciences version 29, applying multivariable logistic regression; variables with p < 0.25 were entered into the model, and statistical significance was defined as p < 0.05. Hypertension prevalence was 28.7% (n=241). Multivariate logistic regression identified several significant risk factors. Increasing age markedly raised odds, especially 60–70 years. Lifestyle factors such as current smoking, alcoholism, high fat and salt intake, not consuming fruits or vegetables, physical inactivity, use of vehicles for transportation, working more than 8 hours daily, and sleeping less than 6 hours nightly were strongly associated with hypertension. Overweight, obesity, and abdominal obesity substantially increased risk, as did a family history of hypertension. The intervention produced large reductions in blood pressure in the experimental group, with mean systolic and diastolic decreases of 20.863 and 13.784 mmHg, respectively, both highly significant by t-test values. In conclusion, the study showed that Jacobson’s Progressive Muscle Relaxation effectively reduces blood pressure, and the prevalence of hypertension was high. Guidelines were developed to promote Jacobson’s Progressive Muscle Relaxation as a non-pharmacological therapy for hypertension management in the studied population. Guideline implementation helps prevent hypertension complications and reduces premature hypertension-related deaths. 2026-01-14T00:00:00Z https://ir.unisa.ac.za/handle/10500/32983 Development of a programme to manage cancer ser-vice delivery in primary health care clinics in Botswana Tsima, Onalenna Cancer remains a growing public health concern in Botswana, placing a burden on primary health care systems. Effective management and delivery of cancer services at the primary care level are essential to improve early detection, referral, and treat-ment outcomes. Purpose The purpose of this study was to develop a programme for the management of cancer services and treatment for adults in Botswana primary health care clinics. The study was conducted in primary healthcare clinics situated in Molepolole, Kanye and Ramotswa for nurses. Although patients were seen at local clinics for follow-up care, the researcher, through the guidance of oncology nurses, accessed patients’ records pertaining to cancer treatment received at the main oncology clinic situated in Princess Marina Hospital in Gaborone. Participants were recruited in these areas, re-spectively, followed by data collection. All sites are in the southern part of Botswana. Methods A convergent parallel mixed methods approach guided the study in three phases. Data were collected simultaneously, analysed independently, and the findings were merged at the end and discussed. Phase 1 addressed two objectives of the study using a qualitative approach to explore the perceptions of Registered nurses in Primary health care clinics regarding the management of cancer patients using a purposive sample consisting of 32 registered nurses. Thematic analysis was used to analyse data. A quantitative approach, in line with Objective 2, was utilised to assess cancer patients xii (n = 135), outcomes regarding their quality of life and satisfaction with services re-ceived in primary healthcare clinics, using the EuroQol EQ-5D instrument to collect data and SPSS Version 27 was used to analyse data. Based on a confidence level of 95% and a margin of error of 5%, the sample size for cancer patients was 135 and was recruited at an oncology clinic in a tertiary hospital when they turned up for review, because in primary healthcare clinics they do not keep their records. Phase 2 involved a scoping review to determine and map out the existence of programmes for managing cancer. Phase 3 was the development and validation of a programme to support can-cer care and services in primary health care clinics. Findings In Phase 1 (the qualitative phase), four major themes emerged, which were: Lack of knowledge and skills on cancer care; delays in the diagnosis of cancer; the need to support cancer patients; and a programme to guide cancer care services. The results were consistent with findings from cancer patients (quantitative approach). Out of 135 cancer patients interviewed, most patients (80%) rated services from primary healthcare clinics as unsatisfactory, indicated a lack of support from the local clinics, and rated services as poor. Coclusion The study found that primary healthcare clinics in Botswana are currently not ade-quately equipped to deliver comprehensive cancer care services. There is a need to develop and implement a structured programme that focuses on improving healthcare provider competencies, strengthening early detection and referral systems, and en-hancing psychosocial and clinical support for patients. Recommendations The developed programme is envisioned to improve the quality of care for cancer pa-tients. Findings would inform policymakers to resource primary healthcare clinics, such as availing oncology-trained personnel and upskilling those not trained in oncology. A programme would promote standardisation of care to improve cancer service delivery and may also serve as a model for other countries with similar backgrounds and needs. 2025-01-10T00:00:00Z