Theses and dissertations (Health Sciences)
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Item Evaluation of antibiotic-resistant bacteria and genes associated with tuberculosis treatment regimens from wastewater treatment plants in South Africa(2022-05-13) Mtetwa, Hlengiwe Nombuso; Reddy, Poovendhree; Kumari, Sheena K.; Bux, FaizalEssential components of a strong public health system include an efficient surveillance system which helps in early detection and prevention of infectious diseases. This is particularly important for tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB), due to increasing globally infections and the associated economic burdens. TB and MDR-TB infections are high in several countries, with South Africa contributing almost 3% of total infections globally. This advocates for improved surveillance systems to help health authorities respond effectively in developing effective policies for managing and controlling diseases. The reliance on clinical case reports, hospital admissions and clinical surveys, as surveillance methods, has proven to be a challenge in developing countries like South Africa, where there are other competing interests for scarce resources. The development and implementation of alternative surveillance tools for identifying disease severity, the emergence of novel strain and resistance patterns is, therefore, a top priority. One such strategy is the use of sewage or wastewater-based analysis, commonly referred to as wastewater-based epidemiology (WBE), which has received attention lately due to its role in developing early warning and surveillance of SARS-CoV-2 (COVID-19) infections. This study evaluates, method development for utilizing WBE approach for monitoring TB and MDR-TB infections via the detection and quantification of tuberculosis-causing mycobacteria and genes (ARGs) associated with resistance to TB treatment in untreated wastewater. Furthermore, the study contributes towards the understanding potential TB transmission through wastewater. To achieve these, conventional and advanced polymerase chain reaction (droplet digital PCR) assays were optimized for the detection and quantification of total mycobacteria, members of the Mycobacterium tuberculosis complex (MTBC) and ARGs associated with resistance to first and second-line TB drugs. The mycobacteria targeted in this study were total mycobacteria, M. tuberculosis complex, M. tuberculosis, M. africanum, M. bovis and M. caprae. The ARGs (and the antibiotic they encode resistance to, in parenthesis) targeted in this study were; katG (isoniazid), rpoB (rifampicin), embB (ethambutol), pncA (pyrazinamide), rrs (streptomycin), gyrA (ofloxacin), gryB (moxifloxacin), atpE (bedaquiline), ethR (ethionamide), eis (kanamycin/amikacin). Untreated and treated (post-chlorination) wastewater samples from three wastewater treatments plants (WWTPs) in the city of Durban, South Africa were used for this study. All wastewater samples (untreated and treated) analyzed in this study contained total mycobacteria and MTBC at varying percentages per WWTP studied. The human and animal MTBC pathogens such as M. tuberculosis, M. bovis and M. caprae showed a similar prevalence, except for M. africanum, which was less common compared to the others. The highest median concentration detected in untreated wastewater was 4.9(±0.2) Log10 copies/ml for total mycobacteria, 4.0(±0.85) Log10 copies/ml for MTBC, 3.9(±0.54) Log10 copies/ml for M. tuberculosis, 2.7(±0.42) Log10 copies/ml for M. africanum, 4.0(±0.29) Log10 copies/ml for M. bovis and 4.5(±0.52) Log10 copies/ml for M. caprae. A statistically significant difference (p-value ≤ 0.05) in concentrations of each organism was observed between the plants. A significant reduction in copy numbers from untreated to treated samples were observed. However, the log reduction in each WWTP did not show any statistically significant differences when compared between the three WWTPs, irrespective of the organism or group of organisms (p-value ≥0.05). Furthermore, all targeted ARGS were detected in all samples analyzed at varying concentrations. The most abundant ARG in the untreated wastewater was rrs, associated with resistance to the aminoglycosides, specifically streptomycin. In contrast, pncA gene associated with resistance to the TB drug pyrazinamide was the least detected. Furthermore, the resistant gene associated with bedaquiline (aptE) was also detected in all samples, albeit at low concentrations. This antibiotic is a new addition to the TB treatment regimen in South Africa and it is concerning that resistance has already been detected. The occurrence and concentration of these ARGs were lower in the treated wastewater in most instances, ranging from 1 log copy/ml to over 4 log copies/ml except for selected genes at few instances. The study makes novel major contributions, firstly, the detection of M. tuberculosis complex members in the untreated wastewater at high concentrations signifies a potentially high prevalence of TB in the study area. Secondly, the detection of M. africanum in South African wastewater also signifies that some of the TB infections in the communities could be caused by this pathogen. M. africanum is the main causative agent of TB in West Africa but is not frequently reported clinically in South Africa. Finally, the presence of diverse ARGs associated with TB drugs also points towards an association between the drug use and resistance profile in the area. These results further support the potential application of WBE to gather data on MDR-TB within communities with limited or no clinical data. The detection of the aptE gene also shows that resistance to the new drug, bedaquiline, could already be developing in the communities. The study also observed that the wastewater treatment plant configuration did not significantly influence the removal of these mycobacteria. Furthermore, selective conditions in the WWTPs may contribute to increased concentrations of ARGs during the treatment processes as indicated by increased concentrations for certain ARGs detected in the treated wastewater. This warrants further studies to determine whether the genes detected in the effluent are extracellular or carried in viable microorganisms, to assess the viability and infectivity of the microorganisms carrying these genes in the effluent samples and therefore the potential public health risks associated with the exposure to wastewater. In conclusion, this study establishes the potential of molecular surveillance of wastewater for monitoring TB and MDR-TB infections in communities and supports the use of WBE as a public health strategy to combat infectious diseases.Item An evaluation of the waste management cycle utilised by fresh produce market informal traders in Durban, KwaZulu-Natal(2021-05-27) Sahathu, Renisha; Ghuman, Shanaz; Kistnasamy, JoyBACKGROUND: Informal markets are located at various Central Business Districts (CBD) within the eThekwini Municipality with hundreds of individuals visiting these markets due to the fresh produce and low prices that are available at these markets. There are no storage facilities that are provided to the traders for extended life span of their fresh produce hence there are large quantities of food waste or organic waste which is disposed of on a daily basis. These wastes are collected by Durban Solid Waste (DSW) regularly and are disposed of at one of the three active landfill sites within the municipality. Proper waste management of these wastes are imperative as the impacts of negative waste management has dire consequences to health, and the environment and can take up a large proportion of the municipal budget to correct those situations. Solid waste emanating from informal markets are the second highest municipal solid wastes after residential wastes that are landfilled. These wastes contain a high fraction of waste for which diversion alternatives exists however, these practices have not been implemented. AIM: This study aimed to evaluate the waste management cycle utilized by fresh produce market informal traders in Durban, KwaZulu-Natal. METHOD: A descriptive, cross sectional study was conducted using questionnaires that were administered to the participants. The questionnaires were the main research tool utilized for the study. The study was conducted at two markets within the Durban Municipality. These were the Early Morning Market and the Verulam Market of a total of seventeen markets within the municipality. Simple random samplings were used in order to achieve a degree of accuracy and representativeness. To achieve a 95% confidence level, participants were invited to respond to the study having signed the informed consent form. Descriptive statistics were presented in the form of graphs, cross tabulations and other figures for the quantitative data that was collected. The Pearson’s Chi-squared test was used where applicable for bivariate associations between categorical variables. Confidence intervals of 95% were calculated and p<0.005 were considered to be statistically significant. RESULTS: A total of 197 of informal traders within the two markets responded to the questionnaire. The results indicated that 89.2% (n=173) were females while 10.8% (n=21) were males. The data revealed that 41.6% (n=82) of the informal traders did not have a formal education while 33.0% (n=65) had partial secondary education with 39.9% (n=77) being within this sector for between six to seven years. Only 0.5% (n=1) of the respondents indicated that they had additional occupations. Respondents sought information relating to their business and waste management mainly via the radio (n = 166, 84.3%) and word of mouth (n = 148, 75.1%). A portion of 39.6% (n=78) indicated that they received information via city brochures and pamphlets. Food waste was found to be the most prevalent waste stream that was generated by the informal traders as was reported by 99.5% (n=196) of the informal traders that responded. This was followed by the waste streams of paper (n=180, 91.4%), cardboard (n=176, 91.4%) and plastic packaging (n=171, 86.8%). Disposing of their waste at the storage facility that was provided by the market management was the most prevalent disposal method that was identified by the respondents (n=195, 99.0%) while 2.5% (n=5) identified that their wastes were landfilled while 4.1% (n=8) stated that they disposed of their waste via open dumping. CONCLUSION: This study concluded that the most prevalent waste streams that are generated by the fresh produce market informal traders do have alternative disposal methods instead of landfilling. The informal traders indicated that they would be willing to participate in recycling and composting programmes which must be implemented by the market management in conjunction with the local authorities. The study further indicated that the practices of waste management undertaken by the informal traders are influenced by the facilities that are provided by the municipality (p<0.005).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.Item The assessment of cardiopulmonary health risks associated with PM₁₀ and PM₂.₅ exposure on the community of Kriel Town and Thubelihle Township in the province of Mpumalanga(2020-06-10) Shezi, Lucky; Pillay, Julian David; Gabela, Sibusiso DerrickBackground: In the wake of rapid industrialisation and urbanisation amongst developed and developing countries, there has been increasing awareness that air pollution, especially particulate matter (PM) and its components, is linked with a variety of adverse health effects. There is strong evidence suggesting that air pollutants originating from industrial/commercial facilities may cause adverse effects on human health. Objectives: To analyse the levels of PM10 and PM2.5 emissions for Kriel and Thubelihle during the year 2017, using the Kriel village air monitoring station and the Elandsfontein monitoring station; To determine the incidence of cardiopulmonary conditions amongst the town of Kriel residents (within a 10-kilometre radius of the Eskom-owned Kriel coal power station) and Thubelihle Township residents (residing outside a 14- kilometre radius of the Kriel coal- power station); and to establish the association, if any, between PM10 and PM2.5 emissions at each site. Methods: The study was a quantitative, cross-sectional and descriptive study conducted to provide information regarding particulate matter air pollution and the incidence of cardiopulmonary conditions in the town of Kriel and the Thubelihle Township in Mpumalanga province. The health records were obtained of all the people who were diagnosed or treated for cardiopulmonary conditions during the months of January 2017 to June 2017 at Kriel Community Health Centre (CHC) and the Thubelihle Township CHC. Data on the exposure to ambient PM levels was also obtained from January 2017 to June 2017. Results: This study established that there was a statistically significant difference between PM10 and PM2.5 emissions at the town of Kriel and Thubelihle Township. The mean PM10 emissions in the town of Kriel was 46.25±25.23 µg/m3 and 28.70±15.05 µg/m3 in Thubelihle Township (p < 0.005; Mann-Whitney U). The mean PM2.5 emissions in the town of Kriel was 24.31±13.21 µg/m3 and that of Thubelihle Township was 20.23±10.35 µg/m3 (p < 0.005; Mann-Whitney U). The study also established that the incidence of cardiopulmonary conditions amongst the town of Kriel residents and Thubelihle Township residents was significantly different (c2 = 146.60, df = 4; p˂0.05). This study revealed that there was a significant relationship between PM10 and PM2.5 concentration at the town of Kriel and Thubelihle Township. The town of Kriel PM10 and PM2.5 emissions were (p˂0.05; r=0.63 Spearman’s rho). Thubelihle Township PM10 and PM2.5 emissions were (p˂0.05; r=0.61 Spearman’s rho). Conclusion: This study has demonstrated the association between PM levels and the incidence of cardiopulmonary conditions such as asthma, bronchitis, pneumonia and bronchiectasis amongst the community members of Kriel and Thubelihle who reside in the vicinity of the coal- power plant. The Emalahleni Municipality in Mpumalanga, the Department of Environmental Affairs and Eskom are urged to review environmental policies towards lowering PM pollution to acceptable levels.Item Exploring the selfhood of primary school teachers in the teaching and learning of Environmental Education : a mixed methods approach(2020-06-10) Ruthanam, Melishnee; Reddy, Poovendhree; Pillay, DaisyEffective learning in environmental education, which is introduced at primary school level in South Africa, has the potential to encourage behavioural modification essential to mitigate current environmental issues. While methods of delivery and teaching resources are important, the educator is considered the greatest determinant of knowledge delivery and retention. Consequently, this study explored the selfhood of teachers of Life Skills influence curriculum delivery and learning in environmental education. A mixed methods intervention approach was employed with participants of one school receiving a teaching intervention and the other school designated as the control. Participants included five Grade 5 public primary school Life Skills educators and Grade 5 learners from the KwaDukuza area. All learners completed an assessment book post intervention which was designed to evaluate environmental knowledge retention. Qualitative findings from pre and post interviews with educators was evaluated by thematic analysis. Parker Palmer’s Theory of Selfhood to analyse the data using key conceptual tools such as ‘we teach who we are’ and ‘identity and integrity’ (Palmer 1997). Shulman’s Theory forms the framework to help understand the knowledge base of the educator which frames teacher education and teaching practice (Shulman 1987). This study offered a nuanced perspective of Environmental Education at primary school level within KZN. The main themes emanating from the qualitative aspect of the study were teaching experiences, years of teaching, contextual challenges which influenced teaching methods and reasons for adopting these methods for environmental education. Despite the similar challenges across both schools, certain educators were able to introduce innovation into their teaching. Those educators displayed a greater passion and intrinsic belief in the subject which manifested in their pedagogic efforts. The quantitative findings of this study indicated that there was no statistical significance when knowledge and understanding was compared between the intervention and control school (p>0.05). It can be concluded that regardless of the method of teaching employed, knowledge and understanding of learners remained similar therefore the greatest determinant of successful environmental education is the teacher. The selfhood and experiences of the teacher played a significant role in ensuring effective environmental education deliveryItem A lifecycle evaluation of health care waste management by general practitioners in South Durban(2019-09-05) Boodhram, Litonya; Kistnasamy, Emilie Joy; Baatjies, Roslynn; Euripido, RicoHealth care waste management (HCWM) poses a major risk due to its hazardous and deleterious effects on the environment and communities. It is imperative that specific and correct strategies from generation to final disposal, are implemented at all health care facilities (HCFs). A search of the literature has shown that many incorrect HCWM procedures have been found in HCFs, especially in developing countries. In South Africa, research on HCWM was mainly undertaken in municipal or government hospitals while it appeared to be non-existent in the private sector. This study therefore minimized this important gap in the private sector by investigating the lifecycle evaluation of HCWM by General Practitioners (GPs) in South Durban. The objectives included the following: 1) to assess the GPs‟ knowledge and practices of the hierarchy of waste principles; 2) to evaluate occupational risks associated with handling health care waste in GPs‟ surgeries and 3) to determine regulations utilized during the HCWM process in GPs‟ surgeries. GPs belonging to the Durban South Doctors Guild (DSDG) were assessed in a two staged interview process using a questionnaire and a regulations checklist. Overall, the results indicated that private practicing GPs in the South Durban area do practice HCWM in a responsible manner. Age appeared to play a significant role in terms of knowledge and practices. The areas of compliance showed that correct segregation was practiced by 92% of the sample group and 100% of the GPs utilized accredited waste collection services. Areas of concern were that while regular HCWM seminars were convened by the DSDG, the response rate was poor. Additionally, there seemed to be a lack of knowledge regarding the definition of infectious waste as 18% of GPs noted that their facilities did not produce this type of waste. The occupational risks appeared to be minimal with only 6% of GPs experiencing needle-stick injuries. The GPs were knowledgeable and practiced HCWM according to appropriate South African legislation. In response to the areas of concern, seven recommendations are proposed. This study established that HCWM in private practicing GPs surgeries in the South Durban area are being carried out correctly and in accordance with specific South African regulations and policies. It would also be beneficial when undertaking future research to obtain more holistic outcomes by including GPs who: a) are younger than the majority age group noted in this study; b) have their surgeries in other previously disadvantaged and under-resourced communities; c) are female and; d) are of African, White or Coloured descent.Item An epidemiological study of selected risk factors associated with low back pain amongst refuse truck drivers in the eThekwini Municipality(2005) Miosh, S. RamroopMotivation: Lower back pain (LBP) has been found to affect workers and often result in higher costs to industry than any other musculoskeletal disorder. Traditionally, the most widely investigated risk factors for LBP have been biomechanical demands of the job. By examining LBP, both its prevalence and distribution, it becomes possible to focus on contributory risk factors that bring on its onset. Aim: To identify the selected risk factors associated with prevalence of LBP amongst refuse truck drivers in the eThekwini Municipality, and to evaluate the relationship between the selected risk factors and the prevalence of LBP.