Faculty of Health Sciences

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Echocardiography nomograms in Black South African neonates
(2020-06-10) Hadebe, Nondumiso Memory; Prakaschandra, Rosaley; Ntsinjana, Hopewell; Cilliers, Antoinette
The subspecialty of Paediatric cardiology has adapted and refined techniques adopted from adult cardiology to manage children, (Mahle, Blaine and Silverman 2009:33). Although a quantitative evaluation of cardiac chambers, valve annulus and great vessel dimensions in paediatric echocardiography is important, nomograms for these structures are limited. Several studies have already provided normal values in the paediatric population that represent most populations of the world but there is lack of data that has been published in sub-Saharan Africans, (Lemmer et al. 2014:1 and Roge et al. 1978:285). AIMS AND OBJECTIVES Aim: To establish reliable echocardiography nomograms for cardiac chambers, valve annuli, great vessels and thymus dimensions in the Black South African neonatal population. Objectives: To determine normal values of cardiac chambers, valve annuli, great vessel and thymus dimensions. To determine inter-observer variability. To determine the effect of confounding factors such as gender and type of delivery on the measurements obtained. METHODS This is a descriptive, cross-sectional study evaluating cardiac chambers, valve annuli, thymus and great vessel dimensions in 386 African neonates with normal hearts using echocardiography. The study data consists of two arms, a retrospective arm utilizing echocardiographic data acquired during a previous study entitled “To assess the accuracy of pulse oximetry screening as a tool to detect critical congenital heart disease in asymptomatic newborns” and a prospective arm. INCLUSION CRITERIA: Healthy newborns at an age of 12 hours or more before discharge. Patients without any heart disease, with a “normal heart” by echocardiography excluding hemodynamically non-significant patent ductus arteriosus and patent foramen ovale. Black South African patients. Full term babies delivered by caesarian section and normal vertex. EXCLUSION CRITERIA: Patients less than 12 hours from birth. Patients with known structural heart lesion. Patients who are non- black South Africans. Pre-term neonates. DATA COLLECTION AND ANALYSIS: Collected data was entered on excel spreadsheet and analyzed using excel, XLSTAT 2019 and STATISTICA version 13.5.0 statistical packages for analysis by the principal researcher (Nondumiso M. Hadebe). A p-value of less than 0.05 and significance level of 95% was considered statistically significant. A professional biostatistician at University of the Witwatersrand was consulted for assistance in data analysis. Homoscedasticity and heteroscedasticity were tested using Shapiro-Wilk, Kolmogorov-Smirnov, Breusch-Pagan and White tests. The inter-observer variability was tested with intraclass correlation coefficient using Pearson’s correlation coefficient to detect bias. Weight was used to express measurements to body size and to predict mean values of each echocardiographic measurement that were expressed as Z-scores. RESULTS A total of 386 patients from both arms were enrolled with almost equal gender distribution with a slightly higher percentage of females, 191 (49%) were males and 195 (51%) were females. The study involved neonates born through normal vaginal delivery (NVD) and through caesarian section (C/S) which showed equal distribution. The assumption of normality was tested which showed most measurements being homoscedastic. Heteroscedasticity was tested which showed most measurements to be homoscedastic. Effects of confounding factors were tested which showed that body weight has a significant effect on all cardiovascular dimension measurements. Mode of Delivery (MOD) had a significant effect on the size of atrioventricular valve, pulmonary artery and pulmonary artery branch measurements. Gender and BSA had no significant effect on most measurements but with some significant effect on a few measurements. There was no significant effects seen for body length (BL) and gestational age (GA). The echocardiography measurements of 168 patients were used to test for inter-observer variability which showed a strong correlation on most measurements. Birth weight was used to express cardiac measurements to body size. All echocardiographic measurements were grouped into 3 categories of weight and are presented as mean and +/-3 SD. Z-scores and its boundaries for all measurements is presented graphically. This study showed slightly higher dimensions to previous studies from other centres. CONCLUSION This study presents nomograms that are reliable because they were acquired from healthy neonates using current recommendations by the American Society of Echocardiography, (Lopez et al. 2010: 465-495). Weight showed significant potential as a confounding factor and as an independent variable for data normalization. This study showed slightly higher dimensions to previous studies emphasizing that it is important to develop and use regional nomograms because of the effects of environmental, economic and social factors of the region. This study covered the gap of knowledge on cardiac chamber, valve annuli, and arterial and thymus dimensions in the neonatal age group. Further studies are required to reinforce these findings that will also involve the right cardiac dimensions. More studies are needed based on African paediatric populations including the all paediatric age groups (0-18 years).
The effect of a dance and music programme on the functional ability of the residents of an old age home in Pietermaritzburg, KwaZulu-Natal
(2016) Gqada, Nomusa Constance; Govender, S.; Puckree, Threethambal
Life expectancy has increased rapidly since the beginning of the twentieth century and people aged 65 and older form the fastest growing segment of the population. With the onset of old age, comes social, physical and psychological challenges that result in morbidity and loss of independent life. For some of the socially and economically marginalized elderly this often means living in a long term facility. This study determined the effect of a dance and music programme on balance and function in the residents of a selected old age home in Pietermaritzburg. Aim of the study The study determined the effect of a dance and music programme on the balance and functional ability of the residents of the old age home. Methodology A pre-test/post-test experimental design was used in this study. The eligible participants were randomly assigned to two groups, the experimental and the control groups. The experimental group participated in the 12 week programme of a dance and music programme offered twice weekly while the control group received standard care. Both groups’ functional abilities and balance capabilities were assessed before and after the intervention. Results The results revealed that dance and music programme did not statistically improve balance and function. Function improved in the experimental group post-test compared to the pre-test. Positive feelings expressed during the classes indicate that the intervention had a positive effect on the participants. Conclusion The dance and music programme improved function. It is recommended that residents of the geriatric home be offered this dance and music programme as a long term activity.
The epidemiology of work related back pain in full-time restaurant waitron staff within the eThekwini Municipality
(2020-11-30) Wolff, Alexia Michaela; Haffejee, Firoza
Background Low back pain (LBP) is one of the leading causes of morbidity in high-, middle- and lowincome populations and is one of the most common and most expensive occupational health problems in developed and developing countries. This affects the working population as LBP has a detrimental effect on work performance, therefore it is an important clinical, social, economic, and public health problem affecting the population. Internationally, risk factors in the development of LBP in the working population include prolonged standing, awkward posture and incorrect lifting. There is limited literature on prevalence of LBP, the risk factors associated with LBP and its impact on waitrons in South Africa. This study aims to determine the prevalence, clinical presentation, risk factors and impact of work-related LBP amongst full-time restaurant waitron staff within the eThekwini Municipality. Methodology This study was a mixed methods study comprising qualitative and quantitative components. The quantitative research tool consisted of a previously validated selfadministered questionnaire whilst the qualitative component consisted of voice recorded semi-structured interviews using an interview guide to obtain information on low back pain from participants. The data collected from the questionnaires were entered into an Excel spreadsheet and thereafter analysed using SPSS. Descriptive statistics were used to describe categorical outcomes, whilst Pearson’s chi square or Fisher’s exact tests in the case of categorical variables, and t-tests for continuous variables were used to assess factors associated with LBP. The audio recordings from the qualitative interviews were transcribed verbatim and exported into a Microsoft Word document. Thereafter, thematic analysis was used to analyse the qualitative data to identify common themes and subthemes. Results Of the 340 questionnaires which were distributed, a total of 180 questionnaires were completed by waitrons in the eThekwini Municipality, resulting in a 52.9% response rate. The point, three-month period and annual prevalence was recorded at 50.0%, 62.2% and 78.2%, respectively. Within this population, LBP was associated with the ethnicity of the participants (p=0.002) where Indians had a 7.7 times increase in the odds of prevalent LBP compared with Black Africans (OR = 7.713; 95% CI = 1.273-46.718; p = 0.026) and Whites a 5.9 times increase in the odds of prevalent LBP than Black Africans (OR = 5.891; 95% CI = 1.429-24.289; p = 0.014). Low back pain was associated with the education of the participants (p = 0.002) where participants with high school education had an almost 12 times increase in the odds of prevalent LBP than those with tertiary education (OR = 11.967; 95% CI = 1.399-102.387; p = 0.023). Prolonged standing or walking during a work shift was associated with LBP (OR = 42.808; 95% CI = 2.346-780.985; p = 0.011). Onset of LBP was common during a long single shift or when working a double shift and pain sessions tended to last between one to two hours. The frequency of LBP experienced averaged two to three times a week, where pain was at its worst in the evenings. Low back pain in waitrons commenced gradually without injury and the severity of LBP was unchanged since it initially started. Low back pain resulted in moderate impact on the work of waitron staff, sometimes resulting in absenteeism and bed rest. Eight in-depth, qualitative interviews were conducted. Two main themes emerged from the data: low back pain characteristics and type of treatment. Interviewees discussed pain, onset and duration, and relieving factors as part of LBP characteristics, where they reported first experiencing LBP as young adults. Their onset of LBP was common during a long single work shift or when working a double shift. They re-iterated that prolonged standing and lifting or carrying heavy objects aggravated their LBP. Various therapies were used by interviewees to relieve the pain which included analgesics, antiinflammatories, heat therapy and topical gels. Type of treatment included chiropractic. There was good knowledge of the services offered by chiropractors and various types of chiropractic treatment available. Conclusion The prevalence of LBP amongst waitron staff within the eThekwini Municipality was high. Work-related factors were associated with the onset of LBP. These included prolonged standing, constant walking for long periods of time, carrying heavy loads and falling. Low back pain negatively impacted on their work due to absenteeism as bed rest was required. Various treatment options, including chiropractic were utilized. Participants had some knowledge of what constitutes chiropractic treatment and the types of services offered.
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).
Experiences of homosexual patients’ access to primary health care services in Umlazi, KwaZulu-Natal
(AOSIS OpenJournals, 2015) Cele, Nokulunga Harmorny; Sibiya, Maureen Nokuthula; Sokhela, Dudu Gloria
Background: Homosexual patients are affected by social factors in their environment, and as a result may not have easy access to existing health care services. Prejudice against homosexuality and homosexual patients remains a barrier to them seeking appropriate health care. The concern is that lesbians and gays might delay or avoid seeking health care when they need it because of past discrimination or perceived homophobia within the health care thereby putting their health at risk. Aim of the study: The aim of the study was to explore and describe the experiences of homosexual patients utilising primary health care (PHC) services in Umlazi in the province of KwaZulu-Natal (KZN). Method: A qualitative, exploratory, descriptive study was conducted which was contextual in nature. Semi-structured interviews were conducted with 12 participants. The findings of this study were analysed using content analysis. Results: Two major themes emerged from the data analysis, namely, prejudice against homosexual patients by health care providers and other patients at the primary health care facilities, and, homophobic behaviour from primary health care personnel. Conclusion: Participants experienced prejudice and homophobic behaviour in the course of utilising PHC clinics in Umlazi, which created a barrier to their utilisation of health services located there. Nursing education institutions, in collaboration with the National Department of Health, should introduce homosexuality and anti-homophobia education programmes during the pre-service and in-service education period. Such programmes will help to familiarise health care providers with the health care needs of homosexual patients and may decrease homophobic attitudes.
Experiences of homosexuals' access to primary health care services in Umlazi, KwaZulu-Natal
(2015-03) Cele, Nokulunga Harmorny; Sibiya, Maureen Nokuthula; Sokhela, Dudu Gloria
Introduction Access to effective health care is at the heart of the discourse on how to achieve the health related Millennium Development Goals. Lesbian and gay persons are affected by a range of social and structural factors in their environment, and as a result have unique health needs that might not be met by existing health care services. Sexual stigma remains a barrier to seeking appropriate health care. Lesbians and gays might delay seeking health care when needed or avoid it all together, because of past discrimination or perceived homophobia within the health care system. Aim of the study The aim of the study was explore and describe the accessibility of primary health care services to lesbians and gays in Umlazi in the province of KwaZulu-Natal. Methodology A qualitative, exploratory, descriptive study was conducted which was contextual in nature. Aday and Andersons’ theoretical framework of access was chosen to guide this study. Semi-structured interviews were conducted with 12 lesbian and gay participants. The findings of this study were analysed using content analysis. Results Four major themes that emerged from the data analysis were discrimination of homosexual men and women by health care providers and community members in PHC facilities; attitudes of homosexual men and women towards health care providers; homophobic behaviour and equality of PHC services. Few participants were satisfied with the primary health care services they received. Intervention by the Department of Health, Department of Education, curriculum planners and Health Professionals Councils is recommended wherein homosexuality education should be addressed during pre-service and in-service education sessions so as to familiarise health care providers with such clients’ health care needs and to decreased homophobic attitudes.
An exploration of the role of the Sarva Dharma Ashram in the development of youth and their families in the Welbedacht community
(2020-11-30) Gurcharan, Yashna; Bhagwan, Raisuyah
Historically, faith-based organisations have been at the forefront of developing and empowering disadvantaged youth and their families. They have been known to provide not only spiritual support but also material relief to needy families and communities. Despite the fact that they play a salient role in spiritual and social development very little empirical research, exists which attests to their value in developing contexts. It is within this context that the current study was developed. It sought to understand the role of the Sarva Dharma Ashram in the development of youth, their families and the community in the Welbedacht area. A qualitative research approach was used in the study. Specifically a case study design was used, with the Sarva Dharma Ashram being considered as the case for analysis. Three samples were recruited to shed light on the Ashram, as the case of analysis. The samples included the Board members of the Sarva Dharma Ashram, family members of youth, and community members of Welbedacht. The data was collected through semi-structured interviews with the Board members and family members. Data was collected till saturation. Four Board members of the Ashram were interviewed and ten family members were interviewed. A focus group discussion was used to collect data from ten community members. An interview and focus group guide served as the data collection instruments in this study. In total twenty-four people participated in this study. Data collection with all three samples took place at the Sarva Dharma Ashram. The data was analysed using the process of thematic analysis. The transcripts were read several times for patterns and similar wording. Thereafter, the main themes and sub-themes were identified which highlighted how the Ashram contributed to families and the community. There were five broad themes that emerged from the data. These reflected the experience of poverty and financial hardship endured by children, youth and their families in the community and the varied and multifaceted spiritual and material support extended to families and the community through diverse initiatives of the Sarva Dharma Ashram. The study found that the Ashram acted as a focal point within the disadvantaged community of Welbedacht and a huge immediate resource to youth, families and the community when any psycho-social or financial distress was encountered. The feeding scheme was found to be one such initiative where schools in the vicinity were provided with meals regularly. Moreover spiritual activities at the Ashram such as the Satsangh programme (group devotional singing), were found to uplift families and individual members who faced distress and isolation. Empowerment programmes for unemployed women were aimed to uplift women and enable them to become more financially independent. Faith is a core motivator for the work that faith-based organisations undertake and influences how the initiatives and activities of the Ashram are implemented. The transformational benefits of the activities being implemented at the Sarva Dharma Ashram provide tangible evidence of how crucial such organizations are within underresourced communities. The study highlighted the problems experienced by children, youth, and their families in disadvantaged communities and how spiritual and social support can enable family and community well-being. Clarke and Jennings (2008:15) wrote “the faith element of the faith-based organisation is not an add-on to its development activity, operating alongside. It is an essential part of that activity, informing it completely.” The Sarva Dharma Ashram was found to represent this through its services and programmes for the benefit of the Welbedacht community.
The factors associated with student recruitment and student profiles in Dental Technology at a University of Technology
(2017) Dlamini, Philiswa Charity,; Sunder, Roshnee; Bass, Gregory Hylton; Puckree, Threethambal
With the transformation in Higher Education (HE), the number of Black African students entering South African universities increased significantly (72%). Black African students accounted for 77.38% of the total student population at Durban University of Technology (DUT). It has been noted that the majority Black African students in HE are first-generation students, many are under-prepared, and come from low-socioeconomic backgrounds. Students from this racial group tend to make incorrect career choices due to a lack of knowledge, experience, and adequate vocational guidance and career counselling. To add to this, many University of Technology programmes, such as Dental Technology, are vocational in nature and prepare students for unfamiliar industries. The aim of this study is to determine the factors associated with student recruitment practices and student profiles in the Dental Technology programme at the DUT. This cross-sectional study employed a mixed method approach. An online survey recruited Dental Technology students who entered the programme from 2008 to 2012. The students’ demographic information was retrieved from the Management Information System (MIS) Department. The survey generated categorical data, which was analysed using the SPSS (Statistical Package for the Social Sciences) which included frequencies, cross-tabulation, Chi-Square test, and Spearman's Rank Order Correlation. Semi-structured interviews with Dental Technology lecturers and the staff involved in student recruitment practices generated qualitative data which was analysed using QSR NVIVO 10. Common themes were classified and discussed. The findings showed that 75% of Dental Technology students were Black African. Only 28% came from urban areas and 81.4% of students attended government schools. Furthermore, 60% relied on financial aid for the payment of their tuition fees. Two categories of necessary attributes emerged i.e. general attributes for an HE student (intrinsic qualities e.g. passion, positive attitude) and the practice specific attributes for Dental Technology (e.g. good eye-hand coordination, manual dexterity). However, the academic staff indicated that the programme is not attracting its desired students. Added to this, is the fact that from the 2008 – 2012 initial intake of 157 students, 41% dropped out of the programme. According to Dental Technology staff, there are no programme-specific student recruitment practices, and they rely on the institutional recruitment practices. However, qualitative findings showed that the DUT employs a generic approach which includes branding and direct promotion with academic departments only minimally involved, reducing the likelihood of effectively recruiting desired students for specific academic programmes such as Dental Technology. About 83% of students indicated that they had not been exposed to any of the DUT’s recruitment practices while they were still in high school. With these findings, it can be concluded that the association between the profiles of the student participants and the current student recruitment practices in the Dental Technology programme is incongruent and weak. In essence when students are recruited to enrol in academic programmes in an institution there needs to be a strong relationship between academic departments and the staff members responsible for recruiting students as the academic staff members are better able to clearly explain the intricacies of their respective programmes and they have an accurate understanding of their desired students. The student recruitment personnel are equipped to sell or market the institution and its offerings to prospective students, but there is clearly a need for the Dental Technology programme to pay more attention to the manner in which their students are recruited and retained. This will help to improve the programme's pass rates and dropout rates while addressing the issues of access, equity, diversity.
Feasibility and acceptability of utilising short message service for follow-up care of oupatient mental health care users in the uMgungundlovu District
(2018) Ramlucken, Lucelle; Sibiya, Maureen Nokuthula; Zikalala, N.P.
Background The mental well-being of an individual is affected by physical, social and psychological factors, which result in a psychiatric diagnosis. Difficulty in concentration and attention is experienced, and they become dependent on their families for financial and social support. Over the years, there has been a rapid growth in the use of mobile technology which has been proven to increase treatment adherence. Short message services may improve service delivery through appointment reminders, and improve communication between health care workers and patients. Aim of the study The aim of this study was to determine the feasibility and acceptability of utilising a short message service to remind outpatient mental health care users (MHCU) of their follow-up care in the uMgungundlovu District. Methodology The study employed a non-experimental quantitative survey. The study took place at four outpatient psychiatric clinics in the uMgungundlovu District in KZN. A non-probability convenient sampling method was used to select 182 participants at the psychiatric clinics. Results The majority of the respondents n=169 (92.9%) indicated that they would be interested in receiving the short message service. Results indicated that it would be feasible, acceptable and expedient to MHCUs to have access to the service.
Guidelines to enhance the human caring attributes amongst the undergraduate nursing students and nurse graduates in KwaZulu-Natal
(2020-06-10) Zikalala, Nomusa Penicca; Sibiya, M. N.; Jinabhai, C. C.
The nursing profession needs caring individuals. Graduating nurses who interrelate with others in an empathetic and compassionate manner is obligatory for nursing to uphold the image of being a caring profession. Not only nursing’s reputation is at stake, but also having caring or uncaring nurses does have financial bearing in healthcare. South Africa is witnessing a sharp increase in medical malpractice litigation as patients increasingly become aware of their rights in a setting of an overburdened health system with limited resources. The consequences of increased litigation are a further reduction in the state’s ability to finance health care because of large pay-outs and a continuing increase in malpractice premiums in the private sector. Aim The aim of this study was to critically analyse the role played by theoretical and clinical learning experiences, in influencing the development of human caring attributes among undergraduate nursing students and newly graduated professional nurses (less than five years of experience) in the province of KwaZulu-Natal (KZN) in order to establish clear guidelines that could be used by lecturers to enhance human caring attributes among the nursing students. Methodology The convergent mixed method design (Qualitative + Quantitative) was used in the current study. This method allowed the researcher to use concurrent timing to implement the qualitative and quantitative strands during the same research process, prioritise both methods equally, but kept the strands independent and only mixed the quantitative and qualitative results during the overall interpretation. The quantitative aspect enabled the researcher to gather information from undergraduate nursing students and newly graduated professional nurses (less than five years of experience) from both selected KZN College of Nursing (KZNCN) and University of Technology (UoT) using the Caring Behaviour Inventory Tool after the researcher received permission from the author. The qualitative aspect allowed the researcher to gather information from the newly graduated professional nurses (less than five years of experience) and nursing students’ from KZNCN and UoT, understanding of the concept human caring, to explore the intrinsic and extrinsic factors related to the development of human caring attributes from their perspectives and to determine their experiences in both the theory and the clinical setting that contributed to the development of human caring attributes through semi-structured in-depth interviews. Focus group discussions with nurse educators from the selected KZNCN and UoT as well as nurse managers and nursing students from DUT and KZNCN practice, also enabled the researcher to gather some rich information from these participants. The quantitative data was analysed using version 25.0 of the Statistical Package of Social Sciences and the qualitative data was analysed using Tech’s method of data analysis. Findings The quantitative data showed that the nursing students and newly graduated professional nurses had a clear idea regarding the constituents of caring in nursing. The findings identified a caring nurse as being giving the patient information, so that he/ she can make a decision, supporting the patient, giving good physical care, giving instructions or teaching the patients, treating patient information confidentially, making the patient physically or emotional comfortable, helping to reduce the patients’ pain, encouraging the patient to call if there are problems, showing respect for the patient and giving good physical care. The qualitative findings of the current study revealed that there was a unanimous agreement amongst the nurses irrespective of their professional ranks about the understanding of the concept human caring. These findings also revealed that the lack of human and material resources, unconducive working environment and lack of management support impact negatively on the quality of patient care as well as nursing students’ integration of theory into practice. The researcher also established clear guidelines that can be used by lecturers to enhance human caring attributes among the nursing students. Recommendations for implementation and evaluation of the effectiveness of the developed guidelines were suggested for future research.
Impact of HIV/AIDS scale-up on non-HIV priority services in Nyanza Province, Kenya
(2017) Opollo, Valerie Sarah Atieno; Puckree, Threethambal
Background: The HIV pandemic has attracted unprecedented scale-up in resources to curb its escalation and manage those afflicted. Although evidence from developing countries suggests that public health systems have been strengthened as a result of scale-up, only anecdotes exist in other countries. Despite scale-up, the prevalence of HIV/AIDS is still high and the resultant mortality and morbidity demands a refocus. Furthermore, the HIV/AIDS epidemic has severely strained vulnerable health systems in developing countries leading to concerns among policy makers about non-HIV priority services. Although anecdotally, it is clear that HIV scale-up has had profound effects on health systems, available evidence does not allow for an assessment of the impact of such effects on health care access, service delivery or medical outcomes for non- HIV conditions. The aim of this study was to determine the impact of HIV/AIDS scale-up on non-HIV priority services in the former Nyanza Province, Kenya. Additionally we determined the benefits and detriments of HIV programmes, and identified the elements of successful HIV programs and their effect on scale-up and last but not least determined the perceptions, attitudes and experiences of health care staff towards scale-up and integration of health care services. The first part of the main sequential study reviewed practices during scale-up by looking at public health facilities within the Province at Nyanza in Kenya. This looked at health management information systems (HMIS) and routine health facility client records for five years, 2009-2013 with a comparison of trends in 2009 to that in 2013. This data was reviewed in order to show trends in delivery of HIV priority and non-HIV services. The second part of the study utilized a prospective cross sectional survey to determine perceptions, attitudes and experiences xi of facility personnel towards HIV/AIDS scale up. Randomly sampled facilities involved in the delivery of any aspects of HIV diagnosis care and treatment were investigated. Self-administered questionnaires and in-depth interviews were used to obtain information on impact of HIV services on non-HIV priority services on health managerial staff in the facilities and key informants who have shaped scale up. We created a qualitative codebook based on three major themes identified from the data: (1) Meaning and importance of HIV scale-up (2) Perspectives of scale-up on service delivery on non-HIV services and (Ministry of State for Planning) Health facility staff awareness. The findings indicate that the interventions that were utilized in the scale-up of HIV in 2009 resulted in significant increases in uptake of the service in 2013 (p<0.01) and total integration of HIV and non-HIV services at all the health facilities thereby contributing to improved health outcomes beyond those specifically addressed by HIV programs. This study has also shown that utilization of both HIV and non-HIV services increased significantly for both years after integrated HIV care was introduced in the health facilities (p<0.01). Notable increases were found for ANC utilization (p=0.09), family planning (p=0.09), screening for tuberculosis and malaria (p<0.01) and provision of support services (p<0.01) to HIV infected people. The scale up of HIV in the region had several human resource policy implications resulting from staff turnover and workload. Stakeholder engagement and sustainability are critical in the sustenance of these initiatives. Strategic alliances between donors, NGOs and the government underpinned the scale-up process. Policies around scale-up and health service delivery were vital in ensuring sustainability of scale- up and service integration. This study has attempted to provide evidence on the impact of HIV scale-up on non-HIV service delivery in three different settings, in two different time periods and it therefore concludes that the evidence is mixed with most of the impact being positive with some aspects that still needs development. It is critical to pursue the integration of HIV and non- HIV services in a strategic and systematic manner so as to maximize the public health impact of these efforts. The proposed model, best practices and practices requiring improvement will be communicated to the relevant ministries to ensure its integration into policy.
Integrating students with disabilities into nursing education : a South African perspective of nurse educators’ experiences
(Elsevier BV, 2022) Moodley, Selvarani; Mchunu, Gugu
Nurse educators play a pivotal role in integrating student nurses who have disabilities (SNWDs) in nursing education. Understanding the specific experiences of nurse educators may help reduce negative attitudes and discriminatory practices and improve the integration of SNWDs. This article aims to explore and describe nurse educators’ experiences of integrating SNWDs into nursing education institutions training programmes in KwaZulu-Natal, South Africa. A qualitative, descriptive, and exploratory design using a multiple embedded case study approach was adopted. Purposive sampling was used to collect data from five key informants via individual interviews and two focus group discussions comprising of nurse educators who had experience training SNWDs. Trustworthiness and ethical considerations such as obtaining individual written consent from each participant was maintained. Recordings were transcribed verbatim and analysed using conventional content analysis. This study concludes that while every effort was made to integrate SNWDs into nursing education, there are still important gaps not yet captured in the research, relating to the direct experiences of nurse educators. Nurse educators’ understanding of disability accentuates the call for nurse educators to broaden their understanding of disability beyond the medical model. Moreover, the lack of early disability disclosure disadvantages SNWDs from timeous support and reasonable accommodation.
An investigation into recognition of prior learning within the National Certificate: Emergency Care Programme in the Western Cape
(2016) Cermak, Radomir; Bhagwan, Raisuyah; Naidoo, Raveen
Purpose Emergency care education and training in South Africa is experiencing an important transformation period, involving migration from short course based training to a newly proposed, formalised, three-tier qualification system, aligned with the Higher Education Sub-framework. Many existing and experienced holders of short course emergency care certificates face the challenge of gaining access to formal emergency care programmes without meeting the minimum entry requirements. Recognition of Prior Learning (RPL) will therefore become one of the key strategies for planned migration of short course graduates into professional learning programmes. However, the research reports on RPL practice in the field of emergency care are scarce. Hence, valuable lessons about RPL in emergency care programmes are missed. The purpose of this study is to explore the efficacy of RPL practice within the National Certificate: Emergency Care (NCEC) Programme in the Western Cape, through the experience of ambulance emergency assistants, who applied for RPL on the Programme and the paramedic educators involved in the facilitation and RPL assessment on the NCEC Programme. Methodology The design of this descriptive exploratory study was qualitative, and was set in the interpretative paradigm using a case study mode of inquiry. The qualitative data was collected through semi-structured focus groups, individual interviews, and document analysis. The participants were from Cape Peninsula University of Technology (CPUT), Department of Emergency Medical Sciences, and the Western Cape Government College of Emergency Care (WCCEC). Collected data was interpreted by means of thematic analysis, set against the context of the study objectives and the theoretical framework. Finding The study revealed three main themes related to RPL efficacy in the NCEC Programme. These included the need for RPL training for educators involved in RPL, lack of support and guidance for RPL assessors and participants, and the need for careful selection of RPL assessment methods. The document analysis highlighted the gap between a comprehensive and sound RPL policy document and the practical implementation of these policies. Conclusion and Recommendations The emergency care field requires greater awareness and information on RPL processes, principles, assessments, and requirements. The higher education institutions, as the sole providers of the newly proposed formal emergency care programmes need to consider building capacity for RPL by means of training and dedicating academic staff to RPL, and developing comprehensive RPL policies, in collaboration with relevant stakeholders in the field. RPL assessment methods need to be more diverse and tailored to the individual RPL claimants. Further research on RPL will ensure a fair, social inclusive and redressing process during the planned migration of emergency care education and training.
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 and attitudes about HIV infection and prevention of mother to child transmission of HIV in an urban, low income community in Durban, South Africa: Perspectives of residents and health care volunteers
(AOSIS Publishing, 2016) Haffejee, Firoza; Ports, Katie A.; Mosavel, Maghboeba
Background: HIV prevalence is high among South African women of reproductive age and transmission of HIV from mothers to children is a concern. This study ascertained the level of knowledge about HIV infection and prevention, particularly prevention of mother to child transmission (PMTCT) amongst South African women from a low income commu-nity. It also established the challenges in delivering HIV education from the perspectives of health care volunteers. Method: Female residents (n ¼ 67) from Kenneth Gardens, a low income community in Durban, South Africa were interviewed. In-depth semi-structured interviews were con-ducted with 12 health care volunteers who were either health care workers or residents who provided some form of social support in the community. Results: Themajority of respondents indicated that amother could transmit HIV to her child but were unable to specify how. Many women had general HIV/AIDS knowledge but were unable to identify essential prevention behaviours and were not very receptive to more information on HIV/AIDS. They were supportive of routine testing procedures and child bearing amongst HIV positive women. Health care volunteers indicated a need for a community clinic in the area. They also had limited knowledge of PMTCT and indicated that there was a need for more ed-ucation on HIV, particularly to encourage the youth and men to use preventative measures. Conclusion: Innovative ways to impart knowledge particularly of PMTCT and updated standards of practice are essential. It is important that the community understands how transmission occurs so that prevention can follow.
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.
The knowledge, understanding and perceptions of professional nurses, working in primary health care clinics, about autism spectrum disorder
(2018) Williams, Neil Arnold; Sokhela, Dudu Gloria; Basson, Petro Magdalena
Background Abstract The Centers for Disease Control and Prevention (CDC) in the United States has found that more children than ever before are being classified as having autism spectrum disorders (ASDs) (Chiri and Warfield 2011: 1081). According to Matenge (2014: 1), ASD is a pervasive developmental disorder characterised by two essential features: a combination of impairments in social interaction and social communication, and restricted, repetitive, and stereotyped patterns of behaviour, interests and activities. Malcolm-Smith et al. (2013: 4) report that data on the incidence, prevalence, and impact of ASD in South Africa are almost entirely lacking. No epidemiological studies of ASD have been conducted in the country (Malcolm- Smith et al. 2013: 4). Diagnostic and intervention services, particularly at state level, are scarce (Malcolm-Smith et al. 2013: 4). Hence, those that are in place are heavily overburdened. Of particular concern for South Africa are research findings indicating that ASD is under-identified in low socioeconomic status communities, so in these contexts ASD often goes undiagnosed, or is diagnosed late (Malcolm-Smith et al. 2013: 4). Matenge (2014: 19) argues that there is, therefore, a need to assess the level of knowledge, understanding and the experiences of South African nurses regarding autism, as they are usually the first professionals that families of children with autism contact. Research purpose The purpose of this research was to determine the knowledge, understanding and perceptions of professional nurses who work in primary health clinics in eThekwini Health District, KwaZulu-Natal, regarding ASD. Research design A quantitative, non-experimental, descriptive research survey design was utilised. A self-reporting questionnaire was used to collect data. Sampling and sample size Simple random sampling was used to determine which clinics in the eThekwini health district would be part of the study. The sample size for the clinics was thirty four, of those thirty were eThekwini municipality clinics and four KwaZulu-Natal Department of Health clinics. These clinics were utilised and provided the 275 professional nurses needed. The sample was calculated with a margin of error and an alpha value of 0.05; the researcher needed a minimum of 275 respondents. The researcher selected the respondents utilising non-probability, convenience sampling. Data analysis Data was analysed with the assistance of the statistician, using SPSS version 22. Descriptive statistics were used to explore differences between or among groups (Grove, Burns and Gray 2013: 217). Inferential statistics are used to draw conclusions regarding the differences between groups in the population from which the samples are drawn and the relationship between the variables in the population (Morgan et al. 2015: 84). Both descriptive and inferential statistics were used to analyse data in this study. Conclusion and findings It was found that the average professional nurse working in a primary healthcare clinic has 65.8% knowledge and understanding of ASD. Of particular concern is that the majority of respondents 51% (n=141) did not know or understand that the child with autism loves routine which is a key symptom in making a diagnosis of ASD, which may lead to late, or missed diagnosis. Eighty eight percent (n = 242) of respondents felt that they would benefit from further training on the identification and diagnosis of ASD. It was also found that respondents that have completed the Psychiatric Nursing Science course were more knowledgeable about ASD and confident in diagnosing ASD and counselling parents on ASD and available ASD services in the community. Recommendations The researcher recommended that: Autism spectrum disorder to be included in the curriculum for nurses training and that regular in-service training be done to keep the professional nurses up to date with on new information related to ASD. It was also recommended that all children should be screened for ASD at 18 and 24 months at all PHCs in eThekwini district and that posters on the signs and symptoms of ASD should be displayed at primary healthcare clinics in full view of patients, parents and staff
The leadership potential of generation Y practitioner nurses : basis for a developmental framework
(2018) Manson, Theresa Anne; Sibiya, Nokuthula N.; Nkosi, Zethu Z.
Background This study addresses the global leadership crisis in healthcare. Generation Y nurses are the face of the future for the nursing profession and they will soon form the majority cohort of nurses worldwide. Leaders look similar all over the world, and Filipino nurses are now working in most countries. Their leadership ability will no doubt impact on healthcare worldwide. There has been a lack of academic research focusing on the leadership needs of Generation Y nurses, and in particular a lack of mixed methods research in this field. Aim The aim of the study was to develop a sustainable, structured, Generation Y appropriate leadership framework for practitioner nurses, incorporating the knowledge, skills and abilities required so that they are adequately prepared to fulfil leadership at the bedside. Methodology The study design was a multistage mixed methods advanced framework, with concurrent and sequential phases. The design suitably addressed the quantitative and qualitative research questions. Integration occurred at multiple levels. The Relationship-Based Care (RBC) model was adapted to serve as the theoretical framework. Data was collected on Generation Y Filipino nurses working at a hospital in Saudi Arabia. The data collection methods included the online VIA-24 strengths survey, the American Organization of Nurse Executives (AONE) leadership survey on ‘the leader within’ using Benner’s rating scale, and semi-structured face-to-face interviews. The quantitative data was analysed using statistical measures, while the qualitative data was analysed using Tesch’s coding and thematic analysis. Findings The three sets of data revealed insights into the perceptions, leadership needs and leadership development of Generation Y nurses. The significant findings were that Generation Y nurse’s rate ‘fairness’ as the most important character strength and they want equal opportunity to take on leadership roles. The character of a leader determines leadership ability and effectiveness, and they believe they have leadership ability, and that anyone can lead. Generation Y nurses are keen to take the lead, but they need further personal and professional development, and a clear career plan. They value collaborative teamwork, relationships and good communication. They have a clear leadership vision, and strongly desire leadership education that is creative, innovative, technology-driven and fun. They want to learn through active learning and reflective practice. The outcome of the study led to the development of a leadership framework for practitioner nurses that can be used to prepare them for future leadership roles.
A model for staff retention for radiographers employed at selected tertiary hospitals in the KwaZulu-Natal province, South Africa
(2021-05-27) Pillay, Melisa; Sibiya, M. N.; Nkosi, P. B.
Background Radiography as a profession is evolving, with an increased demand for the retention of radiographers. The staffing crisis in radiography is not only a South African concern but also global a one, with public hospitals in the KwaZulu-Natal province being evidence to the shortage. This crisis is exacerbated by the challenge in retaining radiographers. Various factors have led to the turnover of radiographers from the public to the private sectors, as well as emigration to other countries. Therefore, there is a dire need to identify these factors and retain radiographers in KZN‟s public hospitals. Aim The aim of this study was to explore the factors that influence the retention of radiographers employed by tertiary hospitals in the KZN province in order to develop a model to improve staff retention. Method The explanatory sequential mixed methods design was used to conduct this study in two phases. Phase 1 was conducted in the form of questionnaires with closed-ended questions. These questionnaires were answered by the radiographers and managers employed in public tertiary hospitals in the KZN province. A total of 138 questionnaires were completed, returned and analysed. The findings from phase 1 were used to develop a semi-structured interview with open-ended questions. A total of 10 participants from the five selected hospitals were included to participate in the interviews. The results of the two phases were then integrated. The Statistical Package for the Social Sciences (SPSS version 22) and statistical analysis tests were used to analyse the quantitative data, whilst thematic analysis was used to identify themes from the qualitative data. The Herzberg‟s two-factor theory was used as a guide to the factors that influence the retention of staff. Findings The results from the two phases of data collection indicated that a lack of career pathing was the primary motivational factor affecting staff retention. There were also three hygiene factors that affected staff retention, namely the influence of working conditions on staff retention, government policies and inadequate remuneration. Factors that were identified as having a negative effect on staff retention were related to the increase in resignations and the factors that had a positive effect were related to a lesser intent to leave. The outcome of the study led to the development of a model for the staff retention of radiographers. Conclusion The factors that influenced resignation and the factors that were conductive to staff retention were explored. This led to the development of a model for staff retention.
A model to improve the quality of life for elderly people living in a rural setting of uThungulu District, KwaZulu-Natal
(2016) Ndlovu, Busisiwe Adelaide; Sibiya, Maureen Nokuthula; Puckree, Threethambal
Background An increase in the world's population of ageing people is occurring not only in developed countries but also in developing countries. In South Africa, the proportion of the population aged 50 and over increased from 14.8% in 2006 to 15% in 2009 and is predicted to be 19% by 2030. This means that the supply of services for the elderly people should match the demand at all times, otherwise the quality of life of these senior citizens will be compromised. This study aimed at developing a model that would improve the quality of life for elderly people living in the uMhlathuze and uMlalazi sub-districts of the uThungulu district, KwaZulu-Natal. Methodology A qualitative, exploratory, descriptive design was applied for this study. A semi-structured interview guide based on the Health Related Quality of Life Theory and Maslow’s hierarchy of needs was used. Random sampling was used to select the elderly participants. Purposive sampling was used for the selection of the chairpersons of non-governmental organisations, and the District Programme Manager. Audits were conducted in the clubs that elderly people with chronic disease participate in. Data analysis followed Tesch’s steps after which themes and categories were formulated. Results Three major themes that emerged from the data analysis were social well-being of elderly people, physiological factors and psychological factors. The results revealed that elderly people experience poor living conditions and suffer poverty due to a number of factors which including the high unemployment rate of their children. Often the children are involved in substance abuse using the elderly person’s money pension money, which leaves them without any food items in the household. According to the District Programme Manager, there was a project on integrated chronic disease management that was conducted at uThungulu district by the Department of Health. The integrated chronic disease management focused on the population in general of all ages, yet in this study the focus has been on elderly people, which is why the researcher developed a model to improve the QoL of elderly people, due to their unique needs. Conclusion This research study gathered information regarding social, economic, health and environmental factors in rural areas which will help in bringing issues of elderly people’s quality of life to awareness. This research will deepen the knowledge and skills of professionals on ageing issues, especially in rural areas/communities.