Theses and dissertations (Health Sciences)

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An appraisal of homoeopathic proving methodology as a bridge between the indigenous and rationalist-scientific understandings of medicinal plants : the case of Strychnos henningsii
(2011) Ross, Ashley Hilton Adrian; Conolly, Joan Lucy; Kayne, Steven Barry
Aim This study sought to appraise homoeopathic proving methodology as a bridge between the indigenous and rationalist-scientific understandings of medicinal plants through a detailed exploration of the relationships existing between data derived from respective paradigmatic explorations of a single African traditional medicinal plant, Strychnos henningsii [Red bitterberry]. Methods The data derived from the implementation of a triple-blind, placebo-controlled homoeopathic proving methodology, on 32 healthy human subjects (50 percent placebo), using the bark of Strychnos henningsii in the 30CH potency, were evaluated for internal consistency and coherence, and subsequently compared to data derived from a phytochemical analysis of the crude bark sample, and translated data derived from semi-structured mothertongue interviews of eight Zulu traditional healers. The proving data took the form of subjective journal data and the results of four objective blood measures of erythrocyte sedimentation rate (ESR), redand white blood cell indices, and liver functions. The subjective data were evaluated in terms of defined inclusion criteria and presented in standard materia medica and repertory formats, and tabulations of objective data were subjected to independent statistical analysis, using repeated-measures ANOVA and profile plots. The crude bark sample was analysed in terms of the presence of strychnine and other indole alkaloids, using highperformance liquid chromatography-mass spectrometry, and interview data related to the indigenous understanding and application of Strychnos henningsii within the traditional African medical paradigm, were audiovisually recorded, collaboratively translated, and independently verified. ABSTRACT iii Qualitative data processing and analysis was effected with the aid of NVivo® software, and a range of comparative analyses were effected with the aid of Radar® homoeopathic software, materia medica references and the Mappa Mundi elemental theory model. Results The proving yielded 581 subjective symptoms, covering a broad range of physical and mental disease manifestations, and nine statistically-significant treatment effects within the objective data set. These included elevation of ESR and changes in two red blood cell indices, four white blood cell indices and two liver function indices. The two proving data sets were demonstrated to show high levels of correlation, although these correlations were not demonstrable for all provers. The phytochemical analysis confirmed the presence of between two and five strychnine-related compounds (excluding strychnine itself), and the field interview data served to confirm all except two documented traditions of use, as well as identifying a number of novel indications and application of Strychnos henningsii bark. The comparative analyses demonstrated the integrity of homoeopathic proving methodology as a mode of scientific investigation, and significant and widespread overlaps of proving symptomatology with both the pharmacology and toxicology of strychnine, and the physical and metaphysical understanding and application within the traditional African medical paradigm. Conclusions Homoeopathic proving methodology was discussed in terms of the evident degree of overlap with the indigenous and rationalist-scientific paradigms, and the incomplete nature of the homoeopathic ‘totality’. A number of recommendations were made for future cross-paradigmatic research.
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.
Assessment of psychological stress on the clinical performance experienced by paramedic students during clinical assessments
(2023-05) Ismail, Erefaan; Jinabhai, Champaklal Chhaganlal; Prakaschandra, Dorcas Rosaley; Sobuwa, Simpiwe
Background This study presents a comprehensive insight into the degree of psychological stress experienced by paramedic students during clinical assessments. Available evidence shows that high anxiety levels may impact performance negatively, which can lead to poor patient safety outcomes. To achieve the objectives of the study, multiple validated psychological and physiological biometric tools were utilised to generate the most accurate and ‘complete’ stress profiles for this cohort to date. Methodology At a specific university, the total undergraduate Bachelor’s Emergency Medical Care (BEMC) student population was (n) 83 students, of which (n) 56 enrolled as voluntary participants to form the experimental group. Data collection occurred during this cohort’s final-term clinical assessments. Meanwhile for comparison, the control group’s data (n 15) was collected during their clinical simulations practice in class (non-assessment conditions). Psychological stress was measured using the validated State-Trait Anxiety Inventory Questionnaire and concurrently, the following stress indicators were utilised to capture the participants’ physiological biomarkers, which included saliva samples (for both α-amylase and cortisol assay), heart rate, respiration rate, as well as heart rate variability, as recorded by the Hexoskin smart vest’ connected platform. To the author’s knowledge, it was the first time in Africa that this biometric online technology was utilised to capture respiration and cardiovascular stress biomarkers in this context. Results The State-Trait Anxiety Inventory results showed a strong positive correlation between the Y2 scores before and after assessment (r = 0.78). In addition, there was a moderate positive correlation (r = 0.78, p = <0.001) between the total State-Trait Anxiety Inventory score, before assessment and the total State-Trait Anxiety Inventory score after assessment, meaning the participants experienced elevated anxiety levels at each point in time. The majority who indicated they experienced elevated anxiety levels (87.5%; n = 49), showed a linear relationship between their measured biomarkers and State-Trait Anxiety Inventory anxiety scores. For example, a statistically significant association was observed between the Y2 scores and RR, for the period after the experiment, particularly in the group with a Y2 score of >40. When the data was stratified by year of study, a similar significant association occurred between the State-Trait Anxiety Inventory scores and observed RR (p<0.001). The mean heart rate for the exposed group were significantly higher (p = 0.026) for the before and during assessments, but not after the assessments (p = 0.2), when compared to the mean HR for the control group. The experimental groups’ Heart Rate Variability (only standard deviation of normal-to-normal R-R intervals method) during the assessments were significantly higher than the control group (p = 0.020). However, there were also exceptions to this linear relationship ‘rule’, specifically related to the salivary assay results, where the findings of the α-amylase assay over time (before and after assessment), revealed that the enzyme levels of the enzyme decreased over time, although the change in concentration was not statistically significant (p = 0.31). In contrast, there was a significant difference in the cortisol assay results of the first year group, in comparison to the groups of other years, both their before- (p = 0.006) and after-experiment results (p = 0,003). Conclusion The study findings highlighted that both the control and experimental groups were exposed to clinical simulation-based learning environments which predisposed them to elevated anxiety levels (before, during and after these activities), which may impact learning and performance negatively. Ultimately, students must develop the ability to integrate their cognitive ability, specialised practical knowledge and ethical awareness, including stress management skills into clinical practice to become caring and professional healthcare providers (paramedics).
An audit tool for relicensing inspection to assess quality and patient safety in eThekwini private hospitals
(2018) Chellan, Jamila; Sibiya, Maureen Nokuthula; Bhagwan, Raisuyah
Background In South Africa, the National Core Standards are advocated as the cornerstone for improving quality and patient safety in health care organisations. To align to the Department of Health’s legislative and policy mandates, the Office of Health Standards Compliance developed the National Core Standards for Health Establishments in South Africa that provide a benchmark of quality of care against which the delivery of health services can be monitored. Through the implementation of the National Core Standards (NCS), an assessment of a health facility’s compliance to service standards can be measured. Aim The aim of this study was to develop an audit tool for relicensing inspection to assess quality and patient safety in eThekwini private hospitals Methodology An exploratory sequential mixed methods research design was used to assess nursing staff perceptions regarding the current relicensing audit process and the existence of best practice standards in (n=4) private hospitals in eThekwini district. A purposive sampling technique was employed to recruit clinical managers in the qualitative phase of the study. A total of (n=24) participants were interviewed from approximately 40 clinical managers, guided by data saturation; (n=9) from Hospital A, (n=7) from Hospital B, (n=5) from Hospital C and (n=3) from Hospital D. The clinical managers are the unit managers (middle management) and nursing services managers (higher management) in charge of all clinical services in the hospital and are directly involved in relicensing inspections. In the quantitative phase of the study, a simple random sampling technique was employed to include nursing staff in direct contact with the patients. The total population of nurses was 569 of which 270 were sampled for the study. The approach adopted for qualitative data analysis was an inductive approach. The concepts identified were translated into codes, then codes translated into themes and categories. The themes according to which data was organised were based on the conceptual framework that guided the study. The quantitative data was analysed using version 23.0 of the Statistical Package of Social Services. In the documentation review phase a total of 59 documents were reviewed from each hospital, amounting to 236 documents.Quantitative content analysis was used to analyse the documentation using a deductive approach. The goal was to identify important themes or categories within the content of the documents that corroborated with findings of both phases of the study and as related to the NCS and the Batho Pele principles. Results The results of the study showed that the participant private hospitals in eThekwini district have not fully implemented the approach to practice standards and healthcare audits in relation to three clinical domains of the National Core Standards and the Batho Pele Principles. Although best practice policies and procedures exist in private hospitals in eThekwini district, the results of the study showed that there is inconsistent checking of the clinical domains in the participant hospitals during relicensing inspections. Recommendations from participants for a standardised audit process led to the development of an audit tool for relicensing inspections based on the National Core Standards and the Batho Pele Principles for private hospitals in eThekwini district
Building a contemporary model for integrating digital technologies to improve mental health services and wellbeing in public healthcare system in Nigeria
(2023-10) Fashoto, Olubumni; Sibiya, Maureen Nokuthula; Oladimeji, Olanrewaju
Background The world is constantly experiencing the outbreak of infectious diseases, social unrest and insurgencies in some areas. The World Health Organization (WHO), together with other regulatory authorities, imposed movement restrictions (locally, regionally and internationally) and other preventative measures to alleviate the catastrophic impact of the coronavirus disease (COVID-19). The practice of using digital health technologies to provide mental health services has been generally abysmal; however, with the lockdown and restrictions of movement and physical meetings, it became necessary to adapt and utilize available digital technologies to provide mental health services. Meanwhile, prior to the COVID-19 lockdown in most African countries, mental healthcare services were basically provided through physical meetings of patients with their therapists and psychiatrists for various therapeutic and medical care services. The introduction of digital technology to mental health services presents unprecedented opportunities to provide mental health care services remotely to the affected populace. Advancement in information and communication technology is positively changing the way people interact and accomplish tasks across almost every sector of human endeavour and particularly, the health sector. This can circumvent existing delays in accessing mental health services, and the shortage of healthcare professionals, while supporting remote counselling and consultation and improving timely mental health care response between doctors and patients in case of social distancing measures. This is crucial for Nigeria, and other low- and middle-income countries, in order to manage and mitigate the emerging public mental health crisis caused by the outbreak of infectious diseases, social unrests and insurgencies. Aim The aim of this study was to develop a contemporary model for integrating digital health technologies to improve mental health services and wellbeing in the public healthcare system. Methodology The study was guided by two theoretical frameworks; the Health Belief Model (HBM) and Unified Theory of Acceptance and Use of Technology (UTAUT) model. The study adopted mixed-method convergent design to gain participants’ viewpoints on the study. A purposive sampling technique employing the snowball method was utilized in selecting participants for qualitative study, while the proportional stratified sampling method utilizing probability proportion to size (PPS) technique was adopted in selecting participants for the quantitative study to increase the chances of equal representation. Questionnaires were distributed to three hundred and seventeen (317) Healthcare professionals, selected from four psychiatric Hospitals in South-West Nigeria. A total of 16 participants from the four selected psychiatric hospitals participated in the interview. Descriptive analysis and Structural Equation Modelling (SEM) were computed on quantitative data while thematic analysis was employed to analyse qualitative data in the formulation of themes and sub-themes. The result from both analyses was triangulated to provide an overall picture of the study. Findings The study found several challenges with the provision of adequate and efficient services in public mental healthcare facilities in Nigeria, such as human resource challenges, brain drain, lack of infrastructure and strains on Healthcare professionals (HCPs). Findings from the study indicated that digital technologies are sparingly utilized in public mental healthcare service delivery due to lack of policy and framework. HCPs perceive digital technologies to be beneficial to themselves and their clients. The highlighted benefit to patients reduces levels of stigmatization, decreases the financial burden, enhances easy accessibility to therapists, strengthens adherence, mitigates relapse incidences and improves timely intervention. However, HCPs are concerned that the integration of digital technologies with mental health service delivery may prompt unwanted access, compromise patient data security and also, erratic power supply and network challenges could hamper smooth online therapy sessions. However, the integration of digital technologies in public healthcare can improve the delivery of mental health services remotely, on a wide scale, and most importantly can mitigate the impact of pandemic outbreaks and other health emergencies. Conclusion Findings from the study showed HCPs’ knowledge, perception of digital tools, challenges and barriers to the adoption and utilization of digital tools. The findings aid the development of a model that integrates digital technologies into public mental healthcare to improve service delivery in Nigeria. Transition from traditional/conventional space of mental healthcare service delivery to digital space requires a collaborative approach with Computer scientists (i.e. software developers and database administrators), Data scientists, investors, stakeholders and mental healthcare professionals. The proposed model serves as a contemporary framework that Government, policy makers in the Ministry of Health and Management of mental health facilities in Nigeria can adopt which will provide the needed awareness of the benefit of technological intervention. Furthermore, the model can be utilized to revise the existing policies and Standard Operating Procedures in public mental health sector.
Child and youth care work in the South African context : towards a model for education and practice
(2021-05-27) Allsopp, Janet Merle; Bhagwan, Raisuyah
Child and youth care work is a new profession in South Africa, regulated by the South African Council for Social Service Professions. Practitioners work in the life-space of young people in different settings. This study sought to document the current reality and contribute to future improvements in child and youth care work. The aim of the study was to develop a model to guide child and youth care practice and education in South Africa. Using the theoretical underpinning of the ecological systems theory, a qualitative methodology was adopted in an exploratory descriptive design. This allowed participants to provide perspectives on the roles and functions of child and youth care workers and the nature of child and youth care work in a South African context. The study sought participants’ understanding of the educational preparation of professional level child and youth care workers, and the further knowledge and skills that may be required. Conducted in three provinces of South Africa, the study also included four international participants from the North American context who were familiar with the local child and youth care work sector. Five samples were selected and included a total of 57 participants. One of the samples was child and youth care workers functioning at the auxiliary level, and another was child and youth care workers functioning at the professional level of registration. Six focus groups were run with these samples, including 44 participants in total. Individual in-depth interviews were held with participants in the three other samples. These samples comprised employers of child and youth care workers, local child and youth care work experts, and international child and youth care work experts within this experience of child and youth care work in South Africa. Thirteen in-depth interviews were held in total. Seventeen primary themes and 50 sub-themes emerged. The findings revealed that child and youth care work in South Africa is founded on a knowledge base from the North American context, but is affected by the local context of poverty, and the framework of children’s rights within which child and youth care workers function. South African child and youth care workers were found to work with children as well as families in community-based settings, health settings, education settings, and in child and youth care centres. The roles and functions of child and youth care workers are aligned to the local scope of practice as articulated in legislation. The study found that a role undertaken by child and youth care workers not included in the scope of practice is that of stakeholder and referral management. The nature of child and youth care work included life-space work as the central context of the work, which is further characterised by relationshipbuilding and a spiritedness in caring. Child and youth care workers are negatively impacted by the limited knowledge of their role on the part of other professionals and community members, and the continued struggle for professional recognition in the field. The education of child and youth care workers was found to be constrained by Western theoretical frameworks and to be insufficiently contextualised in the South African practice reality. Child and youth care workers would be better prepared through the application of an Afrocentric curriculum and the enhanced teaching of complex child and youth care work practice. Access to tertiary level education in child and youth care work was found to be limited. A schematic model representing key elements of South African child and youth care work practice and education was presented.
A communication model on electronic integration of patients’ health information and records management in tertiary hospitals
(2023-05) Akinyemi, Oluwatoyin Rhoda; Sibiya, Maureen Nokuthula; Oladimej, Olanrewaju
Background Access to patient medical history information that is maintained by the provider over time, which may include all of the key administrative and clinical data relevant to people's care under a specific provider, such as demographics, progress notes, problems, medications, vital signs, immunizations, laboratory data, and radiology. Due to manual record keeping, reports may become cumbersome in retrieving and putting patients in difficult situations before they can access healthcare services, but they have been found to be easier and more reliable when integrated electronically. Aim The aim of the research was to develop a communication model for the electronic integration of hospital patient health information and records management, highlighting the flow of communication between members of the health team contributing to patient care in tertiary hospitals. Methodology A convergent parallel mixed methods approach was used to guide the study. 61 Health Information Management Professionals were used for the quantitative study using the questionnaire. 20 selected healthcare professionals across various disciplines who were managing patients with electronic health records were involved in the qualitative study, where they were asked to provide answers to online interview guide questions. Analysis of the quantitative data was done using frequency tables, percentages, one sample statistics test, a t-test and other statistical tests, while content analysis using the four stages was employed to analyse qualitative data Findings Results from both quantitative and qualitative methods showed that staff proficiency in computer/software skills was rated highest for MS Word while the lowest was for MS Access. There was also significant proof that environmental support exists for the implementation of electronic health records (EHRs) in hospitals. EHRs offer numerous benefits that manual methods do not, such as a reduction in patients’ waiting time, easy accessibility, faster ward rounds, enhanced confidentiality and a reduction in staff workload, to mention a few. Barriers to successful implementation and integration were also highlighted, including staff shortages, large numbers of patients, and a lack of information and communication technology navigation skills among workers. Poor staff attitudes towards EHR, a lack of necessary training, and inadequate funding had moreover been found to be the barriers to the electronic integration of patients’ health information and records management.
A comprehensive healthcare managerial framework that explicates the manner in which workload factors influence the nurses’ well-being : a case study of a Saudi Arabian hospital
(2021-05-27) Chetty, Krishnavellie; Sibiya, M. N.; Naidoo, V.
The shortage of specialized intensive care unit (ICU) nurses is a workload factor that negatively influences the provision of quality nursing care by compromising workplace productivity and job satisfaction. Work pressures are evident in health systems throughout the world, where there is growing concern over a nursing shortage in relation to the country's disease profile, population increases, chronic disease growth and increased life expectancies. Although workload plays a fundamental role in staff and patient well-being, minimal research has been conducted on the evaluation of workload effects and its impact on nurses' wellbeing among Saudi Arabian ICU nurses. Aim The aim of the study were to determine the various workload factors that influence the well-being of ICU nurses working in a Saudi Arabian Hospital and to develop a comprehensive healthcare managerial framework that explicates the way workload factors influence nurses’ well-being. Methodology Using a convergent parallel mixed methods design, data were collected by means of semi structured interviews, with 20 participants in the qualitative phase. A survey questionnaire, that was developed and adapted from the Job Demand Resource (JDR) Model, was used to collect to data from 200 participants. The quantitative data were analysed using the latest version 25 of SPSS and qualitative data were analysed using Tesch’s method of data analysis. Findings The findings from the study were aligned to the JDR Model and provided evidence that ICU nurses experienced various workload factors that influenced their well-being and productivity. It was found that the high job demands cause strain and health impairment, which are associated with decreased job satisfaction of staff working in the ICUs of Saudi Arabian hospitals. On the basis of these findings, the researcher proposed and developed guidelines for the implementation of a comprehensive managerial framework that explicated workload factors that influence the well-being of the ICU nurses. The proposed framework can be utilized as an interactive tool that will set out clear actionable steps, providing ongoing guidelines on how healthcare organisations should plan and implement suitable workloads, efficiently and effectively, to ensure staff health and well-being.
Contributing factors affecting erythropoiesis and analysis of erythropoiesis bioassay in renal patients in KwaZulu-Natal
(2016) Benjamin, Sherilene Cheryl; Adam, Jamila Khatoon; Assounga, A.G.
Erythropoietin (EPO) is widely used in patients with chronic renal failure and is a necessity. However, due to the cost implications and the medical complications in our population it is imperative to review the factors affecting the process of erythropoiesis and the analysis of cell proliferation and cell viability in the bioassay. Complications such as hypertension and risk of worsening a malignancy cannot be ignored. We had previously analysed variations of erythropoietin levels in haemodialysis patients over a six month period. This study aims to evaluate erythropoiesis in conjunction with various laboratory, demographic, clinical parameters and inflammatory markers, in the population of haemodialysis patients. EPO, antibody level and antibody activity were analysed in the population groups as EPO responsive and EPO sensitive patients. This is a prospective, experimental and controlled study. Fifty nine patients were randomly selected from haemodialysis units of Addington and King Edward VIII Hospitals following an informed consent and 15 healthy individuals were also selected as controls. Demographic parameters (age, sex), clinical parameters (weight, height, skin folding, EPO doses and blood pressures (BP) were recorded. Pre-dialysis serum was used to measure laboratory markers (haemoglobin, transferrin, ferritin, albumin, ESR, C reactive protein, creatinine and urea). EPO levels and antibody levels were measured by ELISA, the optical density of each well was determined within fifteen minutes using the microplate reader set at 450 nm. All results were statistically analysed using SPSS statistical package version 21 (IBMR). Patients requiring very high doses of EPO to reach Hb of 11g/dL, and they remained anaemic after at least three months of adequate EPO doses were considered to be EPO resistant. Those who responded to the usual EPO doses were labelled EPO sensitive. The bioassay was used to quantify cell proliferation and cell viability in the presence of EPO. The UT 7 cells were cultured in medium, in the presence of serum from the EPO resistant, EPO sensitive patients and the healthy, control subjects. Luminescence was read with the Glorunner Microplate Luminometer and was recorded in relative light units (RLU). The analysis revealed: a non-significant positive correlation between haemoglobin and erythropoietin levels. However, a strong negative correlation was found between CRP and albumin level (R= -0.591; (p=0.001), which was not significant. No correlation was found between haemoglobin or erythropoietin levels and CRP or albumin. There was a positive correlation with systolic and diastolic blood pressures and mean arterial pressures which was statistically significant (p <0.05). EPO dosages and Hb levels were correlated significantly (p < 0.05). No correlation of EPO levels and Hb; age and Hb was found to be significant (p = 0.08). The UT 7 cells cultured in serum in medium alone with RHuEPO containing cells were statistically significant (p <0.01)). Reduction of ATP stimulation between medium and serum was observed. However, mean arterial pressures had a significant association with EPO resistance (p = 0.041) odd ratio- 1.066. In conclusion, EPO level is not a useful tool for the monitoring of its use as it does not correlate with EPO goal of red blood production in our patients. The neutralizing antibodies did not correlate with any of our variables contributing to erythropoiesis, and are therefore not confirmed as playing a major role in erythropoiesis. From the analysis of our results the key contributing factors of EPO doses, malnutrition and age were more significant in erythropoiesis. However the higher doses of EPO significantly increased the blood pressures and the mean arterial pressures (MAP). The analysis of the bioassay showed lack of difference between EPO responsive and EPO sensitive patients. This observation warrants further studies to clarify the role of serum of haemodialysis patients in erythropoiesis.
A critical analysis of the implementation of obstetric management guidelines on common causes of maternal death, as applicable to midwives
(2021-05-27) Sewnunan, Asha; Puckree, T.; Basson, Petro Magdalena
Background Despite interventions by the United Nations which formulated the Sustainable Development Goals (SDGs), to replace the unmet targets of the Millennium Development Goals, the maternal mortality ratio (MMR) remains high in low-andmiddle income countries including South Africa (SA). The goal 3 of the SDG aims to achieve less than 70 maternal deaths per 100 000 live births by 2030, globally. The slow but steady decline in the number of maternal deaths in SA with 339 deaths over the last 2014-2016 triennium falls short of the SDG targets (National Department of Health, 2017). The institutional MMR for potentially preventable maternal deaths in South Africa was 83.3 over the last triennium. The management of obstetric emergencies in SA is based on the interventions laid out in the Essential Steps in Managing Obstetric Emergencies (ESMOE) which was adapted from internationally recognised obstetric management guidelines that have proven to reduce MMR’s if effectively implemented. The availability of a good clinical guideline is only part of the solution but ensuring effective implementation in the clinical environment is of greater significance to reduce preventable maternal deaths. Aim The aim of this study was to analyse the impact of the implementation of the ESMOE guidelines by midwives on the management of the common causes of maternal deaths. This included identifying gaps, challenges and successes of its implementation by the midwife at the different levels of health care facilities with the ultimate aim of developing a practice framework to implement the interventions into midwifery training, to improve relevant knowledge and skills in providing quality emergency obstetric care. Methodology A multi method data collection approach using quantitative and qualitative designs was implemented in four phases. This study was conducted in two of the eleven districts of KwaZulu-Natal. All level of hospitals and CHCs (eleven) in eThekwini (District A) and Ugu (District B) were chosen based on purposive sampling including the districts health system’s referral pattern. Data was collected by the researcher using self-designed data capturing sheets. Quantitative data was collected on resources and ESMOE training at all eleven selected facilities, as well as a retrospective chart review on a total of 17 maternal deaths that occurred over a specified period to assess the implementation of ESMOE interventions. Face to face interviews were conducted by the researcher with 14 ESMOE trained midwives to determine the barriers and challenges they experience that impedes successful implementation of the ESMOE interventions. To test for significant trends in the quantitative data, inferential statistics was applied, including Pearson’s correlation, ttests, Mann Whitney U test, Kruskal Wallis Test and Chi-square tests. Descriptive statistics included means and standard deviation as applicable. Relevant frequencies were represented in tables and graphs. Chi-square test of independence were used on cross-tabulations to see the significant relationships in resources at the various health facilities. The Kruskal Wallis test was used to compare specific variables across the different types of health facilities. The qualitative data was analysed using thematic content analysis. Finally, a Delphi Technique using ESMOE experts was employed to validate a practice framework to implement relevant ESMOE modules into midwifery training to enhance competencies of midwives and implementation of the guidelines. Results The findings of this study indicated that many barriers and challenges exist that prevent successful implementation of ESMOE interventions which would further reduce maternal mortality rates in SA. Of the 11 facilities chosen 45.5% (n= 5) were community health centres, whilst 54.5% (n=6) were hospitals. In phase two the results revealed that the CHCs and DH did not meet the criteria of being fully BEmONC compliant, which resulted in increased referrals to regional and tertiary hospitals. This was evident by the significant difference in normal vaginal deliveries at combination hospitals as compared to CHC (p=.037). An average of 2505 deliveries were conducted at combination/regional hospitals over a four- month period with averages of 1247 at a DH and 957 at a RH as compared to only 224 deliveries at a CHC. A general shortage of essential equipment was found across facilities. The CHCs had significant shortages of CTG machines and intravenous regulators. Staff with ESMOE training were insufficient to staff all the maternity units across the facilities. District A, the bigger of the two districts with eight facilities had a significantly lower number of ESMOE trained advanced midwives (n=11) as compared to District B with three facilities (n=12). The number of maternal deaths that occurred over January 2016 to April 2016 at three combination hospital were 82% (n=14) as compared to 12% (n=2) at the regional hospitals and only 6% (n=1) that occurred at a District hospital and no deaths at a CHC. Deaths due directly to hypertension were 41% (n=7), HIV was 6% (n=1), whilst 53% (n=9) were from other causes not directly relevant to this study. A significant number of relevant maternal deaths 54.5% (n=6) were due to delays in seeking treatment and sub-standard care. Transport delays to the health facility contributed to 18.2% (n= 2) deaths, whilst non-compliance to treatment and poor record keeping were found in 27.3% (n=3) of the relevant maternal deaths. The interviews with the midwives in phase three yielded results that were suggestive of inadequate ESMOE training, lack of updates, lack of regular skills and drills exercises that contributed to lack of knowledge and skills in providing effective EmOC. Other challenges in effectively implementing emergency obstetric care included poor morale due to staff shortages, heavy burdens of workload, lack of motivation and support that contributes to sub-standard care. In the final phase the researcher took these findings and built on this by developing an algorithm that shows the need to improve midwifery clinical competencies. This algorithm was taken further to develop a practice framework that proposes to implement ESMOE interventions into the basic midwifery training to improve relevant knowledge and skills in managing obstetric emergencies effectively within a collaborative team approach. Conclusion This study has shown that gaps in the implementation of ESMOE guideline interventions in the selected facilities in KZN could have contributed to sustained high MMR in the province. The midwives expressed the need for regular training and updates to continuously improve and maintain their knowledge, skills and competencies in providing effective obstetric care. The data allowed the development of an algorithm for improved emergency obstetric patient care and a practice framework for training of midwives to ensure optimal implementation of the guidelines.
Design and evaluation of alumina/feldspar resin infiltrated dental composite materials
(2008) Le Roux, Andre Rayne; Lachman, Nirusha; Walker, Mark; Botha, C. Theo
Introduction: Incorporating a feldspar chemical bond between alumina filler particles is expected to increase the wear resistant and flexural strength properties, while reducing flexibility of dental composites. Aims and Objectives: An investigation was carried out to evaluate the influence of the feldspar chemical bonding between alumina filler particles on wear, flexural strength and flexibility of experimental alumina/feldspar dental composites. It was hypothesized that wear resistance and flexural strength would be significantly increased with increased feldspar mass, while flexibility was expected to decrease. Methods: Alumina was chemically sintered and bonded with 30%, 40%, 50% and 60% feldspar mass, silanized and infiltrated with UDMA resin to prepare the dental restorative composite material specimens. Results and conclusions: Significantly higher wear resistant characteristics resulted with increased feldspar mass (p<0.5). Improvements in flexural strength characteristics as the feldspar mass was increased was not statistically different (p>0.5). Flexibility characteristics as the feldspar mass was increased was not statistically different (p>0.5). The alumina/feldspar specimens showed lower flexibility (mm displacement) than SR ADORO (p<0.05). Feldspar chemical bonding between the alumina particles may improve on the wear resistance and Flexibility of alumina/feldspar composites when compared to SR ADORO. This study evaluated the influence of a chemical feldspar bond between alumina filler particles.
Developing academic and clinical collaboration guidelines for nurse training at a public nursing college in KwaZulu-Natal, South Africa
(2024) Maharaj, Sangeetha; Ngxongo, Thembelihle Sylvia Patience; Razak, Ayisha
Introduction and background Global reports of theory, practice gaps, decreased levels of competency and challenges with utilising clinical reasoning amongst newly qualified nurse graduates, have created a major concern in a complex healthcare environment, which requires efficiency. In South Africa, like most African countries, the healthcare system is predominantly nurse-driven, requiring nurses to have the necessary competencies and expertise to effectively manage the country’s disease burden and meet the healthcare needs of the South African community. Challenges have however, been identified in the clinical training of nurses which may impact on their graduate competency. These challenges may be attributed to deficiencies in the integration of theory and practice, and clinical support provision for nursing students. Aim of the study The aim of the study was to develop academic and clinical collaboration guidelines for nurse training at a public nursing college in KwaZulu-Natal, South Africa. Objectives of the study The objectives of the study were: to gain in-depth insight into the practices for clinical education of nursing students at a public nursing college in KwaZulu-Natal; explore and describe the role of the nursing educator with regards to clinical accompaniment and clinical teaching; explore and describe the experiences of the clinical ward staff in supervision and mentoring of nursing students; explore and describe the experiences of student nurses regarding clinical teaching and learning and develop guidelines for academic and clinical collaboration for nurse training in public nursing colleges. Research Method A qualitative exploratory design with a constructivist approach was utilised. Ethics approval was obtained from the: Durban University of Technology Institutional Research Ethics (Irec. No. 200/21). All participants, which comprised 49 academic staff, 43 professional nurses and 21 students registered in the Diploma in Nursing Programmes, were purposively sampled. Data were collected using focus group discussions and one-on-one semistructured interviews conducted between January and May 2022 and analysed manually using the content analysis strategy and following the eight-step analysis procedure by Tesch (1990). Findings The study findings revealed five themes namely: ineffectual clinical training structure; inadequate collaboration and supportive relationship between the academic institution and clinical placement area; clinical placement institutional challenges, clinical preparedness of students prior to clinical allocations and graduate competency not guaranteed on completion of training. These factors posed challenges to nursing students meeting their mandatory training objectives during their placements. The guiding principles of Schünemann, Fretheim and Oxham (2006), were utilised to develop guidelines for facilitating academic and clinical collaboration for nurse training at a public nursing college in the province of KwaZulu-Natal, South Africa. The Delphi technique was utilised to incorporate inputs from expert members on the group. Conclusion Challenges being experienced during the clinical learning placements of nursing students at this college, could result in theory and practice gaps during and after training. The guidelines developed, aims at enhancing the collaborative relationships between the academic and clinical partners in nurse training and can be used by the management of both structures who are responsible for nurse training, to improve the clinical training platforms. Recommendations The study recommendations are aimed at strengthening clinical training platforms for students at Public Nursing Colleges and includes: improving collaborative relationships between the academic and clinical partners in nurse training; planning together with clinical stakeholders for all resources required; prioritising nursing students meeting their clinical objectives and developing mutual nurturing relationships. A need exists to address challenges of student supervision, mentoring, negative staff attitudes and a lack of standardised clinical practice between the academic and clinical training partners. A review of the system of clinical preparation, accompaniment, and supervision of nursing students is critical.
Development of a financial management competency framework for nurse managers at selected public hospitals in KwaZulu-Natal, South Africa
(2018) Naranjee, Nellie; Sibiya, Maureen Nokuthula; Ngxongo, Thembelihle Sylvia Patience
Background In the South African context, the Nurse Manager (NM) is responsible for and manages the nursing side of the health care organisation. Public hospitals face the challenges of poor management, underfunding, deteriorating infrastructure and poor standards. The consequences are that NMs have to do more with less. This necessitates that the NMs should have the competencies and skills to enable them to use the existing resources more efficiently and equitably and be able to manage and contain costs within their departments. However, NMs do not necessarily have financial management skills and competencies to manage the current health care financial situation. This then highlights the need for financial preparation of all NMs. Aim The aim of the study was to explore the financial management roles of NMs in their current work environments, identify financial management development needs necessary for NM practice, and ultimately to develop a financial management framework to improve the skills of NMs. Methodology A qualitative, grounded theory approach was used to explore the financial management skills and competencies and developmental needs of NMs. Nursing Managers, Financial Managers, Operational Managers and Chief Executive Officers of public hospitals in KwaZulu-Natal participated in the study. The data was collected by means of interviews. The sample size for the interviews was guided by data saturation and comprised 18 participants. Findings The study findings revealed that NMs are involved in financial management activities within the hospitals. However, they do not necessarily have the requisite financial management skills and competencies to function in their financial roles. From the findings the researcher was able to propose and develop a framework to improve the financial management competencies of NMs in the public sector. It was concluded that NMs do indeed practice financial management and therefore require the relevant knowledge, skills and competencies. Recommendations include the development of a financial management training programme to be implemented based on the identified needs of NMs in the public sector. Another recommendation is that undergraduate and post graduate nursing programmes include financial management programmes that would be relevant and applicable to the specific financial management activities that nurses practice daily.
Development of a model to predict bulking in full-scale wastewater treatment plants, and the impact of bulking in the receiving environment
(2021-05-27) Deepnarain, Nashia; Bux, Faizal; Kumari, Sheena; Reddy, Poovendhree; Stenström, Axel
Sludge bulking has been a continuous operational hurdle affecting the solids-liquid separation in wastewater treatment plants (WWTPs) worldwide. Excessive growth of filamentous bacteria is the primary and common cause of sludge bulking, which can have negative impacts on the wastewater treatment efficiency. Filamentous bacteria serve as the backbone structure of flocs which assist in the sludge settling process, however, their prolific growth result in slow sedimentation due to inadequate settling of flocs. The main focus of this research was to develop a model to assist in a clearer understanding of the bulking sludge phenomenon in relation to filamentous bacterial growth and to identify predictors of bulking in different biological nutrient removal (BNR) WWTPs. The growth of filamentous bacteria and sludge bulking in different WWTPs and its association with sludge bulking incidents were evaluated using different statistical models [viz. artificial neural networks (ANN), principal component analysis (PCA), cluster analysis and Decision Trees]. In addition, the effect of bulking on pathogen discharge and its potential impact on the community was assessed using a microbial risk assessment model. A total of seven WWTPs were investigated to identify the most common and dominant filamentous bacteria during bulking and non-bulking periods. A total of ten filamentous bacterial species were identified in this study with their dominance varying across the selected WWTPS during the sampling period. Based on the filament index scale ranging from 1 (None filament) to 7 (Excessive filament), the developed ANN model predicted sludge volume index (SVI) in relation to the abundances of ten filamentous species as model inputs. Among the filamentous bacteria identified, Eikelboom Type 0041 attained the highest impact on SVI, followed by Gordonia spp., Nostocoida limicola, and Thiothrix spp. Developing a model for a WWTP, with proper calibration and validation against plant operational data, can allow for proper evaluation of filamentous bacteria associated to bulking, with effective mitigating strategies. Hence, in this study, a Decision Tree model was further implemented as a novel approach in the form of a case study to evaluate the effect of influent wastewater characteristics and plant operational parameters on the dominant filamentous bacteria and sludge bulking for prediction and control. Various factors such as pH, temperature, dissolved oxygen (DO), sludge retention time (SRT), food-to-microorganisms (F/M) ratio, soluble chemical oxygen demand (sCOD), total COD (tCOD), NH4 + -N, total Kjeldahl nitrogen (TKN), phosphorus as phosphate (PO4 3- -P), TP, and total suspended solids (TSS) were considered to have an impact on filamentous dominance. High bulking incidents were observed during long SRT and nutrient deficient (low F/M) conditions. However, a negative correlation was observed with soluble sCOD and ammoniumnitrogen (NH4-N). Type 0092 was the dominant species largely responsible for sludge bulking in the selected plants, which prevailed at low F/M (< 0.08 kg COD/kg MLSS d-1 ) conditions. The secondary filaments Candidatus Microthrix parvicella increased in their abundance at low temperature (< 15.5°C), causing an increase in SVI at lower ambient temperatures. In addition, an increase on Thiothrix spp. was linked with the unbalanced ratio between readily biodegradable COD and nutrient conditions. The last objective of this study provided an assessment from an environmental health perspective, by investigating the impacts of bulking on the receiving environment, using a quantitative microbial risk assessment (QMRA) approach. This was done by studying the difference in selected microbial pathogen abundance during bulking and non-bulking conditions using qPCR. Salmonella was the most dominant species of the investigated microorganisms, during the study period (2270– 96733 copies ng-1 of DNA) followed by E. coli (4133 – 76847 copies per ng of DNA); whereas, Mycobacterium was the least (542 – 3340 copies ng-1 of DNA). During high bulking with SVI >200 mL g-1 , positive correlations were found between the selected pathogens in the final effluent. The QMRA model was applied to investigate the safety of treated effluent for (a) children, women, and men during recreational activities, (b) farmers during irrigation practices, and (c) consumers of edible plants (vegetables). The QMRA values during all bulking events exceeded the tolerable risk of 10-4 (i.e. less than one case of infection per 10 000 people) per year, as recommended by the world health organization (WHO). In addition various disinfection scenarios such as chlorination, ultraviolet (UV) and ozonation were tested to control the risks associated with pathogenic bacteria, for further information of safe disposal and reuse of the treated effluent. The application of UV provided the most effective treatment to reduce the pathogenic bacteria, except for the case of children that were exposed to Salmonella infection. To the best of my knowledge, the probable health risks associated with the discharge or reuse of WWTPs effluents under different sludge bulking events have not yet been systematically evaluated using QMRA. This research can potentially lead to the development of appropriate model systems for bulking control in full-scale WWTPs, while highlighting some of the significant contributors, environmental impact and mitigation strategies. The outcomes of this research will contribute to the current global body of knowledge in relation to predictive models for filamentous bulking control in full-scale WWTPs.
The development of a nano-sized eggshell and titanium dioxide desensitising paste to re-mineralise teeth
(2019) Onwubu, Stanley Chibuzor; Mdluli, Phumlane Selby; Singh, Shenuka
Dentin hypersensitivity [DH] is a common occurrence and notable painful condition among dental patients. Clinically, the pain associated with DH is caused by external stimuli such as thermal, tactile, osmotic or chemical changes from open dentinal tubules. Traditionally, the treatment of DH is the use of at-home desensitising toothpaste. While there is a variety of desensitising paste such as Sensodyne® and Colgate sensitive Pro-Relief TM to treat DH, the dentin tubule remineralising characteristics of these paste are, however, limited in an acidic environment which could result in DH relapse. The limiting abilities of these desensitising paste prompt this study to develop a desensitising agent using nano-sized eggshell-titanium dioxide (EB@TiO2) as an active ingredient in the management of DH. A quantitative research design and an experimental research strategy were adopted. The research design included three phases. In phase one of this study, different characterisation techniques such as Fourier Transform Infrared Spectroscopy (FTIR); X-ray Diffraction (XRD); Energy Dispersive X-ray Spectroscopy (EDX) and Scanning Electron Microscope (SEM); High Transmission Electron Microscopy (HRTEM); and Thermo-Gravimetric were used to confirm the modification of EB@TiO2. Phase two, on the other hand, assesses the suitability of the EB@TiO2 as an oral healthcare product by examining its cytotoxicity and antibacterial properties. By contrast, phase three investigated the quality of the EB@TiO2 as a new approach to the management of DH. Particularly, the acid resistant, abrasivity, and remineralisation characteristics of EB@TiO2 were studied using bovine and eggshell model, respectively. Different analytical technique such as pressure sensor, gas displacement test, Atomic Force Microscope, Raman Spectroscopy, SEM, and EDX were used to examine the product quality of EB@TiO2 in comparison with some commercially available paste. In addition, a mathematical model was used to predict the duration and rate of remineralisation of EB@TiO2. Both descriptive and inferential statistics were used to present the data (P=0.05). The validity of the study was achieved following SANS 1302 (2008) requirement for preparation, developing, and testing toothpaste. The reliability was determined via reproducibility and repeatability of tests. Paper I and II examines the effectiveness of commercially available toothpaste in the prevention of tooth decay, using eggshell powder as a substitute for the human tooth. Paper I established that eggshell model can be used as a substitute for the human tooth to study the acid resistant properties of toothpaste. The salient point of the paper is that all the tested toothpaste were effective against erosive attacks. However, the eggshell alone without the protective covering of toothpaste showed limited acidic resistance. Paper II established that acid resistance properties of EB@TiO2 were significantly better than eggshell alone. The paper confirmed that modifying eggshell with titanium dioxide improved its acidic resistance characteristics. Paper III and IV evaluate the acidic resistance of EB@TiO2 using a bovine model. Paper III and IV established that the protective effects of EB@TiO2 were superior to the tested commercially available toothpaste. The FESEM, AFM, and Raman test further confirmed that EB@TiO2 offer better protection on the tooth enamel. Paper V and VI assess the occluding capabilities of EB@TiO2 and eggshell alone in comparison with other desensitising toothpaste. Paper V confirmed that there was complete remineralisation of the dentin tubules in the samples treated with EB@TiO2. At higher magnification, the particles of EB@TiO2 were very much evident. The EDX spectrum reveals that the Ti peaks observe before and after post acidic treatment were comparable. Paper VI established that occlusion of EB@TiO2 was highly effective in an acidic environment, as occluded tubules remained intact post-acidic treatment. In addition, the cytotoxicity study identified that EB@TiO2 had little effect on the NIH 3T3 cell line even at the highest concentration of 100μg/ml. Manuscript I assess the occluding capabilities of EB@TiO2 in comparison with a known occluding desensitising agent (Pro-Argin and NovaMin). Manuscript I established that as the brushing days increase the remineralisation or dentin tubule occluded by each respective desensitising agent improved. It was found that the occluding capabilities of EB@TiO2 were more superior to both Pro-argin and NovaMin products in both saliva and without saliva. Manuscript II described the use of the logistic equation to predict the remineralisation of the EB@TiO2. Manuscript II established that the logistic equation effectively predicted the remineralisation trends of EB@TiO2 and Pro-argin toothpaste (Colgate Pro-relief). Manuscript III assesses the abrasivity of EB@TiO2 in comparison with calcium carbonate, and hydrated silica containing toothpaste. Bovine enamel specimen was used for the in vitro experiment. Manuscript III established that enamel loss from the brushed surface, regardless of the sample group, were statistically different when compared to the covered surface. The study found that the abrasivity of EB@TiO2 were comparable with the calcium carbonate toothpaste. It was also established that EB@TiO2 was less abrasive when compared against hydrated silica containing toothpaste. In conclusion, the experimental finding has exhaustively provided evidence on the suitability of EB@TiO2 as an active ingredient in toothpaste formulation. The study, therefore, provides new evidence and approach for the management of DH, particularly in low-income countries where the cost of oral healthcare may be too high.
Development of a policy framework for the establishment of physical exercise programmes in reducing non-communicable diseases in the Province of Kwazulu-Natal, South Africa
(2022-09-29) Gumede, Musa
Background This study follows a mixed method methodology, and researched tenets of physical exercise beneficial to health. The study took place in eThekwini Municipality among members of physical exercise clubs, trainers and administrators. The study population comprised of urban, township and rural areas. The participants included scholars, the youth, and elderly populations. The participants were questioned as to whether they had pre-existing chronic cardiac disease, or related non-communicable diseases. Aim The aim of this study was to develop a policy framework for physical activity in adult communities in the province of KwaZulu-Natal, South Africa. Methodology The study follows an exploratory, sequential mixed methods approach that begins with a qualitative phase, where experts, trainers, and government officials were interviewed on their observations and role in supporting the physical exercise programmes. The interviews were conducted on a one-to-one basis and took an average of forty-five (45) minutes. This was followed by the quantitative phase that involved conducting a survey by questionnaire on participants in physical exercise programmes. Fifteen participants consisting of two government officials, eight trainers and five experts were interviewed during the qualitative phase and a total of 364 participants participated in the survey, with 224 females and 140 males, where 25% of the participants were students. A proportion of 15.6% of the participants came from rural areas, whereas 43% came from urban areas, with the remainder residing in townships and informal areas. Findings The results indicated that 84% of the respondents participated in physical exercise programmes or sport while at school, 89% participated in exercise or sporting programme while at school, with a value of p<.001. A proportion of 93% of participants did not suffer from chronic heart disease or hypertension and 60% were not offered health check-ups by facilities whereas a significant 68% of facilities ONLY offered for a health check-up when participants were ill or injured, p<.001. Using a one sample t-test, there was significant agreement that facilities were adequate and in good condition, p<.001; and that the usage of these facilities and what was found to be on offer was acceptable/good, p<.001. In terms of physical exercise intensity, the findings indicated that a significant 86% of participants took part in mild exercise regularly, and a significant number took up to 90 minutes a day, p<.001. A significant 67% of participants performed moderate exercise regularly for up to 90 minutes a day. Whereas a significant 82% participated in vigorous exercise regularly, for 45-90 minutes a day, p<.001. The conclusion of the study is that early initiation of PE in schools contributed to long term health benefits like a lower number of participants with NCDs such as obesity and chronic heart diseases, lower incidents of NCDs were found in physically active individuals and the health benefits are not dependent on intensity of exercise but on consistent exercise whether mild, moderate or vigorous. The study identified a gulf in urban-rural infrastructure availability and usage. The study results are important and contribute to the introduction of physical exercise programmes in schools as part of health promotion, to lobby for development of community recreational facilities and training facilities in rural and urban areas.
The development of an eco-justice model to guide community engagement in Health Sciences
(2020-11-30) Chandramohan, Sandhya; Bhagwan, Raisuyah; Sibiya, Nokuthula
Humanity is facing massive health problems, physical pathologies and ecological damage that cannot be ignored. This escalating destruction of all forms of life on earth is a consequence of human action. Such destruction is reinforced by a worldview that denies nonhuman nature any value, respect or justice. Although the South African Department of Education developed the White paper on the Transformation of Higher Education (Department of Education 1997: 10), which committed universities to policies and programmes for community development, as part of the universities mandate there is no educational model that guides community engagement with regard to eco-issues. This study focused on developing a model to guide community engagement in Health Sciences through a qualitative approach. A developmental research paradigm was used as the research design. This paradigm allowed for the use of a qualitative research approach to design the new model. Data was collected from academics and students from Health Sciences, and faith-based leaders; through interviews and focus group discussions. Qualitative data analysis using thematic data analysis was utilized to transform the data into findings. The findings of the study confirm the ongoing damage to the eco-systems and how such environmental damage contributes negatively on health. These finding recommend that higher education embrace community engagement as a tool to create community awareness on eco-justice issues. For this to be successful it is recommended that community engagement be incorporated into Health Science modules in order to transform the Health Science curriculum. The developed eco-justice model for Health Sciences can serve as a guide for academics and students as they work in collaboration with their communities on eco-justice issues to reduce the resultant negative impact on health.
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.
The effect of optimizing cerebral tissue oxygen saturation on markers of neurological injury during coronary artery bypass graft surgery
(2011) Harilall, Yakeen; Adam, Jamila Khatoon; Reddi, A.
Surgical revascularization of the coronary arteries is a cornerstone of cardiothoracic surgery. The enduring nature of coronary artery bypass grafting (CABG) bespeaks of its history and proven efficacy. However, cerebral deoxygenation during on-pump coronary artery bypass graft surgery may be associated with adverse neurological sequelae. Advanced age and the incidence of preoperative co-morbidity in patients presenting for coronary artery bypass graft surgery increases the potential for stroke and other adverse perioperative outcomes (Murkin, Adams, Quantz, Bainbridge and Novick, 2007). It is hypothesized, that by using the brain as an index organ, interventions to improve cerebral oxygenation would have systemic benefits for cardiac surgical patients. In an attempt to predict those patients that are predisposed to cerebral complications, investigators have used neurological monitoring ie, Near infrared spectroscopy (NIRS) to enhance detection of hypoxic conditions associated with neurological injury (Hoffman, 2006). Serum S100B protein has been used as a biochemical marker of brain injury during cardiac surgery. Elevated levels serve as a potential marker of brain cell damage and adverse neurological outcomes (Einav, Itshayek, Kark, Ovadia, Weiniger and Shoshan, 2008). Aims and Objectives of the study This prospective, quantitative, interventional study was carried out to maintain cerebral tissue oxygen saturation during cardiopulmonary bypass above 75% of the baseline level by implementation of a proposed interventional protocol. The analysis of S100B which is a marker of neurological injury and optimization of regional cerebral oxygen saturation would allow for the formulation of an algorithm which could be implemented during on-pump coronary artery bypass graft surgery as a preventive clinical measure further reducing the risk of neurological injury. Central venous lines (CVP) are inserted routinely during cardiac surgery. Central venous oxygen saturation is a global marker of tissue oxygenation. A secondary aim of the study was to determine if a correlation existed between central venous and cerebral tissue oxygen saturations. If a positive correlation existed then central venous oxygen saturation could be used as a surrogate measure of cerebral tissue oxygen saturation during on-pump coronary artery bypass graft surgery. This study is one of the first done in the South African population group. Methods Forty (40) patients undergoing on-pump coronary artery bypass graft surgery were recruited at Inkosi Albert Luthuli Central Hospital. Patients were randomized into a control group (n=20) and interventional group (n=20) using a sealed envelope system. The envelope contained designation to either group. Envelopes were randomly chosen. Intraoperative regional cerebral oxygen saturation (rSO2 ) monitoring with active display and treatment intervention protocol was administered for the interventional group. In the control group regional cerebral oxygen saturation monitoring was not visible to the perfusionist operating the heart lung machine during cardiopulmonary bypass (blinded). Recording of regional cerebral saturation was conducted by an independent person (another perfusionist) who was not involved in the management of the case so as to ensure that no interventions were carried out on the control group. Arterial blood samples for the measurement of serum S100B were taken pre and postoperatively. An enzyme immunoassay (ELISA) was used for the quantitative and comparative measurement of human S100B concentrations for both groups. Central venous oxygen saturation was monitored from the CVP using the Edwards Vigileo monitor. Cerebral monitoring constituted the use of Near infrared spectroscopy monitoring using the Invos 5100c, Somonetics Corp, Troy MI monitor. Adhesive optode pads were be placed over each fronto- temporal area for cerebral oxygen measurement. During cardiopulmonary bypass, eight time period measurements of mean arterial pressure (MAP), heart rate, temperature, activated clotting time (ACT), patient oxygen saturation (SpO2), partial pressure of carbon dioxide (pCO2), haematocrit, lactate, pH, haemoglobin (Hb), base excess (BE), potassium (K+), sodium (Na+), glucose, calcium (Ca2+), central venous oxygen saturation (ScvO2), cerebral tissue oxygen saturation (rSO2), fraction inspired oxygen (FiO2 ), sweep rate, pump flow rate (cardiac index), and percentage isoflurane per patient were taken. The time periods when data was recorded included: 5 minutes after onset of cardiopulmonary bypass, aortic cross clamping, after cardioplegic arrest, during distal anastomosis, during proximal anastomosis, during rewarming, after aortic cross clamp release and before termination of cardiopulmonary bypass. Baseline measurements were also taken. Clinical data recorded for both groups included: the number of grafts performed, cardiopulmonary bypass time, cross clamp time, red blood cells administered (packed cells), amount of adrenalin infused and total cerebral desaturation time. A prioritized intraoperative management protocol to maintain rSO2 values above 75% of the baseline threshold during cardiopulmonary bypass was followed. Cerebral desaturation was defined as a decrease in saturation values below 70% of baseline for more than one minute. Interventions commenced within 15 seconds of decrease below 75% of baseline value. Results The results of the study show that there was a highly significant difference in the change in S100B concentrations pre and post surgery between the interventional and control groups. The intervention vii group showed a smaller increase in S100B concentration of 37.3 picograms per millilitre (pg/ml) while the control group showed a larger increase of 139.3 pg/ml. Therefore, the control group showed a significantly higher increase in S100B concentration over time than the intervention group (p < 0.001). Maximizing pump flow rates was the most common intervention used (45 times) followed by maintaining partial pressure of carbon dioxide to approximately 40 mmHg (28 times), increasing mean arterial pressure by administration of adrenalin (11 times) and administration of red blood cells to increase haematocrit (11 times). There was a highly statistically significant treatment effect within the intervention group for each of the above interventions compared with no intervention. The above mentioned interventions significantly affected right and left cerebral oxygen saturations. However, administration of red blood cells was not found to significantly increase right (p = 0.165) and left (p = 0.169) cerebral oxygen saturation within the intervention group. The study highlighted a significant difference between the intervention and control groups in terms of cerebral desaturation time (p <0.001). The mean desaturation time for the control group was 63.85 minutes as compared to 24.7 minutes in the interventional group. Cerebral desaturation occurred predominantly during aortic cross clamping, distal anastomosis of coronary arteries and aortic cross clamp release. Predictors of cerebral oxygen desaturation included, partial pressure of carbon dioxide (pCO2), temperature, pump flow rate (LMP), mean arterial pressure (MAP), haematocrit, heart rate (HR) and patient oxygen saturation (SpO2). Central venous oxygen saturation was not significantly related to right (p = 0.244) or left (p = 0.613) cerebral oxygen saturations. Therefore central venous oxygen saturation cannot be used as a surrogate measure of cerebral tissue oxygen saturation during on-pump coronary artery bypass graft surgery. viii Conclusion These findings demonstrate the positive effect of optimizing cerebral oxygen saturation using an interventional protocol on markers of neurological injury (S100B). Optimization of pump flow rate, partial pressure of carbon dioxide and mean arterial pressure would result in increased cerebral oxygen saturation levels and a reduction in neurological injury. Therefore, an algorithm incorporating these interventions can be formulated. Monitoring specifically for brain oxygen saturation together with an effective treatment protocol to deal with cerebral desaturation during on-pump CABG must be advocated.
The efficacy of an instructional model on the quality of teaching and learning using assessment
(2017) Mohapi, Mogapi Jeremia; Adam, Jamila Khatoon; Ngwenya, Thengamehlo Harold
The key aim of this study was to investigate the efficacy of the student-centric Integrated Teaching and Learning Model Using Assessment (ITLMUA) to enhance the effectiveness, efficiency and quality of student learning and teaching in a Clinical Technology programme. The ITLMUA provides a pragmatic theoretical framework for developing and enhancing perceptions and conceptions of pedagogics and associated educational and psychological theories, particulary assessment information to review, reflect and improve educational constructs of teaching, learning, assessment and educational research. The efficacy of ITLMUA uses effectiveness, usability and participants’ satisfaction as the key criteria in evaluating the impact of ITLMUA on the quality of student learning. The ITLMUA’s efficacy is judged in terms of participants finding it academically beneficial, valuable, suitable, useful and meaningful to instructional strategies and practices in higher education (HE). The motivation for the study is premise on lecturers’ adherence to conventional instructional strategies and practices and lack of instructional model that guides and measures the effectiveness and the quality of student learning and teaching. Increased workloads and superfluity of academic gatherings are some of the factors that exacerbate adherence to conventional instructional practices, including lack of academic qualification to understand the princples of educational practice in HE. This study promote and encourage integrated, authentic, dynamic and innovative instructional practices that demonstrate theoretical interest and practical relevance, such as active learning (AL) that is underpinned by learning theories and pedagogical principles. Furthermore, the study analyzed and identified some of the implementation challenges in introducing the integrated instructional model in a conventional learning environment in order to justify how and why it is imperative to adopt an integrated performance-based instructional model in the face-to-face (F2F) learning environment. The study proposed to provide an instrument that can be utilized to enhance the quality of student learning and teaching. The integrated instructional model can assist lecturers to reflect on their pedagogical practices with the intention of enhancing their subsequent pedagogical practices and strategies. The theoretical and conceptual framework of ITLMUA offered the lecturers an opportunity to integrate conventional and contemporary instructional practices. These frameworks have previously been underpinned by learning theories and pedagogical principles to enhance the quality of learning and teaching. Design-based research (DBR) methodology was utilized as it offered a systematic, flexible methodology that is theory-driven, and involves contextually-sensitive design principles and theories of the learning environment. It also offers the opportunity to review and redesign the ITLMUA as the research process develops, and new theoretical and conceptual framework information emerges. In addition, the DBR integrates research, design and practice into a single useful process which results into a usable product that is supported by a theoretical framework. Active learning is one of the teaching strategies that is supported and promoted by this study to improve quality learning and teaching in order for students to comply with and satisfy the academic quality standards and learning outcomes expected of them. This is can be achieved through meaningful engagement and active involvement in academic activities that promote critical analytical skills and competencies through collaborative and cooperative learning, and within a structured, supportive and facilitated learning environment. The learning environment should be characterized by student-centered and lecturer-facilitated instructional practices such as active learning teaching strategies. To enhance the quality of learning and teaching, lecturers attempt to match and modify their teaching strategies to accommodate the wide range of students in their classes, all of whom have different needs and expectations. Qualitative and quantitative research methods were used to gather data. Data analysis techniques included content analysis, the constant comparative method, factor analysis (FA) to reduce data in order to correlate and relate variables to components. Cronbach’s alpha was used to determine reliability of items. The study has demonstrated the utility, usability and efficacy of the ITLMUA as indicated, in the main, by participants’ satisfaction with the instructional model. The study reports on some of the enablers and barriers in the implementation and evaluation of the integrated instructional model and articulated the lessons that have been learned in this academic journey.