Theses and dissertations (Health Sciences)

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Back pain and its relationship to socio-demographic and psycho-social factors in a cohort of pregnant women attending a primary health care clinic in the eThekwini municipality
(2019) Hawker, Carmen; O'Connor, Laura
Background: The prevalence of back pain and general discomfort is not uncommon in pregnant women, often being under-reported until it affects their daily routine. South Africa, a third world developing country has unique risk factors and demographic profile. Although many studies have previously studied the various factors relating to back pain in pregnancy, this topic is far from being exhausted as a research area. Specifically, new studies should be conducted on the prevalence of back pain in pregnancy to analyse the impact it has on women worldwide. Little research has been conducted on rural communities in Africa especially in South Africa, to assess the risk of pregnancy-related back pain. Therefore, the information obtained from this study will provide a better understanding of the demographics, physical demands and psycho-social stresses experienced by pregnant women in this understudied population. Back pain and general discomfort is not uncommon in pregnant women, but it is often under- reported and can be disabling. International studies report a high prevalence especially in the last trimester. Little is known about the prevalence of and risk factors for back pain in South African pregnant women. Thus, this study aimed to determine the relationship between socio-demographic and psychosocial factors in a cohort of pregnant women attending a primary health care clinic in the eThekwini municipality of the province of KwaZulu-Natal, South Africa. Method: A retrospective descriptive cohort design was utilized whereby 382 participants’ files were assessed for eligibility. The files consisted of a socio-demographic questionnaire, a chart review and two epidemiological questionnaires that were administered to the participants during the first and third trimester. Permission to access these files was obtained from the principle investigator of the MRC/DUT project. All participants signed consent forms for research purposes. The data relevant to this study was extracted and analysed using Statistical Package for the Social Science version 24.0 (IMB Analytics). Descriptive statistics were used to describe the data in terms of means and standard deviations or frequencies and count where appropriate. Inferential statistics allowed for relationships between the variables to be assessed. A p - value of less than 0.05 was used to indicate statistical significance. Results: The total of 303 files were included. Participants were Black Africans, mostly single (81.2%, n=229) with a mean age of 25.84 (±SD 6.04). There was a high unemployment rate (70.8%, n=199), with most having obtained a secondary education (77.1%, n=213), and 44.1% (n=122) residing in squatter camps. There was a high human immunodeficiency infection rate (40.5%, n=94). Of the 303 participant files eligible for the study only 46 returned for the third trimester follow up. The prevalence of BP in the first trimester was 12.4% (n=35) and 10.9% (n=5) in the third trimester. LBP was the most (8.5%, n=24) in the first and 10.9% (n=5) in the third trimester, followed by UBP and NP. The incidence of back pain over the duration of pregnancy was zero. Being single (p = 0.03), reporting no stress (p = 0.04), not using pain killers (p = 0.01), and no alcohol consumption in the current pregnancy (p = 0.03) were associated with a decreased risk of back pain. There were no relationships found between the variables and back pain prevalence in the third trimester. Conclusion: The women attending this primary health care clinic are relatively young, come from a low socio-economic area with low reported levels of stress and substance abuse. They reported low levels of back pain. The follow up rate at the third trimester was low and this may skew the results of this study. Further research is needed in this community and South Africa to appreciate the prevalence and impact of back pain in pregnancy.
A case-control study investigating factors associated with neck pain in the indigenous African population in the greater Durban area
(2006) Ndlovu, Prisca Zandile; Korporaal, Charmaine Maria
Neck pain is a common complaint and a common source of disability in the general population with a point prevalence of nearly 13%. Reports indicate that industry related neck disorders (lifetime incidence of nearly 50%) account for as many days of absenteeism as low back pain; one could compare the two clinical conditions in terms of these trends on a global scale. To investigate whether similar trends do exist, 200 participants with neck pain and 200 asymptomatic participants (stratified sampling according to age and gender) that consented to the research were clinically assessed. These participants also completed a questionnaire addressing the factors that have been identified as related to neck pain at the consultation where they were assessed. This research did not involve the treatment of the participants, although a free treatment was given for patients that opted for one or to those that required it post participation in the study. If treatment was outside the scope of the chiropractic clinic, the participants were referred to the appropriate health care provider. The aim of the study was to investigate factors associated with neck pain in the indigenous African population in the greater Durban area. Data was analysed according to the following: Descriptive statistics were interpreted by means of frequency tables, pie charts, bar graphs and / or in a tabular format in order to describe the sample characteristics of the population under study. Inferential statistics included regression analysis in order to determine any relationships between the patient‟s neck complaint characteristics and factors associated with the complaint. SPSS version 11.5 was used for data analysis (SPSS Inc, Chicago, Ill, USA). A p value of <0.05 was considered as statistically significant. Descriptive analysis involved presenting or graphing categorical variables as counts and percentages, and quantitative variables as medians and interquartile ranges due to the skewness of the data. Associations between factors and neck pain were examined bivariately using Pearson‟s chi square or Fisher‟s exact tests as appropriate for categorical factors, or Mann-Whitney tests in the case of quantitative non-parametric data. Finally in order to examine the adjusted independent effects of all factors which were found to be individually significant in the bivariate analysis, multivariate binary logistic regression analysis was done. A backwards elimination modelling technique was used, based on likelihood ratios, with entry and exit probabilities set to 0.05 and 0.010 respectively. Results were reported as odds ratios, 95% confidence intervals and p values. Chi squared analyses was utilised to assess the strength of the relationship and the degree of significance of the relationship. All statistics were analyzed at a confidence interval of 95% and a level of significance where α ≤0.05 (pvalue). The symptomatic participants seemed to be less well educated than the controls. The cases seemed to be less in full time employment, less unemployed, and more self employed than the controls. Income was unevenly distributed among cases and controls. The cases who were working seemed to earn less than the controls who were working. The duration of having neck pain was mainly 1 month. The majority of cases classified their pain as mild. Most participants felt that their pain was worst in the afternoons or related to activities, while they felt their pain was least in the mornings. Frequency of neck pain was mainly constant (36.5%), followed by frequent (32.5%) and seldom (25%). Symptomatic participants mostly reported that their pain began without injury, gradually in 67.5% and abruptly in 13.5%. Fewer symptomatic participants reported pain beginning after an injury (n=22 gradually and n=7 abruptly). The majority reported their neck pain to be stable (38%), while 34% felt it was getting worse and only 19% getting better. More than half of the cases reported difficulty with work due to neck pain. Fewer reported difficulties with daily activities such as washing (30%), sleeping (26%), and lifting (24%). Almost half of the cases rated their disability as none (48%). Only 16% reported severe disability. Thirty-three percent (n=66) reported having been absent from work due to neck pain. The duration of absence in those who were absent was mainly 0-1 week (89.4%). 59 (29%) reported being bed-ridden with neck pain. The most frequent duration was also 0-1 week (81.4%). Ninety three point five percent reported no change in occupational status, while 6 (3%) were demoted, 5 (2.5%) boarded, and 2 (1%) fired. With respect to associated signs and symptoms, 156 (78%) reported to suffer from headaches. In addition, symptomatic participants were asked if they associated their neck pain with any other activities. The most commonly reported factor was stress (22%), followed by bad posture (17%). The other reported factors were reported infrequently. Participants who worked in occupations that involved driving, turning neck, answering the telephone, working in an air-conditioned room, and bending over a desk were significantly more at risk of being cases than controls. Non-occupational factors which were associated with neck pain were worrying a lot, motor vehicle accident, not enough bed support, not using arms to support a book, sitting without back or arm support, not watching TV a lot, and exercising. The results of the study suggest that neck pain within the indigenous African population is associated with the level of education, income, stress levels, bad posture, repetitive movements of the neck, and motor vehicle accidents. It was also found that most of neck pain patients do suffer from headaches. The findings show that neck pain is mostly classified as mild in nature with 1 month duration. Although neck pain was reported to be responsible for at least 7 days of absenteeism from work, causing difficulty with daily activities, most patients reported no disability as a result of neck pain.
A clinical audit of the Durban University of Technology homoeopathic satellite clinic established at Ukuba Nesibindi
(2010) Smillie, Tracey; Naude, David F.; Ngobese, Jabulile Cresancia
In collaboration with Lifeline, Durban University of Technology (DUT) established its first satellite homoeopathic community clinic; Ukuba Nesibindi Homoeopathic Clinic (UNHC). UNHC provides a free homoeopathic primary healthcare service on the third floor of the LifeLine building in Warwick junction, Durban, an area which is classified as being disadvantaged with high crime rates, prostitution, violence, small, informal business and low cost housing. The clinic is run by 4th and 5th year homoeopathic students under the supervision of a qualified homoeopathic practitioner and funded totally by the Department of Homoeopathy – DUT. The purpose of this retrospective clinical audit of UNHC was to determine a patient demographic and disease prevalence profile, as well as identify and describe the major medicines prescribed. Methodology The study used a retrospective, explanatory, and descriptive design method by means of a clinical audit, to determine a patient demographic and disease prevalence profile, as well as identify and describe the various homoeopathic treatment modalities. All the patient files from June 2004 – June 2008 were included for analysis and the data collection spreadsheet (Appendix D) was compiled respectively. IV The data collection form was divided into patient demographics, information on number of consultations and follow-ups, clinical diagnoses, urine dipstick analysis, patient referral information and medicines prescribed. The researcher captured the data, which was analysed and various means of descriptive statistics applied using Excel from Microsoft Office® 2007. Results UNHC opened in 2004 and initially only operated two afternoons per week; in order to cope with the demand for this service which grew rapidly in 2006 an additional consultation afternoon was added. A total number of 862 patients were seen between June 2004 and June 2008, 497 being new patients and 365 being follow up patients. On average 56% of patients came back for more than one follow up consultation during the study period. The majority of patients who attended UNHC during the study period were African females between 40 and 64 years of age who were unemployed and single. Of the 5 most prevalent systemic disorders encountered at UNHC infectious disorders were the most frequent along with cardiovascular, dermatological, psychological and musculoskeletal disorders. Conclusion The significant increase in patient numbers at UNHC and the relatively high percentage of patients who returned for more than one follow up consultation are positive trends and suggestive of UNHC’s success in providing homoeopathic primary healthcare as well as the positive impact it has had on the surrounding community. With additional funding UNHC can improve service provision further; dedicated translators as well as various equipment to facilitate administration will streamline the consultation process significantly and allow for more patients to be seen. Expansion of the scope of diagnostic services provided such as pregnancy and glucose testing will reduce the need for referral for such basic services. V Future studies should formally measure patient benefit in response to treatment in the form of a patient benefit survey; qualitative measures of patient satisfaction with the service provided by UNHC are also warranted.
Dental laboratory waste management in respect of reusing and recycling in KwaZulu-Natal
(2018) Ngombane, Yonela; Bass, Gregory Hylton; Ross, Ashley Hilton Adrian
This qualitative study explored the management of waste in commercial and training dental laboratories in order to determine the practices and attitudes of dental technology practitioners and academics towards reusing and recycling dental laboratory waste products, and alert them to the benefits of waste management on the environment. The research objectives were to establish and report on the extent of waste management that entails waste reduction through reusing and recycling, to uncover alternative uses for dental laboratory waste and the possible economic benefits thereof and to influence dental technology industry on environmental sustainability. The research project was conducted in the interpretive paradigm. In the course of this study dental laboratory owners, dental technicians/technologists and academics from the dental technology programme at a training institution were interviewed. Waste handling in dental laboratories was observed in order to gain greater insight as to current practices in laboratories. Thematic content analysis was employed to analyse the qualitative data. This study found that waste management was poorly understood and practiced amongst the dental laboratory owners, dental technicians/technologists and academics. The study adopted a waste management hierarchy conceptual framework which was influenced by the Waste Act (Act No. 59 of 2008). The negative attitudes towards responsible waste management practices and the poor understanding of waste management by dental laboratory owners, dental technicians/technologists were found to be as a result of the poor understanding of the possible impact that waste from dental laboratories can impose on the environment. The perceived lack of participation in constructive waste management legislation by the South African Dental Technicians Council was also seen to be a contributing factor to the negative attitudes towards responsible waste management practices within the industry. This finding reinforced the finding that the dental industry has no knowledge, understanding and desire to understand waste management and, more importantly, to understand that one does not practice things solely for legislative reasons but that there are economic as well as environmental reasons to practice constructive waste management. On the other hand, this study found that the industry was not averse to engaging in environmental friendly practices provided there is financial gain. This was established after the benefits of waste management practices were explained to the industry.
An epidemiological investigation of food-borne disease surveillance in the Ncera Villages, Eastern Cape, South Africa
(2018) Bisholo, Khanya Zukolwakhe; Ghuman, Shanaz; Haffejee, Firoza
An increase in food-borne disease burden in the world’s population has raised concerns over the reliability of surveillance systems. Research has shown the importance of food-borne surveillance systems used in the detection and management of food-borne illness. Government fiscals are increasingly burdened by the rapid spread of food-borne illness, although the exact economic impact is unclear in many countries. In recent years, food security has been the main agenda overshadowing food safety. A reactional approach to outbreaks is the trend instead of proactive systems. Food-borne disease is associated with low and high socio-economic status populations. More than 30 pathogens were identified as the major causes of food- borne outbreaks globally, and some food-borne pathogens have long term health consequences. Aim: The aim of the study was to investigate food-borne diseases surveillance in Ncera, Mpongo and Needscamp villages and local clinics, in the Eastern Cape, South Africa. Methodology: A retrospective, observational, quantitative study was conducted in two phases. The first phase included the screening of tick registers at Ncera, Mpongo and Needscamp clinics. The screening was to determine the number of food-borne cases that were reported at these clinics. In the second phase, a stratified random sampling method was used to interview 90 households from the above-mentioned villages to determine the number of villagers who suffered from food-borne diseases, symptoms experienced and food safety practices. Results from both phases were compared to determine whether the number of reported cases at the clinics reflected the same number of cases in the villages from 2012 to 2014. The total size of the study population was 5007 people. Respondents were invited to participate having signed informed consent. Data was summarised and described using descriptive statistics such as frequencies, means and standard deviations. Data was analysed using SPSS version 23; cross tabulations and Chi-square tests at a probability of p< 0.05 were done. Graphs and tables were used to graphically represent the data. Results: It was found that the majority of household heads were female (n = 51; 58.6%) and 33 (37.9%) of them were married. Most of the residents (n = 84; 96.5%) use the public health clinics for their medical condition treatment. Fifty-six (64.4%) household heads were HIV negative. The majority of households had a monthly income of R1 500 – R 3 500 (n = 45; 51.7). Less than a tenth (n = 6; 6.9%) of household heads were very concerned about the safety of food prepared at home. The relationship between food safety concern levels about food prepared at home and away from home was statistically significant (p = 0.000), reporting a significant difference in the way people perceive the preparation of food at home and away from home. More than a tenth of the villagers (n = 79; 19.7%) reported through the questionnaire, that they fell ill or thought that they fell ill from something they ate in the past 3 months. More than half (n = 56; 51.3%) of the participants who fell ill with food- borne diseases in these villages did not seek medical treatment for their illness whilst 6 (54.6%) did not see the need to seek medical treatment and reported that they got ill during weekends. Of those who sought medical treatment, 16 (39%) received prescribed medication while 3 (7%) reported that they were not provided with medication by healthcare providers when they suffered from food-borne illness. More than a quarter (n = 109; 27.3%) of household members fell ill from food-borne diseases in Ncera, Mpongo and Needscamp villages during the period 2012 to 2014. Whereas there were four food-borne cases reported to the clinics in the same period. Conclusion: This research gathered information regarding food-borne disease prevalence in Ncera, Mpongo and Needscamp villages. It was observed that there is a gap in the surveillance of food-borne illness in these villages. In some of the tick registers used by healthcare providers at clinics to collect data, vital surveillance information such as gender, age and diagnosis was missing. This study deepens the understanding of food-borne illness and food safety in a village setting.
The evaluation of the quality of sanitation and stored water for domestic use in the Umlazi P Section informal settlement
(2021-12-01) Shangase, Simangaliso Idiom; Pillay, Pavitra; Ndlovu, T. S.
Background The quantity of water delivered and used for households is an important requirement for life as well as basic personal hygiene. Simple hygiene measures have become paramount due to corona-virus 2019 (Covid-2019). South Africa still lacks basic infrastructure to supply adequate quantities of water to all. This problem is exacerbated in the growing informal settlements where infrastructure is limited. A growing awareness shows contamination of water can occur during collection and storage. This results in the deterioration of water quality to the extent that the water becomes undrinkable. Contributing factors include the cleanliness of storage containers as well as the environment in which they are stored. The aim of the study This study aimed to investigate the quality of stored water and the related handling of storage vessels after collection for domestic use at the informal settlement of the Umlazi P Section, in the south-west of Durban. The study objectives The objectives of the study were to determine the knowledge and awareness of water contamination and how water resources can be protected. To discover the exposure of drinking water to waterborne pathogens due to poor storage and hygiene practices using a questionnaire. To test stored water samples for pathogenic organisms using acceptable laboratory methods and compare the findings for compliance with the South African Water Quality Guidelines for domestic use (SANS 241: 2015). To test the pH levels and macroscopic appearance of stored water in order to assess the extent of natural organic and corrosive substances dissolved in domestic water. Study Design This was a descriptive cross-sectional quantitative study aimed at analysing data of exposure of Umlazi P section residents to contaminated water resources. Data collection entailed the administration of a questionnaire to 269 participants, including the laboratory analysis of water samples collected from water storage containers used in each household. Data collection tools The questionnaire was used to obtain information on behavioural characteristics of the participants concerning their knowledge, awareness of practices related to water contamination, storage and waste management. The laboratory analysis of stored water samples included testing for the presence of pathogenic organisms, testing of pH and an analysis of the macroscopic appearance of the water. Laboratory findings were compared in compliance with the South African Water Quality Guidelines for domestic use. Results Majority of the participants (98.5%) indicated they use municipal water services for their daily needs. It was found that most residents (88.1%) did not have any prior education on water storage and (76.6%) indicated a lack of understanding of water contamination. There was a lack of proper hand hygiene and handling of stored water among 48 households (18%). Almost all respondents indicated that they stored their domestic water in buckets which were kept closed when not in use, and (83.3%) indicated that they cleaned the storage containers by washing it in cold water only. It was found that half of the participants are unemployed and 32% of them use pit latrines as toilets. Most of the respondents found the taste of the water palatable. A positive total coliform count was found among 13 (5%) households in the study, rendering their drinking water a high risk for domestic use, 9/13 of these households used pit latrines. The high-risk coliform count, despite it only accounting for 5% of the population is of great concern. Testing results also showed a zero count for Escherichia coli (E.coli) making drinking water acceptable in terms of faecal coliform bacteria. Discussion and Conclusion Results indicate a clear need to develop educational programmes that will enhance knowledge of water contamination to improve water quality. These educational programmes need to focus on hygiene practices to minimise water contamination. Infrastructure development remains a key recommendation as it plays an important role in the removal of human faecal waste in the distribution of water to communal taps. The infrastructure development must entail the provision of more taps to avoid overcrowding and provision of flushable toilets as an effective waste removal method. While the Municipality has played a role in the removal of solid waste, more needs to be done to accommodate all residents in informal settlements to prevent illegal dumping which increases environmental pollution. Considering the variability of water storage periods (between a week to a month) due to the distance between settlements and collection points, the provision of low-cost quality storage containers and treatment chemicals by the Municipality is recommended. The Department of Housing, Water and Sanitation, Health, Education and other Non-Governmental organisations need strengthening of inter-sectoral collaboration to improve the quality of life in informal settlements. The National Water Act of 2003 outlines the role of local government concerning water resources of equitable allocation of water to all citizens and redistribution as well as removal of discriminatory laws that prevent equal access to water (Republic of South Africa – Government act 61 of 2003).
An exploration into students' perceptions regarding dropout within the chiropractic programme at a University of Technology
(2018) Buthelezi, Nqubeko Lizwilenkosi; Ngxongo, Thembelihle Sylvia Patience; Ngobese-Ngubane, J.
Introduction: Chiropractic is a health profession specialising in the diagnosis, treatment and prevention of disorders affecting the bones, joints, muscles and nerves in the body. It is a type of alternative or complimentary medicine concerned with the relationship between the body's structure and its functioning. The Durban University of Technology (DUT) and University of Johannesburg are the two internationally accredited academic institutions in South Africa to offer the chiropractic programme. The Chiropractic Department at the DUT is one of 13 departments within the Faculty of Health Sciences. A student who successfully completes the chiropractic-training programme becomes registered as doctor of chiropractic by the Allied Health Professions Council of South Africa under Act 63 of 1982 (as amended). However, a number of students drop out from the chiropractic programme before completion. Some of these students transfer to other programmes; others deregister and leave the university, while others are excluded because of the progression rule or because of having exceeded the maximum duration of the programme. Aim of the study: The aim of the study was to explore and describe the perceptions of the students regarding dropping out from the chiropractic programme at the DUT. The study aimed to answer three research questions, which were: 1) what are the perceptions of students regarding dropout from the chiropractic programme at the DUT? 2) what are the determinants of student dropout from the chiropractic programme at the DUT? and 3) how can the dropout rate in the chiropractic programme at the DUT be minimised? Methodology: A qualitative, explorative, descriptive and contextual design was employed. The DUT was used as a data collection site. Data was collected between May and June 2018 using one-on-one semi structured interviews with 12 former students who were previously registered for the chiropractic programme and dropped out before completion. Tesch’s eight steps of data analysis guided thematic data analysis. Findings: The students’ perceptions regarding dropout from the chiropractic programme were grouped into five major themes and several subthemes. The major themes included financial constraints, post course employment, personal, course related and socio- cultural factors. All these themes were, according to the participants, determinants of student dropout from the chiropractic programme. Recommendation from the study findings focused on how the dropout rate in the chiropractic programme could be minimised. Conclusion: The study discovered that, according to the students’ perceptions, there are several determinants of the high dropout rate from the chiropractic programme. Some of these are intrinsic chiropractic programme factors such as course structure, workload and assessment strategy. However, other determinants are outside the programme and generic to all university disciplines/programmes. Nevertheless, it is still critical that attention be given to all determining factors to facilitate retention of students into the chiropractic programme. Recommendations: The following recommendations with special reference to policy development and implementation, institutional management and practice, chiropractic education and further research, are presented. The national and institutional policies regarding application and administration of financial aid should be reviewed and guidelines for application and appeals procedures should be made known to students. Student teaching and assessment strategies should be reviewed periodically and input from students be invited. The Chiropractic Department should ensure that information about the programme and qualification is made available to the public. The chiropractic curriculum should include entrepreneurship to provide information and guidance on how to set up own private practice. The chiropractic programme should institute measures of decolonising the programme in order to address challenges of racial discrimination. A broader research study on reasons for student dropout is recommended.
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.
Factors influencing radiographer’s decision making in relation to postgraduate education
(2020-06-10) Mohabir, Ishan; Naidoo, S.; Sibiya, M. N.
Background The research and knowledge produced by postgraduate (PG) alumni is vital in improving the knowledge base of relevant fields. Postgraduate education is essential for an individual’s academic growth and a nation’s economic growth and development. South Africa is lagging behind with regard to PG outputs in various disciplines and radiography is one of them. Radiography is a relatively young academic profession in South Africa. Therefore, PG qualifications are critical to the development of the profession of radiography, both academically and clinically, to strengthen the academic force. The loss of academics, due to retirement and other reasons, necessitates the development of new academic professionals to replenish this expertise. Aim of the study The aim of the study was to explore the factors influencing radiographers’ decision making with regard to postgraduate (PG) education using Cross’s Chain-ofResponse (COR) Model as the theoretical framework to improve the enrolment and quality of PG education. Methodology The study employed an exploratory qualitative research method, using semistructured one-on-one interviews. The interview questions were based on Cross’s Chain-of-Response (COR) Model. The study was carried out at three provincial hospitals in the eThekwini district of KwaZulu-Natal (KZN) as well as three private facilities within the district. The sample consisted of 20 qualified radiographers within these institutions. This research utilized an exploratory design and interpretivist paradigm. Thematic analysis of the collected data was performed with the use of the Atlas.ti software and the implementation of the code, re-code strategy. Findings Seven major themes that emerged from the data analysis were: (a) self-perception (b) attitude towards education (c) goals and expectations (d) life transitions (e) opportunities and barriers (f) information and (g) participation. The emerged themes were aligned to Cross’s Chain-of-Response Model. Conclusion The study revealed that the practicing radiographers in KZN exhibit a high selfperception of their capability of successfully completing PG programmes in radiography. However, many of the participants demonstrate little or no interest in pursuing these programmes. Their attitude and decision making towards pursuing these programmes are negatively influenced by a multitude of factors such as the absence of incentives, lack of time and institutional grievances. Participants consider PG programmes in radiography to simply provide opportunities in the academic field to achieve personal growth and satisfaction. Incentives such as potential growth in their field, monetary gain and/or a subsidy would be the strongest motivating factors to positively influence radiographers’ decision-making towards PG education.
A model to improve the quality of life for elderly people living in a rural setting of uThungulu District, KwaZulu-Natal
(2016) Ndlovu, Busisiwe Adelaide; Sibiya, Maureen Nokuthula; Puckree, Threethambal
Background An increase in the world's population of ageing people is occurring not only in developed countries but also in developing countries. In South Africa, the proportion of the population aged 50 and over increased from 14.8% in 2006 to 15% in 2009 and is predicted to be 19% by 2030. This means that the supply of services for the elderly people should match the demand at all times, otherwise the quality of life of these senior citizens will be compromised. This study aimed at developing a model that would improve the quality of life for elderly people living in the uMhlathuze and uMlalazi sub-districts of the uThungulu district, KwaZulu-Natal. Methodology A qualitative, exploratory, descriptive design was applied for this study. A semi-structured interview guide based on the Health Related Quality of Life Theory and Maslow’s hierarchy of needs was used. Random sampling was used to select the elderly participants. Purposive sampling was used for the selection of the chairpersons of non-governmental organisations, and the District Programme Manager. Audits were conducted in the clubs that elderly people with chronic disease participate in. Data analysis followed Tesch’s steps after which themes and categories were formulated. Results Three major themes that emerged from the data analysis were social well-being of elderly people, physiological factors and psychological factors. The results revealed that elderly people experience poor living conditions and suffer poverty due to a number of factors which including the high unemployment rate of their children. Often the children are involved in substance abuse using the elderly person’s money pension money, which leaves them without any food items in the household. According to the District Programme Manager, there was a project on integrated chronic disease management that was conducted at uThungulu district by the Department of Health. The integrated chronic disease management focused on the population in general of all ages, yet in this study the focus has been on elderly people, which is why the researcher developed a model to improve the QoL of elderly people, due to their unique needs. Conclusion This research study gathered information regarding social, economic, health and environmental factors in rural areas which will help in bringing issues of elderly people’s quality of life to awareness. This research will deepen the knowledge and skills of professionals on ageing issues, especially in rural areas/communities.
The outsourcing of dental prostheses in Gauteng
(2013-01-18) Pillay, Thirusha; Bass, Gregory Hylton; Harrison, J. E.
This study examined the perceptions of South African dental laboratory owners, dental technicians and dentists so as to understand their opinions and experiences regarding the outsourcing of dental prostheses in the industry. The study explored the legislative position of the South African Dental Technicians Council (SADTC). In addition, the study sought the Dental Technicians Association of South Africa (DENTASA) opinion regarding legislation and outsourcing practices in the dental laboratory industry. This is a post-positivist qualitative study conducted in the interpretive paradigm. The study was conducted in Gauteng as this province has the greatest concentration of technicians and dentists. Simple random sampling was used to select participants for individual semi-structured interviews. Interviews were conducted with three different groups of participants – laboratory owners, technicians and dentists. In addition, a representative of the SADTC and DENTASA, respectively, was interviewed. The data collected from interviews was analysed using thematic content analysis. Findings generated from the study revealed that where dental laboratory services are outsourced, no formal contractual relationship exists between parties. Contracts are verbal. The study concluded that the dental technology industry does not operate within clearly defined legal frameworks when outsourcing. It was established that offshore outsourcing occurs infrequently, therefore having minimal impact on the industry and labour market. Technicians interviewed failed to see the potential negative influence that enhanced outsourcing volumes could have on the labour market. The study established that domestic outsourcing is widely practised and dental laboratories receive significant quantities of imported work. The study briefly considered medical device legislation as the South African dental technician industry is reported to be required to comply with the International Standard of Operation (ISO 13485) which will legislate medical device legislation. Dentists stated, confirming a widely held dental technology industry belief that they did not believe that they were sufficiently qualified to carry out laboratory procedures. The study revealed that technicians regularly consult with patients with the consent of dentists. This is, currently, an illegal practice. Disclosure of who is doing the laboratory work does not always occur. It was established that economic consideration was not a driver when respondents considered outsourcing offshore. Quality was considered a more important factor than price. The study found that that no legislation exists in South Africa that regulates the dental laboratory materials used. Therefore, the possibility of inferior material filtering the South African market is real and the need for a regulatory body is indicated. Technicians felt that there is no need to regulate outsourcing in South Africa. Dentists, on the other hand, were ambivalent. In conclusion, it is postulated that dental technology industry is in a developmental stage and there is a need for the industry to understand itself better. This research showed that the dental technology industry has an inexperienced understanding of business practices. A greater emphasis on producing a well rounded dental technician with the knowledge and understanding of general business concepts and practices which include legislation, regulations and ethics related to the industry is indicated.
Patients at Marburg Haven Clinic : a demographic and disease profile
(2014-05-20) Hitge, Candice Elaine; Ndlovu, Prisca Zandile; Korporaal, Charmaine Maria
Aim: A paucity of information on chiropractic patients presenting in public community clinics in South Africa (SA) exists. The purpose of this study was to carry out a demographic and disease survey of the patients that presented to the Marburg Haven Clinic, so to identify the patients that presented in a rural community outreach programme. Methods: A retrospective analysis on the patient files at Marburg Haven Clinic was completed in September 2012. Data recorded included demographic data, presenting complaints, patient history and management protocols. Results: Data of 117 patients were documented. Most patients were female (76.1%), with a mean age of 53.3 years. Indian patients (50.4%) presented most often, with a quarter of the patients unemployed (26.5%) or pensioners (21.4%). Of the employed patients, 26.5% had not specified the type of occupation and 9.4% were non-manual workers. Musculoskeletal complaints (21.2%) were the most common complaints at the Marburg Haven Clinic, with the primary diagnosis of sacroiliac syndrome (16.2%), followed by general myofascitis (22.4%). Common co-morbidities reported were hypertension, diabetes and asthma. Less than half the patient population had undergone previous surgeries and/or sought previous treatment from other medical practitioners. Sixteen patients were contra-indicated for manipulation. Common treatment protocols used were spinal manipulation, spinal mobilisation and stretching. Conclusion: This is a demographic and descriptive study of a public community outreach centre in South Africa. In relation to international studies, similarities were that the majority of the patients were female, anatomical sites of complaint (lumbar and cervical pain), common usage of radiographs, co-morbidities including cardiovascular and endocrine pathologies and manipulation were used as the treatment of choice. A prospective longitudinal study with more specific criteria for patient tracking and more defined data capture requirements is recommended to more accurately gather all data within similar settings.
The perception of homoeopathy amongst African adults resident in Mnambithi Municipality (KwaZulu-Natal, South Africa)
(2010) Lamula, Sboniso Bethwel; Steele, Richard
Introduction All the studies on the perception of homoeopathy in South Africa conducted so far have found that the group least knowledgeable about homoeopathy is the African group. However, no study yet has focused on this group, and tried to find out more detail about their perceptions of homoeopathy. The study took place in Mnambithi, a town in the northern part of KwaZulu Natal within the Uthukela District with a population of about 200 000 people. Aim of the study The overall aim of this study was to determine the perception, knowledge and utilization of homoeopathy amongst African adults resident in Mnambithi, KwaZulu Natal. Methodology The survey method was employed to conduct this study. The research instrument was a self-administered questionnaire. The number of questionnaires completed was 1034, distributed according to suburbs 10.6%, centre of town iii 9.8%, former township areas 58.7% and rural areas 20.6% which approximately reflected the proportion of the population resident in those areas. The data was primarily analyzed by means of descriptive statistics using frequency tables. Results The sample consisted of 50.3% males and 49.5% females, with the largest group of respondents being 41 years old and above. Most were unemployed (61.8%). The educational standard was high, with 43.8% of respondents having matric and 20.4% having a diploma or degree. Most respondents (98.6%) had not heard of homoeopathy before. Only 0.1% of respondents had consulted a homoeopath before. 83.8% of respondents answered that they would consider consulting a homoeopath in the future, and 43.3% indicated they were interested in learning more about homoeopathy. The lack of knowledge about homoeopathy and yet being interested in learning more, is a similar finding to other perception studies. Conclusions It can be concluded from the results that the level of knowledge of homoeopathy amongst respondents was minimal, with only 10 out of 1034 respondents having heard of homoeopathy. Questions relating to the perception of homoeopathy were restricted to those who had heard of homoeopathy, but because of the small number, no conclusions regarding perception can be drawn.
Professionalisation of child and youth care : perspectives of child and youth care workers in eThekwini, KwaZulu-Natal
(2021-12-01) Zondeka, Nokwanda; Sibiya, M. N.; Siluma, N. M.
Background Child and Youth Care (CYC) has always been identified as a fledging profession regardless of the profession having a code of ethics, mandatory training, professional registration and professional associations. This is due to the gap in the process of CYC professionalisation and therefore needs to be addressed through advance literature and publication, especially in South Africa. This study is the first in the South African context to assess CYCWs perspectives of CYC professionalisation. Aim of the study The aim of the study was to assess the perspectives of CYC workers on the process of CYC professionalisation. Methodology A qualitative, exploratory, descriptive, contextual design was used in this study to gather in-depth and meaningful information from 12 CYC workers from 3 CYC centres in eThekwini. Semi-structured interviews with open-ended questions were used to collect data. Tesch’s eight steps of data analysis was used to analyse data obtained. Results Five major themes emerged from the study namely, child and youth care professionalisation; perspectives of CYC workers prior to professionalisation /statutory regulation; the importance of skills, knowledge, attitudes, values and beliefs in CYC professionalisation; aspects of CYC professionalisation achieved; and aspects of CYC professionalisation not achieved. CYC professionalisation was well understood by the majority of participants. Perspectives towards CYCWs prior to professionalisation were shared. There are important aspects of CYC professionalisation that the participants mentioned that are not achieved. Recognition by the professional council, education and training as well as attendance of conferences were achieved aspects of professionalisation. CYC skills, knowledge, values, attitudes and beliefs proved to be significant factors as they were cited to be very useful during practice. Conclusion Participants acknowledged that education and training, registration and a code of ethics are important factors that are expected to lead to the recognition, employment opportunities, dignity and status as well as salary increase for CYC practitioners. The participants also emphasised that major CYC role players have an important responsibility in contributing to the achievements of the above missing expectations.
Profile of lumbar spine conditions requiring surgical intervention in the Orthopaedic Department at a specialist public hospital in Kwa-Zulu Natal
(2018) Hillermann, Jens; O'Connor, Laura
Purpose: Low Back Pain (LBP) is a leading cause of activity limitation and absence from work globally, and the treatment is often complicated and multifactorial. There is little documentation about the types of conditions requiring lumbar spine surgery in the public health care sector in South Africa (SA). The aim of this study was to develop a profile of lumbar spine conditions requiring surgical intervention in the Orthopaedic Department at a specialist public hospital in KwaZulu-Natal (KZN). Methods: This study utilised a descriptive, retrospective, clinical audit design. A total of 112 patient files meeting the study inclusion criteria were analysed and data was extracted and recorded on a data template. Permission to conduct the study was obtained from the KZN Department of Health, the Manager of the King Dinizulu Hospital and ethical approval was obtained from the Institutional Research Ethics committee. The data was analysed using the Statistical Package for the Social Sciences (SPSS) (IBM Corporation). The data was described using means, standard deviations, percentages and count. Inferential statistical analysis was utilised to draw conclusions about populations from sample data. Chi-square and Fischer’s Exact test were used to compare categorical data with a statistical significance of p value ≤0.05. Results: The mean age of the patients was 41.7 years of age (range 3-76 years of age), with more females (55.4%, n = 62) than males (44.6%, n = 50) requiring surgery. More than half of the patients were Black Africans (55.4%, n = 62), with the majority (58%, n = 65) of all the patients being unemployed. Mechanical low back pain (MLBP) was the condition most often requiring surgical intervention (41.1%, n = 46) with lumbar stenosis being the most common diagnosis (17%, n = 19). This was followed by infective spondylitis (33.9%, n = 38). Frankel grading for neurological deficit was most often reported in patients with non-mechanical or infective causes of low back pain. Infective co-morbidity was (39.3%, n = 44) with 19.6% (n = 22) patients suffering from both tuberculosis (TB) and human immunodeficiency virus (HIV), 14.3% (n = 16) from TB alone and 5.4% (n = 6) with HIV/Acquired immunodeficiency syndrome alone. Most patients (91.1%, n = 102) received pre-surgical management consisting of medication either alone or in combination with other therapies such as physiotherapy, back braces, crutches and dietary intervention. The most common surgical procedure utilised was posterior spinal fusion (PSF) (43.8%, n = 49) either alone or in combination with other surgical procedures such as: decompression, biopsy and abscess drainage. This procedure alone was the favoured for non-mechanical LBP (NMLBP) (12.5%, n = 14), while PSF in combination with decompression was favoured the treatment for LBP of infective origin (15.2%, n = 17). Post-surgical management included medication (96.4%, n = 108) and physiotherapy (17%, n = 19); these were administered either individually or in combination. There were only six post- surgical complications; two were metal ware failure and four were infections. Of the four post- surgical infections, all of the patients had HIV/AIDS as a co-morbid condition. The trends suggest that the MLBP patients were predominantly older i.e. 40-69 years (82.6%, n = 38) and from the Indian race group (25.9%, n = 29). This was in contrast to the other types of LBP which predominately affected younger populations (i.e. 10-39 years) and Blacks. There were no differences in gender distribution for both MLBP and NMLBP. However, with LBP of infective origin, females were twice as much affected than males. Conclusion: The profile of lumbar spine conditions requiring surgical intervention at a public hospital is varied and there is a high prevalence of surgery for mechanical and infective cases of lumbar spine pain. Effective management of these conditions may reduce morbidity. Future studies should investigate the economic impact of lumbar spine surgery on health expenditure in South Africa.
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.
A retrospective cohort analysis of the injury profile of internationally competitive surfers
(2009) Murgatroyd, Taryn Lyn; Korporaal, Charmaine Maria
Modern surfing dates as far back as the 1960’s when the first amateur and professional surfing competitions were held (1). Since these humble beginnings, surfing has enjoyed a sustained growth over the last half a century, principally through increased commercialization of surfing apparel and an increased positive association with the lifestyle of surfers. Objectives: The aim of this study was to determine a retrospective cohort analysis of the injury profile of internationally competitive surfers and provide information on chronic, repetitive strain injuries suffered by them. Therefore, for the purpose of this study, the following information was gathered in order to create an injury profile: • Demographics of internationally competitive surfers competing in the Mr. Price Pro, Durban, South Africa, • Prevalence of surfing injuries, • Treatment received for injuries. Methods: This study was a retrospective, quantitative, epidemiological study (9), on the Chiropractic Student Sports Association’s (CSSA) questionnaire in order to produce a retrospective cohort analysis of the injury profile of internationally. On entry into the Chiropractic treatment facility, the surfer is requested to complete their portion of the CSSA questionnaire. Thereafter the senior intern then takes a brief case history, elaborating on the information provided by the surfer, followed by a standard clinical assessment related to the anatomical region or list of differential diagnoses based on the history. iv The study was limited to any surfer, male or female, who was competing on the World Championship Tour or the World Qualifying Series and registered to compete in the Mr. Price Pro. Results: Chronic injuries made up for 52.7% of surfing injuries, with the spine and surrounding musculature being the most commonly affected regions. Factors associated with injury were the repetitive nature of certain aspects of surfing and the age of the surfer. The findings in this study concurred with previous literature with the respect to sustaining of an injury related to surfing. However, many of the findings in this study differed to that of previous literature with respect to the common site of injury. The spine was the most common site of injury, as opposed to lower extremities as had been previously reported. The factors associated with injury also differed somewhat from previous literature. Therefore, this warrants further investigation with due consideration to the recommendations from this study.
Towards the development of a theoretical framework to guide child and youth care practice in South Africa
(2021-05-27) Thumbadoo, Zenuella Sugantha; Bhagwan, Raisuyah; Anglin, James
There has been limited scholarly research undertaken to understand child and youth care practice in South Africa. While there have been research studies undertaken on the Isibindi model, the focus on the actual practice of child and youth care workers has been minimal. The Isibindi model was developed to provide child and youth care services to vulnerable children in the context of their families and communities in South Africa. The core components of the Isibindi model focussed on the recruitment, training, and deployment of unemployed women and men in rural communities as paraprofessional or auxiliary level child and youth care workers. The roles of these child and youth care workers were to visit vulnerable families in local communities and provide children and families with a broad range of child and youth care services. The aim of this study was to identify the unique needs of children and their families within different community contexts across South Africa, and to develop a theoretical framework for understanding how child and youth care practice within the Isibindi model responded to these needs. A qualitative research inquiry was used to implement this study, with a grounded theory approach to guide the inquiry and to understand how Isibindi child and youth care workers practised with children and families in South African communities. The samples of child and youth care workers, children and youth, and community members who were selected as research participants came from three provinces in three specific Isibindi projects that demonstrated good practices according to identified criteria (Alice – Eastern Cape, Naas – Mpumalanga, and Hlabisa – KwaZulu-Natal). Three participants from each of the three research samples were interviewed through a semi-structured interviewing process. In addition, focus group discussions were held with the child and youth care workers in the Isibindi projects that were selected. The study presents the process of data analysis that underlies the emergence of the theoretical framework with the grounded theory concepts of theoretical sampling, memoing, coding, and constant comparison being discussed herein. The search for patterns and connections in the data through the constant comparison approach resulted in the identification of the core category and basic social processes in the child and youth care practice. The findings are discussed with the core category of practising intentionally and its unique properties are presented. This is followed by a discussion of the basic social processes, viz. embedding spirit in practice and embedding love in care, encompassing their respective categories. The integrated elements of practice, namely, practising relationally, creating a child rights culture, and championing social justice and equity are also deliberated, along with their particular properties. The thesis concludes with a discussion on the research findings in relation to the weave of the core category practising intentionally through the theoretical framework discovered. The theoretical framework Inhlanganisela: Integrated Patterns of Practice that emerged from the study was one that in Barney Glaser’s (1998: 68) words: “fits, works and is relevant” for practice, education, policy, and further research. Inhlanganisela is an IsiZulu word referring to a “multi-pronged system of activities which results in a web of movements all with differing directions but all aimed at a singular outcome”.