DOI: 10.14749/1400830125
title: The impact of HIV-AIDS on the health sector 2002: Adult data - All provinces in South Africa

description: Description: 
 The data set contains adult patients' data- demographic, morbidity, behavioural, environmental and data on health facilities (i.e. type, province and health district). Patient biographic data (age, sex, race, residence, nationality, language, type of dwelling, education, employment, income, religion, marital status, etc.). Data on history of hospitalisation of patient and data on patients health status like weight, STIs, pregnancy etc. and symptoms/diseases that had prompted patients to seek medical and health care. Behavioural data includes sexual partnerships, condom use, alcohol/ drug use and circumcision that predisposes one towards infection with HIV.
 Environmental data on pollution, living on farms and access to clean drinking water and food as well as data on HIV status was collected.

 The data contains 192 variables and 1534 cases.
Abstract: 
 The Nelson Mandela / HSRC study of HIV/AIDS (2002) reported an estimated prevalence of 4.5 million among persons aged two years and older. Given the overall impact of HIV/AIDS on South African society, and the need to make policies on the management of those living with the disease, it was important that studies were undertaken to provide data on the impact on the health system. This study was undertaken by the HSRC in collaboration with the national School of Public Health (NSPH) at the Medical University of South Africa (MEDUNSA) and the Medical Research Council (MRC). It was commissioned by the National Department of Health (DoH) to assess the impact of HIV/AIDS on the health system and to understand its progressive impact over time.

 The PIs sought to answer the following questions

 
 To what extent does HIV/AIDS affect the health system?
 
 What aspects or sub-systems are most affected?
 
 How is the impact going to progress over time?


 To answer the questions, a stratified cluster sample of 222 health facilities representative of the public and private sector in South Africa were drawn from the national DoH database on health facilities (1996). A nation-wide, representative sample of 2000 medical professionals including nursing professionals; other categories of nursing staff; other health professionals and non-professional health workers was obtained. In addition to this a representative probability sample of 2000 patients was obtained.

 Data collection methods included interviews using questionnaires and clinical measurements where either a blood specimen or an oral fluid (Orasure) specimen was collected.

 An anonymous linked HIV survey was conducted in the Free state, Mpumalanga, North West and Kwazulu-Natal. Oral fluids were tested for HIV antibodies at three different laboratories and results were linked with questionnaire data using barcodes.

 The adult questionnaire contains the patient's biographical data, hospitalisation history of patients seen at clinics, in-patients interviewed in a hospital, health status, sexual behaviour and the environment.
description: Clinical measurements
description: Face-to-face interview
description: All adult (15-45 years) patients in public and private health facilities in South Africa. (Note: In hospitals only patients in medical wards were included.). Children 15 years and older were included as they were interviewed together with the adult patients.
description: The task was to obtain a representative probability sample of 2000 patients, and at most representative probability sample 2000 health professionals who are in contact with patients undergoing treatment at the selected health facilities. 
The sampling frame was the national DoH's health facilities database (1996). Target population, was selected from two separate sampling frames: - (a) a list of all public clinics in the country (excluding mobile, satellite, part-time and specialized clinics; and (b) a list of all hospitals (public and private) and Private clinics with indication of the number of beds available in each of health facilities from the national DoH database on health facilities (1996).
Provinces and health regions within provinces were considered as explicit strata. Provinces formed the primary stratification variable and the health regions the secondary stratification variable. The Primary sampling unit (PSU) was the magisterial districts within each health region in the case of public clinics, Secondary sampling unit (SSU) were clinics and hospitals- drawn using simple random sampling, and Ultimate/final sampling unit the (USU) the professional and non-professional health workers and patients.
Measure of size (MOS) for public clinics was a monotonic function of the number of clinics per managerial districts. Selected 167 clinics were allocated disproportionately i.e. proportional to MOS. Allocated sample number of clinics within each province was allocated proportionately to the health regions in the province. MOS for hospitals and private clinics was a monotonic function of the number of beds as in DOH's database.
Sample sizes for SSUs:
Public clinics (167)

Public Hospitals (33)
Private Hospitals and clinics (22)

Sample sizes for USUs:

1000 patients
500 nursing personnel 
200 medical doctors
100 other professional health workers
400 non-professional health workers

Public clinics 

1000 patients
500 nursing personnel 
111 nonprofessional personnel( e.g. cleaners)

Public Hospitals 

667 patients
333 nursing Personnel
200 medical doctors
67 other professional
222 non-professionals

Private Hospitals and clinics

333 patients
167 nursing Personnel
100 medical doctors (all to be drawn at hospitals)
33 other professional (all to be drawn at hospitals)
167 non-professionals