Faculty of Health Sciences

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Motion palpation used as a postmanipulation assessment tool for monitoring end-feel improvement : a randomized controlled trial of test responsiveness
(Elsevier BV, 2009-09) Lakhani, Ekta; Nook, Brian; Haas, Mitchell; Docrat, Aadil
A tenet of motion palpation theory is the ability to confirm postadjustive segmental end-feel improvement (EFI). Only one previous trial has evaluated the responsiveness of EFI; this was a study of the thoracic spine. The purpose of this study was to evaluate the responsiveness of postadjustive end-feel for evaluating improvement in putative segmental spinal motion restriction after spinal manipulative therapy (SMT) of the cervical spine.
Methods
A prospective, blinded, randomized placebo-controlled pilot trial was conducted with 20 symptomatic and 10 asymptomatic participants recruited from a chiropractic teaching clinic. The treatment group received SMT, and the control group received placebo detuned ultrasound. Responsiveness was evaluated as the etiologic fraction (% of cases with EFI attributable to SMT) and as the sensitivity and specificity of change.
Results
For the entire sample, the etiologic fraction was 63% (P = .002), sensitivity was 93%, and specificity was 67%. For symptomatic participants, a strong relationship appeared to exist between receiving SMT and EFI (etiologic fraction = 78%, P = .006; sensitivity = 90%; specificity = 80%). A strong relationship was not found for asymptomatic participants (etiologic fraction = 40%, P = .444; sensitivity = 100%; specificity = 40%), where EFI was recorded frequently, whether participants received SMT or detuned ultrasound.
Conclusion
The findings of this study showed that motion palpation of end-feel assessment appears to be a responsive postmanipulation assessment tool in the cervical spine for determining whether perceived motion restriction found before treatment improves after SMT. This observation may be limited to symptomatic participants.
If you are here at the clinic, you do not know how many people need help in the community : perspectives of home-based HIV services from health care workers in rural KwaZulu-Natal, South Africa in the era of universal test-and-treat
(Public Library of Science (PLoS), 2018-01) Perriat, Delphine; Plazy, Mélanie; Gumede, Dumile; Boyer, Sylvie; Pillay, Deenan; Dabis, François; Seeley, Janet; Orne-Gliemann, Joanna; ANRS 12249 TasP Study Group
Limited engagement in clinic-based care is affecting the HIV response. We explored the field experiences and perceptions of local health care workers regarding home-based strategies as opportunities to improve the cascade of care of people living with HIV in rural South Africa as part of a Universal Test-and-Treat approach.
Methods
In Hlabisa sub-district, home-based HIV services, including rapid HIV testing and counselling, and support for linkage to and retention in clinic-based HIV care, were implemented by health care workers within the ANRS 12249 Treatment-as-Prevention (TasP) trial. From April to July 2016, we conducted a mixed-methods study among health care workers from the TasP trial and from local government clinics, using self-administrated questionnaires (n = 90 in the TasP trial, n = 56 in government clinics), semi-structured interviews (n = 13 in the TasP trial, n = 5 in government clinics) and three focus group discussions (n = 6-10 health care workers of the TasP trial per group). Descriptive statistics were used for quantitative data and qualitative data were analysed thematically.
Results
More than 90% of health care workers assessed home-based testing and support for linkage to care as feasible and acceptable by the population they serve. Many health care workers underlined how home visits could facilitate reaching people who had slipped through the cracks of the clinic-based health care system and encourage them to successfully access care. Health care workers however expressed concerns about the ability of home-based services to answer the HIV care needs of all community members, including people working outside their home during the day or those who fear HIV-related stigmatization. Overall, health care workers encouraged policy-makers to more formally integrate home-based services in the local health system. They promoted reshaping the disease-specific and care-oriented services towards more comprehensive goals.
Conclusion
Because home-based services allow identification of people early during their infection and encourage them to take actions leading to viral suppression, HCWs assessed them as valuable components within the panel of UTT interventions, aiming to reach the 90-90-90 UNAIDS targets, especially in the rural Southern African region.
Trial registration
The registration number of the ANRS 12249 TasP trial on ClinicalTrials.gov is NCT01509508.
Implementing universal HIV treatment in a high HIV prevalence and rural South African setting : field experiences and recommendations of health care providers
(Public Library of Science (PLoS), 2017-01) Plazy, Melanie; Perriat, Delphine; Gumede, Dumile; Boyer, Sylvie; Pillay, Deenan; Dabis, François; Seeley, Janet; Orne-Gliemann, Joanna
We aimed to describe the field experiences and recommendations of clinic-based health care providers (HCP) regarding the implementation of universal antiretroviral therapy (ART) in rural KwaZulu-Natal, South Africa.
Methods
In Hlabisa sub-district, the local HIV programme of the Department of Health (DoH) is decentralized in 18 clinics, where ART was offered at a CD4 count ≤500 cells/μL from January 2015 to September 2016. Within the ANRS 12249 TasP trial, implemented in part of the sub-district, universal ART (no eligibility criteria) was offered in 11 mobile clinics between March 2012 and June 2016. A cross-sectional qualitative survey was conducted in April-July 2016 among clinic-based nurses and counsellors providing HIV care in the DoH and TasP trial clinics. In total, 13 individual interviews and two focus groups discussions (including 6 and 7 participants) were conducted, audio-recorded, transcribed, and thematically analyzed.
Results
All HCPs reported an overall good experience of delivering ART early in the course of HIV infection, with most patients willing to initiate ART before being symptomatic. Yet, HCPs underlined that not feeling sick could challenge early ART initiation and adherence, and thus highlighted the need to take time for counselling as an important component to achieve universal ART. HCPs also foresaw logistical challenges of universal ART, and were especially concerned about increasing workload and ART shortage. HCPs finally recommended the need to strengthen the existing model of care to facilitate access to ART, e.g., community-based and integrated HIV services.
Conclusions
The provision of universal ART is feasible and acceptable according to HCPs in this rural South-African area. However their experiences suggest that universal ART, and more generally the 90-90-90 UNAIDS targets, will be difficult to achieve without the implementation of new models of health service delivery.
The psychosocial needs of teenagers orphaned by HIV and AIDS : a qualitative study in KwaZulu-Natal
(2013-03) Gumede, Dumile Olivia; Gumede, Phiwayinkosi; Du Plessis, Gretchen
Dealing with HIV, AIDS, parental illness and death are realities many South African teenagers have to face. Understanding the experiences of such teenagers provides a vital ingress into the complexities of the HIV and AIDS epidemic as a social phenomenon. The objective of this study was to describe the psychosocial needs of orphans aged 13-15 years. In-depth interviews were conducted with a purposeful sample of teenaged orphans in KwaZuluNatal. Findings reveal that these teenagers were confronted with drastic changes before and after the deaths of their parents. Several losses were experienced, such as the loss of a parent, the loss of friends, the loss of a home, an inheritance and a childhood. The care experience of the teenagers differed. Whereas some caregivers provided some of the needs of the teenagers, unmet psychosocial needs and poor care were reported.
Exploring adolescents and young people's candidacy for utilising health services in a rural district, South Africa
(Springer Science and Business Media LLC, 2019-03-28) Nkosi, Busisiwe; Seeley, Janet; Ngwenya, Nothando; Mchunu, S. Lerato; Gumede, Dumile; Ferguson, Jane; Doyle, Aoife M.
We use the 'candidacy framework' to describe adolescents' and young people's (AYP) experiences of health services in a rural KwaZulu-Natal district, South Africa.
Methods
A qualitative approach was used including group discussions, in-depth and key informant interviews with a purposive sample of AYP (n = 70), community leaders (n = 15), school health teams (n = 10), and health service providers (n = 6).
Results
Findings indicate tacit understanding among AYP that they are candidates for general health services. However, HIV stigma, apprehensions and misconceptions about sexual and reproductive health, and socio-cultural views which disapprove of AYP pre-marital sex undermine their candidacy for sexual and reproductive services.
Conclusion
Consideration and understanding of the vulnerabilities and reasons AYP exclude themselves will inform interventions to address their health needs. AYP's participation in the design of health services will increase their acceptability and encourage uptake of services.
Community perceptions of the socio-economic structural context influencing HIV and TB risk, prevention and treatment in a high prevalence area in the era of antiretroviral therapy
(National Inquiry Services Center (NISC), 2018-03) Ngwenya, Nothando; Gumede, Dumile; Shahmanesh, Maryam; McGrath, Nuala; Grant, Alison; Seeley, Janet
Following calls for targeted HIV prevention interventions in so-called "hotspots", we explored subjective perceptions of community members in places considered to be high HIV and tuberculosis (TB) transmission areas and those with low prevalence. Although more people now have access to antiretroviral therapy (ART), some areas are still experiencing high HIV transmission rates, presenting a barrier to the elimination of HIV. A rapid qualitative assessment approach was used to access a sample of 230 people who contributed narratives of their experiences and perceptions of transmission, treatment and prevention of HIV and TB in their communities. Theoretical propositions case study strategy was used to inform and guide the thematic analysis of the data with Research Department of Epidemiology & Public Health, University College London, London, UK. Our results support the concept of linking perceived control to health through the identification of structural factors that increase communities' sense of agency. People in these communities did not feel they had the efficacy to effect change in their milieu. The few socio-economic opportunities promote social mobility in search of better prospects which may have a negative impact on community cohesion and prevention strategies. Communities were more concerned with improving their immediate social and economic situations and prioritised this above the prevention messages. Therefore approaches that focus on changing the structural and environmental barriers to prevention may increase people's perceived control. Multifaceted strategies that address the identified constructs of perceived control may influence the social change necessary to make structural interventions successful.
Sources of social support and sexual behaviour advice for young adults in rural South Africa
(BMJ, 2018-01) Harling, Guy; Gumede, Dumile; Shahmanesh, Maryam; Pillay, Deenan; Bärnighausen, Till W.; Tanser, Frank
While young people in sub-Saharan Africa (SSA) are at greatest risk of HIV acquisition, uptake of HIV prevention interventions among them has been limited. Interventions delivered through social connections have changed behaviour in many settings, but not to date in SSA. There is little systematic evidence on whom young SSA adults turn to for advice. We therefore conducted an exploratory cross-sectional study from whom young rural South Africans received support and sexual behaviour-specific advice.
Methods
We asked 119 18-34 year olds in rural KwaZulu-Natal about the important people in their lives who provided emotional, informational, financial, physical, social or other support. We also asked whether they had discussed sex or HIV prevention with each contact named. We used descriptive statistics and logistic regression to analyse support and advice provision patterns.
Results
Respondents named 394 important contacts, each providing a mean of 1.7 types of support. Most contacts were relatives, same-gender friends or romantic partners. Relatives provided most informational, financial and physical support; friends and partners more social support and sexual advice. Respondents reported discussing sexual matters with 60% of contacts. Sources of support changed with age, from friends and parents, towards siblings and partners.
Discussion
Sexual health interventions for young adults in rural South Africa may be able to harness friend and same-generation kin social ties through which sex is already discussed, and parental ties through which other forms of support are transmitted. The gender-segregated nature of social connections may require separate interventions for men and women.
The impact of self-interviews on response patterns for sensitive topics : a randomized trial of electronic delivery methods for a sexual behaviour questionnaire in rural South Africa
(Springer Science and Business Media LLC, 2017-08-17) Harling, Guy; Gumede, Dumile; Mutevedzi, Tinofa; McGrath, Nuala; Seeley, Janet; Pillay, Deenan; Bärnighausen, Till W.; Herbst, Abraham J.
BackgroundSelf-interviews, where the respondent rather than the interviewer enters answers to questions, have been proposed as a way to reduce social desirability bias associated with interviewer-led interviews. Computer-assisted self-interviews (CASI) are commonly proposed since the computer programme can guide respondents; however they require both language and computer literacy. We evaluated the feasibility and acceptability of using electronic methods to administer quantitative sexual behaviour questionnaires in the Somkhele demographic surveillance area (DSA) in rural KwaZulu-Natal, South Africa.
Methods
We conducted a four-arm randomized trial of paper-and-pen-interview, computer-assisted personal-interview (CAPI), CASI and audio-CASI with an age-sex-urbanicity stratified sample of 504 adults resident in the DSA in 2015. We compared respondents' answers to their responses to the same questions in previous surveillance rounds. We also conducted 48 cognitive interviews, dual-coding responses using the Framework approach.
Results
Three hundred forty (67%) individuals were interviewed and covariates and participation rates were balanced across arms. CASI and audio-CASI were significantly slower than interviewer-led interviews. Item non-response rates were higher in self-interview arms. In single-paper meta-analysis, self-interviewed individuals reported more socially undesirable sexual behaviours. Cognitive interviews found high acceptance of both self-interviews and the use of electronic methods, with some concerns that self-interview methods required more participant effort and literacy.
Conclusions
Electronic data collection methods, including self-interview methods, proved feasible and acceptable for completing quantitative sexual behaviour questionnaires in a poor, rural South African setting. However, each method had both benefits and costs, and the choice of method should be based on context-specific criteria.
Knowledge, attitudes and perceptions of Genomic Medicine among medical students, private medical practitioners and the general public in eThekwini, KwaZulu-Natal
(2019) Naidoo, Levani; Reddy, Poovendhree
The use of genomics in public health has the potential to contribute towards the diagnoses of diseases, ensuring the efficiency of health promotion interventions and assist in developing more effective pharmaceuticals. Research conducted abroad has documented the discourse of public and medical perceptions towards genetic testing, however, there is a lack of information to inform the health sector within South Africa with respect to the knowledge and attitudes of the general public and medical sector towards genetic testing. Therefore, the aim of this study was to document and evaluate the knowledge, attitudes and perceptions surrounding the use of public health genomic (PHG) medicine. This was a quantitative cross sectional study and our convenient sample included representatives from the general public, medical students and medical practitioners within the eThekwini region in KwaZulu-Natal (n=170). Participants were required to fill out administered questionnaires which included likert scale questions. Medical practitioners from both private and public health sector in the KZN region were sampled (n=45). Medical students comprised of second year students from the UKZN Nelson R Mandela medical school who had not yet been exposed to the genetic module in their medical curriculum (n=79). Representatives of the general public included educators from private and public primary schools in Durban and surrounding areas (n=46). Descriptive and frequency analysis using mean, standard deviation and range was used for quantitative variables. Knowledge and attitude responses were stratified by gender, race and for medical practitioners by practice type. Bivariate correlations using Spearman’s rho test and principle component analysis was conducted. Scoring scales were used to determine the level of knowledge and type of attitude among participants towards predictive genetic testing. Results revealed that the knowledge of the general public, medical practitioners and medical students towards the use of public health genomics were adequate. Medical students displayed a negative attitude towards the uptake of predictive genetic testing which was contrary to the positive attitudes of the general public and medical practitioners. Stratification by gender indicated that women from the general public were more accepting of PHG despite the increased costs associated with genetic testing. We found that females were knowledgeable on the primary use of predictive genetic testing, and more Africans (77%) than Indians (46.2%) and Whites (50%) were aware that genetic testing is being offered in South Africa. Results of bivariate correlations revealed that current medical practitioners would still use predictive genetic testing despite the possible ethical, legal, and social implications for the end user. PCA (Principle Component Analysis) confirmed a strong factor loading for a willingness to use predictive genetic testing among the general public. PCA yielded a high factor loading on an awareness for the need for a proper legislative framework for PHG among medical students. Medical students articulated a need for additional training in public health genomics. In order to improve knowledge among the medical fraternity, institutions should adapt undergraduate and post-graduate curriculum to make provision for relevant PHG training that would be extended not only to medical and health care students but offered to qualified practitioners for continuous professional development training. In addition, awareness should be created on various media platforms to inform the public about the availability and costs associated with predictive genetic testing services in South Africa. Relevant stakeholders from both the public and private health sector in South Africa should be aware of the challenges that could impact on the uptake of public health genomics in South Africa, given its potential for use in the NHI (National Health Insurance) structure.
Survey of radiation protection amongst non-radiology staff working in fluoroscopy-guided operating theatres at public health institutions in the eThekwini district of KwaZulu-Natal
(2019-09-05) Hundah, Shillah Nyaradzo; Naidoo, Subradhanalene; Puckree, Threethambal
Background Although fluoroscopy facilitates the performance of less invasive surgical techniques and therefore an increase in its use outside the radiology department, it carries with it the burden of radiation exposure. Several studies on radiation exposure during fluoroscopy-guided surgical procedures have been conducted in South Africa, but no known knowledge, attitude and practices (KAP) study has been conducted on radiation protection. Together with inadequate radiation protection practices among non-radiology theatre staff, the dearth of reported research on this subject has created the need for this study. This study therefore aimed to determine the KAP relating to non-radiology staff during fluoroscopy-guided operating procedures at public health institutions in the eThekwini district of KwaZulu-Natal. The relationships between KAP, demographic factors and intentions to implement radiation protection practices were related to the theory of planned behaviour. Methodology Ethical approval and gatekeeper permissions were obtained from the relevant stakeholders. A quantitative cross-sectional survey was adopted to collect data from non-radiology staff in fluoroscopy-guided operating theatres at eThekwini district public health institutions. Random stratified sampling was used to obtain a sample of 179 participants. A validated questionnaire was administered over 12 weeks. Respondents signed a consent form prior to participating and no names were provided on the questionnaire for purposes of confidentiality. Data were analysed using descriptive and inferential statistical tests such as the Chi- square test, Fisher‟s exact test and Spearman‟s rho correlation coefficient. Results The response rate was 54%, the respondents‟ mean age was 38.46 ± 9.47 years, and the majority (66.7%) were female. The respondents demonstrated moderate radiation-related knowledge (61.22%) and exceptional attitude (98.98%), but poor radiation protection practices (3.06%). The respondents‟ specialty, profession and hospital where they are working demonstrated a significant association with their KAP scores (p < 0.05). There are significant positive correlations between knowledge and attitude (r = 0.270, p = 0.021), and attitude and intention (r = 0.348, p = 0.008), and significant negative (inverse) correlations between knowledge and practice (r = -0.264, p = 0.017), and attitude and practice (r = -0.280, p = 0.014). There are no significant correlations between knowledge and intention, and intention and practice (p > 0.05). Conclusion Although the respondents have good knowledge and attitude, their radiation practices are poor. This indicates a need for further radiation protection training and improved awareness of and research into exact levels of radiation exposure and the consequences of such exposure.