Theses and dissertations (Health Sciences)

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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.
An epidemiological investigation of low back pain in the white population of the greater eThekwini metropolitan area
(2012) Dyer, Brinique Ann; Jones, Andrew D.; Korporaal, Charmaine Maria
Background: Previous investigations on the epidemiology of low back pain (LBP) in South Africa where limited to black, indian and coloured populations to the exclusion of whites. Thus the aim of this study was to determine a LBP profile and an overview of risk factors in the white population in the eThekwini metropolitan area. Objectives: These included documenting the point, period and lifetime prevalence of LBP, describing the characteristics of LBP, identifying the risk factors of LBP and assessing the effect on activities of daily living in the white population in the greater eThekwini metropolitan area. Method: The three most densely populated white suburbs in the greater eThekwini metropolitan were chosen and classified according to income potential (high/middle/low income) to ensure a balanced sample. Six hundred white participants were used in the study having 200 white participants in each suburb. Statistical Program for the Social Sciences (SPSS) version 18.0 was used to analyse the data. Results: The prevalence of LBP was recorded as follows: lifetime prevalence (48%), period prevalence from 0-3 months (21.3%), 6-12 months (18.3%), LBP longer than 12 months (7.8%) and lastly point prevalence was recorded at 34%. All prevalences were notably lower than international and previously published African norms. The majority of the participants who reported current LBP stated that their pain was moderate (54.3%) [only 14.9% had severe pain]. The worst pain occurred in the evening. Non-progression of LBP was reported by most participants (41%), while some participants reported worsening (35.2%) and only (18%) were getting better. Current pain with mild disability was most frequent at 51.8%, often associated with bending and lifting, which were reported as the highest offenders for causing LBP. Only 16.8% of all participants had to stay away from work due to LBP for any period. The demographics of the sample indicated that age had significant difference in predisposing to LBP (the high income (highest age) verse low income (lowest age)). The gender distribution showed higher prevalence of LBP in females (53.3%) and males (46.7%). The factors associated with LBP predisposition in some instances were at odds with the prevailing literature, indicating that further research is required on white population group in Africa.
The epidemiology of neck pain within the indigenous African population in Harare, Zimbabwe
(2019) Blumears, Aimee Ann; Haffejee, Firoza; Makowe, Alistair
Background Musculoskeletal disorders are the leading cause of disability and can impair the quality of life. Of these musculoskeletal disorders, neck pain is one of the most common. Some of the risk factors for neck pain among the African population include low level of education, high-stress levels, low income and motor vehicle accidents. In the international arena, a broad range of risk factors contribute to chronic neck pain. These include female gender, increasing age, poor posture and work habits, twisting and bending of the neck and trunk, low–co-worker support, low socio-economic status and psychosocial factors such as stress and depression. Neck pain presents differently in different populations. The epidemiology of neck pain has not been investigated in Zimbabwe. In this country factors such as economic instability, disruption of social trust, uncertainty about income, high crime rate, unstable healthcare and low morale in the working population have led to the development of psychological disorders such as stress, anxiety, and depression. Furthermore, there has also recently been an increase of vehicle use in Zimbabwe, with concomitant motor vehicle accidents. All of these factors may predispose this population to musculoskeletal pain such as neck pain. However, this requires investigation. This study aimed to estimate the prevalence, risk factors and impact of neck pain in the indigenous African population in Harare, Zimbabwe. Methodology This was a quantitative cross-sectional study based on a previously validated questionnaire sourced from Smith (2016) and conducted in Harare, Zimbabwe. Participants (n = 461) answered a self-administered questionnaire after providing informed consent. The data collected from the questionnaires were captured into an excel spreadsheet and subsequently statistically analysed using SPSS. Standard deviation and mean reports are represented by (mean ± SD) within the text. Where standard deviation is represented by (SD). Tables, graphs and charts were used to present the data. The Inferential analysis was conducted using cross tabulations (interpreted using the Pearson chi- Squared test). The bivariate analysis was done using a Chi-Squared test (Interpreted using the Pearson`s chi-squared test). Odds ratios (OR) were calculated using binary logistic regression, This calculation was used to find dependant variables on an existent independent variable (Willemse 2009: 121). The 95% confidence intervals (CI) were calculated for Odds Ratios and for prevalence (Johnson and Bhattacharyya 2000: 331). A significance of a p- value less than 0.05 was used throughout. Results A total of 461 questionnaires were completed by participants in Harare, Zimbabwe. The point prevalence and 12-month prevalence was 16.4% (95% CI: 0.13 – 0.20) and 26.9% (95% CI: 0.22 – 0.31) respectively. The lifetime prevalence of neck pain was 49% (95% CI: 0.44 – 0.53). Within this population, age was significantly associated with neck pain (p < 0.001) with a larger prevalence within the age group 20 – 35 years. The odds of self-reported neck pain are 2.5 times greater for those with the exposure of self-reported stress compared to the participants without the exposure of self-reported stress (Odds Ratio = 2.5; 95%CI: 1.121 – 5.734; p = 0.025). Lack of finances (22.6%, n =104), work (18%, n =83) and poor living conditions (5.6%, n =26) were the main stressors identified among the participants. Other associations found for neck pain in this population were motor vehicle accidents (p < 0.001) and poor eyesight (p < 0.001). There was an association of neck pain with headaches (p = 0.023), shoulder pain (p < 0.001) and low back pain (p < 0.001). Conclusion Neck pain was prevalent within the indigenous population of Harare, Zimbabwe. Factors that were associated with neck pain in the sample population included stress, age, headaches, shoulder pain, low back pain, motor vehicle accidents, and poor eyesight.
The epidemiology of postpartum low back pain within the eThekwini Municipality area
(2018) Bhoodram, Bhavna; Padayachy, Keseri
Background Previous investigations into the epidemiology of low back pain (LBP) in South Africa were limited to various ethnic groups, student population and work-related activities. There have been many international studies on postpartum low back pain experienced by females which have shown varied results, largely attributed to the various time frames and risk factors. Consequently, there has been a remarkable increase in the use of epidural anaesthesia during delivery. Aim The aim of this study was to determine the prevalence of, and risk factors for, postpartum low back pain within the eThekwini Municipality. Method A quantitative paradigm and a cross sectional epidemiological design was used to survey 384 postpartum females in selected areas within the eThekwini Municipality, having 128 participants in each of the three suburbs (high-, medium- and low-income areas). A pre-validated questionnaire was used to collect data from the females who agreed to participate. The survey contained questions related to low back pain, pregnancy, socio-demographic, psycho-social, lifestyle and occupational factors. The data was analysed using the Statistical Program for the Social Sciences (SPSS) version 24.0. Results The prevalence of LBP was recorded as follows: Of the entire population a 41.1% prevalence for postpartum low back pain was reported, with 54.7% at La Lucia municipal clinic (high-income region), 36.7% at Bluff municipal clinic (low-income region) and 32% at Overport municipal clinic (middle-income region). 57% of the participants who experienced postpartum LBP reported that it had an effect on their daily tasks with 62% stating that the pain presented with a slow/gradual onset. The most common type of pain was described as “sharp/poking” with “dull ache” being the second most common. Non-progression of LBP was reported by 46% of participants, while 26% reported a decrease in pain, 18% noted an increase in pain and 10% were unsure. 28% of the participants noted that the individual episodes of pain they experienced were usually 60 minutes or longer. The population group was split almost uniformly in quarters with regards to how frequently the individual pain episodes occurred i.e.: daily (23%), twice a week (24%), weekly (26%) and monthly (27%). A logistic regression model was fitted in order to establish which variables are associated with lower back pain. The significant variables (p<0.05) were stress levels, type of birth, clinic, race and whether lower back pain was experienced before pregnancy. Conclusion More studies are warranted on this group of individuals as the factors associated with the predisposition of postpartum LBP were in some instances not in keeping with the existing literature. Postpartum LBP has a significant impact on females and their quality of life and therefore effective strategies to prevent and manage postpartum LBP in females are obligatory.
An exploration of the role of the Sarva Dharma Ashram in the development of youth and their families in the Welbedacht community
(2020-11-30) Gurcharan, Yashna; Bhagwan, Raisuyah
Historically, faith-based organisations have been at the forefront of developing and empowering disadvantaged youth and their families. They have been known to provide not only spiritual support but also material relief to needy families and communities. Despite the fact that they play a salient role in spiritual and social development very little empirical research, exists which attests to their value in developing contexts. It is within this context that the current study was developed. It sought to understand the role of the Sarva Dharma Ashram in the development of youth, their families and the community in the Welbedacht area. A qualitative research approach was used in the study. Specifically a case study design was used, with the Sarva Dharma Ashram being considered as the case for analysis. Three samples were recruited to shed light on the Ashram, as the case of analysis. The samples included the Board members of the Sarva Dharma Ashram, family members of youth, and community members of Welbedacht. The data was collected through semi-structured interviews with the Board members and family members. Data was collected till saturation. Four Board members of the Ashram were interviewed and ten family members were interviewed. A focus group discussion was used to collect data from ten community members. An interview and focus group guide served as the data collection instruments in this study. In total twenty-four people participated in this study. Data collection with all three samples took place at the Sarva Dharma Ashram. The data was analysed using the process of thematic analysis. The transcripts were read several times for patterns and similar wording. Thereafter, the main themes and sub-themes were identified which highlighted how the Ashram contributed to families and the community. There were five broad themes that emerged from the data. These reflected the experience of poverty and financial hardship endured by children, youth and their families in the community and the varied and multifaceted spiritual and material support extended to families and the community through diverse initiatives of the Sarva Dharma Ashram. The study found that the Ashram acted as a focal point within the disadvantaged community of Welbedacht and a huge immediate resource to youth, families and the community when any psycho-social or financial distress was encountered. The feeding scheme was found to be one such initiative where schools in the vicinity were provided with meals regularly. Moreover spiritual activities at the Ashram such as the Satsangh programme (group devotional singing), were found to uplift families and individual members who faced distress and isolation. Empowerment programmes for unemployed women were aimed to uplift women and enable them to become more financially independent. Faith is a core motivator for the work that faith-based organisations undertake and influences how the initiatives and activities of the Ashram are implemented. The transformational benefits of the activities being implemented at the Sarva Dharma Ashram provide tangible evidence of how crucial such organizations are within underresourced communities. The study highlighted the problems experienced by children, youth, and their families in disadvantaged communities and how spiritual and social support can enable family and community well-being. Clarke and Jennings (2008:15) wrote “the faith element of the faith-based organisation is not an add-on to its development activity, operating alongside. It is an essential part of that activity, informing it completely.” The Sarva Dharma Ashram was found to represent this through its services and programmes for the benefit of the Welbedacht community.
Feasibility and acceptability of utilising short message service for follow-up care of oupatient mental health care users in the uMgungundlovu District
(2018) Ramlucken, Lucelle; Sibiya, Maureen Nokuthula; Zikalala, N.P.
Background The mental well-being of an individual is affected by physical, social and psychological factors, which result in a psychiatric diagnosis. Difficulty in concentration and attention is experienced, and they become dependent on their families for financial and social support. Over the years, there has been a rapid growth in the use of mobile technology which has been proven to increase treatment adherence. Short message services may improve service delivery through appointment reminders, and improve communication between health care workers and patients. Aim of the study The aim of this study was to determine the feasibility and acceptability of utilising a short message service to remind outpatient mental health care users (MHCU) of their follow-up care in the uMgungundlovu District. Methodology The study employed a non-experimental quantitative survey. The study took place at four outpatient psychiatric clinics in the uMgungundlovu District in KZN. A non-probability convenient sampling method was used to select 182 participants at the psychiatric clinics. Results The majority of the respondents n=169 (92.9%) indicated that they would be interested in receiving the short message service. Results indicated that it would be feasible, acceptable and expedient to MHCUs to have access to the service.
Frontline radiographic human capital development : a case of Zambia and way foward
(2014-06-13) Munsanje, Foster; Gwele, Nomthandazo S.
The shortage of radiologists in Zambia has persistently made the provision of equitable access to optimum radiological services unattainable in the current radiological service delivery system, while equity in distribution of cost-effective and quality healthcare service as closer to the community as possible is at the core of Zambia’s vision in the National Health Strategic Plan. This vision is maintained in Zambia’s Sixth National Development Plan, for the period 2011 to 2015. The number of radiologists as low as three radiologists, for a population of thirteen million people, makes the possibility of ever providing optimum radiological services equitably accessible to the community unattainable, without launching and upholding a precise remedial intervention. The purpose of the study was to develop a framework for sustainable radiographic human capital developmental guidelines embracing advanced radiographic practice and optimum radiological services, with special focus on hospitals without radiologists. The objectives were to: a) analyse the existing radiographic services and/or practices in rural Zambian hospitals without radiologists; b) examine the views of radiographers, physicians, and patients in hospitals without radiologists, regarding adequacy of radiological service delivery; (c) determine desirable competencies for frontline radiographers in comprehensive radiological service delivery, as well as the benefits of such competencies to the community and the health service facilities; d) analyse the healthcare managements’ expectations regarding frontline radiographers’ capabilities in rendering comprehensive radiological services in healthcare settings without the radiologists, e) formulate, implement, and evaluate a training programme for radiographers for comprehensive radiological services; with specific references to client (physician and patient) satisfaction and radiographic competencies; and (f) develop a framework for human capital development for frontline radiographers in providing comprehensive radiological services. The Accenture Human Capital Development Framework (AHCDF) was employed as the theoretical framework to link all key aspects of the inquiry (Thomas, Cheese and Benton, 2003). An Action Research design was used involving multidisciplinary participation, including patients, in the five cyclical phases of the Action Research design; diagnosing, planning, acting, evaluating, and specifying learning. The route of knowledge generation and application was guided by retroductive or abductive cyclical logical process. The interviews, document analysis, and questionnaires were applied to obtain data, whereas a designed training programme for frontline radiographers was piloted and evaluated within this study. The study’s data management and analysis were largely by qualitative methods, though quantitative aspects involving percentages as in descriptive statistics were also involved where appropriate. The discussion, integrates the research findings under appropriate themes of the theoretical framework. An investment perspective in AHCDF is linked to ways of investing in radiographers’ education and training towards extended roles is discussed. The radiographers’ extended roles are seen as a catalyst to desirable radiological technology, radiological service designs, and corresponding radiological service outcome. The benefit of this proposed investment is seen as promoting equitable access to radiological services, with averted or reduced costs ascribed to referrals of patients among hospitals. Consequently, incomes of households and healthcare institutions would be preserved for poverty reduction by reduced referral-related costs. The researcher-devised frontline radiographic human capital developmental (FRHCD) conceptual framework is developed and a way forward recommended.
Impact of vitamins B12, B6 and folate supplementation on cardiovascular risk markers in an elderly community of Sharpeville
(2015-09) Grobler, Christina Johanna
Background: In a vulnerable low-income group with a confirmed high risk of cardiovascular disease, like the elderly in the Sharpeville care centre, an acute intervention is needed in order to improve their health profile. Previous studies suggested homocysteine lowering by vitamin B12, B6 and folate supplementation. The effect of vitamin B12, B6 and folate supplementation on the inflammatory response, thrombotic risk, lipid profile, hypertension, risk of metabolic syndrome and homocysteine metabolism in an elderly, black South African population has never been reported. Objectives: The main aim of this interventional study was to assess the effect of vitamins B12, B6 and folate supplementation at 200% RDA for six months on cardiovascular risk markers of an elderly semi-urbanised black South African community. Design: This study was an experimental intervention non-equivalent control group study design in 104 purposively selected samples of all the elderly attending the day-care centre. Setting and participants: A homogeneous group of respondents was included in the study. All subjects were equivalent in age (>60 years), race (black), unemployed/pensioners (socio-demographic) and 60 years and older attending a day care centre in Sharpeville, situated in the Vaal region, Gauteng, SA. Measurements: The distinctiveness of this study lies in the broad panel of parameters evaluating the CVR in correlation with the increased nutritional intake of vitamin B6, B12 and folate. These included: weight, height, waist, serum cholesterol, high density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, blood pressure, fibrinogen, high-sensitivity C-reactive protein (HS–CRP), homocysteine, vitamin B12, folate, glucose, insulin, adiponectin and fibronectin. Results: A very high incidence (66.36%) of hyperhomocysteinaemia is present in the sample. The mean serum homocysteine level in hyperhomocysteinaemic individuals decreased statistically significantly from 25.00±8.00 umol/l to 18.80±12.00 umol/l after the intervention. The number of respondents with an increased homocysteine level decreased from 100% (baseline) to 67% (follow-up). The supplementation was beneficial (statistically significant changes) to the glucose levels, fibrinolytic status, vitamin B6 serum levels, fibronectin levels and haemopoeiesis (decreased macrocytosis) of all the individuals (regardless of their homocysteine status). Conclusion: It is concluded that supplementation of vitamins B6, B12 and folate at 200% RDA for six months is an effective homocysteine-lowering approach as a strategy to reduce hyperhomocysteinaemia in an elderly population and thereby reduce cardiovascular risk (CVR). The supplementation intervention mentioned is not an effective multifactorial strategy to decrease CVR although beneficial effects were found with other CVR markers independent of homocysteine status.
The knowledge, understanding and perceptions of professional nurses, working in primary health care clinics, about autism spectrum disorder
(2018) Williams, Neil Arnold; Sokhela, Dudu Gloria; Basson, Petro Magdalena
Background Abstract The Centers for Disease Control and Prevention (CDC) in the United States has found that more children than ever before are being classified as having autism spectrum disorders (ASDs) (Chiri and Warfield 2011: 1081). According to Matenge (2014: 1), ASD is a pervasive developmental disorder characterised by two essential features: a combination of impairments in social interaction and social communication, and restricted, repetitive, and stereotyped patterns of behaviour, interests and activities. Malcolm-Smith et al. (2013: 4) report that data on the incidence, prevalence, and impact of ASD in South Africa are almost entirely lacking. No epidemiological studies of ASD have been conducted in the country (Malcolm- Smith et al. 2013: 4). Diagnostic and intervention services, particularly at state level, are scarce (Malcolm-Smith et al. 2013: 4). Hence, those that are in place are heavily overburdened. Of particular concern for South Africa are research findings indicating that ASD is under-identified in low socioeconomic status communities, so in these contexts ASD often goes undiagnosed, or is diagnosed late (Malcolm-Smith et al. 2013: 4). Matenge (2014: 19) argues that there is, therefore, a need to assess the level of knowledge, understanding and the experiences of South African nurses regarding autism, as they are usually the first professionals that families of children with autism contact. Research purpose The purpose of this research was to determine the knowledge, understanding and perceptions of professional nurses who work in primary health clinics in eThekwini Health District, KwaZulu-Natal, regarding ASD. Research design A quantitative, non-experimental, descriptive research survey design was utilised. A self-reporting questionnaire was used to collect data. Sampling and sample size Simple random sampling was used to determine which clinics in the eThekwini health district would be part of the study. The sample size for the clinics was thirty four, of those thirty were eThekwini municipality clinics and four KwaZulu-Natal Department of Health clinics. These clinics were utilised and provided the 275 professional nurses needed. The sample was calculated with a margin of error and an alpha value of 0.05; the researcher needed a minimum of 275 respondents. The researcher selected the respondents utilising non-probability, convenience sampling. Data analysis Data was analysed with the assistance of the statistician, using SPSS version 22. Descriptive statistics were used to explore differences between or among groups (Grove, Burns and Gray 2013: 217). Inferential statistics are used to draw conclusions regarding the differences between groups in the population from which the samples are drawn and the relationship between the variables in the population (Morgan et al. 2015: 84). Both descriptive and inferential statistics were used to analyse data in this study. Conclusion and findings It was found that the average professional nurse working in a primary healthcare clinic has 65.8% knowledge and understanding of ASD. Of particular concern is that the majority of respondents 51% (n=141) did not know or understand that the child with autism loves routine which is a key symptom in making a diagnosis of ASD, which may lead to late, or missed diagnosis. Eighty eight percent (n = 242) of respondents felt that they would benefit from further training on the identification and diagnosis of ASD. It was also found that respondents that have completed the Psychiatric Nursing Science course were more knowledgeable about ASD and confident in diagnosing ASD and counselling parents on ASD and available ASD services in the community. Recommendations The researcher recommended that: Autism spectrum disorder to be included in the curriculum for nurses training and that regular in-service training be done to keep the professional nurses up to date with on new information related to ASD. It was also recommended that all children should be screened for ASD at 18 and 24 months at all PHCs in eThekwini district and that posters on the signs and symptoms of ASD should be displayed at primary healthcare clinics in full view of patients, parents and staff
Lived experiences of post-penectomy for patients receiving healthcare from a public hospital in KwaZulu-Natal : a phenomenological study
(2023-05-31) Ndlovu, Virginia Vuyokazi; Sokhela, Dudu Gloria; Sibanda, M.
Penile cancer is a rare malignancy with prevalence higher in areas of high Human Papilloma Virus (HPV) such as Africa, Asia and South America. In middle- and low income countries where circumcision is not routinely practiced, the rate of penile cancer could be ten times higher. A penectomy refers to a procedure which all or parts of the penis are surgically removed. Total penectomy involves the removal of the entire penis. During this procedure, a new opening is created in the perineum through which urine can pass. In some cases, the testicles, scrotum and lymph nodes may be removed. A partial penectomy involves the removal of part of the penis and typically leaves the shaft intact. Surgical treatment is inevitably mutilating. Despite its therapeutic effectiveness, total penectomy leads to mutilations that affect the ability of patients to void urine while upright. It also affects the patient’s corporal image, genital sensibility, and self-esteem. Purpose: The purpose of the study was to explore the lived experiences of post penectomy patients receiving care in a Public Hospital in KwaZulu-Natal. Methodology This was a qualitative study based on Edmund Husserl’s descriptive phenomenology which is described as the science of the essence of consciousness or inquiry into the consciousness of the patient. Purposeful sampling was used for the study. Data was collected using face-to-face in-depth interviews with patients who had penectomy surgery and were receiving follow-up health care in the selected public hospital. These patients were a year or more post-surgery therefore had sufficient experience to provide rich data. Participants were met and told about the study when they came to the hospital’s outpatient department for their follow up visits, and interviews were conducted where they are most comfortable such as at their homes. Results The data was analysed by means of content analysis and raw data was coded and sorted into sub-categories and categories. Sub-categories were: feeling severe pain, beliefs about causation of illness, feelings of loss of life, sense of self care, coping mechanisms, support system, loss of self-esteem, fear of people knowing about the surgery performed, bodily discomfort from disfigurement, being able to have sexual satisfaction, and use of sexual gadgets. The underlying meaning of categories were formulated into themes which were: thought processes before penectomy surgery, psychological effects of penectomy surgery, difficulty in urination, and sexual function post penectomy surgery. All participants had penile cancer. Pain was the main reason for these participants to make a decision to have the penectomy surgery; participants had severe sores around their penile area and these sores were not healing. Other reasons during their thought processes before making a decision for the penectomy surgery was the penile cancer itself, with participants being worried that if they delay or they do not agree to the surgery the cancer would spread to other organs of the body Conclusion Even though penectomy surgery is a debilitating procedure and inevitably mutilating despite its therapeutic effectiveness, the pain and the illness that the participants were going through led them to take the decision to have the surgery. Outcomes were the relief of pain and healing from penile cancer. No recurrence of cancer was verbalised by the participants after the surgery.
Midwives’ use of symphysis fundal height measurement to monitor foetal growth in eThekwini district, Kwazulu-Natal
(2023-05-31) Dlamini, Londiwe Zibuyile; Ngxongo, Thembelihle Sylvia Patience
Introduction and background: Ending preventable death of new-borns and children under 5 years of age by 2030 is one of the Sustainable Development Goals. Assessment of foetal growth by symphysis fundal height (SFH) measurement is one of the aims of antenatal care (ANC) and is used as the screening tool of choice for foetal growth assessment to identify small and large for gestational age foetuses at increased risk of perinatal morbidity and mortality. Correct estimation of gestational age allows for proper scheduling of ANC visits, informs decision-making at different stages of pregnancy, and is key to correct interpretation of foetal growth. It is a simple and inexpensive clinical activity, widely used during ANC in both high- and low-income settings worldwide, particularly in low- and middle-income countries including South Africa, where access to ultrasound machines and trained ultra-sonographers is limited. The effectiveness of SFH use is largely dependent on accuracy of measurements and the findings being accurately plotted onto the foetal growth chart to allow for accurate interpretation. An error in measurement, plotting and/or interpretation of SFH can result in inaccurate estimation of gestational age and growth monitoring which then becomes difficult and inaccurate, all of which can result in inappropriate interventions such as premature induction of labour or prolonged pregnancies. Aims of the study: The aim of the study was to explore and describe midwives’ use of SFH measurement to monitor foetal growth in ANC clinics located within the primary health care (PHC) clinics under eThekwini Municipality administration in KwaZuluNatal. Research objectives: The objectives of the study were to: explore the current practices of the midwives in the use of SFH management to monitor foetal growth during pregnancy; determine the perspectives of midwives regarding the use of SFH management to monitor foetal growth during pregnancy; explore the challenges if any that were experienced by the midwives in the use of SFH management to monitor foetal growth during pregnancy; and, describe how correct use of SFH measurements to monitor foetal growth during pregnancy can be enhanced. Method: A qualitative descriptive design using the theory of planned behaviour as a framework to guide the study was employed. Data was collected through semi-structured interviews with 20 registered midwives working at ANC clinics and a retrospective record review of 60 maternity case records for pregnant women attending ANC. Data from the interviews were thematically analysed following the six steps of qualitative data analysis, and document analysis used content analysis. Findings: The study findings revealed that in the majority of cases the SFH measurements were done as expected. Nevertheless, situations also prevailed where this was not correctly done, meaning SFH measurements were either incompletely done, incorrectly done or missing. In most cases these were blamed on several challenges experienced by the midwives working in the ANC clinics which included shortage of human and material resources, overcrowded ANC/PNC clinics, time constraints and limited skills. The perceptions of midwives and the culture that prevailed in the ANC clinics influenced how the midwives used the SFH measurement to monitor foetal growth. Conclusion and recommendations: Evidence of good practices from some participants and record reviews support the researcher’s conclusion that although gaps exists in the use of SFH measurements to monitor foetal growths, these gaps could be corrected by addressing all prevailing challenges. A number of these challenges could be overcome with both policy formulation and/or review, particularly with regards to provision of material and human resources; improvement of clinical practice during service delivery, paying particular attention to constructive feedback to staff regarding their performance; and/or aligning the nursing education curriculum more closely to clinical practice.
The perceptions of diagnostic radiography clinical tutors transitioning from being radiographers to clinical educators in public hospitals in the eThekwini District
(2023-05-31) Ncwane, Vukani Siphiwesihle; Khoza, Thandokuhle Emmanuel
Introduction: Clinical tutors display competence in the practice of their craft. However, that competence does not automatically transfer to the area of clinical instruction. A unique aspect of teaching radiologic sciences is the need to be didactically and clinically proficient. Clinical instructors are known as having practical knowledge of teaching, but few understand the basic principles, theories, and concepts of the teaching and learning process. Furthermore, radiographers who transition into the role of clinical tutors are usually expert practitioners but may lack knowledge of best practices regarding student instruction and evaluation. The lack of adequate clinical education and supervision can result in low performance and students failing to apply theory to practice. There is a lack of data studying these issues which might shed light on the perceptions of clinical tutors’ transition. These factors generated the researcher’s interest in formally investigating the perceptions of radiography clinical tutors on the transition from being a radiographer to a clinical educator in the eThekwini district of KwaZulu-Natal. Aim: The study aimed to explore the perceptions of radiography clinical tutors on the transition from being a radiographer to an educator in public hospitals. Ultimately, the study aimed to recommend measures to be put in place to allow for the effective transitioning of radiographers to being clinical educators at public hospitals. Methodology: A non-probability sampling method using purposive sampling was used to select five hospitals within the eThekwini District. From these hospitals, a minimum of seven diagnostic radiography clinical tutors were selected and interviewed. A qualitative methodology design was employed in this study, in which semi-structured and in-depth interviews using open-ended questions were used to collect data from participants. Covid19 rules and protocols were followed. Four main themes generated from the study’s theoretical framework were used for data analysis. Findings: Thematic analysis of the transcribed interviews revealed four main themes, namely: situation, social support factor, strategy, and self-factor. The findings of the study indicated that the majority of participants have had major challenges in the transition process, which has led to negative experiences and only a few had a positive experience. Research participants further revealed that they are experiencing high workloads due to a shortage of staff, which was one of the major barriers that also affected students’ learning and participants’ effective transition. Research participants suggested that the appointed clinical tutor must undergo training before starting their job, whereby the job description will be clearly stated, including the required skills. Lastly, participants postulated that clinical tutors and teaching institutes must create a forum for clinical tutors where they will engage with the university to discuss the issues and challenges of students during clinical training and assist each other with teaching skills. Conclusion: Clinical tutors who participated indicated that they are facing challenges in transitioning from being a radiographer. These challenges affected their abilities to supervise students, which in turn affected the clinical learning progress of students. This, therefore, calls for an extensive intervention of both the learning institution, the hospital management, and other relevant stakeholders to best figure out how these challenges can be tackled. This will allow for a smooth transition and improve students’ supervision and ability to learn at the clinical venues.
A profile of patients presenting with spinal pain at Mahalapye and Shoshong World Spine Care clinics in Botswana
(2017) Armstrong, Candice; O'Connor, Laura
Title: A profile of patients presenting with spinal pain at Mahalapye and Shoshong World Spine Care clinics in Botswana Background: Spinal pain such as low back and neck pain, are common and can cause severe long term pain which results in a major burden on individuals and health care systems (Woolf and Pfledger, 2003; Hondras et al., 2015a). Low-income countries often have few resources for adequately addressing musculoskeletal (MSK) pain (Louw et al., 2007). Thus, World Spine Care (WSC), a non-governmental organization, opened two clinics in Botswana to help improve spinal health care by providing access to MSK specialists (Haldeman et al., 2015). These clinics have been functional since 2012, and to date the profile of patients attending these clinics has not been investigated. Studies on patients attending chiropractic clinics have been carried out internationally (Hartvigsen et al., 2002; Giles et al., 2002; Coulter and Shekelle, 2005; Holt and Beck, 2005; Mootz et al., 2005; Sorensen et al., 2006; Garner et al., 2007; Stevens, 2007; Rubinstein et al., 2008; Martinez et al., 2009; Ailliet et al., 2010; Lischyna and Mior, 2012) and locally (Benjamin, 2007; Jaman, 2007; Mohamed, 2007; Venketsamy, 2007; Higgs, 2009; McDonald, 2012; Hitge, 2014), and yet very little information exists on the patients presenting to clinics in the public sector of Botswana. Demographic and disease profiles of patients vary by clinical setting, from country to country, and within regions of the same country (Hoy et al., 2010a). Thus, this study aimed to determine the demographic and disease profile of spinal pain patients attending the WSC clinics in Mahalapye and Shoshong in Botswana. Method: A retrospective, descriptive study design was used to extract data from the WSC patient files at the Mahalapye and Shoshong WSC clinics from 1 November 2012 to 31 March 2016. The research proposal was approved by the Institutional Research Ethics Committee (IREC); REC 53/16 (Appendix A), WSC (Appendix B) and Botswana MoH (Appendix C). Patient files included had provided consent for their files to be used for research purposes (Appendix F). Data recorded included demographic characteristics, factors related to spinal pain, the presenting complaint and the presence of co-morbid conditions. The data was analysed using Statistical Package for the Social Science (SPSS) version 24.0. Descriptive statistics in the form of graphs and cross tabulations were used to describe the demographic and disease profile of the spinal pain patients. Inferential statistics like chi-square, Fischer’s exact test for categorical variables and Independent student’s t tests for numerical variables were used to determine differences between the two clinics. A p-value of less than 0.05 was used to indicate statistical significance (Singh, 2016). Results: The sample size was 65% (n=714). There was a female preponderance (75.2%, n=537), a mean age of 50.6 years (±SD 16.13). Most patients were married (38%) and the most common occupations were either farmers (18.2%, n=129) or unemployed (16.3%, n=115). The majority of patients suffered from chronic (88%), idiopathic (59.5%), low back pain (69.9%), followed by upper/mid back (19.1%), with the least visits occurring for neck pain (8%). The most frequent diagnosis was joint dysfunction with associated soft tissue disorders. The patients reported mild disability with moderate pain intensity and most patients had not experienced previous spinal pain (60%). The patients did not report a secondary area of MSK pain (28.6%) and 73.9% of patients presented with at least one comorbid condition. Patients attending the rural clinic were older on average (52.7 years, ±SD 16.92) than those at the urban clinic (48.9 years, ±15.29) (p = 0.002). There were more women attending the urban clinic when compared to the rural clinic (p = 0.009), with those attending the rural clinic most often reporting a primary school level of education in contrast to those in the urban clinic having most likely obtained a more than secondary school education (p < 0.001). More patients in the urban clinic had “other mechanical” e.g. joint dysfunction as an aetiology for their spinal pain when compared to the rural clinic (p = 0.039). In terms of pain duration, the rural clinic patients were more likely to present with acute and subacute pain than at the urban clinic (p = 0.001). The rural clinic patients also reported more previous episodes of spinal pain in contrast to those from the urban clinic (p <0.001). Conclusion: The spinal pain patients attending the WSC clinics had many similarities to spinal pain patients internationally and in SA, however unique differences were found specifically when the urban and rural clinic patients were compared. The findings of this study can assist WSC to provide more targeted healthcare at each clinic and within this region.