Theses and dissertations (Health Sciences)

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Chiropractic manipulation and mobilization for postpartum low back pain : a systematic review
(2024) Phakathi, Londeka Nokulunga; Thandar, Yasmeen; Venketsamy, Yomika
Background: Prior research has documented empirical support for the effectiveness of chiropractic treatment for postpartum low back pain (PLBP), mostly in pregnancy but very few in postpartum. Nevertheless, the trustworthiness and calibre of the evidence from these studies has not been adequately scrutinised to authenticate their conclusions and determine whether clinical efficacy or effectiveness is present. Therefore, the objective of this study was to assess the current evidence in the literature about the therapeutic effectiveness of chiropractic manipulation and mobilisation for chronic lower back pain/pelvic girdle pain in postpartum women. Method: This study employed a qualitative evidence synthesis methodology, specifically utilising the Cochrane systematic review strategy. The literature was sourced via an electronic literature search (e.g. Google Scholar, PubMed, Medline, ProQuest Health, etc). The key search terms used were ‘low back pain’, ‘pelvic girdle pain’ together with ‘postpartum’, ‘chiropractic’, ‘manipulation’, and ‘mobilisation’. In addition to the key terms listed above, the search strategy for postpartum low back pain encompassed the following terms: ‘post-natal mechanical low back-ache’ or ‘sacroiliac syndrome/dysfunction’ or ‘sacral subluxation’ or ‘sacral pain’ or ‘lumbopelvic’ or ‘lumbar facet syndrome’. For manipulation and mobilisation, the search encompassed ‘sacral adjustment’ or ‘spinal manipulative therapy’ or ‘manual therapy’. A total of 2127 articles were identified, however 8 were suitable for inclusion. Data was extracted from each included study onto a prepared data extraction sheet. There were 4 reviewers that reviewed the 8 (4 RCTs and 4 CRs) articles included. The independent reviewers only reviewed the 4 RCTs. For Critical Appraisal and Quality of Evidence, Rev Man “Risk of Bias” was used tool for randomised controlled trials (RCTs) and for case reports (CRs), the Joanna Briggs Institute Critical Appraisal Tool (JBICAT) was selected was used. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used to rank the evidence on various levels of clinical strength in relation to treatment outcomes. Results: While 3 of the 4 RCTs demonstrated no significant evidence to support a superior effectiveness of chiropractic manipulation and mobilisation in postpartum low back pain, Pritchard (2001) showed statistically significant evidence in supporting the improvement chiropractic manipulation and mobilisation provided in this demographic. The outcomes in all 4 CRs showed large degrees of favourability to the effectiveness of chiropractic manipulation and mobilisation. However, the quality of the evidence was low to moderate at most, thus affecting the extent to which generalizability can be made, in to relation to postpartum low back pain. Conclusion: This study highlighted a dearth in literature and the need for conducting research of higher quality within this demographic. There were also discrepancies in the utilisation of the LBP term and its clinical scope. It is highly important that these discrepancies are resolved by establishing a more concrete and deliberate guideline or definition of this phrase. The production of more RCTs with larger sample sizes that include a variety of demographic characteristics (race, socioeconomic status, age, etc.), was recommended.
Systematic review of the sensitivity, specificity and validity of the active straight leg raise test in low back pain
(2024) Lee, Andrew Christopher; Korporaal, Charmaine Maria; Jack, D. A.
Background The active straight leg raise test (ASLR) is a commonly used clinical diagnostic test in a heterogenous group of conditions classified as low back pain. It may be used in a battery of tests to obtain a clinical diagnosis or to aid in the assessment of motor control in the lumbopelvic hip complex in the sagittal plane. A few variations of the ASLR exist in the literature. There is therefore a need to analyse the literature to determine to the most appropriate clinical application and interpretation of the test as the incorrect and/or ineffective application of the ASLR may influence patient outcomes. Data sources A systematic review of PubMed, Google Scholar, Cochrane Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus. Study selection All electronic or paper, English articles, which possessed the required key indexing terms and represented randomised and non-randomised controlled study designs were included. Data extraction and synthesis The blind review of the 25 articles was conducted by three independent reviewers (nine reviewers in total) using the non-randomised controlled trials (NOS) and Liddle scales. This allowed the methodological rigour of the article to be ranked. This ranking was compared to a critical appraisal of the article in order to achieve an overall decision with regards to the contribution of the article to the level of evidence for ASLR test. Results The evaluations and combined evidence were then determined for the ASLR under the heading non-pregnancy related PGP, LBP, and LPP, and various lift heights <10cm, 10-30cm, 30-60cm, full available range of motion, and unspecified range of motion. Due to study design (observational), no study exceeded level 3 evidence. Conclusion The ASLR was found to have a valid face construct, but assertions made in relation to its constructed validity in non-pregnancy related LBP is limited and conflicting. It is unclear if a positive ASLR result is from failure form closure of the public symphysis or the SIJ and if motor control is a contributing factor or product of pain.
A model to develop and promote knowledge and practice of breast self-examination among African women in rural KwaZulu-Natal province of South Africa
(2024) Sarmah, Nelisha; Sibiya, Maureen Nokuthula; Khoza, Thandokuhle Emmanuel
Background Breast self-examination (BSE) is considered one of the screening methods used for the early detection of breast cancer in addition to mammography. BSE is a safe, easy, free, and painless method used to identify any abnormalities of the breast and it is highly recommended for breast cancer screening among women in low resourced areas. Despite these recommendations, a low uptake of BSE in low middle-income countries (LMIC) is of concern. To date, a lack of knowledge, awareness, cultural influences, and socio-demographic factors have been highlighted as an influence on the uptake of BSE globally. However, much uncertainty still exists from a South African viewpoint, considering the different sociocultural backgrounds. Aim This study aims to explore and describe knowledge, perceptions, and factors that influence BSE uptake among rural African women in the KZN province of South Africa, and ultimately develop a model to develop and promote the knowledge and practice of BSE. Methodology The research was guided by the Care-Seeking Behaviour (CSB) theoretical framework. The research objectives were achieved by employing a qualitative case study design and an interpretivist paradigm. The data collection process consisted of an in-depth semi-structured one-on-one interview. The sample was selected based on a purposive sampling approach. This study was conducted in the iLembe District of KZN province of South Africa, a predominantly rural district. Study participants were African women aged 20 or older who resided in the rural iLembe District of the province of KZN. Data saturation was achieved with 22 participants. After the data were collected, they were transcribed verbatim and analysed using deductive thematic analysis. Findings In this study, several factors were found to influence the practice of BSE among rural South African women. This included, knowledge and awareness, clinical and socio-demographic influences, preventative healthcare habits, sociocultural factors, breast cancer beliefs, healthcare perception, and delayed healthcare services. In this study, the researcher noted that participants with higher levels of education were more likely to practice BSE. In addition, several participants had various traditional interpretations of breast cancer. Furthermore, there were participants who reported using complementary and self-treatment practices as a habit for health-related concerns. The findings of this study also indicate that participants perception of breast cancer and breast cancer screening may influence their willingness to participate in BSE programmes. Moreover, it was found that social support from family, friends, and community members encourage women to discuss their breast health. A lack of confidence in conventional medical methods of preventative health practices (BSE) was also attributed to clinical and socio-demographic factors and delayed access to healthcare services. Based on the findings of this study, a model was developed to promote BSE knowledge and practice among rural African women in KZN.
An investigation of rejection rates, sources thereof and methods to reduce specimen rejection
(2024) Ballim, Afsana; Mbatha, Joyce Nonhlanhla
Background Specimen rejection occurs when specimens are sent to a medical diagnostic laboratory and are deemed unsuitable for analysis based on specimen acceptability criteria. Patient care may be hindered due to rejections. Specimen rejections impact negatively on patients, healthcare workers and the diagnostic laboratory. The aim of this study was to investigate specimen rejection rates, the contributing factors, and methods to reduce the number of rejected specimens, thereby improving healthcare for the patient as well as improving the financial and quality standing of the laboratory. Materials and methods Rejection statistics were obtained for King Dinuzulu Hospital Complex (KDL) and RK Khan Hospital (RKK) for a period of six months. An investigation of the rejection rates and common causes for rejection was conducted. The information gathered from the rejection statistics was used to create training material for training workshops. Pre training and post-training questionnaires were completed to determine the effectiveness of the training. Rejection statistics were re-collected for two months post the training workshop sessions to evaluate the rejection rates for improvement. Results The initial rejection rates indicated that KDL and RKK exceeded the allowable limit of rejections (National Health Laboratory Service allowable limit < 3%). The primary reason for specimen rejections was identified as errors that occur in the pre-analytical phase, with haemolysis emerging as the predominant contributing factor. Training workshops were conducted, although the improvement in assessment score for the workshop was 49.6% (p < 0.001), the rejection statistics collected post-training workshop showed an insignificant change in overall rejection rates at KDL and RKK (p-value = 0.139 and 0.242 respectively). Conclusion Specimen rejection is a growing problem that requires mitigation. Structured training has shown to improve pre-analytical knowledge, however, it was noted that the interventions taken by offering training workshops did not reduce the rate of specimen rejections.
Assessing the burden of hepatitis B in South Africa, predicting disease prevalence and modelling the impact of hepatitis B birth dose vaccination
(2024) Moonsay, Shelina; Prabdial-Sing, Nishi; Pillay, Pavitra
In 2016, WHO adopted a resolution to eliminate hepatitis B by 2030, targeted at reducing disease burden. In South Africa, HBV disease burden has largely been estimated from community-based or sentinel studies, thereby limiting its accuracy. Since 2009, the WHO recommended the addition of a birth dose of the HBV vaccine to current vaccine schedules to mitigate the risks of vertical transmission. This intervention is crucial to reduce disease burden, given the increased risks of developing chronic disease if contracted at birth or infancy. Despite the introduction of the HBV vaccine into their EPI schedule in 1995, South Africa is yet to fulfil this recommendation. In this study, our objective was to assess HBV disease burden in the public health sector of South Africa through meticulous analyses of an extensive national dataset spanning 2015 to 2019. Additionally, we aimed to model the potential impact of a birth dose of the HBV vaccine using country-specific HBV prevalence data obtained from our own testing conducted on women attending antenatal care in 2017. Over the five years, the national HBV prevalence was 9.02%, declining gradually each year. Overall, males had consistently higher prevalence rates than females. The observed lower infection and higher immunity rates among vaccine-eligible individuals clearly demonstrated the positive impact of the HBV vaccine. Nevertheless, HBV infection among these individuals was quite concerning, highlighting the roll-over effects of suboptimal vaccine coverage rates. The prevalence of HBsAg among pregnant women was alarmingly high at 11.24%, further compounded by the high HBeAg prevalence among these women. These findings alerted us to the increased probability of vertical transmission, representing a concerning source of disease burden in the country. Among vaccine-eligible women under 19 years old, HBsAg prevalence was surprisingly high at 8.08%, noting that these women still had approximately 30 more years of potential child-bearing. These findings pose a serious threat to achieving, or even nearing, WHO elimination goals. Using a deterministic HBV transmission model to simulate the impact of a birth dose of the HBV vaccine, we estimated more than a three-fold reduction in chronic HBV infections and HBV-related deaths, specifically when considering new cases from initiation of our model. In essence, this represents a greater than three-fold reduction in HBV disease burden. Our findings are unique for South Africa given their national representation and country-specific model inputs. Despite the introduction of the HBV vaccine in 1995, hepatitis B remained highly endemic in South Africa. Adding a birth dose to the current HBV vaccination schedule and achieving optimal vaccine coverage rates will markedly reduce country HBV burden. We therefore recommend prompt implementation of a birth dose of the HBV vaccine, together with increased efforts aimed at improving HBV vaccine coverage rates to optimal levels.
Homoeopathic perceptions of gut dysbiosis as a clinically significant obstacle to cure
(2024) Hendriks, Marizel; Ghuman, Shanaz
Echoing Hippocrates' notion that “All diseaes begin in the gut”, recent scientific research strengthens the connection between gut microbial health with overall well-being. This study delves into how South African homoeopathic practitioners address gut dysbiosis, a microbial imbalance within the gut linked to various chronic conditions. Homoeopaths interviewed for this study observed a rise in gut dysbiosis, attributing it to factors like lifestyle choices and medication use. Their treatment approach emphasizes individualized remedies and therapies tailored to each patient's unique physical, mental, and emotional symptoms. Treatment plans often incorporate dietary modifications, alongside the use of probiotics and prebiotics to support gut health. The study reveals gut dysbiosis as a significant obstacle to cure in homoeopathic treatment. The high cost of stool analysis tests restricts their use in assessing gut health, making it challenging for the interviewed homoeopaths to arrive at a diagnosis. Participants expressed a strong need for more comprehensive education on gut dysbiosis and bowel nosodes within the South African homoeopathic training curriculum. In conclusion, this study suggests that gut dysbiosis presents a clinically significant obstacle to cure in homoeopathic treatment for chronic conditions. A holistic approach combining homoeopathic remedies with dietary and lifestyle changes appears to be effective. Further research is warranted to enhance homoeopathic education on gut health and its impact on chronic diseases.
Practice-related hygiene behaviours utilized by Chiropractors pre, during and post the COVID-19 pandemic in South Africa.
(2024) Enslin, Jan-Frederik; Krishna, Suresh Babu Naidu; O’Connor, Laura
Background: The COVID-19 pandemic had an impact on the delivery of healthcare services worldwide. The Allied Health Professions Council of South Africa implemented regulations to control the spread of the virus, including social distancing, face masks/shields, hand sanitisation, surface disinfection, and protective shields. Chiropractors had to incorporate new hygiene measures to ensure the safety of their patients and themselves. Without adherence to proper hygiene protocols, manual therapy poses a substantial risk of transmission for both the practitioner and the patient. There is limited information available regarding the changes made by chiropractors to their practices in response to the pandemic and if these changed behaviours are still being implemented. Exploring and understanding changes in behaviour can help identify areas where chiropractors may need additional support or resources to adapt to new circumstances and can provide valuable information on how the pandemic has impacted the field of chiropractic care. Additionally, by studying how chiropractors adapted during the pandemic can help gain insight into best practices for future challenges or crises that may arise, as well as can help improve patient care and outcomes in the future. Aim: To determine the practice-related hygiene behaviours of chiropractors before, during and post the COVID-19 pandemic in South Africa. Methodology: An anonymous online survey was completed by registered Chiropractors in South Africa (n=119) registered with the Allied Health Professions Council of South Africa, having provided informed consent. The survey consisted of questions related to practice hygiene behaviours pre, during and post the COVID-19 pandemic and distributed via a link on QuestionPro®. The survey closed on 02/02/2024. Results: The study examined the distribution of hand and equipment disinfection in a healthcare setting, before and after the COVID-19 pandemic. The response rate for the survey was 22.45%. A total of 36% of chiropractors had been practicing for seven years and 60% lived in urban or major cities. Most practitioners returned to their work in level 4 of lockdown and practiced as a sole practitioner. The study found a significant statistical difference that sanitiser availability and the use of personal protective equipment were less prevalent before and after the pandemic than during the pandemic. Most chiropractors (78%) felt that the COVID-19 hygiene protocols made them more aware about practice hygiene behaviours. However, 30% of chiropractors believed they were likely to contract COVID-19 if they did not adhere to proper hygiene practices. Barriers to implementing hygiene practices during COVID-19 included patient reluctance, lack of time, resources and difficulty in adhering to hygiene practices. Half of the chiropractors agreed to continue with good hygiene practices post COVID-19. Conclusion: The COVID-19 pandemic resulted in increased adherence to practice related hygiene behaviours with the implementation of safety precautions such as protective screens and face masks. Many of the chiropractors continued to utilise these behaviours after the pandemic.
An exploration of the adoption of personal nonpharmaceutical intervention measures by students at a university of technology in response to the COVID-19 pandemic
(2024) Kell, Colette Melissa; Haffejee, Firoza; Jinabhai, Champaklal C.
Background In March 2020 the World Health Organisation (WHO) declared coronavirus disease (COVID-19) to be a global pandemic. Due to the novel nature of the virus, there was no effective vaccine or established treatment methods, and public health officials turned to the personal non-pharmaceutical protective intervention (NPI) measures of physical distancing, hand sanitisation and the wearing of masks to interrupt disease transmission and ‘flatten’ the pandemic curve. Despite the WHO recommendation that NPIs should be included as part of any pandemic response, prior to the COVID-19 pandemic, little behavioural science research had been conducted on how to improve NPI adoption. During the COVID-19 pandemic, many Knowledge, Attitude and Practice (KAP) surveys investigated NPI compliance, but there is a dearth of qualitative literature to provide insight into the barriers and facilitators to adoption in specific populations. Over the past two decades, the South African Higher education sector has largely been transformed to accommodate students from poor and rural backgrounds. As a result, students requiring accommodation in the urban centres where universities are often based, has dramatically increased. During the COVID-19 pandemic these students effectively became mobile members of their households, returning home at various times and lockdown levels, potentially spreading the disease to relatively isolated areas. In addition, studies have consistently found that young people were more likely to be considered non adopters of the COVID-19 NPIs, partly due to the increase in risk taking behaviour associated with adolescence. In South Africa, the risk behaviour of young people is also of significant public health concern in the context of HIV/AIDS, teenage pregnancy, substance abuse and violence, this is compounded by the limited success of large research interventions. Yet, despite the acknowledgement of the need for specificity in designing youth targeted interventions, there has been little exploration of how and why South African adolescents adopt positive behaviours. Knowledge of which would be useful to better understand behaviour motivation and inform strategies for positive behaviour change. Aim This study aimed to gain an understanding of the factors influencing the adoption of the personal NPIs in response to the COVID-19 pandemic, among students at a University of Technology (UOT). Insight into these factors was used to develop guidelines to inform the design of targeted interventions to promote positive behaviour change by South African adolescents. Methodology This exploratory, qualitative study sought to understand behaviour change using the Capability, Opportunity, Motivation, Behaviour (COM-B) model. Eighteen student participants at a UOT were selected using purposive, maximum variability sampling. Each participant was interviewed individually via Microsoft Teams. Data was transcribed verbatim and analysed both deductively and inductively. Deductive analysis was guided by Theoretical Domains Framework which was developed to integrate with the COM-B model. Where possible, participant statements were coded to the appropriate domain, statements relevant to the aim of the study but did not align with the TDF domains which were inductively analysed using the Tesch approach to qualitative analysis and Braun and Clarke (2006) thematic approach. Findings This study found that NPI adoption among students evolved over time, closely aligned to the available published literature regarding NPI efficacy and WHO recommendations, but not necessarily aligned to or in compliance with government regulations. A notable exception was the reduced compliance when interacting with loved ones. In these circumstances, despite high levels of both the psychological and physical capability to perform the protective behaviours, the participants lacked the social opportunity and emotional motivation to do so. Notable factors that facilitated NPI adoption included trust in international health organisations, personal experience of COVID-19 and an altruistic desire to protect others. Factors that acted as barriers to NPI adoption included in-group trust, government distrust and social disapproval for adoption. The major themes that emerged included the need for autonomy in adolescent health decision making, the importance of social connection, the influence of social media, and the need to include young people in the development of targeted behaviour change interventions (BCIs). Conclusion This study contributes to the limited body of knowledge regarding the factors that served as barriers and facilitators to the adoption of positive health behaviours by South African adolescents in the context of the COVID-19 pandemic. These factors contributed to the development of guidelines which can be utilised by the relevant stakeholders when designing BCIs targeting this group.
Primary caregiver experiences and perspectives on caring for a child with chronic kidney disease within a South African context
(2024) Govender, Shamanie; Adam, Jamila Kathoon
Background: Informal and unpaid caregivers play an important role in the management of paediatric patients who have chronic kidney disease (CKD). The burdens that the caregivers experience during their caregiving roles and responsibilities have not been extensively researched, particularly within this patient population. The high physical, psychosocial and economic burdens experienced by the caregiver can in turn lead to negative impact on the child’s health outcomes and medical treatment. This study ascertained the burdens that caregivers experienced, in their care of paediatric CKD patients, who were receiving haemodialysis, in the renal unit of a large public hospital in KwaZulu Natal, South Africa. Methods of communication and types of information provided by the renal healthcare team and the support needs of caregivers to reduce burden, anxiety and social dysfunction was elicited. Methods: Two standardized instruments, namely, the General Health Questionnaire - 12 and the Paediatric Renal-Care Burden Scale were used to ascertain burden, anxiety, and social dysfunction experienced among caregivers of CKD paediatric patients on haemodialysis. Two semi-structured questionnaires were administered. In the first instance, caregivers were asked to provide information on areas that could assist them to alleviate the burden of caregiving and the second questionnaire was used to ascertain from renal staff, the methods they used to communicate with, and the information they provided to caregivers. Results: Twenty-one caregivers participated in the study, with females providing most of the caregiving duties (76.2%). Using the PR-CBS, financial burden emerged as the highest burden experienced (mean = 4,86 and SD = 0,77). The use of the GHQ – 12, revealed that anxiety and distress were significantly high in caregivers (mean = 0.95 and 0.85) respectively. Overall, 18 caregivers had moderate to high burden. The total mean burden score for the PR-CBS for females was significantly higher than that for males (11.30; SD = 6.11 vs 7.83; SD = 4.70). This is confirmed by the total mean burden score declared by females for GHQ – 12, which was also significantly higher than that declared by males (6.58; SD = 2.83 vs 3.75; SD = 1.80). There was significant positive correlation between GHQ-12 anxiety score (p= 0.003) and PR-CBS burden score (p = 0.005). Conclusion: The prevalence of burdens, anxiety and social dysfunction was significantly high among caregivers of CKD paediatric patients and is often overlooked by the renal Background: Informal and unpaid caregivers play an important role in the management of paediatric patients who have chronic kidney disease (CKD). The burdens that the caregivers experience during their caregiving roles and responsibilities have not been extensively researched, particularly within this patient population. The high physical, psychosocial and economic burdens experienced by the caregiver can in turn lead to negative impact on the child’s health outcomes and medical treatment. This study ascertained the burdens that caregivers experienced, in their care of paediatric CKD patients, who were receiving haemodialysis, in the renal unit of a large public hospital in KwaZulu Natal, South Africa. Methods of communication and types of information provided by the renal healthcare team and the support needs of caregivers to reduce burden, anxiety and social dysfunction was elicited. Methods: Two standardized instruments, namely, the General Health Questionnaire - 12 and the Paediatric Renal-Care Burden Scale were used to ascertain burden, anxiety, and social dysfunction experienced among caregivers of CKD paediatric patients on haemodialysis. Two semi-structured questionnaires were administered. In the first instance, caregivers were asked to provide information on areas that could assist them to alleviate the burden of caregiving and the second questionnaire was used to ascertain from renal staff, the methods they used to communicate with, and the information they provided to caregivers. Results: Twenty-one caregivers participated in the study, with females providing most of the caregiving duties (76.2%). Using the PR-CBS, financial burden emerged as the highest burden experienced (mean = 4,86 and SD = 0,77). The use of the GHQ – 12, revealed that anxiety and distress were significantly high in caregivers (mean = 0.95 and 0.85) respectively. Overall, 18 caregivers had moderate to high burden. The total mean burden score for the PR-CBS for females was significantly higher than that for males (11.30; SD = 6.11 vs 7.83; SD = 4.70). This is confirmed by the total mean burden score declared by females for GHQ – 12, which was also significantly higher than that declared by males (6.58; SD = 2.83 vs 3.75; SD = 1.80). There was significant positive correlation between GHQ-12 anxiety score (p= 0.003) and PR-CBS burden score (p = 0.005). Conclusion: The prevalence of burdens, anxiety and social dysfunction was significantly high among caregivers of CKD paediatric patients and is often overlooked by the renal healthcare team. The experiences of this unique population of caregivers are complex and multifaceted, but despite the various challenges they encounter, they continue to provide care and support for their young patients. Renal healthcare practitioners may use the findings to develop and provide suitable supportive interventions and resources for these caregivers. It is essential that these be included in treatment guidelines for the ill child, not only to reduce caregiver burdens but also to improve the overall CKD paediatric patient outcomes.
The assessment of intensive care unit-acquired weakness in adult patients at risk of post intensive care syndrome
(2024) Van Vuuren, Noline; Prakaschandra, Dorcas Rosaley; Memela, Mduduzi E.; Van der Merwe, E.
Intensive care unit-acquired weakness (ICUAW) is a syndrome of generalised neuromuscular weakness that develops in critically ill patients for which there is no alternative explanation other than the critical illness itself, and which has a prevalence of 25% to 80% in ICU survivors. The diagnosis and grading of ICUAW is made by excluding other causes of neuromuscular weakness and by repetitive clinical examination of muscle strength using the Medical Research Council Sum-Score (MRC-SS). The aim of the study was to evaluate ICUAW, and diagnostic methods available for this condition, in ICU survivors at risk of post intensive care syndrome (PICS) in a South African tertiary public sector hospital. METHODOLOGY: A prospective, single-centre observational study was conducted in a multi-disciplinary tertiary ICU in Eastern Cape. Patients at risk for post intensive care syndrome were included in the study. Patients were evaluated for ICUAW at six weeks and six months post-hospitalisation with the MRC-SS and handheld dynamometry (HDD). Full criteria ICUAW is defined as an MRC-SS of less than 48 out of 60. RESULTS: We enrolled 150 patients in the study, of which 103 patients completed the six month follow-up. At six weeks and six months, respectively, 3 and 2 patients’ MRC SS were less than 48/60. The median MRC-SS was 58/60 (IQR: 52-60) at six weeks and 60/60 (IQR: 58-60) at six months. There was an average change of 32,75% in the mean force from six weeks to six months for all muscle actions on both sides, with p < 0.001 indicating a significant difference. Fair correlations (r = 03-0.5) were observed between the MRC scale and HHD measurements for each muscle action from six weeks to six months. The correlation between the MRC scale and HHD proved to be significant (p < 0.001). CONCLUSION: There is a low incidence of the full criteria of ICUAW in relatively young and previously healthy ICU survivors at risk for PICS. Both the MRC-sum scores and HHD measurements showed a significant improvement over six months and there was an acceptable correlation between them. The findings of this study indicate that the strength assessed by both methods is related and tends to change in a similar direction over time.
Exploring factors influencing patient safety incident reporting by nurses in primary health care facilities in King Sabata Dalindyebo sub-district, Eastern Cape
(2024) Tolobisa, Patiswa; Naranjee, N.; Moonsamy, S.
Patient incident reporting is a crucial activity for enhancing healthcare standards and ensuring patient safety. Reporting patient safety incidents offers a comprehensive overview of incidents, detailing what occurred and how it happened, thereby facilitating learning and improvement. The study identified several factors influencing patient safety incident reporting, including a lack of understanding of incident reporting, a blame culture, minimal support by managers, a lack of training, inadequate facilities, a lack of feedback and debriefing, and the absence of rewards and punishment system. A necessary positive activity to improve health care standards and patient safety is patient incident reporting. Patient safety incidents provides a broad picture of what has happened, how it happened and facilitates learning. AIMS AND OBJECTIVES OF THE STUDY The aim of the study was to explore and describe factors influencing the reporting of patient safety incidents in primary health care facilities from nurses’ viewpoints. The objectives were to explore factors influencing PSI reporting behaviours in primary health care facilities in King Sabata Dalindyebo sub-district, OR Tambo District, Eastern Cape, to explore nurses’ knowledge and understanding of PSI reporting, and to provide recommendations for improving PSI reporting. METHOD In this study, a qualitative, exploratory, descriptive design assisted the researcher in exploring the factors influencing reporting of patient safety incidents by nurses in primary health care facilities. The target population was all 48 nurses permanently employed in the primary health care facilities in Mqanduli cluster, King Sabata Dalindyebo. A non probability, purposive sampling method was used to select the participants for the study, where 10 nurses were interviewed as determined by data saturation. Individual interviews were conducted using semi-structured interviews in English based on an interview guide which lasted for 15-20 minutes for each participant. The data was analysed using the thematic data analysis method. FINDINGS Five themes emerged from the thematic analysis, with 19 subthemes. Themes were: (1) Experiences of patient safety incident reporting, (2) contributory factors to patient safety incidents, (3) importance of patient safety incident reporting (4) barriers to PSI reporting, and (5) recommendations by participants.The reporting process for patient safety is influenced by a number of factors, such as nurses' reluctance to report for fear of punishment, the emphasis placed on unclear reporting systems, management behaviour, lack of training and education, and fear of lawsuits. The experience of implementing patient safety incident reporting necessitates support from management in the form of training and provision of resources, creating a positive work environment and safety culture by not punishing those who make errors, and rewarding those who report patient safety incidents. CONCLUSION The nurses at Mqanduli cluster, King Sabata Dalindyebo Sub-District had challenges regarding the reporting of patient safety incidents due to a number of issues tabled by the participants that were influencing factors to patient safety incidents that should have been prevented such as negligence. The participants proposed recommendations such as development through training of the nursing staff regarding how to report patient safety incidents and provision of resources.
The comparison between apnoea-hypopnoea index in afternoon nap polysomnography and overnight polysomnography at a health establishment in KwaZulu-Natal
(2024) Kibi, Yabanathi; Prakaschandra, Rosaley; Nyamande, Kennedy; Mdluli, Dalincebo Christopher
Background: Sleep-disordered breathing (SDB) is a highly prevalent, though under-recognised, public health problem. The apnoea-hypopnoea index (AHI) is a standard measure used to assess the presence and severity of SDB. It is also a primary measure to assess the effectiveness of SDB treatment. This study aimed to compare the apnoea hypopnoea index (AHI) between the overnight polysomnography (OPSG) and the afternoon-nap polysomnography (ANPSG) tests through the variables measured. This was accomplished by comparing the AHI values and other variables of the ANPSG and OPSG in diagnosing SDB. Method: The study investigated the correlation of the AHI, by measuring the dependent variables using the afternoon nap polysomnography (ANPSG) and overnight polysomnography (OPSG) on the same patients at Inkosi Albert Luthuli Central Hospital (IALCH). A sample size of 25 was deemed adequate for analysis. Patients with the following symptoms and signs, highly suggestive of SDB, were recruited into the study: excessive sleepiness and tiredness during the day, snoring, nocturnal choking or gasping, and restlessness. A validated Epworth screening questionnaire was done at base hospital by the attending physician prior to booking the patient for sleep test. Afternoon nap PSG and overnight PSG data were compared using SPSS (Version 28®), where both descriptive and inferential statistics were used to analyse the data. Results: The majority of patients were females (56%) while males accounted for 44%. Most of the patients were older than 50 years of age (60%) with a mean age of 51.04 ± 10.65 years. The mean BMI was 37.6 ±10.9 (kg/m2), the mean neck circumference was 41.4 ±4.6 cm, the mean weight 103.1 ± 28.6 kg, and the mean height 1.66 ± 0.1m. Furthermore, the correlation coefficient revealed a strong linear association between ANPSG and OPSG. The paired sample test showed that there was a difference between afternoon and overnight polysomnography measured for RDI (p < 0.001), AHI (p = 0.002), NREM (RDI) (p < 0.001), NREM (AHI) (p = 0.001), REM (RDI) (p = 0.005), REM (AHI (p = 0.027), total sleeping time (p < 0.001), and initial REM latency (p < 0.001). The mean value measured for OPSG was higher when compared with the ANPSG for the following variables: RDI (72.85 ± 33.99), AHI (66.76 ± 33.73), NREM (RDI) (72.69 ± 36.48), NREM (AHI) (66.63 ± 36.18), REM (RDI) (76.72 ± 26.65), REM (AHI) (69.64 ± 28.97), total sleep time (421.96 ± 61.03), and initial REM latency (116.74 ± 71.46). ANPSG underestimates the severity parameters of sleep-disordered breathing (SDB). ANPSG may confirm the presence of AHS, however may not grade the true nocturnal severity, and when SDB is at a mild stage, ANPSG may not rule out that SDB will be or will not be present in the OPSG. ANPSG underestimates the value of AHI, RDI and other variables when compared to OPSG, see Annexure 26.
Development of an HIV risk index for university students in KwaZulu-Natal, South Africa
(2024) Pillay, Trishka; Reddy, Poovendhree; Govender, Nalini
Background: Human Immunodeficiency Virus (HIV) infection is a global health challenge, with developing countries most affected by the HIV burden. In South Africa (SA), young people aged 15 to 24 years are exceptionally vulnerable to HIV infection. University students are a segment of this vulnerable age group in SA. Significant effort and resources have been invested in HIV prevention and treatment such as availability of free government issue condoms, a large-scale antiretroviral (ARV) programme and intensification of other public health interventions such as male medical circumcision (MMC) and the availability of Pre exposure prophylaxis (PrEP). Nonetheless, HIV still poses a critical public health challenge 40 years post discovery, particularly among young people. Factors that may increase susceptibility include substance usage, tendency to engage in risky sexual behaviours (RSBs) such as transactional sex, inconsistent condom usage and engaging in sex with multiple partners. Poverty may further perpetuate RSBs such as transactional sex for money or to acquire basic needs. University students form part of the country’s economic backbone and are the future leaders of the country, thus context driven HIV prevention interventions for this unique population are imperative. HIV risk is multidimensional and in order to develop effective prevention interventions, risk factors associated with RSBs and HIV seropositivity must be further explored. Aim: The study aimed to analyse the behavioural and socio-economic components of risk associated with HIV and health among student populations in an attempt to design an evidence based risk index. Methodology: This study used a case control study design. Study sites included the four major public sector higher educational institutions (HEIs) in KwaZulu-Natal, South Africa. A structured questionnaire was used to collect data using convenience sampling from the study population with consisted of 375 HIV uninfected students (controls) and 125 HIV infected students (cases). STATA-version 17 was used to conduct data analysis. Data collected from controls was initially used to conduct a preliminary analysis to explore the association between food insecurity which was a socio-economic risk factor and RSBs. Subsequently, the main analysis was undertaken to investigate associations of the following: socio-economic, behavioural and knowledge risk factors with RSBs and HIV seropositivity using bivariate analysis and logistic regression modelling. Results from the case control data analysed was used to develop an HIV risk index tool, for specific use among university students. Key findings: Preliminary data analysis of control data found significant associations between food insecurity and students engaging in transactional sex for money as well as to meet basic needs. Participants who were food insecure were twice as likely to have multiple sexual partners. The case control analysis with socio-economic risk factors revealed a significant association between socio-economic measures, RSBs and HIV seropositivity. Overall, food insecurity increased the likelihood of multiple partners, transactional sex for money, and transactional sex for basic needs. Students who accessed the government funding scheme and shared the bursary/ loan were more likely to be HIV seropositive. Results from the analysis on behavioural risk factors indicated that heavy episodic drinking [aOR: 2.73 (1.38; 5.44), 0.004], drugs before sex [aOR: 7.46 (2.11; 27.88), 0.003], and a higher number of lifetime sex partners (2 to 5 partners) [aOR: 4.22(1.69; 10.54), 0.002] and ≥ 6 partners [aOR: 16.36 (6.18; 43.28), 0.000] increased students’ likelihood of having multiple concurrent sex partners. High risk behaviours such as sex with multiple partners and inconsistent condom use were more prevalent among HIV uninfected students. Data from our study showed that both HIV infected, and uninfected students displayed a better understanding regarding modes of HIV transmission compared to prevention methods. Students with poor knowledge regarding HIV prevention were 2.34 times more likely to be HIV positive and those demonstrating poor knowledge about HIV transmission were 4.79 times more likely to be HIV positive. Several misconceptions regarding HIV transmission methods were prevalent among both HIV infected and uninfected students. The above findings regarding socio-economic, behavioural and knowledge risk factors were used to develop an HIV risk index tool based on logistic regression models. The risk index score comprises 17 factors and used an aggregated score to formulate three risk categories namely, low, medium, and high-risk categories. Questions were formulated for the risk index tool based on variables used in the data analysis. Conclusion: Our findings demonstrate that university students are at an increased risk of engagement in RSBs which may consequently lead to HIV infection. Therefore, it is of critical importance for public health officials to consider the multidimensional aspects of HIV risk in the university student population when designing interventions targeted at this vulnerable group. Risk measurement is important to guide HIV prevention methods such as Pre-exposure prophylaxis (PrEP). The developed risk index tool has the potential to serve as a powerful public health tool for measurement of HIV risk among university students in developing countries. However, further testing and evaluation is required before implementation.
Attitudes and perceptions of chiropractic care among pregnant women of the eThekwini Municipality : a qualitative study
(2024) Perumal, Sumeshni; Varatharajullu, Desiree
Background: Pregnancy often brings about musculoskeletal discomfort and chiropractic care has been recognised as a beneficial treatment for addressing these issues. However, little qualitative research is available exploring the attitudes and perceptions of pregnant women towards chiropractic care, particularly in a South African context. Aim: This qualitative study aimed to explore the attitudes and perceptions of pregnant women receiving chiropractic care in the eThekwini Municipality, South Africa, with a focus on understanding their experiences, communication with chiropractors and common presenting complaints. Methods: Semi-structured interviews were conducted with 12 pregnant women receiving chiropractic care. Thematic analysis was employed to identify and explore the key themes related to the women’s attitudes and perceptions of chiropractic care during pregnancy. Results: A total of five major themes emerged from the interviews: (1) Positivity towards chiropractic care, (2) Perception of chiropractic care and safety, (3) Readiness to seek chiropractic care after treatment and patient satisfaction, (4) Communication between the patient and chiropractor, and (5) Common presenting complaints. Conclusion: The study offers insightful information about how pregnant women feel about chiropractic care, emphasising the value of emotional support, safe and efficient treatment methods and effective communication. The results highlight the need for more investigation into how pregnancy affects the musculoskeletal system and how chiropractic care might help treat musculoskeletal discomfort associated with pregnancy. The study’s suggestions highlight the value of a patient-centred approach to healthcare and have real-world consequences for raising the standard of care given to expectant mothers.
Psycho-social factors influencing exclusive breastfeeding among the primigravida mothers at a public hospital in the Ugu District, KwaZulu-Natal, South Africa
(2024) Naicker, Jessica; Sibiya, Maureen Nokuthula; Chetty, Krishnavellei
Satisfaction is one of the psychological benefits of exclusive breastfeeding (EBF). This behaviour encourages the mother to continue breastfeeding for up to two or more years. First-time mothers are generally inexperienced at motherhood, which affects breastfeeding initiation and intent. They need frequent professional and social support that must be clinically practical for successful EBF outcomes. Aim of the study The aim of the study was to explore the psychosocial factors influencing exclusive breastfeeding among primigravida mothers at a public hospital in the uGu District, KwaZulu-Natal (KZN), South Africa, using Bandura`s Self-efficacy model as a theoretical framework to promote, support and sustain EBF. Methodology An explorative qualitative design was used in the study. Eleven primigravida mothers from the postpartum ward, aged 18 years and above, who had attended antenatal clinics (ANCs) and delivered at the selected hospital setting, were nominated for the study using purposive sampling. The participants were from day one to day four post-delivery, and all were South African Nationals who belonged to two race groups, namely two Indians and nine Blacks. The ethnicity of Indian participants was Hindu and Muslim, and Zulu and Xhosa for the Blacks. Four participants were HIV-positive. Semi-structured one-on-one interviews, with an interview guide containing demographic sections and the main question to focus the discussion were used. The interview questions were based on Bandura’s Self-efficacy model. Data was collected until data saturation was reached. An accredited research assistant was recruited from the hospital to assist with the language translation of isiZulu to English and English to isiZulu during the interviews. The translation of isiXhosa was not required as the participants were able to understand and speak isiZulu as well. Creswell`s six steps of qualitative thematic analysis were used to analyse the data. Findings Based on Bandura's Self-Efficacy and Social Cognitive Theoretical (SCT) framework, the study has shown that personal, social, and environmental factors strongly influenced maternal attitudes towards breastfeeding efficacy. Five significant themes that emerged from the data analysis were (a) factors influencing maternal self-efficacy, (b) challenges to EBF, (c) cultural influence on EBF, (d) the role of support systems to EBF, and (e) breastfeeding support strategies. Conclusion This study recognized psychosocial and demographic factors influencing breastfeeding efficacy among primigravida mothers. The data suggests the need for critical clinical interventions to be applied by health care workers at health care facilities, policymakers, the Department of Health, the Department of Education, the Department of Labour, the Department of Social Services, and Employers if South Africa wants to reach the global nutritional target of 50% EBF by 2025. In addition, family and partner involvement in education programmes, improved antenatal care services and quality of EBF educational material hand outs, effective utilization of waiting times at Antenatal Centres and implementation of long-acting contraceptives, and sexual reproductive health teachings by school health nurses at schools are among the recommendations to improve EBF practice.
An exploration into the self-reported experiences of musculoskeletal pain in females diagnosed with long Covid within the eThekwini Municipality
(2024) Pillay, Karisa; Abdul-Rasheed, Ashura
BACKGROUND The COVID-19 pandemic caused a worldwide health crisis that prompted an increase in the output of research targeted at expanding the knowledge available about COVID-19, the symptoms experienced and its consequences. Post-acute sequelae of SARS-CoV-2 infection is described as the persistence of symptoms since the initial diagnosis of COVID-19 for more than four weeks and, in most cases, lasting for months at a time. It is also referred to as Long COVID. Musculoskeletal pain (MSP) in relation to this condition is associated with tenderness, discomfort and stiffness of the joints, bones or muscles. Amidst the various reports of symptoms experienced by those affected by Long COVID, MSP has been identified as the most prevalent and debilitating manifestation, common in patients diagnosed with Long COVID. Despite current literature detailing the prevalence of various symptoms associated with Long COVID, a gap in the literature remains in the understanding of the experiences of individuals affected by MSP. Research has identified that women are more likely to endure symptoms of Long COVID, especially MSP, as compared to males. Given that women share a disproportionate burden of Long COVID, it is imperative to get a better understanding of the unique difficulties and lived experiences of women suffering from MSP. A thorough exploration into the various factors that play a role in the onset, development, persistence, and consequences of this symptom is required to fully grasp the experiences women have had whilst enduring MSP. Various factors play a vital role in the influence of an individual’s experiences of MSP throughout their Long COVID journey; these include pre-existing musculoskeletal conditions, the severity of the illness itself, biological changes because of COVID-19, psychological stresses, social determinants of health and health seeking approaches. This qualitative investigation aimed to address this gap in the literature by conducting in depth interviews amongst women with Long COVID experiencing MSP. This approach was to capture the rich perspectives of the participants, detailing daily life experiences, and methods of coping and challenges associated with MSP as a result of Long COVID. The benefits of a deeper understanding of the MSP experiences in women with Long COVID include interventions and support services specifically designed to address the unique challenges and needs that women encounter, resulting in a better quality of life and overall well-being. AIM OF STUDY The aim of this study has been to explore the experiences of MSP as a clinical manifestation of long COVID in women. METHODOLOGY A qualitative, exploratory, descriptive approach was utilised in this study(McLeod 2017). The purpose of a qualitative approach is to obtain a greater understanding of the experiences and perspectives of individuals who provide rich data without the use of quantitative and statistical methods. The sampling strategy utilised in this study was purposive sampling with the snowball method to obtain data. In this study, MSP was explored through the first-hand experiences of women with Long COVID to further understand how this clinical manifestation has affected their quality of life. This study involved conducting individual in-person interviews with a sample size of 12 women with Long COVID, with the purpose of providing personal, engaging interactions to obtain rich, reliable data. The benefit of conducting personal interviews is that it gathers the personal perspectives of individuals and explores responses to questions, which adds reliability to the study. Data was collected until saturation was attained. Data saturation was reached after interviewing the eighth participant, but four additional participants were interviewed thereafter to confirm saturation was reached. RESULTS The data were analysed using Tesch’s method to identify themes and subthemes. This involved the transcription and review of the participant responses, coding the responses according to themes and further categorizing similar themes into subthemes. The main themes that were identified in this study were the common clinical presentation of MSP experience due to Long COVID, negative effects of MSP on the quality of life and the varied and limited choice of healthcare treatment options. The participants shared a commonality with regard to the clinical presentation MSP, as most of them experienced back pain, neck pain, shoulder pain and headaches. The participants reported that they led a poor quality of life due to the extent of MSP which negatively affected their ability to perform daily tasks and resulted in constant fatigue. A high prevalence of anxiety, depression and frustration was experienced by the participants as they were exhausted from trying to find an effective treatment to resolve their pain. Most participants were highly reliant on pain medication to find some type of relief. Others sought alternate methods of care in the form of chiropractic treatment and lifestyle changes. This helped them better manage their pain and improve their general well-being. CONCLUSION The results of this study revealed that MSP is a prevalent and debilitating symptom amongst women with Long COVID. It affects various major aspects of lives, such as physical functioning, socialisation and mental health. A multi-disciplinary approach is imperative to provide efficient and effective health care to patients. Therefore, it is imperative that not only chiropractors but all health care practitioners who come into contact with affected women are able to create well-rounded treatment plans for those patients and converse easily with them to find a solution to their pain.
A feasibility analysis of migrating emergency care providers to the new emergency care qualifications in the Capricorn District in Limpopo, South Africa
(2024) Selahla, Lekgowana Philimon; Sobuwa, Simpiwe; Chule, Ntuthuko Gift
Introduction: Emergency care education and training has historically centred on short courses and on-the-job training, resulting in most emergency care providers lacking formal qualifications. The current legislative changes have restructured emergency care education, introducing a three-tiered qualification system, aligned with international and national standards. These encompass a one-year higher certificate, a two-year diploma, and a four-year professional degree in emergency medical care. Despite these changes, migration to formal emergency care qualifications has never been investigated. This study addresses this knowledge gap by evaluating the feasibility of migrating the existing emergency care providers in Limpopo emergency medical services to the new emergency care qualification structure. Methodology: This study employed a retrospective, quantitative, descriptive design to analyse the feasibility of migrating the existing emergency care providers to the new emergency care qualifications. The study population comprised emergency care providers working for the Limpopo emergency medical services. The total population sampling, a purposive non-probability technique, included all qualified emergency care providers in the Capricorn District in Limpopo. The data collection method used involved extracting relevant documents for the study from employees’ files in the archives storeroom. The data was analysed using the statistical package for social sciences® version 25. Results: A total of 356 (93.68%) participants from a target population of 380 emergency care providers in the Capricorn District, Limpopo emergency medical services, were included in the study. However, 36 participants were excluded due to invalid data as their files did not have matric, identity or emergency care qualification documents. Consequently, the final sample size was 320 (84.21%) participants. Of the 320 participants, two participants were without a matric qualification, bringing about 318 participants in the matric qualification analysis. The findings revealed that most emergency care providers were males 195 (60.94%), with Africans 319 (99.69%) being the predominant racial group. The age distribution revealed that 181 (56.56%) participants fell within the 40 to 49 age range, and the mean age was 45. Regarding emergency care qualifications, the study found that 180 (56.25%) participants held basic ambulance assistant qualification, and 318 (99.37%) participants completed matric. However, many participants lacked the performance levels and subject combinations to enter emergency medical care programmes. A mere 10 (3.14%) passed Mathematics, six (1.89%) passed Physical Science, and 36 (11.32%) participants passed Biology. None of the participants met the criteria for entry into diploma and bachelor's degree programmes. Only three participants met the entry criteria for the higher certificate programme. Conclusion: The study’s findings showed that most of the existing emergency care providers in the Capricorn District do not have the pre-requisite secondary school leaving subjects or the appropriate matric performance levels to enter various emergency medical care programmes. As a result, migration to formal emergency care qualifications through direct access will not be feasible for many of the emergency care providers. The matric results place a substantial number of them in a disadvantaged position.
An exploratory study of compliance with patient radiation safety standards amongst radiographers in Eswatini public hospitals
(2024) Shungube, Amelia; Khoza, Thandokuhle Emmanuel
Background The consequence of non-compliance with patient radiation safety standards is increased unnecessary radiation exposure with high chances of harmful biological effects. Somatic effects may take up to 40 years to manifest, which may cause radiographers to be careless with radiation protection compliance when used. Radiographers performing these procedures are trained to use the minimum amount of radiation necessary by observing the radiation safety standards. The study aimed to explore compliance with patient radiation safety standards by radiographers in Eswatini public hospitals in order to recommend appropriate compliance standards to the Eswatini Ministry of Health. Methodology The research questions were derived using a qualitative exploratory descriptive design, and constructivism paradigms. The data collection process consisted of in-depth one-on one interviews. The sample was selected based on a purposive sampling approach. This study was conducted in the public hospitals in four regions of Eswatini. Study participants were radiographers employed in public hospitals with working experience of at least two years. Data saturation was achieved with 13 participants. After the data were collected, they were transcribed verbatim and analyzed using thematic analysis. Findings Three themes emerged from the data analysis, namely: a) Participants' attitudes towards compliance with radiation safety standards; b) radiographers’ subjective norms; and c) perceived behavioral control factors. This study has revealed a gap in compliance with patients' radiation safety standards amongst radiographers employed in Eswatini public hospitals. Conclusion The study demonstrated awareness and knowledge of patient radiation safety standards amongst radiographers in Eswatini public hospitals. However, compliance with the standards remained a personal decision because radiographers are not obliged to comply. Moreover, other factors contributing to non-compliance included defective lead protective devices; unavailability of all the lead protective designs; inappropriate design of the department building; and unauthorized staff making unjustified x-ray requests. The establishment of a self-regulatory body may assist in improving the situation through the introduction of radiation safety officers who will establish national Radiography policies and guidelines and ensure that radiographers follow them.
Radiation therapists’ experiences of disruptions in radiotherapy service delivery during the Covid-19 pandemic at public oncology hospitals in KwaZulu-Natal, South Africa
(2024) Tshoke, Lesego; Nkosi, Pauline Busisiwe
Background The novel coronavirus (COVID-19) rapidly impacted all human life following its escalation to a pandemic status in early March 2020. This viral pandemic severely affected the world’s developed and developing countries, resulting in disruptions within healthcare delivery systems, including radiotherapy. Although the government guidelines and restrictions to mitigate the risk of viral transmission were implemented, radiotherapy departments were amongst multiple departments forced to promptly adjust in order to encourage continuous clinical care. However, to provide this service, radiation therapists work closely together and in close proximity to their patients. These inherent working conditions resulted in changes in the number of treatments for some patients, clinical working patterns and conventional radiotherapy practice during the pandemic era. This challenge was faced by numerous radiotherapy departments globally, hence there is a need to explore how radiation therapists in South Africa coped to ensure continuous clinical service delivery. Aim The aim of this study was to explore radiation therapists’ lived experiences of the COVID-19 pandemic disruptions on their radiotherapy service delivery at public oncology hospitals in the KwaZulu-Natal (KZN) province, and ultimately recommend strategies to support them to cope with the changes due to the pandemic. Methodology To conduct this research, the researcher employed a constructivist paradigm and a qualitative phenomenological approach. Criterion purposive sampling was used to select two public oncology hospitals, whereby the critical case sampling selected a radiotherapy manager as well as simulator, planning and treatment machine radiation therapists from each to constitute a minimum sample size of ten. Findings The study interview data was analysed using Colaizzi’s Seven-step Method of data analysis to identify themes which were then presented as findings. This resulted in four major themes that revealed the radiation therapists’ common narrative during the COVID-19 pandemic as: Changes in hospital settings, working conditions, radiation therapists’ practices and wellbeing; barriers to radiotherapy service delivery; facilitators to radiotherapy service; and support needed. Conclusion and recommendations In exploring radiation therapists’ lived experiences of disruptions in radiotherapy service delivery in a developing country such as South Africa, there can be strategies that aid in supporting radiation therapists to continue providing clinical service delivery. As part of the recommendations to attain this, the study brought forth managerial training, similar study conduction to validate study, interviewing of patients, psychological support to employees concerned, educational programmes for both patients and employees, remote treatment planning for radiation therapists, as well as routine screening for concerned employees.
An exploration into the utilization of vitamins and minerals by chiropractors in the management of musculoskeletal conditions in runners
(2024) Niemand, Lori Louise; Abdul-Rasheed, Ashura; Thandar, Yasmeen
Background Chiropractors are primary healthcare providers who provide a holistic form of healthcare for the treatment and management of neuromusculoskeletal disorders. The South African chiropractic scope of practice includes dietary advice or supplement recommendations in adjunct to other treatment options when managing a patient. Chiropractors treat a variety of runners of diverse levels, ages, genders and who participate in various domains of running. Runners are at a high risk of developing musculoskeletal (MSK) conditions, with numerous risk factors identified in literature. Musculoskeletal conditions may have a negative impact on a runner’s recovery, performance, quality of life, psychosocial wellbeing and cause financial burdens. Chiropractic treatment is often used to manage MSK conditions in runners but it is unknown what role the utilisation of vitamins and minerals may have in the management of conditions in runners. The utilisation of vitamins and minerals by chiropractors when managing runners has not been investigated; thus, it is unknown how chiropractors prescribe, dispense, or provide nutritional education to runners. The type of supplement recommended for certain conditions in runners remains unknown and the influence that supplementation may have in the management of runners is also unknown. The benefits of understanding supplement utilisation methods by chiropractors will assist the profession in the prevention, treatment and management of MSK conditions in runners. Improved treatment outcomes will assist runners’ recovery, performance and injury rates and promote beneficial outcomes in the chiropractic profession. Aim of the study The study aims to explore the utilisation of vitamins and minerals by chiropractors in the management of MSK conditions in runners. Methodology The study employed a qualitative, exploratory descriptive design to investigate how chiropractors utilise vitamins and minerals in the management of MSK conditions in runners. Interviews were conducted with 15 South African chiropractors, guided by predetermined open-ended questions in a semi-structured manner. The participants needed to be registered with the Allied Health Professions Council of South Africa (AHPCSA), practicing for a minimum of three years, regularly treat runners, and recommend nutritional supplements to runners. The research questions asked chiropractors how they utilise vitamins and minerals when they manage MSK conditions in runners; what type of supplements they advise; for what conditions do they advise supplements; and if supplementation had an influence in the management of runners. The data were analysed to identify themes and sub-themes, using Tesch’s method of data analysis. Results From the data, four main themes with their associated sub-themes emerged. The themes described the active utilisation of nutritional supplements by chiropractors for runners. Sub themes described the factors and reasoning for the recommendation of supplements to runners by the chiropractors. Furthermore, supplement recommendations were identified for both MSK and non-MSK conditions in runners. The data revealed the type of supplements which the chiropractors recommended for certain conditions in the runners. A positive influence of supplementation in runners was reported by the chiropractors. The sub-themes described improvements in the treatment outcomes after supplementation, improved recovery and performance of the runner, and decreased injury rates. A theme of holistic management of runners by chiropractors emerged, which included the use of dietary advice, monitoring of supplementation and interdisciplinary care of the runner when necessary. Conclusion This study determined how chiropractors selected, prescribed and dispensed nutritional supplements to runners. This study revealed which nutritional supplements the chiropractors recommended to runners and for certain MSK and non-MSK conditions, as well as the influence of supplementation in runners. As previous literature has not investigated the recommendation of supplements by chiropractors in runners, this study generated new information to fill a gap in the literature.

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