Faculty of Health Sciences

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An analysis of emergency response times within the public sector emergency medical services in KwaZulu-Natal
(2017) Finlayson, Melissa Joy; Naidoo, Raveen; Brysiewicz, Petra; Naguran, Sageshin
Introduction: Response times are considered to be one of the oldest and most popular indicators which are used to measure the efficiency of Emergency Medical Services (EMS), particularly to cases in which the patient’s condition is deemed to be life threatening. Purpose: To analyse emergency response times within the public sector Emergency Medical Services in KwaZulu-Natal and to compare these to the national norms. Methods: Using a mixed method approach, the study was conducted in two phases. The first phase involved collecting quantitative data for all the cases logged in the Umgungundlovu Health District Communications Centre over a period of one week (seven days). Phase Two involved the collection of qualitative data from focus group discussions which were conducted with three groups which had been identified. These groups included the communications centre staff, operational staff and supervisory staff. The aim of these focus group discussions was to identify factors that influenced response times as well as to propose strategies which would improve these response times. Content analysis was utilised to interpret the qualitative data which had been collected. Results: Quantitative data was collected from a total of 1 503 cases of which 680 were categorised as priority 1 (P1), 270 as priority 2 (P2) and 553 as inter facility transfer (IFT). The majority of the cases (895) had occurred in urban areas. A total of 406 cases were exempted as no patient was transported. The number of these cases was greater on days when the total case load was higher as compared to days with a lower total case load. The mean response time to cases in rural areas was 129 minutes and 110 minutes to cases in urban areas. All the time intervals were found to be longer for cases in rural areas as compared to those for cases in urban areas but with the exception of the EMD response interval. P1 cases had the shortest mean response times for both urban area cases (33 minutes) and rural area cases (95 minutes) as compared to the other case categories. Nevertheless, the national norm of 15 minutes in urban areas and 40 minutes in rural areas was not achieved in the majority of the cases. The mean Emergency Medical Dispatch (EMD) response interval was 41 minutes for P1 cases, 56 minutes for P2 cases and 96 minutes for IFT cases. The qualitative data revealed factors that impacted on the response times and helped to explain and account for the quantitative data results. Challenges regarding the availability of resources, including vehicles, staff and equipment, as well as the way in which such resources are managed, were highlighted. The high demand for services compared to the available resources was raised by the focus group participants with this high demand resulting in extended EMD response intervals. This was exacerbated by the overwhelming demand for IFT cases which are serviced by the same resources as emergency cases and which have a much longer mission time, thus delaying response times continuously. Exempt cases were also found to impact negatively on response times as, although operational vehicles are committed to these cases, services are not required. Inconsistencies with regards to case prioritisation and dispatch triage also emerged. External factors, including poor road infrastructure, lack of road names and house numbers, weather conditions and long distances between EMS bases, the patient or incident location and health care facilities were also identified as factors that resulted in extended response times. Strategies to improve the situation were explored. These strategies included the effective management of resources in order to ensure optimal availability, the introduction of a formal, computer aided, dispatch system, the adoption of demand pattern analysis and dynamic location/relocation models, standardised processes and procedures to guide all areas of EMS operations and the education of both the public and staff. Conclusion: South African EMS response time national norms for both rural and urban areas are unachievable under the majority of circumstances and, thus, they may be said to be unrealistic. Until these national norms, against which the efficiency of EMS in South Africa is measured, are revised, the service will be deemed to be incompetent.
An analysis of the need for accredited training on the administration of intravenous contrast media by radiographers : results of an online survey
(The South African Radiographer, 2012) Swindon, Lynda; Friedrich-Nel, Hesta; Isaacs, Ferial; Munro, Leonie
Role extension has been debated amongst South African radiographers for a number of years. However, the administration of contrast media still remains outside their scope of practice. The Society of Radiographers of South Africa (SORSA) has received anecdotal reports that radiographers are administering contrast media. This practice is a direct infringement of the rights of patients who are required to be treated and examined by health professionals who practice within their legal scope. The aim of this survey was to investigate the views and opinions of South African radiographers regarding the injecting of contrast media and the type of training needed if it were included in the scope of practice of South African radiographers. A questionnaire was sent to 845 radiographers using an online survey programme (SurveyMonkey). The questions related to biographical information, work experience, training and the medico-legal aspects of intravenous contrast media injection by radiographers. The response rate was 21% (n=177). Eighty-one percent (81%) were diagnostic radiographers. Seventy-three percent (73%) practice radiography in a major city. There was an equal representation of the public and private sector, namely 43% for both. Of those from the public sector 47% were from a tertiary healthcare facility. More than seventy-eight percent (>78%) practice radiography in a health facility that provides radiology services. Seventy-three percent (73%) were aware of mild to moderate adverse reactions to contrast media; 45% were aware of severe adverse reactions to contrast media in their workplace. Eighty-five percent (85%) thought that accredited training should include the administration of contrast media as well as resuscitation of a patient. Sixty-two percent (62%) thought the accredited training should include pharmacology and advanced resuscitation. Ninety-three percent (93%) thought the main advantage would be an increase in service delivery to patients; 85% thought the main disadvantage would be potential risk of criminal or civil litigation. Ninety-seven percent (97%) were of the opinion that radiographers who introduce contrast media to patients must have current malpractice insurance. The results of this survey provide new information on the current status of contrast media administration to the patient whose safety and rights remain at the centre of our focus. It is recommended that the statutory body, namely the professional board for radiography and clinical technology (RCT) of the Health Professions Council of South Africa (HPCSA) takes cognizance of the outcome of this study and embarks on a more extensive survey to include a larger sample which would be more representative of the South African radiography population.
Assessing infection control knowledge and compliance in theatre at a private hospital in KwaZulu-Natal, South Africa
(2022-09-29) Naidoo, Elizabeth Laura; Adam, Jamila Khatoon
Infections acquired in a hospital (HAI) often referred to as nosocomial infections are related with increasing morbidity and death among patients that are hospitalised and are predisposed to an elevated risk of infection by health workers (HCWs). The need to maintain an effective infection prevention and control program is therefore essential for quality health care. This study sought to assess the knowledge and compliance of infection control practices of Cardiovascular Perfusionists in theatre at a private healthcare facility in KwaZulu-Natal (KZN) in the city of Durban. A qualitative, research design was used to explore the knowledge and compliance of infection control practices of Cardiovascular Perfusionists by conducting online semi structured interviews. The interviews were conducted online due to the current pandemic of COVID-19, where much consideration was given to social distancing and modes of virus transmission. Duration of the interviews lasted no more than 20 minutes. Prior to conducting the main study, a pilot study was pursued in order to ensure that the interview questions were relevant and that the participants had clear engagement with the questions and no modification nor questions were added to the interview guide. The researcher found that the actual description of the professions differed in the procedures carried out, however, the theatre environment is the same, and only a few questions pertaining to the difference in practice of the participants had to be slightly rephrased in order to be more applicable to the main study. The study was conducted by means of a purposive sample of Cardiovascular Perfusionists. The interviews conducted were limited to only those that practice in the private sector. Participants were chosen based on their ability to provide the necessary information. The interviews were transcribed and then coded by a statistician. The rationale for selecting this strategy was that the researcher was seeking knowledge about the factors that influence the knowledge and compliance of Cardiovascular Perfusionists in the private sector regarding infection prevention and control techniques. Subsequently, these participants would be therefore able to contribute valuable information. The major themes which emerged where namely., infection control and prevention, knowledge of healthcare associated infections, awareness of healthcare acquired infections, cardiovascular perfusionists procedures and precautions followed in cardiovascular surgery. The study found that there is a need for Clinical Technologist specialising in Cardiovascular Perfusion to undergo training in infection control and prevention practices at the higher education and training level. Subsequently, the study reveals that Cardiovascular Perfusionists have a good overall understanding of pathogens and the implications thereof. The study also notes that there is considerable compliance to infection control practices in theatre irrespective of the knowledge pertaining to infection control and prevention policies.
Assessing infection control knowledge and compliance of cardiovascular perfusionists in theatre at a private hospital in Kwazulu-Natal, South Africa
(Durban University of Technology, 2023) Naidoo, Elizabeth; Akpa-inyang, Francis; Odayan, Myenderan; Adam, Jamila
Infections acquired in a hospital (HAI) often referred to as nosocomial infections are related with increasing morbidity and death among patients that are hospitalised and are predisposed to an elevated risk of infection by health workers (HCWs). The need to maintain an effective infection prevention and control program is therefore essential for quality health care. This study sought to assess the knowledge and compliance of infection control practices of Cardiovascular Perfusionists in theatre at a private healthcare facility in KwaZulu-Natal (KZN) in the city of Durban. We conducted a qualitative study based on in-depth interviews with 12 Cardiovascular Perfusionists (CP) who were purposively selected from private sector. The interviews lasted between 20 to 25 minutes and were transcribed, and then thematic analysis were applied using NVivo. The study found that there is a need for Clinical Technologist specialising in Cardiovascular Perfusion to undergo training in infection control and prevention practices at the higher education and training level. Subsequently, the study reveals that Cardiovascular Perfusionists have a good overall understanding of pathogens and the implications thereof. The study also notes that there is considerable compliance to infection control practices in theatre irrespective of the knowledge pertaining to infection control and prevention policies. We concluded that there is an overall good knowledge and understanding regarding infection control practices, although many felt that there exists an inequitable application of infection control policies due to professional biases.
An assessment of the implementation of the provincial cervical screening programme in selected primary health care clinics in the Ilembe region, KwaZulu-Natal
(2002) Sibiya, Maureen Nokuthula; Grainger, Linda D.
Cervical cancer is almost completely preventable, yet it is the second most prevalent cancer amongst women in South Africa. KwaZulu-Natal (KZN) in particular has a high mortality rate of cervical cancer and 1:40 women die from cancer of the cervix. Therefore, in 1997 a cervical screening. policyand-. programme was implemented in the province. The KZN Department of Health and the Sub-Directorate Maternal, Child and. Women's Health needed to know what was happening currently in terms of implementation of the cervical screening programme since it was first implemented three years ago. Therefore, the purpose of the study was to evaluate the implementation of the Provincial Cervical Screening Programme in selected Primary Health Care clinics in lIembe Region, KZN. This study took the form of formative evaluation research. The target population consisted of PHC clinics in KZN that have implemented the cervical screening policy and the programme. The accessible population for this study consisted of the clinics in the lIembe Region. A four-stage selection plan was applied to select the sample from the accessible population. The first stage involved a random selection of two clinics from an urban area and two from a rural area. Within each of the selected clinics, three types of evidence for the evaluation of the implementation of the cervical screening programme were sampled. Therefore, the second stage of the plan was the selection of records. A purposive sample of all records of clients who were diagnosed with abnormal smears was assessed. The third stage involved the selection of all Professional Nurses from each of the selected clinics. Lastly, the fourth stage involved the selection of the day for collecting data on the facilities and resources. The sources of evidence that were used to evaluate the implementation of cervical screening programme by the clinics were non-participant observation, which involved clinic audit, a review of abnormal smear records and self-reports from nurses regarding the cervical screening programme. Results indicated that there was a lack of resources needed for implementing the programme in rural clinics compared to urban clinics. However, all clinics in the study had an adequate supply of the drugs needed for the treatment of abnormal smears. The researcher also found that nurses lacked knowledge regarding the indications for taking smears. On reviewing the records, the researcher noted that most of the results indicated that smears had adequate cells needed for analysis. However, the results indicated that there was a problem with follow-up of clients with abnormal smears. There was lack of necessary resources such as telephones needed to do proper follow-up. Feedback to the clinics from the referral hospital regarding the outcome of the visit was inadequate. The results also indicated thatthe mechanisms of record keeping were poor. Nurses were of the opinion that women should have their first Pap smear at the age of 20 and thereafter at intervals of five years, once they start to be sexually active because of the high rate of sexually transmitted infections and HIV/AIDS in KZN. Therefore, the above results indicate that problems exist at the selected PHC clinics that may result in ineffective implementation of the cervical screening programme.
An assessment of the integration of palliative care in the caring of cancer patients in selected oncology clinics in the eThekwini district in KwaZulu-Natal
(2013-01-18) Sithole, Ntombizodwa Margaret; Sibiya, Maureen Nokuthula; Gwyther, L.
Palliative care research in South Africa is at an early stage and there is an increasing need to develop a body of evidence that is relevant to South African conditions. One of the biggest challenges that palliative care in Africa faces is the projected increase in the number of cancer patients in the developing world by 2050, many of whom will need palliative care. There is a concern at present about the integration of oncology and palliative care services in South Africa and whether or not cancer patients are able to access quality palliative care. Palliative care plays an important role in improving quality of life for people and family members affected by life-threatening illness. It pursues its goal by relieving pain and other distressing symptoms in cancer patients and giving psychosocial support to patients and their families. It should begin at diagnosis and continue throughout treatment, follow-up care, and at the end of life in addition to the cancer treatment which is given Aim of the study The aim of this study was to assess the integration of palliative care in the caring of cancer patients in the selected oncology clinics in the eThekwini district in KZN. Methodology A qualitative, explorative, descriptive and contextual research design was used to guide this study. The study was participative in nature and employed a focus group methodology. The participants in this study were professional nurses who were working at the selected sites in the public urban oncology clinics for more than three months. Two focus groups were conducted within one month of each other at selected oncology sites with participation from 16 oncology nurses. Findings Findings indicated that most participants understood palliative care as end of life care when a patient is beyond curative treatment and that it is often the doctor who determines eligibility. Participants also perceived palliative care in terms of different types of medical treatment. The findings indicated nurses only contacted hospices when the patient was at the last stage of their illness, were often not aware of all the hospices in the area, and acknowledged that communication between the oncology clinics and hospices was not good. Some nurses believed that palliative care is also provided in the oncology clinic and that it is not only the hospices that provide palliative care. Only one oncology nurse who participated in the study mentioned that she is trained in palliative care, but they all showed interest in becoming more knowledgeable in this area and improving relationships between oncology clinics and the palliative care team/hospices.
The association between acute childhood diarrhoea and diarrhoeagenic E.coli present in contaminated soil in informal settlements in Durban
(2016) Ramlal, Preshod Sewnand; Kistnasamy, Emilie J.; Olaniran, Ade O.
In South Africa, under-five childhood morbidity and mortality rates have increased due to diarrhoea with acute diarrhoea posing a major public health threat especially, in informal settlements. Therefore this study sought to, a) investigate community knowledge, attitudes, behaviour and practices (KABP) regarding domestic waste and childhood diarrhoeal management, b) to enumerate and identify diarrhoeagenic E.coli species from soil samples extracted from open waste dump sites and c) to investigate any association(s) with diarrhoeagenic E.coli and potential risk of contracting diarrhoea. This two-phased cross-sectional study in six informal settlements in the greater Durban area constituted, respectively, of the administering of questionnaires to 360 primary caregivers and; sampling the prevalence of diarrhoeagenic E.coli (DEC) in waste dumps using quantitative polymerase chain reaction methodologies. Relationships between socio-demographic and educational status to determine potential household risk factors towards under-five diarrhoea prevalence were assessed. The KABP results identified domestic waste and greywater disposal, mother and child method of sanitation, personal and domestic hygiene practices and mechanical vectors as significant contributory risk factors. Of concern is that more than 80% of under-five children played in or near faecally-contaminated waste dump sites. The recovery of four DEC pathotypes including enterohaemorrhagic E.coli, enteropathogenic E.coli, enterotoxigenic E.coli and enteroaggregative E.coli suggest that its persistence in waste-dump soil has the ability to cause under-five diarrhoea in both sporadic and endemic settings. This commonly transmitted hand-to-mouth illness will necessitate and place huge demands on the primary catalysts of change i.e. local governmental role players and caregivers. These change agents have to ensure highly consistent levels of domestic and personal hygiene and implement feasible reduction strategies to waste-dump exposure of diarrhoeal-causing pathogens, particularly among under-five children living in Durban’s informal settlements.
Causes and effect of student nurses absenteeism at the KwaZulu-Natal College of Nursing
(2015-05) Singh, Pratima; Sibiya, Maureen Nokuthula
INTRODUCTION A four-year diploma nursing programme undertaken by the KwaZulu-Natal College of Nursing provides training to students to become professional nurses. However, it has been noted that absenteeism of student nurses enrolled in this programme has increased. Absenteeism could result in demotion, extension of training or termination of students from the programme. This would result in fewer student nurses completing training and therefore a shortage of professional nurses. AIM OF THE STUDY The aim of the study was to determine the causes and effects of absenteeism amongst student nurses that are currently registered for a four-year diploma programme (R425) in the KwaZulu-Natal College of Nursing (KZNCN). METHODOLOGY A quantitative method was used, which comprised two phases, namely, data collection through the use of a self-administered questionnaire and a retrospective record review. Simple random sampling was used to select students from the peri-urban Midlands and rural uGu districts. Stratified random sampling of 301 student nurses at different levels of training from the three campuses was done. A total of 301 questionnaires were distributed to participants; all were returned, resulting in a 100% response rate. During a retrospective record review student records were examined to assess clinical and theoretical performance of students. Statistical analysis was done using the SPSS version 22.0. RESULTS The results of the study revealed that students experienced problems in the clinical/practical areas that resulted in them absenting themselves. There were 14 terminations of training due to absenteeism. Student nurses who did not absent themselves obtained entry to the examination, whilst students with excessive absenteeism did not obtain entry to the examination.
A clinical audit of the Durban University of Technology homoeopathic satellite clinic established at Ukuba Nesibindi
(2010) Smillie, Tracey; Naude, David F.; Ngobese, Jabulile Cresancia
In collaboration with Lifeline, Durban University of Technology (DUT) established its first satellite homoeopathic community clinic; Ukuba Nesibindi Homoeopathic Clinic (UNHC). UNHC provides a free homoeopathic primary healthcare service on the third floor of the LifeLine building in Warwick junction, Durban, an area which is classified as being disadvantaged with high crime rates, prostitution, violence, small, informal business and low cost housing. The clinic is run by 4th and 5th year homoeopathic students under the supervision of a qualified homoeopathic practitioner and funded totally by the Department of Homoeopathy – DUT. The purpose of this retrospective clinical audit of UNHC was to determine a patient demographic and disease prevalence profile, as well as identify and describe the major medicines prescribed. Methodology The study used a retrospective, explanatory, and descriptive design method by means of a clinical audit, to determine a patient demographic and disease prevalence profile, as well as identify and describe the various homoeopathic treatment modalities. All the patient files from June 2004 – June 2008 were included for analysis and the data collection spreadsheet (Appendix D) was compiled respectively. IV The data collection form was divided into patient demographics, information on number of consultations and follow-ups, clinical diagnoses, urine dipstick analysis, patient referral information and medicines prescribed. The researcher captured the data, which was analysed and various means of descriptive statistics applied using Excel from Microsoft Office® 2007. Results UNHC opened in 2004 and initially only operated two afternoons per week; in order to cope with the demand for this service which grew rapidly in 2006 an additional consultation afternoon was added. A total number of 862 patients were seen between June 2004 and June 2008, 497 being new patients and 365 being follow up patients. On average 56% of patients came back for more than one follow up consultation during the study period. The majority of patients who attended UNHC during the study period were African females between 40 and 64 years of age who were unemployed and single. Of the 5 most prevalent systemic disorders encountered at UNHC infectious disorders were the most frequent along with cardiovascular, dermatological, psychological and musculoskeletal disorders. Conclusion The significant increase in patient numbers at UNHC and the relatively high percentage of patients who returned for more than one follow up consultation are positive trends and suggestive of UNHC’s success in providing homoeopathic primary healthcare as well as the positive impact it has had on the surrounding community. With additional funding UNHC can improve service provision further; dedicated translators as well as various equipment to facilitate administration will streamline the consultation process significantly and allow for more patients to be seen. Expansion of the scope of diagnostic services provided such as pregnancy and glucose testing will reduce the need for referral for such basic services. V Future studies should formally measure patient benefit in response to treatment in the form of a patient benefit survey; qualitative measures of patient satisfaction with the service provided by UNHC are also warranted.
A comparative study of emergency service response intervals in Johannesburg, South Africa and the North West Ambulance Service, United Kingdom
(2019-09-05) Van Der Net, Wynand; Vincent-Lambert, Craig; Kevin, Govender
Background: The primary role of an Emergency Medical Service (EMS) is to respond to an emergency incident within the shortest possible time. As a consequence, response times have historically been used as a key indicator of EMS performance. The City of Johannesburg Emergency Management Services (CoJEMS) provides an EMS to the citizens of the greater Johannesburg metropolitan area in South Africa. The CoJEMS are expected to respond to emergency incidents within 15 minutes, which is the national norm. Before this study there was no complete up-to-date data set or literature describing the extent to which the CoJEMS were meeting this target. The absence of accurate data relating to responsetime intervals was seen as problematic as it limits EMS managers’ abilities to make informed decisions concerning quality management, benchmarking and improvement strategies. Aim: The aim of the study was to investigate, document and describe the time taken by the CoJEMS to complete activities routinely associated with the activation of and response to an emergency incident and to compare these with the response times achieved by the North West Ambulance Services (NWAS) in the United Kingdom. Methods: The research methods included a literature review to identify generic activities that occur from the moment an emergency happens until the patient arrives at a medical facility for treatment. Following this a spreadsheet that was designed to capture the time taken to complete each of the identified activities. Data from 784 calls for the CoJEMS and 786 calls for NWAS were recorded onto the spreadsheet and analysed descriptively. Results: The NWAS had a median overall response time of just 10 min 45 seconds. The median overall time for COJEMs was over twice as long, at 23 min 16 seconds. Conclusion: The NWAS outperformed the CoJEMS in the majority of response-time intervals and the CoJEMS median of 23 min 16 seconds exceeded the national norm and standard of 15 min. Many of the extended CoJEMS response times could be linked to delays in communication between the calltaking department and the EMS dispatch, coupled with a lack of availability of EMS vehicles. Further studies are recommended to determine the reason for the lack of available CoJEMS vehicles, as well as ways to encourage a closer relationship between the different departments within the CoJEMS central communications centre
A comparison of attitudes towards and practices of waste management in three different socio-economic residential areas of Umtata
(2001) Poswa, Tobius Thobile; Combrink, Jane
The purpose of this study was twofold. Firstly, the effect of the social dimensions of households on solid waste practice was investigated in order to examine relationships between socio-economic status and current solid waste practices. Current perceptions and solid. waste practices of households with different socio-economic backgrounds were assessed and compared to explain the influence of socio-economic factors in the planning and operation of a solid waste management system in developing urban areas. Secondly, a waste stream assessment was carried out to examine waste generation and composition trends among different social status residential urban areas. The generally poor state of solid waste services in most developing urban areas in South Africa and the chronic absence of data on domestic solid waste practice in the study area prompted this research initiative. A case study in Umtata involving three residential areas with different socio-economic status was used to assess and explain trends in solid waste practice and contributory factors to variations between different households amongst developing communities from a socio-economic perspective. Data were collected by a waste stream assessment survey involving measuring waste generated from the selected households and analysis of its composition. The waste stream assessment was complemented by a descriptive survey questionnaire, administered by means of personal interviews to each householder or resident in randomly selected households situated in the study area. The survey provided baseline information on solid waste practices and showed that local conditions were unique and thus require a local solution to the solid waste problems. The study showed that the understanding of the relations within households is vital for planning appropriate, effective and sustainable solid waste service programmes /systems. Gender relations, age, educational status and income are significant factors to be considered in planning and effectively operating solid waste management plans.
Comparison of the effectiveness of group interventions on Indian women diagnosed with mild to moderate depression at an urban psychiatric clinic in KwaZulu–Natal
(2004) Chetty, Dayanithee; Brooks, Heidi
The aim of this quasi-experimental study was to compare the effectiveness of a Nurse-facilitated cognitive group intervention, a Volunteer-led support group intervention and a standard treatment Control group on mild to moderately depressed Indian women at an urban community psychiatric clinic in KwaZulu-Natal in terms of their levels of depression and self-esteem over a three-month period. Since antidepressants alone are ineffective in the treatment of depression, the study evaluated group interventions as adjunctive treatments. The first intervention involved 15 group sessions based on Gordon’s teachings (1988a and 1988b), whilst the second intervention consisted of 15 craft-making group sessions. A purposive sample of 45 depressed women was selected and randomly allocated to the three groups. Sample selection criteria included a Beck Depression Inventory score between 9 and 29, being aged between 25 and 65 years and using antidepressant medication. For ethical reasons, all participants continued with their “standard” antidepressant treatment throughout the study. The Personal Profile Questionnaire (PPQ), the Beck Depression Inventory Scale (BDI) 1978, the Rosenberg Self-Esteem Scale (RSE) 1965, the Life-Experience Survey (LES) 1977 questionnaire and a question on exercise were used to assess the effectiveness of the group interventions. Pre-test (prior to the introduction of the intervention) and two sequential Post-test scoring (after 6 and 12 weeks of interventions) were undertaken using the above-named instruments. The Kruskal Willis and Friedman’s test were used to detect changes in levels of depression and self-esteem between and within the three groups respectively, at the p = 0.05 levels of significance. The intergroup comparison showed statistically significant improvements in the BDI score of Experimental groups 1 and 2, with p = 0.00. There were no changes in the Control group. The intra-group comparison showed statistical significant improvements during the study within the intervention groups (p = 0.00 in both cases) but not in the Control group. No statistically significant change in the RSE amongst or within the three group was detected. The study has shown that group interventions as an adjunct to antidepressant treatment are beneficial as rehabilitation programmes for depressed women. Furthermore, volunteers and psychiatric nurses with training in using group interventions may be useful in assisting depressed patients to enhance their quality of life.
Determining the health risk factors impacting residents living in dilapilated buildings in Durban, South Africa
(2021-05-27) Mdoda, Mzimasi; Ghuman, Shanaz
In most developing countries such as South Africa, the phenomenon of buildings dilapidation has persisted in cities. Despite endeavors by the government, municipalities and others to eliminate this point of contention, the problem has remained. In different metropolitan areas such as Durban, Port Elizabeth and Johannesburg in South Africa, the existence and effects of disrepair continue to increase. The primary purpose of the study was to determine the health risk factors impacting occupants of a dilapidated building in Durban, South Africa. A dilapidated building is any building exhibiting signs of being a health hazard. This can be determined by factors such as unsanitary conditions, unsightliness, over-crowding, poor ventilation, mismanagement of refuse or waste, and poor maintenance of the building. A dilapidated building was purposely selected in South Beach, Durban. This is a residential building that satisfied the definition of 'dilapidated building’. The dwelling houses 600 people occupying 140 units. The minimum sample size was 103 Units. The head of the household or his/her proxy was targeted to participate in each unit. The research instrument used to collect primary data was a questionnaire and an inspection survey. Data analysis included descriptive, inferential statistical analysis carried out using the Social Sciences Statistical Package (SPSS Version 26.0 IBM). A Chi squared statistical test of independence and Phi Coefficient and Cramer's V Correlation test has shown a statistical significant association between the painful ankles experienced and the non-use of the elevator to reach the upper floors (p=0.002, phi and V=0.351), crime and depression/ anxiety (p=0.003, phi and V=0.018), lack of air circulation through open windows and TB (p=0.035, phi and V=0.197), as well as enervated waste removal versus medical attention seeking (p=0.003, phi and V=0.197). This research highlights that conditions in a dilapidated building linked strongly with adverse health outcomes of the occupants. A wide range of risk groups has affected occupants’ health, mainly from poor solid waste management, crowded units, and crime. Dilapidated building conditions were linked to a wide range of health problems and symptoms including respiratory infections, headaches, sleepless asthma, crime, ankle pain and mental health. Interventions to ensure healthy buildings and to prevent building dilapidation require a tripartite approach including government, building owners and occupants, with every stakeholder having a role to play in ensuring building health.
Development of a policy framework for the establishment of physical exercise programmes in reducing non-communicable diseases in the Province of Kwazulu-Natal, South Africa
(2022-09-29) Gumede, Musa
Background This study follows a mixed method methodology, and researched tenets of physical exercise beneficial to health. The study took place in eThekwini Municipality among members of physical exercise clubs, trainers and administrators. The study population comprised of urban, township and rural areas. The participants included scholars, the youth, and elderly populations. The participants were questioned as to whether they had pre-existing chronic cardiac disease, or related non-communicable diseases. Aim The aim of this study was to develop a policy framework for physical activity in adult communities in the province of KwaZulu-Natal, South Africa. Methodology The study follows an exploratory, sequential mixed methods approach that begins with a qualitative phase, where experts, trainers, and government officials were interviewed on their observations and role in supporting the physical exercise programmes. The interviews were conducted on a one-to-one basis and took an average of forty-five (45) minutes. This was followed by the quantitative phase that involved conducting a survey by questionnaire on participants in physical exercise programmes. Fifteen participants consisting of two government officials, eight trainers and five experts were interviewed during the qualitative phase and a total of 364 participants participated in the survey, with 224 females and 140 males, where 25% of the participants were students. A proportion of 15.6% of the participants came from rural areas, whereas 43% came from urban areas, with the remainder residing in townships and informal areas. Findings The results indicated that 84% of the respondents participated in physical exercise programmes or sport while at school, 89% participated in exercise or sporting programme while at school, with a value of p<.001. A proportion of 93% of participants did not suffer from chronic heart disease or hypertension and 60% were not offered health check-ups by facilities whereas a significant 68% of facilities ONLY offered for a health check-up when participants were ill or injured, p<.001. Using a one sample t-test, there was significant agreement that facilities were adequate and in good condition, p<.001; and that the usage of these facilities and what was found to be on offer was acceptable/good, p<.001. In terms of physical exercise intensity, the findings indicated that a significant 86% of participants took part in mild exercise regularly, and a significant number took up to 90 minutes a day, p<.001. A significant 67% of participants performed moderate exercise regularly for up to 90 minutes a day. Whereas a significant 82% participated in vigorous exercise regularly, for 45-90 minutes a day, p<.001. The conclusion of the study is that early initiation of PE in schools contributed to long term health benefits like a lower number of participants with NCDs such as obesity and chronic heart diseases, lower incidents of NCDs were found in physically active individuals and the health benefits are not dependent on intensity of exercise but on consistent exercise whether mild, moderate or vigorous. The study identified a gulf in urban-rural infrastructure availability and usage. The study results are important and contribute to the introduction of physical exercise programmes in schools as part of health promotion, to lobby for development of community recreational facilities and training facilities in rural and urban areas.
The effectiveness of environmental education on waste management practices in Mtumbane and Maheng townships in Port St. Johns, Eastern Cape
(2018) Njiva, Innocent Dalumzi; Kistnasamy, Emilie Joy; Govender, Thashlin
In this democratic era, two of the largest previously disadvantaged communities in Port St Johns i.e. Mtumbane and Maheng were still without waste collection services. Solid waste was dumped indiscriminately and posed risks to health and the environment. To help these communities to achieve better health, this study aimed to investigate the effectiveness of environmental education on waste management practices (WMP). The key objectives entailed establishing the knowledge, attitude and behaviour of sampled households towards WMP; evaluating the intervention of the 4Rs (reuse, reduce, recycle and recover) of WMP as taught to Grades 4 to 7 residing in the previously sampled households and assessing the impact of the intervention on WMP in these households. This study was undertaken in three phases. The pre-intervention and post-intervention phases included questionnaire administration occurring over two months. The intervention comprised the teaching of the 4Rs of WMP and the completion of a daily diary by Grades 4 to 7 residing in the previously sampled households.This study focused on statistically significant differences that were reported between pre- and post- intervention. The differences were meant to establish if the respondents had any changes in knowledge regarding solid waste management. Results showed that the use of plastic bags increased which showed a significant difference (p-value 0.034).Indiscriminate dumping of waste in Mtumbane decreased whereas in Maheng, there was no difference with their practices. Among the majority of respondents from Mtumbane, waste was regarded as something useful (p-value 0.003). The education associated with waste management for both townships increased by more than 15% and that made a significant difference (p-value 0.025). Further, more than half of the respondents in Mtumbane separated their waste. The results show that there was a significant difference (p-value 0.001) in Mtumbane and not in Maheng. This significant difference may be attributed to the distribution of adequate information as the two townships vary in distance from the municipal offices i.e. Mtumbane: three kilometres and Maheng: 15 km). It was found that the number of respondents willing to pay for waste collection services increased post-intervention (p-value 0.003). It appears that in every aspect when pre- and post-intervention were reported, there was a positive difference after the intervention phase. Four recommendations are proposed: (1) organising solid waste cleaning campaigns and environmental education in schools and communities; (2) the introduction of the 4Rs to communities; (3) the provision of communal waste skips and (4) the use of incentives to foster proper waste disposal practices. It is important for all future studies to consider a method for disseminating important information to the community in order that waste management strategies can be fully and successfully implemented.
An epidemiological investigation into low back pain in schoolteachers within the Greater Tzaneen Municipality in Limpopo, South Africa
(2022-09-29) Prinsloo, Imé Mari; Docrat, Aadil; Prince, Cleo Kirsty
Background: Low back pain (LBP) is a common and significant disease found in the entire population but increased among the working population. Studies have shown that prevalence among LBP in schoolteachers are increased, yet there has been limited studies looking at urban and rural schoolteachers simultaneously. Objectives: To determine the incidence and lifetime prevalence of low back pain among schoolteachers within the Greater Tzaneen Municipality, South Africa; to determine the risk factors (in terms of demographics, lifestyle, and occupational factors) of developing LBP; and to determine the management strategies sufferers of LBP use to get relief. Methods: This was a quantitative, descriptive, cross-sectional study conducted within schools of the Greater Tzaneen Municipality. Teachers working in both the urban and rural school setting were approached to partake in the study. Those who met the criteria were invited to complete the selfadministered questionnaires, online or hard copies. In total 345 questionnaires were completed. Results: Of the 345 completed questionnaires 67% reported having LBP. Significant associations were made between the prevalence of LBP and increased mental stress (51.5%). Similarly, LBP sufferers had a higher BMI (p=.010); have been teaching for longer, (p=.049); and spend more time working at a computer, p<.001. Aggravating factors of LBP included bending/twisting the body, lack of sleep, reaching overhead, sitting, standing, and stress/tension. The strongest corresponding factor being stress and tension (p<.001). Conclusion: In this specific community there was no significant difference in prevalence of LBP between urban and rural schoolteacher. Notwithstanding previous research, this study highlights that global statistics is not always appropriate in South African context. This draws attention to the need for research specifically based on our diverse country.
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, Faizal
Essential 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.
An evaluation of the appropriateness of emergency medical service (EMS) responses in the eThekwini health district of KwaZulu-Natal
(2014-07-23) Newton, Paul Richard; Naidoo, Raveen; Brysiewicz, Petra
Introduction: The Emergency Medical Service (EMS) is required to respond to cases of life threatening illness or injury which may later be found to be non-emergent thus creating a mismatch between the dispatch of limited EMS resources and actual patient need. This study proposed that such a mismatch presently exists among South African urban EMS systems resulting in unacceptably high levels of inappropriate emergency responses. The purpose of this study therefore, was to evaluate the appropriateness of EMS responses in comparison to patient needs in a South African urban EMS system. Methods: All emergency cases dispatched over a 72 hour period at the Emergency Medical Communication Centre (EMCC) of the eThekwini Emergency Medical and Rescue Service (EMRS), a public sector urban EMS system, were prospectively enrolled in a quantitative study employing a descriptive, comparative design. Computer generated Vehicle Control Forms (VCF) containing dispatch data were matched and compared with Patient Report Forms (PRF) containing epidemiological and clinical data to describe the nature and extent of inappropriate responses based on patient need. Data were subjected to simple descriptive analysis and comparisons were analysed with correlations and chi-square. The Pearson's г and Spearman's rho were used to establish significance between more than two variables. Results : A total of 1689 cases were enrolled in the study of which 1385 met the inclusion criteria; 304 cases were excluded due to incomplete or duplicated data. The demand for EMS resources fluctuated widely throughout the day with levels peaking at midday and declining sharply after midnight. The median response time across all priorities was 56 minutes (IQR 59min) with just under half (46.4%) of all cases having a response time of more than an hour and almost one in ten (9.5%) exceeding 2½ hours. Significant variations existed between dispatch and on-scene priority settings and category descriptors most notable of which was seen in the highest priority ‘red code’ category which constituted more than 56% of all cases dispatched yet accounted for less than 2% on-scene (p <0.001). Conversely, over 80% of ‘red code’ responses actually required a lower priority response. Similarly, significant discrepancies were seen in the allocation of resources compared to the interventional needs of patients where it was shown that more than 58% of all cases required no interventions and just under 36% required only basic life support (BLS) level interventions (p <0.001). Of those patients triaged as ‘red code’ on-scene, less than 12% were initially allocated an appropriate Advanced Life Support (ALS) level of response and, of particular concern, only 7% of patients found to be dead or ‘blue code’ on-scene were initially dedicated a ‘red code’ response. Conclusion: South African urban EMS systems are presently unable to meet the needs of patients in terms of demand and matching resources to patient needs with evidently high levels of inconsistent and inappropriate responses resulting in sub-optimal use of limited resources.
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).
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, Joy
BACKGROUND: 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).