Research Publications (Health Sciences)
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Item An analysis of the need for accredited training on the administration of intravenous contrast media by radiographers : results of an online survey(The South African Radiographer, 2012) Swindon, Lynda; Friedrich-Nel, Hesta; Isaacs, Ferial; Munro, LeonieRole extension has been debated amongst South African radiographers for a number of years. However, the administration of contrast media still remains outside their scope of practice. The Society of Radiographers of South Africa (SORSA) has received anecdotal reports that radiographers are administering contrast media. This practice is a direct infringement of the rights of patients who are required to be treated and examined by health professionals who practice within their legal scope. The aim of this survey was to investigate the views and opinions of South African radiographers regarding the injecting of contrast media and the type of training needed if it were included in the scope of practice of South African radiographers. A questionnaire was sent to 845 radiographers using an online survey programme (SurveyMonkey). The questions related to biographical information, work experience, training and the medico-legal aspects of intravenous contrast media injection by radiographers. The response rate was 21% (n=177). Eighty-one percent (81%) were diagnostic radiographers. Seventy-three percent (73%) practice radiography in a major city. There was an equal representation of the public and private sector, namely 43% for both. Of those from the public sector 47% were from a tertiary healthcare facility. More than seventy-eight percent (>78%) practice radiography in a health facility that provides radiology services. Seventy-three percent (73%) were aware of mild to moderate adverse reactions to contrast media; 45% were aware of severe adverse reactions to contrast media in their workplace. Eighty-five percent (85%) thought that accredited training should include the administration of contrast media as well as resuscitation of a patient. Sixty-two percent (62%) thought the accredited training should include pharmacology and advanced resuscitation. Ninety-three percent (93%) thought the main advantage would be an increase in service delivery to patients; 85% thought the main disadvantage would be potential risk of criminal or civil litigation. Ninety-seven percent (97%) were of the opinion that radiographers who introduce contrast media to patients must have current malpractice insurance. The results of this survey provide new information on the current status of contrast media administration to the patient whose safety and rights remain at the centre of our focus. It is recommended that the statutory body, namely the professional board for radiography and clinical technology (RCT) of the Health Professions Council of South Africa (HPCSA) takes cognizance of the outcome of this study and embarks on a more extensive survey to include a larger sample which would be more representative of the South African radiography population.Item Assessing infection control knowledge and compliance of cardiovascular perfusionists in theatre at a private hospital in Kwazulu-Natal, South Africa(Durban University of Technology, 2023) Naidoo, Elizabeth; Akpa-inyang, Francis; Odayan, Myenderan; Adam, JamilaInfections acquired in a hospital (HAI) often referred to as nosocomial infections are related with increasing morbidity and death among patients that are hospitalised and are predisposed to an elevated risk of infection by health workers (HCWs). The need to maintain an effective infection prevention and control program is therefore essential for quality health care. This study sought to assess the knowledge and compliance of infection control practices of Cardiovascular Perfusionists in theatre at a private healthcare facility in KwaZulu-Natal (KZN) in the city of Durban. We conducted a qualitative study based on in-depth interviews with 12 Cardiovascular Perfusionists (CP) who were purposively selected from private sector. The interviews lasted between 20 to 25 minutes and were transcribed, and then thematic analysis were applied using NVivo. The study found that there is a need for Clinical Technologist specialising in Cardiovascular Perfusion to undergo training in infection control and prevention practices at the higher education and training level. Subsequently, the study reveals that Cardiovascular Perfusionists have a good overall understanding of pathogens and the implications thereof. The study also notes that there is considerable compliance to infection control practices in theatre irrespective of the knowledge pertaining to infection control and prevention policies. We concluded that there is an overall good knowledge and understanding regarding infection control practices, although many felt that there exists an inequitable application of infection control policies due to professional biases.Item Exploring health provider’s knowledge on the home-based maternal and neonatal health care package in Rwanda(Springer Science and Business Media LLC, 2022-12) Nishimwe, Clemence; Mchunu, Gugu G.Rwanda implemented post-natal care home visits by maternal community health workers (M-CHWs) in charge of maternal and newborn health care in 2010 as a component of a home–based maternal and neonatal health care package (HB-MNHCP), this being a complementary strategy to facility-based postnatal care to improve survival. The country has not met its Sustainable Development Goal (SDG) 3 target of less than 70 maternal mortalities per 100,000 live births and less than 12 neonatal deaths per 1,000 live births. This study therefore aimed to establish the knowledge of the health providers, providing HB-MNHC services as part of their antenatal, delivery and postnatal care program, specifically the M-CHWs services. Methods The cross-sectional descriptive study included 79 purposively sampled health care providers who were directly involved in the various components of the HB-MNHCP, namely: professional nurses, midwives, M-CHW, social workers, supervisors and data managers. The Kibogora, Muhima and Nyamata District Hospitals and two rural, semi-urban and urban health facility were included. Data was collected using questionnaires from April to July 2018. This study followed the STROBE checklist form: Cross –sectional studies. Results Overall, 88.6% (n=70/79) of participants knew about the M-CHW three home visits scheduled during pregnancy, 73.4% (n=58/79) about the three postnatal home visits after birth when the weight was normal, and 64.6% (n=51/79) about the five PNC home visits for low birth weights. Most (97.5%, n=77/79) knew that the mother and newborn should be screened during the same M-CHW home visits, and 87.2% (n= 68/79) were aware of the seven postnatal core competencies of delivering key maternal and newborn interventions during PNC home visits. Conclusions There were varying levels of knowledge among the HB-MNHCP staff, indicating the need for ongoing monitoring and training to ensure that the correct information is provided to the mothers throughout the antenatal and postnatal periods. While most of the M-CHWs appear to have had the correct knowledge, their executing of some activities needs to be monitored to ensure that they provide the required services, as this is an important step in lowering the maternal and infant mortality and enabling Rwanda to meet its SDG 3. Home visits by the M-CHWs could increase referrals and reduce maternal and newborn mortality.Item GSTM1, GSTP1 and NQO1 polymorphisms and susceptibility to asthma among South African children(SAJEI, 2012) Reddy, Poovendhree; Naidoo, Rajen N.; Robins, Thomas G.; Mentz, Graciela; Li, Huiling; London, Stephanie J.Gluthathione-S-transferase (GSTM1 and GSTP1) and nicotinamide quinone oxidoreductase (NQO1) genes play an important role in cellular protection against oxidative stress, which has been linked to asthma pathogenesis. We investigated whether common, functional polymorphisms in GSTM1, GSTP1, and NQO1 influence susceptibility to asthma among schoolchildren in South Africa. Genomic deoxyribonucleic acid (DNA) was extracted from 317 primary schoolchildren, aged 9-11 years, from the urban, underprivileged socio-economic communities of Durban. GSTM1 (null vs. present genotype), GSTP1 (Ile105Val; AA →AG+GG) and the NQO1 (Pro/Ser; CC →CT/TT) genotypes were determined using polymerase chain reaction. Among the children, 30% were GSTM1 null, 65% carried the G allele for GSTP1, and 36% carried the C allele for NQO1.There was a high prevalence of asthma of any severity (46.1%), with 20.4% reporting persistent asthma. The GSTP1 AG+GG polymorphic genotype was significantly associated with persistent asthma (adjusted OR = 3.98; CI = 1.39, 11.36, p-value = 0.01). Neither the GSTM1, nor the NQO1, genotype was a significant predictor of persistent asthma. Therefore, the GSTP1 A/G variant may modulate the risk of persistent asthma among our sample.Item The impact of self-interviews on response patterns for sensitive topics : a randomized trial of electronic delivery methods for a sexual behaviour questionnaire in rural South Africa(Springer Science and Business Media LLC, 2017-08-17) Harling, Guy; Gumede, Dumile; Mutevedzi, Tinofa; McGrath, Nuala; Seeley, Janet; Pillay, Deenan; Bärnighausen, Till W.; Herbst, Abraham J.BackgroundSelf-interviews, where the respondent rather than the interviewer enters answers to questions, have been proposed as a way to reduce social desirability bias associated with interviewer-led interviews. Computer-assisted self-interviews (CASI) are commonly proposed since the computer programme can guide respondents; however they require both language and computer literacy. We evaluated the feasibility and acceptability of using electronic methods to administer quantitative sexual behaviour questionnaires in the Somkhele demographic surveillance area (DSA) in rural KwaZulu-Natal, South Africa.Methods
We conducted a four-arm randomized trial of paper-and-pen-interview, computer-assisted personal-interview (CAPI), CASI and audio-CASI with an age-sex-urbanicity stratified sample of 504 adults resident in the DSA in 2015. We compared respondents' answers to their responses to the same questions in previous surveillance rounds. We also conducted 48 cognitive interviews, dual-coding responses using the Framework approach.Results
Three hundred forty (67%) individuals were interviewed and covariates and participation rates were balanced across arms. CASI and audio-CASI were significantly slower than interviewer-led interviews. Item non-response rates were higher in self-interview arms. In single-paper meta-analysis, self-interviewed individuals reported more socially undesirable sexual behaviours. Cognitive interviews found high acceptance of both self-interviews and the use of electronic methods, with some concerns that self-interview methods required more participant effort and literacy.Conclusions
Electronic data collection methods, including self-interview methods, proved feasible and acceptable for completing quantitative sexual behaviour questionnaires in a poor, rural South African setting. However, each method had both benefits and costs, and the choice of method should be based on context-specific criteria.Item Molecular surveillance of tuberculosis-causing mycobacteria in wastewater(Elsevier BV, 2022-02) Mtetwa, Hlengiwe N.; Amoah, Isaac Dennis; Kumari, Sheena; Bux, Faizal; Reddy, PoovendhreeThe surveillance of tuberculosis infections has largely depended on clinical diagnostics and hospitalization data. The advancement in molecular methods creates an opportunity for the adoption of alternative surveillance systems, such as wastewater-based epidemiology. This study presents the use of conventional and advanced polymerase chain reaction techniques (droplet digital PCR) to determine the occurrence and concentration of total mycobacteria and members of the Mycobacterium tuberculosis complex (MTBC) in treated and untreated wastewater. Wastewater samples were taken from three wastewater treatment plants (WWTPs) in the city of Durban, South Africa, known for a high burden of TB/MDR-TB due to HIV infections. All untreated wastewater samples contained total mycobacteria and MTBC at varying percentages per WWTP studied. Other members of the MTBC related to tuberculosis infection in animals, M. bovis and M. caprae were also detected. The highest median concentration detected in untreated wastewater was up to 4.9 (±0.2) Log10 copies/ml for total mycobacteria, 4.0 (±0.85) Log10 copies/ml for MTBC, 3.9 (±0.54) Log10 copies/ml for M. tuberculosis, 2.7 (±0.42) Log10 copies/ml for M. africanum, 4.0 (±0.29) Log10 copies/ml for M. bovis and 4.5 (±0.52) Log10 copies/ml for M. caprae. Lower concentrations were detected in the treated wastewater, with a statistically significant difference (P-value ≤ 0.05) in concentrations observed. The log reduction achieved for these bacteria in the respective WWTPs was not statistically different, indicating that the treatment configuration did not have an impact on their removal. The detection of M. africanum in wastewater from South Africa shows that it is possible that some of the TB infections in the community could be caused by this mycobacterium. This study, therefore, highlights the potential of wastewater-based epidemiology for monitoring tuberculosis infections.Item Predictors of tuberculosis treatment defaulting in informal dwellers within the eThekwini Municipality, KwaZulu-Natal(FIDSSA, 2014) Rajagopaul, Althea; Reddy, Poovendhree; Kistnasamy, Emilie JoyGlobally, tuberculosis causes more than 2-million deaths annually. Despite the implementation of the directly observed treatment strategy (DOTS) in South Africa, cure and defaulter rates have not reached World Health Organization (WHO) target rates. This causes concern as it may increase the risks of the development of multiple drug-resistant tuberculosis. Prior to commencement of this study, the eThekwini Municipality reported a defaulter rate of 18.9% in 2007 and 29% in 2009, which is higher than the WHO guideline of 5%. In 2011, eThekwini reported a defaulter rate of 24.3%. Given these statistics and the impact that these high rates may have on susceptible populations and an already overburdened health system, this study aimed to investigate predictors of defaulting in informal dwellers of eThekwini Municipality, KwaZulu-Natal. The study population comprised 102 defaulters and 102 non-defaulters from informal settlements within eThekwini. It was a cross-sectional descriptive study. The Prince Cyril Zulu Communicable Disease Centre electronic tuberculosis register was used to trace defaulters who were interviewed from informal settlements. Demographic data for non-defaulters were matched from the Prince Cyril Zulu Communicable Disease Centre electronic tuberculosis register, but were not physically traced. A questionnaire was administered to all defaulters and retrospective data were obtained from the Prince Cyril Zulu Communicable Disease Centre register for non-defaulters. Multivariate logistic analysis found smoking, alcohol use and having a family member with tuberculosis to be statistically significant predictors of defaulting. Smoking [odds ratio (OR): 2.79, 95% confidence interval (CI): 1.15, 6.77, p-value ≤ 0.005], alcohol consumption (OR: 7.04, 95% CI: 2.96, 16.71, p-value ≤ 0.005), and having a family history of tuberculosis (OR: 4.60, 95% CI: 2.34, 9.04, p-value = 0.01), were all significantly associated with defaulting in informal dwellers. Smoking, alcohol use and having a family member with tuberculosis were predictors that informal dwellers would default from their treatment. These factors should be included in tuberculosis management programmes.Item Prenatal exposures and DNA methylation in newborns: A pilot study in Durban, South Africa(Royal Society of Chemistry, 2016) Goodrich, Jaclyn M.; Reddy, Poovendhree; Naidoo, Rajen N.; Asharam, Kareshma; Batterman, Stuart; Dolinoy, Dana C.The in utero environment has the potential to influence epigenetic programming and subsequently the health of offspring. Even though pregnant women living in urban Africa are exposed to multiple chemicals and infectious agents that may impact their developing children, the neonatal epigenome has not been studied in these regions. We assessed whether prenatal exposures to air pollution and maternal human immunodeficiency virus (HIV) are associated with changes to DNA methylation throughout the epigenome using a pilot sample from the Mother and Child Environmental (MACE) birth cohort, of which 36% of the mothers are HIV positive. Families living in a high air pollution region (south Durban, n = 11) and a low air pollution region (north Durban, n = 11) with comparable socioeconomic characteristics were selected for analysis. DNA methylation was quantified in cord blood plasma DNA at >430 000 CpG sites using the Infinium HumanMethylation450 BeadChip. Sites associated with living in south Durban or maternal HIV infection (p < 0.001) were more likely to be hypomethylated and located in CpG islands. Top differentially methylated sites by region of Durban were enriched in pathways related to xenobiotic metabolism, oxygen and gas transport, and sensory perception of chemical stimuli when performing gene set enrichment testing with LRpath. Differentially methylated sites by maternal HIV status were enriched in cytochrome P450s, pathways involved in detection of chemical stimuli, metabolic processes, and viral regulation and processing. Given the small sample size of the study, future work examining the impact of prenatal exposures to air pollution, maternal infection, and antiviral treatment on the epigenome and downstream health implications is merited in Sub-Saharan African populations.Item Rehabilitation of repaired flexor tendons of the hand : therapist's perspective(South Africa Society of Physiotherapy, 2014) Mncube, N. M.; Puckree, ThreethambalINTRODUCTION: Successful outcomes following flexor tendon repairs in the hand are dependent on a team approach to management and rehabilitation. In South Africa, the public sector therapists’ perspective on rehabilitation of the hand has not been explored. URPOSE: This study determined the public sector therapists’ perspective on rehabilitation of patients with flexor tendon repairs in two districts of one province in South Africa.Practices in urban and rural settings were compared METHODS: A cross sectional survey accessed urban and rural public sector therapists involved in the rehabilitation of repaired flexor tendons of the hand. The questionnaire sought information on the initiation and frequency of rehabilitation, initiation of active movement exercises, initiation of resistiveexercises, discontinuation of protectivesplints, the use and presence of flexor tendon protocols in the facility, proximal interphalangeal joint (PIP) joint contractures, suture technique, work experience and choice of protocol. RESULTS: Therapists worked closely with physicians and found comfort in the availability of protocols. The majority of therapists in regional (93%) and tertiary hospital (94%) used established protocols compared to their district hospital counterparts (p<0, 05). External attributions were more significant in making key decisions for rehabilitation. The Strickland formula was not used as an outcome measure. CONCLUSION: Therapists are not confident in managing repaired flexor tendons of the hand. Therapists in urban health facilities rely on established rehabilitation protocols compared to their rural counterparts. Team work is evident in both settings.Item Status of usage of Information Communications Technology by academic staff at a selected nursing training institution in South Africa(Kamla-Raj Publications, 2015) Maharaj, S.; Mshunquane, N.; Puckree, ThreethambalAdvances in information communications technology (ICT) has impacted every sphere of human life including the training of health care professionals and the delivery of health care. Training institutions have incorporated ICT into all spheres of student life and delivery in varying degrees. This study determined the status of usage of ICT by academic staff in a selected nurse training college in South Africa. Questionnaires were administered to 95 academic staff at the selected institution. The majority of academics at rural (86%) and urban (96%) campuses had access to a desktop computer and printer. Personal cellphones were used to communicate with students and colleagues using Facebook (15-20%) and SMS (43-58%). Staff had limited access to internet service or to electronic systems for student administration or research (<10%). Despite advances in ICT usage in nursing education globally, challenges exist in adopting it in the selected training institution.Item Variations in housing satisfaction and health status in four lower socio-economic housing typologies in the eThekwini Municipality in KwaZulu-Natal(Taylor and Francis, 2013-07-26) Narsai, Prishah; Taylor, Myra; Jinabhai, Champaklal C.; Stevens, FredA study was done in the Durban Area, South Africa amongst residents (n = 300) of four lower socio-economic housing typologies: Reconstruction and Development Programme (RDP) houses, informal settlements (IS), traditional rural houses (TR) and inner-city apartments (IC). Respondents living in IC were most satisfied with their dwellings, those living in RDP houses and in IS were the least satisfied. People living in the IC perceived their health best, while those living in IS perceived it as worst. Major reasons for dissatisfaction with housing were pest infestation in their dwelling in the past 12 months, inadequate toilet facilities, high temperature, unclean neighbourhood, poor ventilation and dust. Pest infestation and poor ventilation were mentioned most frequently by flat dwellers whilst RDP, IS and TR households complained about inadequate toilet facilities. For many people living in low socio-economic housing, both housing and service provision remain inadequate.