Theses and dissertations (Health Sciences)

Permanent URI for this collectionhttp://ir-dev.dut.ac.za/handle/10321/12

Browse

Now showing 1 - 20 of 23

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 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.
Determining the health risk factors impacting residents living in dilapilated buildings in Durban, South Africa
(2021-05-27) Mdoda, Mzimasi; Ghuman, Shanaz
In most developing countries such as South Africa, the phenomenon of buildings dilapidation has persisted in cities. Despite endeavors by the government, municipalities and others to eliminate this point of contention, the problem has remained. In different metropolitan areas such as Durban, Port Elizabeth and Johannesburg in South Africa, the existence and effects of disrepair continue to increase. The primary purpose of the study was to determine the health risk factors impacting occupants of a dilapidated building in Durban, South Africa. A dilapidated building is any building exhibiting signs of being a health hazard. This can be determined by factors such as unsanitary conditions, unsightliness, over-crowding, poor ventilation, mismanagement of refuse or waste, and poor maintenance of the building. A dilapidated building was purposely selected in South Beach, Durban. This is a residential building that satisfied the definition of 'dilapidated building’. The dwelling houses 600 people occupying 140 units. The minimum sample size was 103 Units. The head of the household or his/her proxy was targeted to participate in each unit. The research instrument used to collect primary data was a questionnaire and an inspection survey. Data analysis included descriptive, inferential statistical analysis carried out using the Social Sciences Statistical Package (SPSS Version 26.0 IBM). A Chi squared statistical test of independence and Phi Coefficient and Cramer's V Correlation test has shown a statistical significant association between the painful ankles experienced and the non-use of the elevator to reach the upper floors (p=0.002, phi and V=0.351), crime and depression/ anxiety (p=0.003, phi and V=0.018), lack of air circulation through open windows and TB (p=0.035, phi and V=0.197), as well as enervated waste removal versus medical attention seeking (p=0.003, phi and V=0.197). This research highlights that conditions in a dilapidated building linked strongly with adverse health outcomes of the occupants. A wide range of risk groups has affected occupants’ health, mainly from poor solid waste management, crowded units, and crime. Dilapidated building conditions were linked to a wide range of health problems and symptoms including respiratory infections, headaches, sleepless asthma, crime, ankle pain and mental health. Interventions to ensure healthy buildings and to prevent building dilapidation require a tripartite approach including government, building owners and occupants, with every stakeholder having a role to play in ensuring building health.
The development of an eco-justice model to guide community engagement in Health Sciences
(2020-11-30) Chandramohan, Sandhya; Bhagwan, Raisuyah; Sibiya, Nokuthula
Humanity is facing massive health problems, physical pathologies and ecological damage that cannot be ignored. This escalating destruction of all forms of life on earth is a consequence of human action. Such destruction is reinforced by a worldview that denies nonhuman nature any value, respect or justice. Although the South African Department of Education developed the White paper on the Transformation of Higher Education (Department of Education 1997: 10), which committed universities to policies and programmes for community development, as part of the universities mandate there is no educational model that guides community engagement with regard to eco-issues. This study focused on developing a model to guide community engagement in Health Sciences through a qualitative approach. A developmental research paradigm was used as the research design. This paradigm allowed for the use of a qualitative research approach to design the new model. Data was collected from academics and students from Health Sciences, and faith-based leaders; through interviews and focus group discussions. Qualitative data analysis using thematic data analysis was utilized to transform the data into findings. The findings of the study confirm the ongoing damage to the eco-systems and how such environmental damage contributes negatively on health. These finding recommend that higher education embrace community engagement as a tool to create community awareness on eco-justice issues. For this to be successful it is recommended that community engagement be incorporated into Health Science modules in order to transform the Health Science curriculum. The developed eco-justice model for Health Sciences can serve as a guide for academics and students as they work in collaboration with their communities on eco-justice issues to reduce the resultant negative impact on health.
Effects of secondary traumatic stress amongst nurses in an acute tertiary psychiatric hospital in KwaZulu-Natal
(2022-05-13) Chinaboo, Anashnee; Mahlanze, Hazel Thokozani; Sokhela, Dudu Gloria
BACKGROUND: Mental healthcare nurses (MHCNs) are often exposed to the narratives of the mental healthcare users (MHCUs) who often describe graphic details of occurrences or incidents they have experienced such as child abuse, violence and sexual assault. Due to their empathetic engagement and level of exposure to the MHCUs trauma, MHCNs may become traumatised themselves resulting in secondary traumatic stress (STS). PURPOSE OF THE STUDY: The purpose of the study was to determine the prevalence and the personal and professional effects of STS among nurses working in a tertiary psychiatric hospital in KwaZulu-Natal (KZN). METHODOLOGY: The study followed a quantitative, non-experimental descriptive design and took place at a tertiary psychiatric hospital in KZN. Non-probability purposive sampling was used to select 183 respondents. Data were collected using survey questionnaires. The theoretical framework was the Professional Quality of Life Model (ProQOL) (Stamm 2005). RESULTS: The findings of this study showed that there is a prevalence of STS. Although 66.5% (n = 122) of the respondents experienced little too mild to no STS, a significant percentage of the respondents (33.5%, n = 61) experienced moderate to high levels of STS. The enrolled nurses (ENs) reported higher levels of STS, job dissatisfaction and personal life dissatisfaction compared to the registered nurses (RNs) and enrolled nursing assistants (ENAs). RECOMMENDATIONS: The inclusion of STS into the nursing curriculum is recommended.
The epidemiology of neck pain within the indigenous African population in Harare, Zimbabwe
(2019) Blumears, Aimee Ann; Haffejee, Firoza; Makowe, Alistair
Background Musculoskeletal disorders are the leading cause of disability and can impair the quality of life. Of these musculoskeletal disorders, neck pain is one of the most common. Some of the risk factors for neck pain among the African population include low level of education, high-stress levels, low income and motor vehicle accidents. In the international arena, a broad range of risk factors contribute to chronic neck pain. These include female gender, increasing age, poor posture and work habits, twisting and bending of the neck and trunk, low–co-worker support, low socio-economic status and psychosocial factors such as stress and depression. Neck pain presents differently in different populations. The epidemiology of neck pain has not been investigated in Zimbabwe. In this country factors such as economic instability, disruption of social trust, uncertainty about income, high crime rate, unstable healthcare and low morale in the working population have led to the development of psychological disorders such as stress, anxiety, and depression. Furthermore, there has also recently been an increase of vehicle use in Zimbabwe, with concomitant motor vehicle accidents. All of these factors may predispose this population to musculoskeletal pain such as neck pain. However, this requires investigation. This study aimed to estimate the prevalence, risk factors and impact of neck pain in the indigenous African population in Harare, Zimbabwe. Methodology This was a quantitative cross-sectional study based on a previously validated questionnaire sourced from Smith (2016) and conducted in Harare, Zimbabwe. Participants (n = 461) answered a self-administered questionnaire after providing informed consent. The data collected from the questionnaires were captured into an excel spreadsheet and subsequently statistically analysed using SPSS. Standard deviation and mean reports are represented by (mean ± SD) within the text. Where standard deviation is represented by (SD). Tables, graphs and charts were used to present the data. The Inferential analysis was conducted using cross tabulations (interpreted using the Pearson chi- Squared test). The bivariate analysis was done using a Chi-Squared test (Interpreted using the Pearson`s chi-squared test). Odds ratios (OR) were calculated using binary logistic regression, This calculation was used to find dependant variables on an existent independent variable (Willemse 2009: 121). The 95% confidence intervals (CI) were calculated for Odds Ratios and for prevalence (Johnson and Bhattacharyya 2000: 331). A significance of a p- value less than 0.05 was used throughout. Results A total of 461 questionnaires were completed by participants in Harare, Zimbabwe. The point prevalence and 12-month prevalence was 16.4% (95% CI: 0.13 – 0.20) and 26.9% (95% CI: 0.22 – 0.31) respectively. The lifetime prevalence of neck pain was 49% (95% CI: 0.44 – 0.53). Within this population, age was significantly associated with neck pain (p < 0.001) with a larger prevalence within the age group 20 – 35 years. The odds of self-reported neck pain are 2.5 times greater for those with the exposure of self-reported stress compared to the participants without the exposure of self-reported stress (Odds Ratio = 2.5; 95%CI: 1.121 – 5.734; p = 0.025). Lack of finances (22.6%, n =104), work (18%, n =83) and poor living conditions (5.6%, n =26) were the main stressors identified among the participants. Other associations found for neck pain in this population were motor vehicle accidents (p < 0.001) and poor eyesight (p < 0.001). There was an association of neck pain with headaches (p = 0.023), shoulder pain (p < 0.001) and low back pain (p < 0.001). Conclusion Neck pain was prevalent within the indigenous population of Harare, Zimbabwe. Factors that were associated with neck pain in the sample population included stress, age, headaches, shoulder pain, low back pain, motor vehicle accidents, and poor eyesight.
An exploration into the management and diagnosis of Polycystic Ovarian Syndrome by Complementary and Alternate Medical (CAM) practitioners in the eThekwini area
(2021-05-27) Khan, Faathimah N.; Maharaj, Madhueshwaree
Polycystic Ovarian Syndrome (PCOS) is a prevalent reproductive endocrinopathy which presents a significant clinical and public health problem (Morgante et al. 2015). PCOS can affect females throughout their lifespan leading to serious complications such as obesity, infertility, type two diabetes mellitus and cardiovascular disease (De Leo et al. 2016). The conventional approach to treating PCOS is guided by what symptoms affect the patient most such as infertility, hirsutism, acne and so forth. Many of the conventional treatments for PCOS such as metformin, anti-androgens and oral contraceptives can cause harmful adverse side-effects (Lamba et al 2018:65). Adverse side-effects, complications, dissatisfaction in various aspects of the patient- practitioner experience and failed therapies are among the main reasons that patients opt for Complementary and Alternative Medicine (CAM) therapy. CAM fulfils the expectations not met by conventional medicine, particularly the psychological impact of PCOS on patients, which are assessed by only a few conventional practitioners (Fauser et al. 2012). Aim of the study This study aimed to document existing therapeutic protocols in the management of PCOS from diagnosis to treatment used by practitioners within various disciplines of CAM in the context of their unique philosophical background. Furthermore, this information may be valuable in bridging any potential gap in information across the five CAM modalities investigated in this research with regards to PCOS. These modalities were: homoeopathy, Ayurveda (AV), Unani Tibb (UT), Traditional Chinese Medicine (TCM) and naturopathy. Methodology A qualitative approach was used to document the perceptions and protocols used in the diagnosis and management of PCOS by practitioners of the five selected CAM v modalities practicing within the boundaries of the eThekwini municipality. Stratified purposive sampling was implemented in order to select a sample frame of 12 participants. Data was collected by means of personalised, semi-structured interviews and the data collected was analysed using Tesch’s (Tesch 1990:329) and Creswell’s (Creswell 2014) methods. Results CAM philosophies are underpinned by the principles of innate healing, an individualised constitution and governing factors which manage homeostasis. TCM philosophy is guided by the yin and yang concept, homoeopathy by the vital force and miasms, AV by three doshas. UT by four humours and naturopathy by lifestyle factors. PCOS patients were generally classified as being sycotic and/or cancerinic (miasmatically) according to homoeopathy, having a melancholic, sanguineous temperament according to UT, presenting with excessive kapha and vata according to Ayurveda and a predominant yang deficiency with heat and moisture according to TCM. PCOS is a multi-faceted reproductive endocrinopathy which requires extensive management. The different roles of a family physician, endocrinologist, dermatologist, dietitian and gynaecologist in the diagnosis and holistic management of PCOS is performed collectively by a CAM practitioner. PCOS is considered an affliction of the woman and not merely as a disease of the ovaries and therefore much attention is drawn to the emotional drivers, particularly stress and abuse which affect these patients’ quality of life (QoL). Diagnostics reported by participants included: 1) A clinical diagnosis congruent with established diagnostic criteria such as the Rotterdam criteria which identified the pathognomonic features of PCOS and 2) A CAM-specific diagnosis which evaluated the entirety of the patient’s symptoms, emotions and characteristics in order to determine a constitutional weakness. vi This study found that management of PCOS, according to CAM participants, was aimed at correcting hormonal, ovulatory and menstrual imbalances, improving fertility, reducing obesity, managing infertility and improving the patient’s QoL. Management strategies generally comprised: 1) CAM-specific therapy which included medicines and/or procedures, 2) Adjunctive therapy which included supplements and the use of other modalities and 3) Lifestyle intervention which included dietary counselling, physical activity recommendations and emotional counselling. Conclusion In conclusion, PCOS is a multi-faceted condition which requires emotional support concomitantly with therapeutic support due to the clinical spectrum of changes that can have an impact on females’ psychological health.
A group analysis evaluation of selected synthetic recreational drug isolate remedies in terms of known materia medica
(2013-10-31) Chhiba, Ujaswee; Maharaj, Madhueshwaree; Somaru, Nevorndutt
The addition of a large number of new remedies to the homoeopathic materia medica has made it challenging to select the correct remedy for a patient. Locating individual remedies within groups makes it easier to understand, remember and apply the information from the remedies. The aim of this research study was to evaluate common themes and symptomatology of homoeopathic remedies belonging to the synthetic recreational drug isolate group, as represented in the known homoeopathic materia medica and repertory. Most remedies derived from synthetic recreational drug isolate sources have not been well documented or comprehensively proven in homoeopathy, so are not well represented in repertory programs. Therefore, in addition, remedies in this study were selected according to the homoeopathic significance of each remedy, the availability of actual provings and representation in materia medica, the existence of a synthetic derivative of the drug, and if the drug was commonly used. The selected remedies were then subjected to a manual rubric extraction process in which common rubrics were extracted. The common rubrics were analyzed to determine common sensations within the group. The extracted sensations were then defined using a dictionary and synonyms were determined using a thesaurus. Each sensation was subjected to a literature search to test its validity. Second and third order analyses were performed based on the results. The most common sensations found as a result of this process were: dryness, itching, fear, anger, restlessness, anxiety, indifference, heaviness, heat, acute and weakness. The active and passive reactions and compensations of the synthetic recreational drug isolate group were also analyzed. The active reactions included anger, rage, acute, violence, impatience and irritation. Passive reactions were heaviness, numbness, dullness, faintness, weakness and coldness. The compensatory reaction included sensations of ecstasy, elation and euphoria or tranquillity. Each remedy was classified into specific miasms based on Sankaran’s miasmatic model (Sankaran, 1997). Each remedy was categorized as a particular miasm if the literature showed a clear predominance of the themes associated with that miasm. Many of the remedies had features of the AIDS, Cancer, Sycotic and Tubercular miasms. Pathological tendencies of the synthetic recreational drug isolate group involved the throat, eyes, stomach, nervous system, male genitalia and sleep patterns. Clinically, the remedies can be used in cases of mental disorders such as psychosis and schizophrenia, chronic fatigue, visual and sleeping disorders, anorexia nervosa and neurological disorders such as chorea, tremors and formication. The results of this study appear to confirm the application of the group analysis methodology as outlined by Sankaran (2002). The results also add depth to the existing literature on synthetic recreational drug isolate remedies.
A group analysis evaluation of the class Arachnida in terms of known materia medica
(2010) Weston, Marion; Ross, Ashley Hilton Adrian
Two centuries ago it was possible to practice with only 100 remedies. Today with the constantly expanding materia medica, complexity itself tempts the homeopath to remain inside this range of remedies. It is due to the pioneering work of authors like Scholten (1993) and Sankaran (2005) that the vast materia medica of today can be summarized and understood through a method like group analysis which links naturally related substances via their common symptomatology. This not only offers new aspects to well known remedies, but highlights the smaller, not so well known remedies, resulting in a more comprehensive understanding of the materia medica. Relatively few homeopathic remedies derived from the Araneae order are extensively utilized for the homeopathic treatment of patients. Therefore the spider remedies represented in the literature of Mac Rep computer program® were subjected to the group analysis method in order to extend the overall knowledge of this particular group of homeopathic remedies. The spider remedies were first analyzed in terms of their quantitative representation in the repertory (amount of rubrics) and then a sample group was chosen. This selection was screened for common sensations using the above mentioned computer program. The significance of a common sensation was confirmed by cross-checking the materia medica of all16 homeopathic spider remedies listed in Mac Reference® computer software for its occurrence. The findings were interpreted within the backdrop of the established animal characteristics of homeopathic remedies (Sankaran, 2005:24-31). The primary sensations extracted and confirmed in the rest of the Araneae group were stinging, stitching, shooting, sensitive, sore, cold, faint, paralytic, twitching and full. Significant synonyms of the first order analysis were heaviness, spasm, cramp, numbness and weakness. Second order and third order analysis not only provided symptoms of the mind, but led to the proposed themes common in spider remedies. The majority of themes like hyperactivity, restlessness, increased sexuality, impulsive violence and aggression, the periodicity of complaints, heightened sensitivity to music and the love for dancing are comparable to Mangliavori’s (2004) clinical findings and to Sankaran’s (2005) proposed spider characteristics. A miasmatic differentiation of each member of the sample group was performed according to Sankaran’s extended miasmatic model (2005:7). Araneus diademus was found to belong to the sycotic- as well as malarial miasm, Latrodectus hasseltii to the syphilitic-, Loxoceles reclusa to the leprous- and Tarentula hispanica and Theridion curassavicum to the tubercular miasm. Pathological tendencies of the Araneae remedies were found to involve the nervous system, eyes, heart, muscular – skeletal system, sexual organs and the mind. Examples of diseases common in Araneae remedies were found to be: mental disorders like anxiety neurosis, ADHD, depression, mania, sexual disturbances, STD’s, neurological disorders, angina pectoris, myocardial infarction, spinal irritation, migraines, meningitis etc. The results of this research were found to support group analysis methodology as outlined by Sankaran (2005). However additional knowledge drawn from Sankaran’s 2008) most recent research into animal remedies and from the natural history of spiders was necessary to be able to interpret the results correctly and to illustrate an in-depth picture of the common characteristic features of the Araneae remedies.
A homeopathic drug proving of Yam ha-Melach 30CH with a subsequent comparison to the materia medica of its constituent minerals
(2009) Wallace, Natasha; Couchman, Ingrid
Provings are important to expand known materia medica and advance homeopathy. The Dead Sea was chosen as a substance because it has numerous therapeutic properties in its crude form, making Yam ha-Melach an invaluable homeopathic remedy as the therapeutic properties of a substance is increased during the potentization process. Objective The objective of the study was to investigate the therapeutic potential of Yam ha- Melach 30CH, on healthy provers and to record the signs and symptoms produced, so that it may be prescribed according to the Law of Similars, to those presenting with similar symptoms and further to compare the materia medica of Yam ha- Melach’s constituent minerals with symptoms obtained from the proving of Yam ha- Melach 30CH. Methodology This proving took the form of a randomised double-blind, placebo controlled study. The potency used was the 30th centesimal potency or 30CH. The proving population consisted of a combined project of twenty provers who met the inclusion criteria (Appendix A). Ten percent of the test group (two subjects) received placebo and the rest received Yam ha-Melach 30C (18 subjects). In order for the study to have remained double blind, neither the researchers nor the provers were aware of who received placebo and who received the remedy. Data collection was in the form of a journal kept by each prover, in which their symptoms were recorded daily for a total of five weeks, before, during and after taking the powders. On completion of the proving, data obtained from the journals were analyzed by the researcher for suitability of symptoms for inclusion in the materia medica of Yam ha-Melach. These symptoms were then translated into ii materia medica and repertory language, and a homeopathic picture of the remedy formulated. Data obtained from the case histories and physical examinations (Appendix E) and group discussions were also considered. A comparison between the ‘minimum characteristic syndrome’ of Yam ha-Melach and the symptoms on the mental, emotional and physical planes of each of Yam ha- Melach’s main constituent mineral remedies and their group themes were made, whereby the essential similarities and differences between them were elucidated. The main constituent minerals of the Dead Sea are magnesium chloride, potassium chloride, sodium chloride, bromide and sulphur. The materia medica of Yam ha- Melach’s main constituent minerals therefore included the remedies: Magnesium muriaticum Kali muriaticum Natrum muriaticum Bromium Sulphur The proving symptoms were also compared to the materia medica group themes of the Magnesuims, Kali’s, Bromatums, Muriaticums and the Natrums in Scholten’s Homeopathy and Minerals (Scholten, 1993). Rabinowitz (2008) conducted an analysis of the proving symptoms, comparing the symptoms with existing indications of the Dead Sea’s clinical therapeutic use, in a parallel study of similar methodology. Symptoms were taken from the groups of both studies and included in the materia medica and repertory for Yam ha-Melach. Results The symptoms obtained from the proving had a very definite polarity. On the one side there was depression and loneliness, whilst on the other side there was happiness. This was shown also on the mental sphere, which varied from confusion to mental clarity. iii The main symptoms of this proving were the dreams, especially of war; violence; evil; religion; family and friends. Provers experienced a wide range of symptoms on mental, emotional and physical levels during the study. The main themes were feelings of loneliness and isolation, depression and hopelessness, being emotionally overwhelmed and crying, irritability and frustration, worrying about family and friends, needing affection, paranoia, oversensitivity and mood swings; and the feeling of being relaxed, calm and happy. The polarity continued on the physical level with regards to sleep, energy and appetite. On the physical level provers experienced dehydration resulting in headaches, dry itchy skin, eyes and mouth with diarrhea or constipation as well as nausea and vomiting. Some of the subjects had no appetite while others had an increase in appetite. Provers noted flu and hay fever like symptoms as well as joint and muscle stiffness and pain. Numbness, pins and needles and increased sensitivity were present in the extremities of most provers. Provers noticed pimples and dry patches on skin with severe itchiness and burning all over. Sleep was affected with some provers having difficulty sleeping, waking up all the time and others sleeping like a ‘rock.’ There was either a lack of energy or an increase in energy levels. Some provers had hot flushes and others felt cold and noticed fluctuations of body temperature. There was a general increase in perspiration. Some provers displayed black rashes and black stools. Provers experienced a general aggravation from alcohol. The main cravings were for salty food and coffee. The main aversion was for sweets. There was a general increase in thirst among the prover population. Conclusions The 30CH potency of Yam ha-Melach produced clearly observable signs and symptoms in healthy provers. Comparing the symptoms elucidated from the proving iv of Yam ha-Melach to the materia medica of its mineral constituents attempted to expand and clarify the therapeutic action of the remedy and allowed a better understanding of the similarities and differences between Yam ha-Melach and these remedies that exist in known materia medica. A complete and thorough understanding of Yam ha-Melach and its relationship to these remedies was achieved and contributed to a comprehensive remedy picture and aided in its practical application. The comparison revealed that Yam ha-Melach was most similar to Magnesium muriaticum on mental, emotional and physical planes. Both remedies had similar feelings of aggression, depression, being overwhelmed quickly, dreams of water, anxiety and restlessness, lethargy and similar sensations and complaints on the physical level. This is interesting as the Dead Sea consists of 53% magnesium chloride, 37% potassium chloride, 8% sodium chloride, low concentration of sulfate ions and a high bromide concentration. Magnesium chloride is therefore the main mineral constituent of the Dead Sea.
An investigation into burnout among emergency care providers at a private ambulance emergency medical service in Gauteng
(2018) Sibanda, Thulani Thomas; Pillay, B.; Muhlbauer, D.
Introduction Being a healthcare provider can be stressful as the job places demands on healthcare practitioners’ physical, emotional and mental functioning. The stress emergency care providers experience is unique and severe because they are exposed to an array of occupational stressors in their everyday lives. They deal with the very sick and dying, respond to emergencies that put their lives and the public’s lives at risk, they are even sometimes the victims of crime while they perform their duties. All of these occupational stressors create a risk of burnout for the emergency care provider. Emergency care providers who suffer from burnout are more likely to make clinical errors when treating patients and no longer have the ability to show empathy to their patients. Severe burnout may result in depression and suicidal behaviour. Aim of this study The aim of this study was to investigate the burnout of emergency care providers at a private ambulance emergency medical service in Gauteng to understand the extent and impact of burnout on emergency care providers. The objectives of the study were to assess burnout among emergency care providers using the Copenhagen Burnout Inventory (CBI), to establish whether the levels of burnout vary among different emergency care providers, and to establish if there is a relationship between burnout and the demographic variables gender, marital status and qualification. A further objective was to establish if there is a relationship between variables and distractor questions. Methodology This study was a quantitative study in the form of a cross-sectional survey utilizing the CBI as the burnout measurement tool. Results The findings of the study highlight that burnout is high among emergency care providers. Thirty percent of emergency care providers who participated in the study suffered from burnout. Most of the emergency care providers experienced higher levels of ‘personal burnout’ and ‘work burnout’ when compared with ‘burnout related to patient care’. Conclusion These findings are cause for concern, not only for the patients they attend to but also for the emergency care providers themselves.
An investigation into the roles of registered nurses and psychiatric nurses at in-patient psychiatric facilities and its implications for nursing education in KwaZulu-Natal
(2015) Joubert, Perrene Dale; Bhagwan, Raisuyah
Introducion Mental health nurses face challenging positions in practice. They are required to support and care for people hospitalised for treatment of mental illnesses on their recovery journeys but are also expected to manage ward administrative tasks, admit patients, attend meetings, dispense medication and communicate with patients (Gunasekara, Pentland, Rodgers and Patterson 2014: 101; Fourie, Mc Donald, Connor and Bartlett 2005: 135). It has been suggested that mental health nurses spend more time managing the ward environment and staff matters resulting in little time to develop and maintain therapeutic patient relationships (Fourie et al. 2005: 135). Problem Statement Research conducted in other countries identified the roles of the psychiatric nurse and mental health care nurses as attending to patients’ basic needs, assistance with self-care activities, monitoring and administering medication, ensuring safe environments in the health care setting and health education (Rungapadiachy, Madill and Gough 2004; Bowers 2005; Seed, Torkelson and Alnatour 2010). Although there is evidence of studies in psychiatric and mental health nursing locally, little is known about the roles of registered nurses and psychiatric nurses at in-patient facilities. OBJECTIVES • To explore which mental health problems are most commonly seen amongst psychiatric patients at these facilities. • To investigate the challenges faced by psychiatric nurses when caring for psychiatric patients. • To investigate what specialized knowledge and skills are required when nursing such patients. • To investigate whether their education and training prepared them adequately to deal with psychiatric patients and suggest guidelines to strengthen nursing education. METHODOLOGY The study utilized a quantitative non-experimental descriptive design to survey registered nurses and psychiatric nurses at in-patient psychiatric facilities in KwaZulu-Natal. A census was utilized in this study as the entire population was sampled. Data were collected using survey questionnaires. Phase two of the study, qualitative content analysis of Psychiatric nursing curricula strengthened the survey findings. FINDINGS Findings of this study showed that 98.4% of respondents believe psychiatric nursing care is an important aspect of holistic nursing practice. Respondents agree that challenges are commonly encountered in psychiatric nursing practice and that they are prepared to deal with these patients. However the aspects most frequently identified as needing greater attention in the Psychiatric nursing curricula were The Mental Health Care Act no 17 of 2002 and practical management of aggression, violence and de-escalation
An investigation of factors impacting on the retention of radiographers in KwaZulu-Natal
(2016) Thambura, Muchui Julius; Swindon, Lynda; Peer, F.
Introduction The staffing crisis in the healthcare profession is an issue of global concern and South Africa is amongst the countries affected. Radiography is one of the professions in allied healthcare, that is affected. The statistics from the Department of Health (DoH) in KwaZulu-Natal (KZN), as at August 2013, indicate a marked decrease in the number of radiographers between 2008 and 2012. Private practice statistics were unavailable as these are confidential. Purpose of the study This study aimed to investigate the factors impacting on the retention of radiographers in KZN, in order to obtain information that may assist the DoH to improve their retention policies. The objectives of the study were to investigate: the reasons why KZN radiographers resign from their places of employment; the reasons why KZN radiographers choose to remain in their place of employment; and the factors that impact on job satisfaction. It was also the intention of this study to identify possible input that may contribute to the retention of KZN radiographers. Methodology This research was conducted in 11 districts of KZN, South Africa. Radiographers in all categories of radiography who had worked in KZN and then left the profession, those who had emigrated, as well as those who were working in KZN were targeted in an attempt to obtain a wide range of data related to the objectives. A quantitative, descriptive survey, using a cross-sectional design, was used. A stratified non-random sampling method was used to select the public and private hospitals from which data was collected. The target sample size was estimated at 300 radiographers from all four categories in both public and private hospitals, however the researcher obtained only 191 participants. The population size of KZN radiographers was 859; a sample size of 266 was required at the 95% confidence level. However, with the high attrition rate, the sample of 191 was more than adequate for the available number of respondents and was considered to be statistically acceptable by the statistician. The response rate was 191, of which 20 responses were received from the 29 emigrants contacted, and 16 responses from the 19 participants who had left the profession. Three questionnaires were used to target the three categories of the respondents. Results of the study The results of this research indicate that radiographers emigrated within ten years of graduating, which is a highly productive age. The workload was the main cause of resignation for four (66,7 percent) emigrants as well as five (31,3 percent) radiographers who had left the profession. Private hospitals were reported as having lower workloads, better facilities and greater financial rewards than public hospitals. Increased remuneration influenced the migration of radiographers from public to private practices. It was also noted that six (37,5 percent) participants reported the crime rate as being one of the three main factors contributing to emigration, while two (12,5 percent) highlighted poor financial reward in KZN. The third main factor was stated to be better prospects for professional advancement abroad. A lack of professional recognition and progression in radiography in KZN was identified by two (12,5 percent) participants as factors that impacted on job satisfaction. Conclusion and Recommendation This research study is of significance to the DoH and Department of Public Service and Administration (DPSA) as the results may be used to assist them in improving the level of retention of radiographers in KZN. The creation of opportunities for professional development, advancement and diversification of the scope of practice for radiographers, as well as role extension and expansion, were factors identified as being important in the retention of radiographers. The working conditions were found to be generally unsatisfactory and needing improvement. It is suggested that retention could be improved through the development of strategies such as introduction of flexible schedules, creation of opportunities for further training and education. It is further suggested that a similar type of study be conducted in other provinces so as to compare the retention challenges facing other provinces in South Africa and thereby gain a national overview.
Knowledge, attitudes and perceptions of health care users towards HIV self-testing at selected Gateway clinics at eThekwini District, KwaZulu-Natal
(2017) Gumede, Sibongiseni Daphney; Sibiya, Maureen Nokuthula
Background Human immunodeficiency virus (HIV) testing, treatment and prevention programmes have been initiated and implemented, but nearly 19 million of the 35 million people globally who are living with HIV do not know they have it. A new and powerful movement called 90-90-90 has been set in motion where the target is that by the year 2020, 90% of all people should know their HIV status, 90% of those testing HIV positive should be commenced on lifelong antiretroviral treatment and 90% of the people receiving treatment should be virally suppressed. It is argued the new innovative HIV self-testing strategy can increase the uptake of HIV testing among key populations and the general public. Aim of the study The aim of the study was to assess health care users’ knowledge, attitudes and perceptions towards HIV self-testing at selected Gateway clinics in eThekwini District, KwaZulu-Natal. Methodology A quantitative, non-experimental descriptive design was used to determine knowledge, attitudes and perceptions of health care users at three selected Gateway clinics in eThekwini Health District. The researcher requested permission and was granted to conduct the study from all the relevant stakeholders. Human rights were protected and ethical considerations were adhered to throughout the research process. The convenience sample was 442 participants with a minimum of 98 and a maximum of 246 participants sampled from each of the three study sites. A survey questionnaire was used to collect data. Version 23 of SPSS was used to analyse data. Graphs and tables were used to represent frequencies. Inferential statistical were used to test whether any of the response options were selected significantly more or less than others Results Results of the study revealed that health care users had a reasonable knowledge of HIV self-testing and there were indications that they would use it if it was made freely available to the public and was properly regulated. Generally, there were indications that health care users had positive attitudes towards HIV self-testing. It was seen as a good idea as it can be performed in the privacy of one’s home and the person would be first to know about the results. Results also revealed that there could be more people who would know their HIV status and people could test more frequently. There were perceptions that there would be no difficulty in performing an HIV self-test. The lack of pre-test counselling, false negative results, possible coercion and sale of unregulated testing kits seemed to be issues of concern that require addressing if HIV self-testing is to be promulgated.
Midwives’ use of symphysis fundal height measurement to monitor foetal growth in eThekwini district, Kwazulu-Natal
(2023-05-31) Dlamini, Londiwe Zibuyile; Ngxongo, Thembelihle Sylvia Patience
Introduction and background: Ending preventable death of new-borns and children under 5 years of age by 2030 is one of the Sustainable Development Goals. Assessment of foetal growth by symphysis fundal height (SFH) measurement is one of the aims of antenatal care (ANC) and is used as the screening tool of choice for foetal growth assessment to identify small and large for gestational age foetuses at increased risk of perinatal morbidity and mortality. Correct estimation of gestational age allows for proper scheduling of ANC visits, informs decision-making at different stages of pregnancy, and is key to correct interpretation of foetal growth. It is a simple and inexpensive clinical activity, widely used during ANC in both high- and low-income settings worldwide, particularly in low- and middle-income countries including South Africa, where access to ultrasound machines and trained ultra-sonographers is limited. The effectiveness of SFH use is largely dependent on accuracy of measurements and the findings being accurately plotted onto the foetal growth chart to allow for accurate interpretation. An error in measurement, plotting and/or interpretation of SFH can result in inaccurate estimation of gestational age and growth monitoring which then becomes difficult and inaccurate, all of which can result in inappropriate interventions such as premature induction of labour or prolonged pregnancies. Aims of the study: The aim of the study was to explore and describe midwives’ use of SFH measurement to monitor foetal growth in ANC clinics located within the primary health care (PHC) clinics under eThekwini Municipality administration in KwaZuluNatal. Research objectives: The objectives of the study were to: explore the current practices of the midwives in the use of SFH management to monitor foetal growth during pregnancy; determine the perspectives of midwives regarding the use of SFH management to monitor foetal growth during pregnancy; explore the challenges if any that were experienced by the midwives in the use of SFH management to monitor foetal growth during pregnancy; and, describe how correct use of SFH measurements to monitor foetal growth during pregnancy can be enhanced. Method: A qualitative descriptive design using the theory of planned behaviour as a framework to guide the study was employed. Data was collected through semi-structured interviews with 20 registered midwives working at ANC clinics and a retrospective record review of 60 maternity case records for pregnant women attending ANC. Data from the interviews were thematically analysed following the six steps of qualitative data analysis, and document analysis used content analysis. Findings: The study findings revealed that in the majority of cases the SFH measurements were done as expected. Nevertheless, situations also prevailed where this was not correctly done, meaning SFH measurements were either incompletely done, incorrectly done or missing. In most cases these were blamed on several challenges experienced by the midwives working in the ANC clinics which included shortage of human and material resources, overcrowded ANC/PNC clinics, time constraints and limited skills. The perceptions of midwives and the culture that prevailed in the ANC clinics influenced how the midwives used the SFH measurement to monitor foetal growth. Conclusion and recommendations: Evidence of good practices from some participants and record reviews support the researcher’s conclusion that although gaps exists in the use of SFH measurements to monitor foetal growths, these gaps could be corrected by addressing all prevailing challenges. A number of these challenges could be overcome with both policy formulation and/or review, particularly with regards to provision of material and human resources; improvement of clinical practice during service delivery, paying particular attention to constructive feedback to staff regarding their performance; and/or aligning the nursing education curriculum more closely to clinical practice.
A model for the prevention of work-place violence towards public service emergency care providers in Gauteng province
(2021-12-01) Khoza, Tshikani Lewis; Sibiya, M. N.; Mshunqane, N.
Background Workplace violence is an alarming world-wide phenomenon that also affects healthcare providers. However, among healthcare providers, Prehospital Emergency Care Providers (PECPs) are particularly at risk of workplace violence as they provide direct patient care in often hostile and undefined public areas whilst interacting with the patient, their family members and bystanders. Gauteng Province is South Africa’s economic hub and the most populous province. In Gauteng Province, workplace violence towards public service PECPs persists, producing a negative impact on the effectiveness of the public healthcare system, despite the measures that have been put in place. Aim The aim of this study was to develop a model to prevent of workplace violence against public service PECPs in Gauteng Province. Methodology The study was conducted using a non-experimental, cross sectional and mixed methods design guided by a social constructivism/ interpretivism paradigm with an interpretative framework founded on pragmatism. Overall, 413 questionnaires were administered in the quantitative subphase. The qualitative subphase the study included seven (7) face to face semi-structured interviews from the management cohort and focus group discussions comprised of 35 PECPs. Parallel mixed methods analysis was used to analyze the data. Findings The findings of this study revealed that even with the current preventative measures in place, there is a high incidence of workplace violence towards public sector emergency care providers within low and middle income communities of Gauteng who rely on state funded healthcare. The risk factors to workplace violence included service delivery frustrations and protests, high crime rates, a lack of reliable backup and emergency care providers being perceived as easy targets. Workplace violence results in a lack of job satisfaction and a poor perception of workplace safety culture amongst PECPs and a decreased quality of and limited access to emergency medical care amongst the low and middle income communities in Gauteng. The findings and meta-inferences generated by the mixed results informed the development of a proposed model for the prevention of workplace violence towards public service PECPs in Gauteng Province.
A patient benefit and perception survey of the Durban University of Technology homoeopathic satellite clinic established at Ukuba Nesibindi
(2015) Watson, Tannith; Naude, David F.; Ngobese, Jabulile Cresancia
Introduction In collaboration with LifeLine, Durban University of Technology (DUT) established its first satellite homoeopathic clinic; Ukuba Nesibindi Homoeopathic Clinic (UNHC). UNHC serves as a teaching clinic which is part of a Bachelors and Masters of Technology: Homoeopathy programme. It provides a free homoeopathic primary healthcare service at the LifeLine building in Warwick junction, Durban, an area which is classified as being disadvantaged. The area in which UNHC is situated consists primarily of small, informal businesses and low cost housing and experiences high crime rates, prostitution and violence. The purpose of this study was to evaluate the patients’ perception of the services provided by UNHC and to determine how patients are responding to treatment at UNHC so as to try formally quantify the percieved effectiveness of homoeopathy as a form of treatment in the primary healthcare sector. Methodology This study was a quantitative, descriptive survey to determine the patients’ perception of the services provided at UNHC and to determine their response to the homoeopathic treatment received. Non-probability, convenience sampling was applied over a 12 month period (August 2012 – August 2013) in which 44 consenting research participants were recruited. To be included in the study the participants had to be follow-up patients (with an existing file at the UNHC), over 18 years of age and at least conversant in isiZulu or English. Results A data collection tool in the form of a questionnaire was designed to obtain data around a variety of variables pertaining to the patients’ satisfaction of the service provided and response to treatment. The administration and general satisfaction was received with very positive results. Ninety-eight percent of the sample group agreed that the staff at the clinic are polite, quick to help patients and informed the patients of the waiting time for an appointment. Eighty-six percent agreed that the waiting time for an appointment was good enough; however thirty-six percent were dissatisfied with the waiting time for the medication. Sixty-one percent of the participants were satisfied with the clinic offering afternoon only appointments but 32 percent disagreed on the suitability of available times. The category “Professionalism” dealt with the perceptions of the front entrance, waiting room, toilets and treatment rooms as well as the comfort and privacy of the doctor’s rooms. Overall there was a positive perception of these. Twenty-five percent of the sample disagreed that there was enough privacy in the consultation rooms which is a large number. The overall impression of the attending homoeopathic student included perceptions of their appearance, skill, friendliness, manners, organisation, care and confidence. Ninety- seven percent of the research participants had a positive perception of these. All participants perceived the attention given to their case as being either ‘Good’ or ‘Very good’. The main diagnostic group of conditions that presented as primary and secondary complaints were Genitourinary based (34%) followed by gastrointestinal (14%), respiratory (14%) and headaches (11%). The results from the data collected suggest that overall the majority of participants experienced improvement (eighty-two percent of the main complaints and ninety-three percent of the secondary complaints respectively) after receiving treatment from UNHC. In addition, those who experienced improvement attributed such improvement to the homoeopathic treatment they received (100% of those with improved primary complaints and 92% of those with improved secondary complaints). Patients also rated their perceived changes to general state of health, sleep, general well-being, energy, mood, appetite and weight as the holistic nature of homoeopathy aims to achieve improvements in not just the main complaint but in the patients other general health variables as well. The results proved to be positive in this regard as the majority of the participants stated that their general health variables had improved, with 93% agreeing that their overall ‘general well-being’ was either ‘significantly better’ or ‘better’ since receiving treatment. Conclusion This survey was able to provide valuable insight into the participants’ perceptions on the clinic and the use of homoeopathy as a form of treatment in the healthcare sector. It is clear from the results that the patients recruited responded well to the treatment received and furthermore it was encouraging to note that they attributed these improvements to their main complaints, secondary complaints and overall health variables to the homoeopathic treatment they received at UNHC. Patients showed a good level of satisfaction with the clinics location and amenities. What needs to be addressed is the professional appearance of the clinics entrance and waiting room so as to create a good first impression and attract new patients. Privacy during consultations were deemed insufficient by twenty-five of the sample and this could be improved by better training of the student interns and by separating the filing cabinets, clinicians room and dispensary from the consultation rooms. The absence of an elevator at UNHC is concerning as this inhibits access to this facility by disabled patients; efforts to obtain a consultation room on the ground floor is a priority. The waiting time for medication can be improved and reduced by having a second clinician with which the student interns can discuss their cases and treatment methods. Since the implementation of this survey, the operation times of UNHC have changed for 2014. The clinic now operates on a Monday from 08h00-16h00 and a Thursday from 13h00-16h00 which allows for a morning time period in which patients can be seen improving access accordingly. The study showed some very positive results in all aspects. Although limited in terms of sample size, the outcomes of this study are encouraging and support the inclusion of homoeopathy within the public healthcare system of South Africa.
Perspectives of educators on leaderships' handling of conflict in schools in the Phoenix circuit
(2021-04) Pillay, Deshini; Govender, Saths; Dorasamy, Nirmala
This study focused on the perspectives of educators on leaderships’ handling of conflict in schools in the Phoenix Circuit. The purpose of this study was to investigate secondary and primary school educators’ perspectives of prevailing leadership styles when resolving conflicts within the school context. Conflict management by leadership is important as it reflects on the type of leadership skills used in an institution. The role of a leader in an organization is vital as it impacts significantly on the institution at large. A leader is accountable for everything that transpires at the institution. In light of the aforementioned, the school principal should be seen as a fundamental agent of transformation, creating a space for deliberation and dialogue. School leaders need to work closely with their educators, hence there needs to be collaboration amongst them. Inappropriate leadership styles have a tremendous impact on the culture of teaching and learning and the performance of learners. Moreover, the morale of educators is affected. The researcher conducted the study in the Phoenix Circuit as this area had many documented cases of unresolved conflict (SADTU Member Welfare Case File 2014). The members (SADTU Member Case File 2014) put forward a motion that within Phoenix, there were conflicts between leaders and educators in various schools that required urgent intervention from the South African Democratic Teachers Union (SADTU) Phoenix Branch. Owing to the many unresolved cases of conflict in the Phoenix Circuit from 2013, the researcher found that this warranted investigation. The members (SADTU Member Case Files 2014) stated that cases of unresolved conflict in schools was a cause for concern as there were grievances from educators regarding conflict management at their schools. SADTU is the largest teacher union in South Africa, representing 70% of the teaching force. Hence the researcher purposively selected SADTU and furthermore, the researcher is an executive member of the Phoenix Branch of SADTU. The aim of the study was to investigate the perspectives of educators on leaderships’ handling of conflict in schools. The three objectives were: to determine the challenges experienced by leaders in schools; to analyze how conflict is managed within schools; and to critically analyze the appropriateness of leadership styles employed in conflict management. This study used Transformational Leadership theory to address the complexity around leaders and the Co-operation and Competition theory to address the issues underlying conflict management, which underpinned the analysis of leadership and conflict management in schools in the Phoenix Circuit. The perspectives of educators and school management teams (SMTs) was explored using a combination of interview schedules for SMTs and survey questionnaires for educators. The Phoenix Circuit, which was the focus of study, falls under the Mafukuzela-Gandhi Circuit Management Centre, Province of KwaZulu - Natal. The researcher, being an executive member of the SADTU Phoenix Branch, had access to reports on conflict from 2013 which were pending and warranted the urgency of this to be researched. The study revealed that quite often, whether conflicts are resolved or aggravated depended on the leadership styles of school principals in particular and members of the SMT in general. Authoritarian styles of leadership aggravated school conflict situations, whilst authentic democratic, transformational leadership styles contributed significantly to the resolution of conflict situations and the restoration of a culture of teaching and learning.
A retrospective chart review of the guiding symptoms of the successful prescription of Natrum muriaticum at a homoeopathic satellite clinic
(2018) Sibeko, Nompumelelo Marcia; Ngobese-Ngubane, J.C.; Maharaj, M.
Brief background In the practice of Homoeopathy, widely acting remedies or polychrest homoeopathic medicines are prescribed in the treatment of a wide range of clinical conditions. The documenting of the guiding symptoms in successfully treated cases will assist in offering guidelines for the prescription of remedies in the future and thus serves as scientific and clinical verification of the remedies. The operational definition of success for the purposes of clinical verification is the alleviation or improvement of existing symptoms (Van Wassenhoven 2013). This definition was applied in the context of this study. To facilitate high standards of health care as well as teaching and learning, Durban University of Technology (DUT) Department of Homoeopathy in collaboration with Lifeline established its first Homoeopathic Community Clinic in 2004 called Ukuba Nesibindi Homoeopathic Community Clinic (UNHCC) located in Warwick Junction, Durban. UNHCC provides a free Homoeopathic primary health care service on the third floor of the Lifeline building in Acorn Road, Warwick Triangle, less than one kilometre from the main DUT campus The area is classified as being disadvantaged with high crime rates, prostitution, violence, small informal businesses and low cost housing (Smillie 2010, Watson 2015 and Dube 2015). Aim of the study The study aimed to determine and compare the guiding symptoms of the successful prescription of Natrum muriaticum at Ukuba Nesibindi Homoeopathic Community Clinic (UNHCC) between 2013 and 2016. Methodology A retrospective chart review was conducted at the Ukuba Nesibindi Homoeopathic Community Clinic on the patient files between 2013 and 2016. A rubric (Appendix B) was used to document the demographics, clinical conditions, homoeopathic guiding symptoms, posology and follow up presentation of each chart where Natrum muriaticum was successfully prescribed. Furthermore, a comparison of the guiding prescribing symptoms was made against existing materia medica. A sample size of 197 patient files which had appropriate consent forms enclosed allowing for the use of information for research purposes was established. Prior to gathering the relevant information and the commencement of the study, gate keeper permission to conduct the study on patient files and at the mentioned location was requested and granted by all relevant stakeholders. The actual sample size was derived from the successful cases with follow ups until data saturation. Files that were excluded from the 197 patient files were of those patients who did not attend the follow up appointment and cases which were not treated successfully with the remedy. The sample size for the study was 37. Descriptive statistics was derived and illustrated using bar graphs and pie charts. Tabulations and graphical presentation of the comparison were created. Themes and inferences were drawn based on the emerged data from the symptoms and rubrics. Thereafter, a comparison to the existing materia medica was conducted by comparing the arising symptomatology with the existing content in the materia medica. Results The results of the study showed that the symptoms that arise in the study corresponded with the symptoms in the existing materia medica, however there were additional symptoms that emerged in the study and these symptoms were not listed in the materia medica, but were successfully treated with Natrum muriaticum. It was concluded that the guiding symptoms that were considered in formulating the prescriptions of Natrum muriaticum correlate with the characteristic symptoms of Natrum muriaticum in the materia medicas by Vermeulen, Boericke and Phatak
Semen analysis of renal transplant patients undergoing immunosuppressive treatment
(2017) Moodley, Neville Sivanandan; Adam, Jamila Khatoon; Naidu, S.
Introduction The prevalence of infertility is increasing at an alarming rate globally. Many couples are afflicted with infertility due to an array of diseases, trauma and psychological stresses. Renal disease is one such pathophysiological condition which is increasing amongst the younger age group. Often the progression of chronic renal disease leads to end stage renal failure that requires a renal transplantation. Post renal transplant, immunosuppressive agents are routinely prescribed to prevent allograft rejection. Immunosuppressive agents are potent drugs that can have deleterious side effects on semen parameters. However, the effects of the immunosuppressive agents on semen parameters in the literature are unclear and require further investigation. It is, therefore, important to assess the effects of immunosuppressive agents on semen, especially the three vital aspects of sperm concentration, motility and morphology which form the basis of male reproduction. Aims and Objectives of study This was a prospective observational study evaluating the effects of different immunosuppressive regimens on sperm parameters in post renal transplant male patients. The main aspects of semen parameters such as sperm concentration, motility and morphology that determine reproductive potential were assessed in the study patients and compared to the gold standard of semen analysis according to the World Health Organisation (WHO) reference values. Methodology Thirty-four renal transplant patients were recruited from the databases of both private nephrologists in the greater Durban area and the academic renal unit at Inkosi Albert Luthuli Central Hospital. Following bioethical approval and informed consent, patients were required to produce a semen sample by masturbation. A questionnaire documenting the patient’s lifestyle, aetiology of renal disease, transplant date and immunosuppressive duration and regimen were recorded. The semen samples were analysed comprehensively according to the protocol on semen analysis recommended by the WHO. This included the macroscopic investigation (volume, appearance, colour, viscosity, liquefaction time and pH) and microscopic evaluation (sperm concentration, total motility, morphology, IgG/IgA and vitality). Sperm concentration, total motility, morphology and vitality were examined and recorded in duplicate to strengthen the validity of the results. A biostatistician analysed the data and determined the statistical analysis. Descriptive statistics determined values of semen parameters in renal transplanted males and in each race demographic. The one sample t-test analysed the statistical significance between the mean study values and the WHO reference values. The effect of the immunosuppressive agent on semen parameters was determined using multiple linear regressions whilst ROC analysis determined the sensitivity and specificity of sperm concentration, total motility and morphology in predicting pregnancy from the patients that fathered children post renal transplant. Results The mean sperm concentration and morphology in the study patients were 14.0 mill/ml (95% Confidence Interval (CI) 10.2 – 17.7) and 3.3% (95% CI 2.7 – 3.9), respectively. Although values obtained were minimally lower than the WHO reference values, these results were within the 95% CI of the WHO guidelines. Motility evaluation revealed higher values of 43.2% (95% CI 36.6 – 49.7). In contrast, sperm vitality was considerably decreased, 47.5% (95% CI 40.6 – 54.4). All semen parameters exhibited no statistical significance (one sample t-test) when analysed against the WHO reference values except for sperm morphology, (p = 0.025; p< 0.05) which showed decreased morphology irrespective of immunosuppressive regimen. Semen volume 1.7 ml (95% CI 1.3 – 2.0) and pH 7.7 (95% CI 7.6 – 7.9) were both within the WHO guidelines. Descriptive statistics according to racial demographics showed no differences in semen values. An almost perfect linear relationship existed between total sperm motility and vitality (r = 0.967). Multiple linear regressions of duration and dosages of immunosuppressive drugs tacrolimus and mycophenolate mofetil, could not predict the effect of the immunosuppressive agents on sperm concentration, total motility and morphology. There was a significant difference in morphology between those with and without children post renal transplant. Those with children post renal transplant exhibited a higher morphology value, (p = 0.001; p< 0.05). Sensitivity and specificity analysis of the patients with children post renal transplant concluded that morphology is the most optimal indicator and predictor of pregnancy (AUC = 0.854). Tacrolimus was the common immunosuppressive agent used in the four patients that fathered children. This was more evident in patients that underwent therapy with Sirolimus followed by Cyclosporin A (CsA) and changed to Tacrolimus as the last immunosuppressive agent used for maintenance therapy. Conclusion The ability to procreate in renal transplanted males has become increasingly difficult and emotionally challenging. In this study sperm concentration and morphology of renal transplanted males exhibited parameters similar to the general fertile population. Total motility possessed a higher range of values in contrast to sperm vitality which showed a significant decrease from the WHO reference values. The effect of immunosuppressive treatment on semen parameters could not be clearly defined due to the number of immunosuppressive regimens that patients were subjected to intermittently resulting in small sample sizes within each immunosuppressive regimen grouping. The majority of patients underwent a triple maintenance therapy of tacrolimus, MMF and prednisone. The dosage and duration of these tacrolimus and MMF was inconclusive in determining a beneficial or detrimental relationship on semen parameters. Morphology was shown to be the most significant indicator in predicting pregnancy in patients that fathered children. Tacrolimus was a common immunosuppressive agent used in the majority of patients that fathered children. It may have protective effects on sperm parameters as shown in patients that fathered children. This was a study with a small sample size and further investigations are required in a larger cohort of patients to assess individualized effects of the different immunosuppressive agents on sperm parameters.