Theses and dissertations (Health Sciences)

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An analysis of inter-healthcare facility transfer of neonates within the eThekwini Health District of KwaZulu-Natal
(2013-01-18) Ashokcoomar, Pradeep; Adam, Jamila Khatoon
Introduction The safe transfer of neonates from one healthcare facility to another is an integral component in the process of neonatal care. Neonates, a term applying specifically to infants during the first 28 days of life, are transferred from medical healthcare facilities which do not have specialist care or intensive care management to more specialised facilities in order to improve their clinical outcome and chance of survival. The transfer system is thus an important aspect of the overall care provided to neonates. The transfer process, however, poses a threat of aggravating the clinical condition of the neonate. Inter-healthcare facility transfer of a neonate requires careful planning, skilled personnel and specialised equipment to maintain the continuum of care, as this directly impacts on the morbidity and mortality of the neonate. Purpose of the study The purpose of the study was to undertake a descriptive analysis of the current neonatal inter-healthcare facility transfer system in the eThekwini Health District of KwaZulu-Natal (KZN). This service is provided by the public sector ambulance service known as the Emergency Medical Rescue Service (EMRS). The study, based on 120 consecutive transfers, assessed the clinical demographics of the neonates, the time taken to complete the transfers, including time sub-intervals, the equipment that was necessary for the transfers and the qualifications and procedures performed by the transfer team. The study also identified any adverse events that were encountered during the transfers. Methodology The study was conducted from 19 December 2011 to 30 January 2012. It used quantitative methodology and a non-experimental prospective design to undertake a descriptive analysis of 120 inter-healthcare facility transfers of neonates within the eThekwini Health District of KwaZulu-Natal. Data collection relied upon two types of questionnaires. A descriptive survey method incorporated logistic and deductive reasoning to evaluate the objectives of this study. Frequency distributions were generated to describe data categories. Bivariate analysis was conducted using chi- square. Results During the study period there were a total of 120 neonatal inter-healthcare facility transfers. All referrals were undertaken by road ambulances. Eighty-three (62.2%), transfers were undertaken by the operational ambulance units, 35 (29.2%) by the obstetric unit and 2 (1.7%) by the planned patient transport units. Thirty one (28.5%) transfers were on Fridays, followed by 24 (20.8%) on Mondays and 20 (16.6%) on weekends. Ninety seven (80.8%) were during the hours of dayshift (07h00-19h00) and 23 (19.2%) were during nightshift (19h00-07h00). Of the 120 neonatal transfers, 29 (24.2%) were specialised transfers, of which 22 (75.9%) were ventilated. With reference to the gestational ages of the neonates being transferred 90 (76.7%), were pre-term, 26 (21.7%) were term and 2 (1.7%) were post-term. There were 11 (9.2%) newborns (from birth to 4 hours), 56 (46.7%) early neonates (from 4 hours to 7 days) and 53 (44.2%) late neonates (from 7 days to 28 days). Of the 120 neonatal transfers, 90 (75.0%) were pre-term having associated co-morbidities and 49 (40.8%) had respiratory problems. The mean time ± standard deviation (SD), taken by EMRS eThekwini to complete an inter-healthcare facility transfer was 3h 49min ± 1h 57min. The minimum time to complete a transfer was 55min and the maximum time was 10h 34min. The mean time ± SD from requests to dispatch was 1h 20min ± 1h 36min. The delays in dispatch were associated with no ambulances being available 70 (58.3%), no ALS personnel available 48 (40.0%), no equipment available 23 (19.2%) and no ILS personnel available 7 (5.8%) to undertake the transfers. Junior or inexperienced personnel in the communication centre also contributed to the time delays by dispatching ALS personnel for non-specialised transfers and requesting neonatal equipment when it had not been requested by the referring personnel for the transfer. The mean time ± SD from the referring hospital to the time mobile to the receiving hospital was 43min ± 26min. Six (5.0%) neonates were clinically unstable at the referring facility for transfer. For 15 (12.5%) transfers, neonates had been inappropriately packaged for transport by the hospital staff, which added to the delays, p. value = 0.018. The necessary equipment was unavailable for 37 (30.8%) of the transfers. The lack of equipment was due to problems such as poor resource allocation, and malfunctioning, inappropriate, insufficient and unsterile equipment. The pre- departure checklist had not been completed in 50 (41.67%) of the transfers. The study identified 10 (8.3%) adverse events related to the physiological state of the neonate and included 1 (0.8%) mortality. Nine (7.5%) neonates suffered serious life threating complications during transportation, 8 (6.7%) of which were due to desaturation, 6 (5.0%) due to respiratory deterioration, 3 (2.5%) due to cardiac deterioration and 1 (0.8%) due to temperature related problems. Eighteen (15.0%) of 120 transfers experienced equipment related adverse events of which 9 (7.5%) were associated with ventilators, 9 (7.5%) with incubators, 3 (2.5%) with the ambulance, 2 (1.7%) with the oxygen supply and 1 (0.8%) with arterial cannulation. Five (33.3%) of the 15 equipment related adverse events contributed directly to life threatening physiologically related adverse events, p. value = 0.007. Conclusion and recommendation The Emergency Medical Rescue Service (EMRS) is involved in the transportation of a significant number of neonates between various healthcare facilities in the eThekwini Health District, some requiring intensive care and some not. This descriptive, prospective study has identified numerous shortfalls in the service provided by the EMRS in the eThekwini District. Inter-healthcare facility transfer of neonates can be safely performed by the transport services if the operations are well co-ordinated and there are dedicated, specialised and trained transport teams armed with appropriate equipment and medication, together with the guidance of policies and quality assurance. Transport teams must be trained to provide this specialised care in various environments, including ground and air ambulances and understand the multiphase neonatal transfer processes. There must be good communication and co-ordination by all role players, which is underpinned by good team work to improve the standards of neonatal care and monitoring. Only then can clinical excellence be achieved when transporting neonates between healthcare facilities.
The epidemiology of low back pain in construction workers in the eThekwini Municipality of KwaZulu-Natal
(2024) Moodley, Verushan; Pillay, Julian David
Background Low back pain (LBP) is a significant musculoskeletal disorder and a major occupational health concern globally. In developing countries, occupational LBP remains a major public health crisis, with high levels of LBP reported, resulting in high levels of absenteeism, disability, and a loss of productivity. Construction workers are involved in one of the most physically demanding occupations, making them exceedingly susceptible to LBP. They are also exposed to a variety of demographic, lifestyle, and occupational risk factors that may further predispose them to LBP. In South Africa, research on LBP amongst construction workers is currently lacking. The aim of this study was, therefore, to determine the epidemiology of LBP in construction workers in the eThekwini Municipality of KwaZulu-Natal. Methodology This study adopted a cross-sectional survey design. Participants were recruited from the two largest construction companies in the eThekwini Municipality. A sample size of 256 construction workers was used and questionnaires were provided to the participants at their respective companies. The questionnaire was divided into four sections, namely demographic factors, lifestyle factors, occupational factors, and LBP history. IBM SPSS version 28 was used to analyse the data. Descriptive statistics, such as mean, standard deviation and range, were used to summarise continuous data. Frequency counts and percentages were used to summarise categorical data. Risk factors for LBP were assessed for those who reported LBP. Pearson’s chi-square tests or Fisher’s exact tests were deemed as appropriate and were used to assess categorical factors, while t-tests were used to assess mean differences for continuous variables. A p-value of <0.05 was used to indicate statistical significance. Results A total of 256 construction workers in the eThekwini Municipality were investigated in this study. The mean age of the male participants was 34.2 ± 9.2 years, while the female participants were 37.5 ± 8.1 years. The mean BMI of the men was calculated as 24.1 ± 3.9 kg/m2 and for the women it was 32.0 ± 10.1 kg/m2. The females had a mean weight of 78.7 ± 18.7kg and the men had a mean weight of 69.8 ± 9.9 kg. The males had a mean height of 1.7 ± 0.1kg and the females had a mean weight of 1.6 ± 0.1 kg. The point and period prevalences were 16.8% (n=43) and 26.2% (n=67) respectively. The study reported that 54.3% of the participants experienced LBP on both sides of the lumbar spine, 43.2% experienced it daily, and 48.1% had mild pain. Factors such as height (p=0.507), weight (p=0.657), and BMI (p=0.657) were not significantly associated with LBP. It was noted that age (n=81; p=0.124) was marginally non-significantly higher in those with LBP. No association between LBP and sex was noted (p=0.517) and LBP was equally likely in men and women (31% in men and 37.5% in women). A longer duration of smoking (p=0.015), a higher number of cigarettes smoked per day (p=0.047), the presence of work-related stress (p=<0.001), personal stress, or both, were significantly associated with LBP. The general workers (43.2%; n=16), followed by the erectors (33.3%; n=6), were most likely to have LBP. The most frequently used treatment was getting advice from a general practitioner, 56.7% (n=17), followed by self-medication, 30% (n=9). Conclusion LBP continues to be a major health burden on construction workers, impacting their daily activities and causing disability. The prevalence of LBP reported in the study was similar to some of the previous studies, whilst it varied from others. Notwithstanding this, LBP in construction workers is a concern requiring urgent attention. A joint intervention strategy between health professionals and the construction industry is required. This will reduce absenteeism, stress, decreased productivity, and activity limitations.
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).
The relationship between asthma and outdoor air pollutant concentrations of sulphur dioxide (SO2), oxides of nitrogen (NOx), ozone (O3) total reduced sulphates (TRS), carbon monoxide (CO) and respirable particulate matter less than 10 microns (PM10) in learners and teachers at Settlers Primary School in Merebank, south Durban
(2005) Kistnasamy, Emilie Joy; Barratt, Graham James
South Durban is in the province of Kwazulu-Natal in South Africa and is home to two international petro-chemical refineries, a paper mill, sewage works, an international airport, a chemical tank farm with approximately 970 tanks, a number of landfill sites, an airport, various processing and manufacturing industries which are all in close proximity to residential and recreational areas. This area is known as the South Durban Industrial Basin (SDIB). Serious concerns have arisen about the potential health impacts that could arise from ambient air pollution from these industries. Learners and staff at the Settlers Primary School situated in Merebank, a suburb in the SDIB, perceived themselves to be at risk for air pollutant related health effects owing to the schools’ geographic location. The aims of this study was a) to determine the prevalence of asthma among learners from Grades 3 and 6 and staff at Settlers Primary School and b) To investigate whether outdoor air pollutant concentrations of sulphur dioxide (SO2), oxides of nitrogen (NOx), ozone (O3), total reduced sulphur (TRS), carbon monoxide (CO) and respirable particulate matter less than 10 microns (PM10) were associated with increased signs and symptoms of asthma in the study population.
The status of usage of information technology systems within campuses of the KwaZulu-Natal College of Nursing
(2015-03-10) Maharaj, Sangeetha; Puckree, Threethambal; Mshunqane, Nombeko
Background The rapid growth in information and communication technology (ICT) in the 21st century has impacted all spheres of human activity, including the health sector. The change introduced by ICT requires educational institutions to relook at the way in which they develop and implement their education programmes. In contemporary clinical practice environments, ICT skills are providing benefits for nurses as well as for the patients they care for. Aim The aim of the study was to investigate the status of usage of ICT by academic staff, students and administrators within campuses of the KwaZulu-Natal College of Nursing which consists of 11 main campuses and 14 sub-campuses. Methodology A quantitative, cross sectional study was conducted which included academic staff, administrative staff, and students (R425 and R212) of the KwaZulu-Natal College of Nursing. A random sample of 576 individuals participated in the study consisting of academic staff (176); administrative staff (30) and students (340). Participants completed a questionnaire that established their demographic data and ICT usage. Results The questionnaire response rate was academic staff (80%), students (89%) and administrative staff (93%). The findings showed that while respondents were able to manage work related activities; they experienced poor access to computer training with 66% indicating they had access to computer training. The access to computer training for the administrative staff was 50%, with 8% of rural and 1% of urban students having access to training. The majority of academic staff have access to desktop computers with there still being a divide in terms of rural access as compared to urban access p=0.24. Significantly more administrative staff had access to desktop computers than those who do not p<.0005. The access to desktop computers for students was low, with 22% of respondents in both rural and urban campuses indicating that they have access. Access to the internet was low for all respondent groups with a significant difference between those who have access compared to those who do not have access p=<.0005, for both the academic and student groups. There is a low use of ICT for the purposes of teaching and learning with the majority of respondents (60%) indicating that they do not use ICT for teaching compared to those who do p=.0007. All respondent groups have experienced poor ICT support with the majority indicating that they do not receive ICT support p=<.0005. The usage of the online library was low for all groups, with 61% of academic staff, not accessing the online library for reasons of access, or knowledge about the library, 23% of urban students and 20% of rural students have indicated ever using the online library. Conclusion The study highlights the need for the KZNCN to be on par with higher education institutions globally in access to and usage of ICT. Benchmarking with higher education institutions in the health and other sectors is essential, in order for the KZNCN to benefit from the trend in incorporating technology into the teaching and learning process. Strong collaboration is necessary between the KZNCN as an academic institution and clinical health facilities to ensure that the developments in ICT within both sectors are reflected in the teaching and learning process, so that graduating nurses are able to function effectively. Clear policy documents and guidelines are required for the KZNCN which reflect the norms required for both ICT equipment and systems to enable functioning of the institution within an increasingly technological environment.