A mixed methods analysis of clostridioides difficile infection and implementation of a quality improvement intervention in public sector hospitals in Cape Town, South Africa

Abstract

Background: Clostridioides difficile or Clostridium difficile infection (CDI), is a global health threat known for devastating outbreaks, high-cost complications, readmissions and mortality. While CDI is widely studied in high resource settings, existing literature neglects low resource settings. Prior to this study, no publications were available on the epidemiology of CDI and CDI patient outcomes in the secondary hospitals in the public healthcare sector — gaps this thesis addresses. No publications existed on provider awareness of CDI and CDI management workflow in sub-Saharan Africa. This thesis aims to a) determine baseline CDI patient characteristics, management of and contribution to mortality in SA, b) identify CDI perceptions and practices among healthcare providers in SA secondary hospitals, including facilitators and barriers to providing quality CDI care, and c) develop a CDI intervention and analysis thereof.