Theses and dissertations (Health Sciences)

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Chiropractic students’ perception and practice of patient education on management of musculoskeletal conditions at a tertiary education teaching clinic
(2023-05-31) Nieuwenhuis, Hardus; Maharaj, Praveena; Korporaal, Charmaine Maria
Background Modern healthcare is characterised by patient-centred care, which requires that healthcare professionals have equal proficiency in communication and practical skills. As part of their duty as healthcare professionals, chiropractors must show patients how to help themselves through patient education, which requires communication skills. Patient education no longer solely involves or refers to knowledge transfer alone, but rather working with patients in their specific context to build knowledge together from a partnership perspective and to share power in this dynamic. From this perspective, patient education becomes a tool to empower patients and improve their self-efficacy and coping habits, without constantly relying on passive care. This study presents a detailed evaluation of patient education within a South African chiropractic student context at the Durban University of Technology. Aims and Objectives This study aimed to describe chiropractic students’ perceptions and practice of patient education of musculoskeletal conditions at a teaching clinic. The objectives were to evaluate the students’ perception of patient education and the strategies they use; their self-reported practice of patient education; barriers that students face when educating patients; factors that contribute to their patient education skills development, and to determine whether there is an association between demographics, their perception and practice. Methods The study was an anonymous web-based questionnaire with a cross-sectional design within a quantitative paradigm. The survey used in this study stems from a physiotherapist study. Permission was obtained from the author to replicate the study in a South African context at the Durban University of Technology Chiropractic Day Clinic (DUT CDC). The original survey was then put through a focus group and pilot study and subsequently adapted to include questions related explicitly to chiropractic and the student population at the Durban University of Technology. Weekly reminders were sent via email to class representatives to distribute among their respective classes. A total of 42 completed questionnaires were used for analysis in this study. Cronbach’s alpha was used to assess internal consistency of scales. The scale scores were computed by averaging the 18 items for Question 6 and Question 5 respectively where Ttests were used to compare these scores between the demographic variables for binary data, ANOVA for ordinal data and Pearson’s correlation analysis, where the demographic variable was quantitative and normally distributed. A Wilcoxon signed ranks test was used for the comparison of time spent on patient education at initial consults and time spent on patient education at follow-up consults Results Overall, the students viewed most of the patient education items to be important and should be discussed with patients. In practice, however, the frequency of their practice did not correspond to the perceived importance. Only a few items were practised to the same extent as the perceived importance thereof. The chiropractic students’ discussions with their patients tend to focus on the main complaint of patients. In most cases, students educate their patients through one-on-one discussions, physical demonstration and anatomy models. During initial visits, students usually spend between 6–15 minutes educating their patients; in follow-up visits, the time is reduced to 6–10 minutes. In most cases, students cited patient characteristics as a barrier to effective patient education. For the chiropractic students, developing their patient education skills was largely dependent on their interactions with supervising clinicians. There was no association between demographics, perceived importance, and practice behaviour in this study. Conclusion Although the patient education topics were generally deemed important by chiropractic students, the topics considered most important are directly related to the main complaints of their patients, with more complex topics not being perceived as necessary as those directly related to the complaint, such as diagnosis. Like their perceptions, the students most frequently addressed the topics they deemed important; thus, their perceptions and practice were congruent (for issues related to the main complaint of the patients). An important finding of this study was that, although DUT follows an evidence-based paradigm, many students perceived pathoanatomical explanations to be important and, thus, provided their patients with such explanations, even though the literature does not support it. In addition, the students reported several methods through which they educate their patients. However, the assessment of whether it was successful was mainly centred around physical activity rather than the patients’ understanding of the information discussed. The results indicate an opportunity to improve the patient education skills of students, as they appear to have difficulty adjusting to difficult situations, and thereby perceive factors to be barriers that are not actual barriers but rather challenges.
A descriptive study into the cold chain management of childhood vaccines by nurses in primary health care clinics in the uMgungundlovu District
(2015-03-03) Pillay, Shamla; Ngcobo, S.; Botha, Izel
Introduction This research was a descriptive study into the cold chain management of childhood vaccines by nurses in Primary Health Care Clinics in the uMgungundlovu District. It is imperative for health professionals to follow the procedures and policies set out by the immunisation and health manuals by of the World Health Organization. The success of any childhood vaccination programme depends on how well nurses and health professionals are able to adhere to the laws, regulations and procedures. There is also a need for clinics and health institutions to be flexible enough to deal with certain constraints so that the vaccination programmes are not interrupted for extended periods of time but rather run efficiently and benefit the intended population. As a result pandemics are easily avoided and a healthy generation of children will bring about a better society. Methodology The study was carried out in two phases i.e. an observational study and a self-administered questionnaire. In the first phase, the observational study was carried out at 14 different clinics in the uMgungundlovu District. In the second phase, the cold chain management of vaccines by nurses was explored by means of a self-administered questionnaire. Results The key findings of the observational study include that on most occasions policy was not being implemented. Furthermore there were no contingency plans to deal with equipment and electricity issues, no monitoring and evaluation systems, poor recording keeping, poor management of the cold box, access to stock and the actual management of the cold chain for vaccines. The self-administered questionnaire was completed by 276 nurses via a simple random sample from the different clinics. The most salient aspects of the research in this phase of the study revealed that education and experience of the nurses are crucial to the sustainability of the childhood immunisation programme. Not surprisingly, some of the findings were similar to that of the observational study. Issues surrounding equipment and electricity, monitoring and evaluation systems, poor recording keeping, poor access to stock and ordering of stock were prevalent in this phase of the research as well. Conclusion Recommendations have been made for ongoing communication between the Department of Health, the District Office of Health and clinics so that the short and long term problems identified are solved.
The epidemiology of work related back pain in full-time restaurant waitron staff within the eThekwini Municipality
(2020-11-30) Wolff, Alexia Michaela; Haffejee, Firoza
Background Low back pain (LBP) is one of the leading causes of morbidity in high-, middle- and lowincome populations and is one of the most common and most expensive occupational health problems in developed and developing countries. This affects the working population as LBP has a detrimental effect on work performance, therefore it is an important clinical, social, economic, and public health problem affecting the population. Internationally, risk factors in the development of LBP in the working population include prolonged standing, awkward posture and incorrect lifting. There is limited literature on prevalence of LBP, the risk factors associated with LBP and its impact on waitrons in South Africa. This study aims to determine the prevalence, clinical presentation, risk factors and impact of work-related LBP amongst full-time restaurant waitron staff within the eThekwini Municipality. Methodology This study was a mixed methods study comprising qualitative and quantitative components. The quantitative research tool consisted of a previously validated selfadministered questionnaire whilst the qualitative component consisted of voice recorded semi-structured interviews using an interview guide to obtain information on low back pain from participants. The data collected from the questionnaires were entered into an Excel spreadsheet and thereafter analysed using SPSS. Descriptive statistics were used to describe categorical outcomes, whilst Pearson’s chi square or Fisher’s exact tests in the case of categorical variables, and t-tests for continuous variables were used to assess factors associated with LBP. The audio recordings from the qualitative interviews were transcribed verbatim and exported into a Microsoft Word document. Thereafter, thematic analysis was used to analyse the qualitative data to identify common themes and subthemes. Results Of the 340 questionnaires which were distributed, a total of 180 questionnaires were completed by waitrons in the eThekwini Municipality, resulting in a 52.9% response rate. The point, three-month period and annual prevalence was recorded at 50.0%, 62.2% and 78.2%, respectively. Within this population, LBP was associated with the ethnicity of the participants (p=0.002) where Indians had a 7.7 times increase in the odds of prevalent LBP compared with Black Africans (OR = 7.713; 95% CI = 1.273-46.718; p = 0.026) and Whites a 5.9 times increase in the odds of prevalent LBP than Black Africans (OR = 5.891; 95% CI = 1.429-24.289; p = 0.014). Low back pain was associated with the education of the participants (p = 0.002) where participants with high school education had an almost 12 times increase in the odds of prevalent LBP than those with tertiary education (OR = 11.967; 95% CI = 1.399-102.387; p = 0.023). Prolonged standing or walking during a work shift was associated with LBP (OR = 42.808; 95% CI = 2.346-780.985; p = 0.011). Onset of LBP was common during a long single shift or when working a double shift and pain sessions tended to last between one to two hours. The frequency of LBP experienced averaged two to three times a week, where pain was at its worst in the evenings. Low back pain in waitrons commenced gradually without injury and the severity of LBP was unchanged since it initially started. Low back pain resulted in moderate impact on the work of waitron staff, sometimes resulting in absenteeism and bed rest. Eight in-depth, qualitative interviews were conducted. Two main themes emerged from the data: low back pain characteristics and type of treatment. Interviewees discussed pain, onset and duration, and relieving factors as part of LBP characteristics, where they reported first experiencing LBP as young adults. Their onset of LBP was common during a long single work shift or when working a double shift. They re-iterated that prolonged standing and lifting or carrying heavy objects aggravated their LBP. Various therapies were used by interviewees to relieve the pain which included analgesics, antiinflammatories, heat therapy and topical gels. Type of treatment included chiropractic. There was good knowledge of the services offered by chiropractors and various types of chiropractic treatment available. Conclusion The prevalence of LBP amongst waitron staff within the eThekwini Municipality was high. Work-related factors were associated with the onset of LBP. These included prolonged standing, constant walking for long periods of time, carrying heavy loads and falling. Low back pain negatively impacted on their work due to absenteeism as bed rest was required. Various treatment options, including chiropractic were utilized. Participants had some knowledge of what constitutes chiropractic treatment and the types of services offered.
An evaluation of sick building syndrome amongst administrative employees in an office environment in Durban, KwaZulu-Natal
(2021-05-27) Moodley, Demi; Niranjan, Ivan; Ghuman, Shanaz; Nadasen, Naadiya
Introduction: Approximately 90% of the populace spends their time indoors. The building environment, in which an individual is ensconced, is directly related to the sustenance of the health of the human body as well as psychological well-being (Murniati 2020: 278). Sick Building Syndrome (SBS) has been a controversial topic over the years, as there are several definitions published in research. Nevertheless, common SBS symptoms and characteristics make it prevalent as a consequence of exposure to several possible indoor factors such as; low/ high temperature, inadequate ventilation, overcrowding, stress, poor building and ventilation maintenance, inadequate cleaning and pollutant accumulation. Methodology: This study focuses on investigating the association between indoor carbon dioxide levels (CO2), air flow rate, indoor temperature and the prevalence of SBS contributing to the health and wellbeing of employees in an administrative office building in Durban, KwaZulu-Natal. This was achieved with the use of two phases of investigation. A commonly used questionnaire on health, lifestyle and office conditions focused on their perceptions of the participants, regarding their environment. Thereafter, objective sampling of CO2, indoor temperature and air flow rate was conducted and assessed. Both sampling methods were discussed and assessed simultaneously in relation to the Biopsychosocial Model as the objective sampling further validated the outcome from the questionnaire results. Results: The results showed that there was a correlation between age (p-value < 0.01), female gender (p-value < 0.01; n= 135), psychological conditions and physical environmental quality (temperature, ventilation and CO2; p-value < 0.01) with SBS. No correlation was identified between lifestyle conditions, smoking behavior, ergonomic factors, noise and illumination with the occurrence of Sick Building Syndrome (p-value > 0.05). It can be said that more than half of the participants were unhappy due to their working conditions. This did not meet the 80% occupant satisfactory requirement in the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) standard 62.1. As a result of the below standard specifications and under maintained ventilation and air-conditioning system, an accumulation of CO2 occurred towards the end of the day with an overall low temperature on the sampling days. The accumulation of CO2 in the afternoon was a result of the extraction system which was not adequate to supply the level of overcrowding in the building. Furthermore, the negatively perceived environment added to the factors above resulting in the common SBS symptoms of watery eyes, dizziness, dry and burning eyes, fatigue/ tiredness, drowsiness/ lethargy, headaches, sinusitis, blocked /stuffy nose, runny nose, skin irritations, sore dry throat and influenza like symptoms being experienced amongst most participants. The most significant (p<0.001) symptoms experienced by participants were headaches and sinusitis. The defining factor which determined the prevalence of SBS was if the symptoms disappeared after a few hours of leaving the building and almost all (p-value <0.01; n=165) participants stated that this was true. Conclusion: It can be concluded employees in the office of study definitely experienced SBS. Finally, recommendations were suggested in relation to the hierarchy of control as well as transitioning into ‘green’ buildings. This is the first study in South Africa to associate SBS in an office using a multidisciplinary method since 1993 in South Africa (Truter 1993:1).
Framework to mitigate disruptive behaviours involving radiographers at central hospitals in Harare Metropolitan Province, Zimbabwe
(2022-09-29) Chinene, Bornface; Nkosi, Pauline Busisiwe; Sibiya, Maureen Nokuthula
Background Disruptive behaviours in healthcare have become an unprecedented global problem, transcending borders, work settings and professional groups. Concerns about their impact on patient safety has led many international medical organisations and other healthcare professions to escalate the urgency of knowing the prevalence, causes and consequences of these unprofessional behaviours in different healthcare settings. Evidence shows that assessing and mitigating disruptive behaviours is critical to empowering health workers to focus on delivering high-quality, cost-effective and safe patient care. However, there is a paucity of literature exploring disruptive behaviours involving radiographers in Zimbabwe. Additionally, there is no written policy to monitor and mitigate disruptive behaviours in the Zimbabwean radiography workforce. The challenge of disruptive behaviours is of significant concern for radiographers because they use radiation that has hazardous effects on living organism cells. Aim The aim of the research was to explore disruptive behaviours involving radiographers and the consequences thereof at central hospitals in Harare Metropolitan Province in order to develop a framework to mitigate these behaviours so that healthy radiography work environments are promoted. Methodology A mixed-methods convergent parallel approach using the parallel databases variant was employed. Disruptive behaviours from 100 randomly sampled radiographers were evaluated using a semi-structured questionnaire. In addition, in-depth interviews were conducted with 11 radiography managers selected by criterion purposive sampling, in order to explore factors and strategies to mitigate these behaviours. Findings Disruptive behaviours involving radiographers in HMP are rampant and create an unhealthy work environment that can lead to compromised patient radiation protection by negatively affecting the implementation of radiation protection protocols or procedures. Cultural and environmental factors relating to disruptive behaviours in Harare Metropolitan Province include a power hierarchy, the work environment and the absence of a reporting framework. Nevertheless, the strategies to mitigate these behaviours may include awareness, willingness to address the behaviours and conflict resolution.
A homoeopathic drug proving of Hoodia gordonii 30CH, with a subsequent comparison of proving symptomatology to its toxicology as a raw substance and to homoeopathic remedies of repertorial similarity
(2016) Swana-Sikwata, Tembeka Stella; Hall, Cornelia Maria
Introduction The aim of this study was to determine the effect of Hoodia gordonii 30CH on healthy provers, and to record the clearly observable signs and symptoms produced and the subsequent comparison to its toxicology as a raw substance and to homoeopathic remedies of reportorial similarity. Methodology The investigation was a randomised, double-blind placebo controlled trial, using the substance in the 30th potency. This was prepared according to the German Homoeopathic Pharmacopoeia. A sample of 20 provers, in good health, was recruited. Sixteen received verum as the experimental group and four in the control group received a placebo. Each of the 20 provers received a journal in which they recorded symptoms on a daily basis for a period of six weeks, including a one week observation prior to taking the powders, and a period of five weeks after administration of the powders. The information from the journals and case histories was edited, collated and translated into materia medica and repertory language and used to compile a proving profile of the remedy by qualitative methods. The remedy was only revealed to the participants after completion of the proving study period. The researcher compared the similarities and new symptoms of the remedy with the existing knowledge of its toxicology to prove the first hypothesis. A detailed and extensive literature review of Hoodia gordonii’s unique characteristics was conducted. A further comparison with other similar remedies according to the highest numerical number of rubrics on repertorisation was conducted. Results The proving remedy produced a wide variety of symptoms on the mental, emotional and physical levels of which many had polarities. In broad terms the following were identified from the proving symptoms of Hoodia gordonii: • Increased confidence and feeling refreshed, renewed energy, cheerfulness, concentration, alertness, calm, forgetfulness, unhappy, sadness and depression with desire to be left alone. • Anxiety for unknown reason and for the future, about finances; restlessness and busyness. • Tiredness, fatigue and exhaustion. • Positive feeling regarding home and family. • Mental exhaustion and aversion to study. • Common sensations were throbbing, pulsating, sharp, aching, heat, pressing, heavy, pulling, splitting, cramps. • Perceived attack or danger in dreams. • Painless diarrhea and constipation, nausea, headaches, vertigo, sore red eyes, nasal congestion and sinuses, toothache, tonsillitis and dryness of throat; bronchitis, heart palpitations. • Menses with breast tenderness and increased sexual stimulation, joint pain. • Unquenchable thirst, polyuria, appetite increase and decrease, sleeplessness and sleepiness with deep sleep, cold, increase perspiration, influenza and depressed immune function. Conclusion The data obtained from this proving study of Hoodia gordonii when comparing the new symptoms of the remedy with similarities to the existing knowledge of its toxicology proved the first hypothesis to be true. Three hundred and twenty four rubrics were produced and 17 were new rubrics; of these a total of 20 rubrics that represented the essence of the remedy were selected and used in the repertorisation process. A comparison of the highest numerical value of rubrics with other similar remedies on repertorisation found Hoodia gordonii 30CH to be most similar to: Atropa belladonna, Phosphorus, Lachesis mutus, Sulphur and Veratrum album.
An injury surveillance of patients utilising the Durban University of Technology (DUT) Chiropractic Treatment Facilities at the 2013 World Transplant Games
(2015-06) McBean, Michael John; White, Horace Lindsay; Nook, Deborah D.
Background: The 19th Iteration of the World Transplant Games was hosted in Durban, South Africa in 2013. This biennial, international, multisport event showcases the talents of transplant athletes, whilst demonstrating the benefits of organ transplantation. To date, limited research is available on transplant athletes. This study aimed to determine the injury profile of transplant athletes who presented to the Durban University of Technology Chiropractic Treatment Facilities during the 2013 World Transplant Games. Methods: This retrospective, descriptive cohort study analysed the data collected at the Chiropractic Treatment Facilities at the 2013 World Transplant Games. For inclusion, each WTG Form required completion, reflecting all the elements of that participant’s chiropractic consultation. The data recorded on the World Transplant Games Form generated the data analysed in this study. The data described the frequency (frequency tables), nature and management of injuries treated at the Chiropractic Treatment Facilities during the 2013 World Transplant Games. In order to determine relationships cross tabulations were used. Results: There were 964 athletes registered for the 2013 World Transplant Games, of which 153 presented to the Chiropractic Treatment Facilities (an utilisation rate of 15.9%). A total of 259 consultations by the athletes (n = 223; 86.1%) and non-athletes (n = 36; 13.9%) were recorded. The majority of the treated athletes were White (n = 91; 59.5%), males (n = 109; 71.2%), in which kidney transplant recipients accounted for 37.3% (n = 58) of the total number. Track athletics had the highest injury rate (34.5% of all reported injuries). Athletes sustained injuries to 14 different anatomical regions, with the thigh (26.9%) and shin/calf (20.5%) being the most frequently injured. The majority of injuries (n = 164; 66.4%) were “overuse” injuries, with myofasciitis, muscle strains and thoracic facet syndrome being the most frequently obtained diagnoses (25.5%, 16.6% and 6.5% respectively). The most frequently employed treatment modalities were those of massage (32.1%), ischemic compression (16.3%) and manipulation (13.4%). It was noted that the most injuries sustained (88.3%) were not severe enough to result in an inability to continue current or future participation. Conclusions and Recommendations: Transplant recipient athletes injuries concur with the literature on non-transplant athletes, indicating that solid organ transplantation does not predispose the athlete to different or more serious injuries which would require different management protocols by health care personnel treating these athletes. Further investigation into individual sports is encouraged, to develop accurate, effective injury management and preventative strategies to more appropriately diagnose and treat injuries incurred by transplant athletes and then to prevent them from recurring. An informed healthcare approach towards event organising and athlete treatment will improve preventative strategies and athlete management.
An investigation into the prevalence and risk factors of occupational low back pain amongst commercial pilots registered with the South African Civil Aviation Authority
(2015-03-06) Stander, Barend Jacobus; Matkovich, Grant
Background Occupational low back pain (LBP) has been described as a significant burden to society. Although there is uncertainty and conflicting studies on the exact causes and combination of causes of LBP, it has been found that occupations which require prolonged sitting periods and have exposure to physical factors such as whole body vibration (WBV) and / or awkward posture, results in increased likelihood for LBP. Pilots are not sheltered from the development of LBP, with the lifetime prevalence of LBP varying from 31.5% to a significant 82%. Additionally, point prevalence varies significantly between 5.1% and 68%, which illustrates that individual pilot and / or occupational factors may contribute to specific pilot subgroups. This could apply to commercial pilots, who use seats that were found to be ineffective in terms of their depth and inclination, therefore limiting the height and impact of the lumbar support. There is a paucity of studies performed on LBP relating to commercial pilots, specifically, on their unique occupational setting. Research is therefore warranted to illustrate the possible risk factors to which they are exposed to, as impeded performance may lead to catastrophic consequences if a pilot’s ability to complete actions critical to flight becomes hindered. Aim To determine the prevalence of low back pain (LBP) in commercial pilots and identify possible risk factors that pilots are exposed to. Study designs The study transpired as a cross sectional questionnaire survey. Participants Study comprised of 100 commercial pilots registered with the South African Civil Aviation Authority (SACAA) and affiliated with the various participating companies utilizing O.R. Tambo International Airport. Methodology All commercial pilots registered with the SACAA and who make use of the O.R.Tambo International Airport (operate through or from) and affiliated with the participating companies during the research study, was approached for participation. Pilots were required to sign and agree to the letter of information and informed consent, as well as the confidentiality agreement. Questionnaires were distributed and all documents were collected, following completion thereof. Pilots were not allocated to more than one group during the data collection (recording) phase of the study. Subgroup analysis was however not excluded in the analysis. IBM SPSS version 21 was used for analysis. A p value <0.05 was considered as statistically significant. Demographics of the pilots were described in the same manner as in the case of categorical variables, and using summary statistics such as mean, standard deviation and range for quantitative variables. Prevalence and characteristics of the low back pain is described using relative frequency and percentages, with 95% confidence intervals. Associations between risk factors and low back pain was identified with log linear regression analysis and tested using Pearson’s chi square test in the case of categorical variables and t-tests in the case of continuous variables. Results The lifetime prevalence of LBP amongst commercial pilots was 80.8%, with the annual prevalence reaching 68.7%. Majority of commercial pilots were white, married males, with nearly the entire population having reached similar educational levels. Considering the male predominance of this population, gender was significantly associated with LBP. Although the female population was much smaller than the male population, it was also found that females were six times more at risk of developing LBP; however the risk was not statistically significant. Awkward posture such as twisting and being stressed at work were found to be significantly related to LBP. Having a history as an ex-smoker or non-smoker was found to be a risk for LBP development. BMI was also significantly related to LBP; however, an inverse relationship is indicated. Having a subjective rating of good health versus excellent health was also an indicator of risk for LBP. Conclusion: Commercial pilots have a significant risk for LBP development. It was found that subjective ratings of own health was a good indicator of LBP whereby good health versus excellent health, was a significant risk factor. Although greater portions of the populace are white males, normally less at risk, a significant lifetime and annual prevalence of LBP was found. Furthermore, the small female population had potentially considerable contribution to the prevalence of LBP through their significant odds ratio. Being a current smoker carried less risk in comparison to a history of an ex-smoker or non-smoker, which further complicates the so often debated contribution of this proposed risk factor. Interesting results were found through the inverse proportional relationship that exists between BMI and LBP, whereby every unit increase in BMI results in a relative decreased risk for LBP development. Majority of the proposed risk factors of LBP was not found to be significant, except stress and twisting, which were found to be common risk factors amongst commercial pilots.
The relative effectiveness of homeopathic preparations of pythium spp. compared to Previcur (Propamocarb), in the control of pythium root rot (damping off) in cabbage and cucumber seedlings
(2002) Basson, Jo-Anne; Laing, Mark D.
The purpose of this study was to expand on the foundations laid by previous homeopathic research, using controlled agricultural experiments as an objective disease system. More specifically, these trials were to investigate and evaluate the efficacy of a fungicide (Previcur') against homeopathic preparations of a plant pathogenic fungus, Pythium, on seedlings infected with this fungus. Pythium is a worldwide problem and continues to cause substantial crop losses. Few chemical methods are available to control this disease and alternatives are being sought which are more cost-effective, safer for the environment and do not lead to pathogenic resistance. Relatively few trials using Homeopathy in plant pathology have been done to date. Furthermore, many of the earlier trials proved to have little scientific credibility, due to poor methods and insufficient data. More recent trials have shown interesting results, which have opened the doors for further investigation. This study compared the effects of Previcur\xAEagainst Homeopathic preparations of Pythium, on infected cabbage and cucumber seedlings. There were 28 trays for each crop and seven treatments per crop: four Homeopathic treatments (9CH, 15CH, 30CH and 200CH), two controls (one inoculated and the other un-inoculated) and Previcur'. The seedlings were treated twice weekly, using a 2.5ml drench per seedling, and were harvested three weeks after planting. The trial was run twice, in succession. Based on the nature of Pythium and the disease it causes, four parameters were measured in this trial. To assess the germination rate, the seedlings were counted three days after planting, to establish how many had broken the surface soil. To assess survival rate, the seedlings were counted at the time of harvesting. To assess growth, the seedlings were initially weighed wet (immediately after harvesting) and then dry (after 24 hours in an oven at 50\xB0C). The data was analysed by two methods: the General Linear Models Procedure (GLMP) produced ANOVA tables, which compared the variation between the four replicates of each of the seven treatments. The data was also analysed with the Student Newman Keuls (SNK) test, to determine the variation between the seven treatments. The results showed that Previcur®consistently produced the best or second best results, in terms of mean wet and dry weights, which was evident in the statistical analysis. However, a noticeable trend emerged with the 30CH treatment: it provided the lowest mean weights in seven of the eight parameters measured while showing evidence of consistent statistical significance from the other treatments throughout both trials. The implications were that this treatment had either enhanced the disease process or had suppressed plant growth. Student Newman Keuls (SNK) test, to determine the variation between the seven treatments. This trial raised issues regarding the effects of homeopathy on disease, as well as the internal mechanisms of disease control within plant structures. Further research into this area is encouraged, to further the platform already laid by statistically valid trials done thus far.
The risk factors of soil-transmitted helminth infections : a need for appropriate measurement methods
(2018) Amoah, Isaac Dennis; Stenström, Thor-Axel; Reddy, Poovendhree; Seidu, Razak
Soil-transmitted helminths are a major health concern, especially in tropical and sub-tropical regions. Poor sanitation and poverty are major pre-disposing factors contributing to increase in infections. Infection with STH is mainly through exposure to water, soil and food contaminated with the eggs of these parasites. Accurate detection and quantification of STH eggs in environmental samples is therefore critical for the determination of infection risks from exposure. Accurate detection of these eggs is also important in the adoption of risk reduction strategies. This thesis presents the development of a revised method for the accurate detection and quantification of STH eggs in different environmental matrices, such as wastewater, sludge etc. It further presents the application of this method in the comparative determination of STH egg reduction efficiencies of centralized wastewater treatment plants and decentralized wastewater treatment (DEWATS) plants in Durban, South Africa and Maseru, Lesotho. The concentration of viable STH eggs in dried sludge from Durban, South Africa and Dakar, Senegal was also determined and compared with both WHO guidelines and South African national standards for sludge reuse. The risks of infection with STHs for different populations exposed (directly and indirectly) to wastewater, wastewater contaminated surface water and sludge were determined using both quantitative microbial risks assessment and epidemiological approaches. Despite the plethora of methods available for the detection and quantification of STH eggs in the environment there is no internationally accepted method, however the most commonly used methods are based on the principles of sedimentation, differential flotation and microscopy. These are mainly adaptations of the WHO and USEPA methods. These methods were found to be similar with a few differences which affected the recovery rates reported. However, the major challenges with the conventional methods are the time needed for sample analysis and the use of reagents that could possibly affect the recovery of viable STH eggs. A new revised method was developed based on review of literature and laboratory experiments. In this method the heterogeneity of environmental samples was accounted for by the development of different pre-processing steps, involving the use of detergents to aid in the separation of eggs from particles in samples such as sludge, UD waste and untreated wastewater. Additionally, the use of sieves of different pore sizes ensured that the number of debris on the microscope slides was reduced considerably. The use of these sieves also reduced the time need for sample analysis, due to the elimination of the spontaneous sedimentation step, which is commonly used. This spontaneous sedimentation step takes between 12-24 hours therefore prolonging the time needed for sample analysis. Reagents such as acetoacetic acid and ethyl acetate were found to result in considerable loss of egg viability after just 5 minutes of exposure. This new method therefore does not involve their usage. The elimination of the use of acetoacetic acid and ethyl acetate step also reduces the number of steps involved in sample analysis. This reduces room for error as well as helping in fast analysis of samples. In addition to a much faster sample analysis the method has recovery percentages of 80.25% to 97.63% in sludge and wastewater samples respectively, with sensitivity of 2-3 eggs per liter in wastewater samples and 5-7 eggs per 20 gram of sludge. Exposure to STH eggs in the environment is mainly through wastewater, either treated or untreated, this exposure could therefore be eliminated through wastewater treatment. Centralized wastewater treatment systems are the most favored treatment options globally. These centralized treatment systems incur high cost of construction, maintenance and operations which may hamper the robustness in developing countries and rural areas. One of the most widely used alternative means of wastewater treatment is the anaerobic baffled reactors (ABRs) and planted gravel filters (PGFs) (collectively referred to as DEWATS in this thesis), which have been considered as low cost, effective wastewater treatment options. However, there is lack of comparative assessment of the STH egg removal efficiency of these two different wastewater treatment approaches. Eggs of Ascaris spp, hookworm, Trichuris spp, Taenia spp and Toxocara spp were the commonly recorded STH eggs in the untreated wastewater at the inlets of the centralized wastewater treatment plants as well as the DEWATS plants (except for Toxocara spp). There was variation in STH egg concentrations between and within the study areas, indicating difference in STH infections among the populations both in Durban and Maseru. STH egg removal varied between and within the different wastewater treatment plants as well. The DEWATS plants achieved 95-100% STH egg removals as compared to the 67 to 100% in the centralized wastewater treatment plants. This could be attributed to the difference in treatment processes. Among the different STHs, reduction in Ascaris spp eggs was significantly higher, irrespective of the type of treatment, which is attributed to the high relative density of the egg resulting in a higher settling velocity than the other STH eggs. Reduction or elimination of STH eggs through wastewater treatment is achieved by removing the eggs from the wastewater into the sludge. STH egg concentration in sludge is therefore mostly higher than in the wastewater. Sludge from Durban and Dakar after 60 days of drying under ambient environmental conditions contained very high concentration of viable STH eggs. Ascaris spp, hookworm, Trichuris spp, Taenia spp and Toxocara spp were the commonly recorded STH eggs, except for Dakar were Taenia spp and Toxocara spp were not detected in the sludge. STH egg concentrations were higher in Dakar than in Durban, with viable STH egg concentrations exceeding both the USEPA regulatory value (≤0.25 eggs/g TS) and the WHO guideline value (≤1 eggs/g TS). This variation in egg concentration could be attributed to the difference in prevalence and intensity of STH infections in the two study areas. Over a ten-month study period concentration of viable eggs in the sludge from Durban varied considerably, probably influenced by the environmental conditions. A decay rate of 0.0056 per day was calculated for egg die-off during drying. The rate of decay is low therefore drying alone cannot produce sludge meeting both local and international standards and guidelines for sludge reuse. Determination of STH infection risks due to exposure to wastewater and sludge either directly or indirectly is critical in the prevention of infection. Exposure to the effluents during wastewater irrigation is one major route of infection. STH egg concentrations in the final effluents from the centralized and DEWATS wastewater treatment plants were consistently higher than the WHO recommended guideline for unrestricted agricultural use (≤ 1 helminth egg/L), whereby the direct reuse of the effluents for agriculture was found to pose a higher risk than the WHO tolerable risk of infection (1 ×10-2 pppy) for farmers and consumers. Annually the use of effluents from the DEWATS plants poses the least risk of infection (1.9 ×10-2 (±2.4×10-4)), which is marginally higher than the WHO tolerable risk value. Well maintained DEWATS plants are more efficient in removing or reducing the concentration of STH eggs in wastewater and therefore pose the least risks of infection compared to centralized wastewater treatment plants. Consumers of vegetables from these farms are also at considerable risks of STH infections. Probabilistic assessment of the STH infection risks showed that farmers applying sludge from Durban and Dakar without adequate protective measures had risks of infections higher than the WHO tolerable risks figure (1×10-2 pppy). Based on the estimated risks of infection after decay, exposure to farm soil after 40-50 days of sludge application may reduce the risks of infection to levels lower the WHO tolerable risks value. However, this may not be practical due to the need for farmers to attend to their crops frequently. Incorporation of the decay of the eggs into the risks assessment also indicated that, using lettuce as a representative vegetable, harvesting of vegetables in Dakar could be done after 40 days of sludge application to reduce the risks of infection to the WHO tolerable value but in Durban harvesting after 30 days ensures that consumers are protected. Therefore, to protect both the farmers and consumers exposed to STH eggs through wastewater/sludge reuse in agriculture the implementation of the WHO multi-barrier approach to risk reduction is required. Risks of STH infections could be directly estimated using epidemiological approaches. By using this approach, the concept of STH infection risks for farmers using wastewater was assessed through direct measurements of the concentration of STHs both in wastewater used for irrigation and the farm soil, as well as the actual load of STHs ova in the stool of farmers and their family members. In Kumasi, Ghana, wastewater used for irrigation of vegetables and the farm soil contained high concentration of STH eggs. There was positive correlation between STH concentrations in the wastewater/soil and STH eggs load in stool of the exposed farmers. Stool analysis after 3 months, following deworming, showed a fast re-infection rate. Farmers exposed to the wastewater were three times more likely as compared to the control group of non-farmers to be infected with Ascaris spp (OR = 3.9, 95% CI, 1.15-13.86) and hookworm (OR = 3.07, 95% CI, 0.87-10.82). These risks of infection were higher in the rainy season than the dry season. This corresponds to a higher egg concentration in wastewater used for irrigation during this period. This indicates a relationship between STH infection and egg concertation in the environment. This study therefore contributes to the evidence-based conclusion that wastewater irrigation contributes to a higher incidence of STHs infection for farmers. In conclusion, this thesis therefore presents a new revised method that can be used to determine the STH egg concentration in different environmental samples. The development of this method also provides an opportunity to comparatively assess the STH egg reduction/removal efficiency of the more commonly used centralized wastewater treatment plants and DEWATS plants. The accurate quantification of viable STH eggs provide inputs for the probabilistic assessment of STH infection risks for different populations exposed to effluents from these two wastewater treatment approaches. This assessment of risks provides a public health perspective to the wastewater treatment. Additionally, it was concluded with the used of this method that drying of sludge for 60 days in Durban or Dakar does not produce sludge of good quality for agricultural application. This was confirmed by the estimates of STH infection risks determined using quantitative microbial risks assessment. This thesis therefore shows the importance of accurate quantification of STH eggs in the determination of infection risks either though QMRA or epidemiological approache
A study of the effectiveness of homoeopathically prepared dilutions of abscisic acid, molybdenum and allopurinol in inhibiting or promoting the germination of barley seeds (Hordeum vulgare)
(2008) Evans, Nicole Paula
Introduction This study investigated the effectiveness of homoeopathic dilutions of abscisic acid (ABA), molybdenum and allopurinol on inhibiting or promoting the germination of barley seeds (Hordeum vulgare cv. Stirling, ex Caledon, Western Cape, South Africa, 1998 harvest). Recent research involving ABA and seed germination has shown mixed results, with Bruni (2001), finding there to be statistically significant biological effects, but Couchman (2001) not. Objective/Aim/Purpose The purpose of this study was to evaluate the effectiveness of homoeopathic dilutions of ABA, molybdenum and allopurinol (two substances which have an effect on ABA metabolism), especially those above the 10-23 level (Avogadro’s dilution limit), on germination, in light of recent findings. Abscisic acid, a plant hormone and molybdenum, a trace element, both play an essential role in inducing dormancy of the seed. Allopurinol, a therapeutic drug, has also been shown to affect ABA metabolism and therefore seed germination. The study used all three substances individually and in combination, in homoeopathic dilutions ranging from 4CH to 200CH potency. Methodology There were 7 treatments with 5 potencies per treatment (4CH, 9CH, 15CH, 30CH and 200CH). Each potency level for each treatment had a control, which meant there were 5 controls per treatment. The seeds (distally cut) were placed in 9cm Petri dishes (20 seeds in each), with 5 repetitions, 100 seeds per dilution level with one control of 20 seeds. There were thus 600 (120 x 5) seeds per treatment and 4200 seeds in total (600 x 7 treatments). Seeds were germinated in the dark at a constant temperature. Counts were done every 24 hours for 3 days and the data recorded. The criterion for germination was radical emergence. Results The data was analysed statistically using Univariate Analysis of Variance (STATISTICA version 6). The results showed statistically significant interaction between treatments and potencies and a One-Way Anova was then used to analyse each treatment to determine the effectiveness of each potency. Statistically significant differences were noted between potencies for each treatment. From the results it was clear that the most effective treatment for stimulating germination was the treatment utilizing homoeopathic dilutions of allopurinol. The most effective treatment for inhibiting germination was the treatment utilizing ABA in homoeopathic dilutions. The 30CH (10-60) showed a statistically significant effect on the stimulation of germination across almost all treatments, whereas the 15CH (10-30) showed a statistically significant effect in inhibiting germination in most treatments. Conclusion It is evident from the results of this study that all the treatments produced distinct biological effects, whether it be stimulating germination or inhibiting germination in homoeopathic dilution.