Theses and dissertations (Health Sciences)
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Item Practice-related hygiene behaviours utilized by Chiropractors pre, during and post the COVID-19 pandemic in South Africa.(2024) Enslin, Jan-Frederik; Krishna, Suresh Babu Naidu; O’Connor, LauraBackground: The COVID-19 pandemic had an impact on the delivery of healthcare services worldwide. The Allied Health Professions Council of South Africa implemented regulations to control the spread of the virus, including social distancing, face masks/shields, hand sanitisation, surface disinfection, and protective shields. Chiropractors had to incorporate new hygiene measures to ensure the safety of their patients and themselves. Without adherence to proper hygiene protocols, manual therapy poses a substantial risk of transmission for both the practitioner and the patient. There is limited information available regarding the changes made by chiropractors to their practices in response to the pandemic and if these changed behaviours are still being implemented. Exploring and understanding changes in behaviour can help identify areas where chiropractors may need additional support or resources to adapt to new circumstances and can provide valuable information on how the pandemic has impacted the field of chiropractic care. Additionally, by studying how chiropractors adapted during the pandemic can help gain insight into best practices for future challenges or crises that may arise, as well as can help improve patient care and outcomes in the future. Aim: To determine the practice-related hygiene behaviours of chiropractors before, during and post the COVID-19 pandemic in South Africa. Methodology: An anonymous online survey was completed by registered Chiropractors in South Africa (n=119) registered with the Allied Health Professions Council of South Africa, having provided informed consent. The survey consisted of questions related to practice hygiene behaviours pre, during and post the COVID-19 pandemic and distributed via a link on QuestionPro®. The survey closed on 02/02/2024. Results: The study examined the distribution of hand and equipment disinfection in a healthcare setting, before and after the COVID-19 pandemic. The response rate for the survey was 22.45%. A total of 36% of chiropractors had been practicing for seven years and 60% lived in urban or major cities. Most practitioners returned to their work in level 4 of lockdown and practiced as a sole practitioner. The study found a significant statistical difference that sanitiser availability and the use of personal protective equipment were less prevalent before and after the pandemic than during the pandemic. Most chiropractors (78%) felt that the COVID-19 hygiene protocols made them more aware about practice hygiene behaviours. However, 30% of chiropractors believed they were likely to contract COVID-19 if they did not adhere to proper hygiene practices. Barriers to implementing hygiene practices during COVID-19 included patient reluctance, lack of time, resources and difficulty in adhering to hygiene practices. Half of the chiropractors agreed to continue with good hygiene practices post COVID-19. Conclusion: The COVID-19 pandemic resulted in increased adherence to practice related hygiene behaviours with the implementation of safety precautions such as protective screens and face masks. Many of the chiropractors continued to utilise these behaviours after the pandemic.Item 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).Item Hygiene practices as a contributing factor to diarrhoea in preschool children in Mpumalanga Township, KwaZulu-Natal(2021-05-27) Ntshangase, Samukelisiwe Nomonde; Ghuman, Shanaz; Haffejee, FirozaBackground: Diarrhoeal disease is reported by the World Health Organisation (WHO) as the second leading cause of mortality in children under five years old, and worldwide is responsible for the deaths of almost 525 000 children annually. Diarrhoea is defined as the passage of three or more loose or liquid stools per day, or more frequent passage than is normal for the individual and can last for several days. Diarrhoea is typically a symptom of an infection in the intestinal tract, caused by a variety of bacteria, viral and parasitic organisms. The disease is spread through contaminated food or drinking water or from person-to-person as a result of poor hygiene practices. Acute diarrhoea is a major cause of hospitalisation in South Africa, especially in children under two years of age. Diarrhoea is the main cause of morbidity and mortality in KwaZulu-Natal, even though case fatality decreased between 2014/15 and 2015/16. South Africa has improved the health and well-being of children through the introduction of the rotavirus vaccine into the National Immunisation Programme in 2009, the only known preventative measure against rotavirus diarrhoea. Aim/Objectives: The study aimed to determine if hygiene practices of parents/guardians and ECD educators contributed to diarrhoea in children attending the centres. Interdependent factors related to diarrhoea in children were also investigated. The objectives of the study included determining the prevalence of diarrhoea in children five years and under at ECD centres in Mpumalanga Township, KwaZulu-Natal; identifying risks factors that may contribute to diarrhoea in children; and assessing the knowledge, attitudes and practices of ECD educators and parents/guardians to diarrhoea and hygiene. Methodology: A descriptive cross-sectional study design was conducted using self-administered questionnaires at the research tool. The study was done at ten Early Childhood Development (ECD) centres in Mpumalanga Township, KwaZulu-Natal, South Africa. The total number of centres registered with the Department of Social Development in the area was 41 at the time of the study, with the total of educators approximating 177 and 3326 children attending the ECD centres. Simple random sampling was used in order to achieve a degree of accuracy and representativeness. The parents/guardians were selected from the same schools that were randomly selected for the educators. To achieve a 95% confidence level, respondents were invited to participate having signed informed consent. Statistical analysis was performed using SPSS version 26.0. Frequency distribution of categorical variables and means, standard deviation and ranges of continuous variables were calculated. Various graphs and tables were used to illustrate variables. The Pearson’s Chi-squared test was used where applicable for bivariate associations between categorical variables. Multivariate regression modelling was done with the inclusion of relevant covariates. Odds ratios were calculated for binary outcome variables. Confidence intervals of 95% were calculated and p values < 0.05 were considered statistically significant. Results: A total of 385 parents/guardians of 427 children attending ECD centres and a total of 121 ECD educators answered the questionnaires. The results indicated that 91.6% (n=350) of parents/guardians had flushing toilets and all the ECD centres had flushing toilets. Over 87.2% (n=333) parents/guardians reported that the toilets were indoors and 86.8% (n=105) ECD educators indicated that the centres had indoor toilets. The data revealed that over 60% (n=210) of parents/guardians said their child uses the toilet and 22.8% (n=76) had children who used nappies, thereby disposing the stools in the municipal collected waste. Only 0.9% (n=3) of parents said they buried the stools and 3.6% (n=12) said they left the child’s stools in the open. Drinking water was easily accessible in this study population as households had indoor taps (n=311, 80.8%), outdoor tap on the premised (n=70, 18.2%) and ECD centres indoor taps (n=109, 90.1%). Approximately 85% (n=307) of parents/guardians washed their hands more frequently after defecating when there was an indoor tap. Furthermore, parents/guardians who had handwashing sinks closer to the toilet washed their hands more frequently compared to those with handwashing sinks furthest (p=0.000). The study found that parents/guardians with a tertiary qualification were five times more likely to seek medical care than parents/guardians with a primary education education (OR=5.201, 95%CI=1.48-18.28, p=0.010). The administration of ORT was consistent across all levels of parental/guardian education (primary school, secondary school and tertiary). Homemade oral rehydration solution was mostly administered by parents/guardians with primary (n=5, 20.0%) and secondary education (n=21, 19.3%) compared those with tertiary education. The mean number of children under five years who had diarrhoea in the 12 months preceding this study was 1.23 (SD=0.53). Cryptosporidium infection was the likely cause of the watery diarrhoea in this population since rotavirus immunisation was given to the children. Conclusion: This study found that children were more likely to get diarrhoea from other children, compared to adults. How parents/guardians washed their hands was 1.239 times likely to contribute to children under the age of five getting infected with diarrhoea. The p-value of 0.010 was obtained in the association of type of toilet in the household and a child having diarrhoea. Knowledge around diarrhoea must be strengthened, more so in prevention, and when seeking medical care. Caregivers should be encouraged to have oral rehydration treatment readily available, to be used as needed.