The study sites are situated in public health care facilities in the Drakenstein area and comprise 1 hospital and primary care clinics. Approximately 90% of the population obtain health care in public sector facilities; the hospital provides the only site in this area where babies are delivered.
Paarl Hospital is a secondary level hospital serving a population of approximately 200,000. Ill children are referred to the hospital via the primary health care clinics in the community, or present directly to the emergency unit after hours. There are well-established referral pathways from primary care clinics to the hospital. The hospital has a well-functioning paediatric department, providing in-patient and ambulatory services. The inpatient paediatric ward has 68 beds. There is a well-functioning radiology department and on-site laboratory facilities. There is a busy 24-hour casualty unit which provides emergency medical and trauma care to over 3000 patients a month. The obstetric unit provides perinatal care and antenatal ultrasonography for approximately 4,800 births a year. A study research team is based at Paarl hospital.
Primary care clinics
In addition to Paarl hospital, the clinical sites for this study will be at 2 primary care clinics, TC Newman and Mbekweni clinics. Primary health care clinics in the public sector in South Africa provide free preventative (e.g. immunizations) and curative services to children and families. These clinics are well-established primary health care clinics providing routine care including antenatal care, prevention of mother to child HIV transmission and childhood immunizations. They are the first health facility that sick children from this geographical area attend. There is a study team based at each clinic.