Exploring socio-economic factors influencing incidences and outcome of multidrug resistance tuberculosis among patients and facility staffs in Makana Sub-District, Eastern Cape
- Authors: Cannon, Lesley-Ann https://orcid.org/0000-0002-7635-277X
- Date: 2022-02
- Subjects: Multidrug resistance , Tuberculosis
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/26706 , vital:65958
- Description: Background Drug-resistant Tuberculosis (DR-TB) is one of the main causes of global public health crisis, due to the morbidity and mortality rates associated with the disease. This DR TB is a complex illness having direct and indirect impact on finances, social functioning, and quality of life of infected individuals. Major research advances have been made in the diagnosis and treatment of DR-TB. However, minimal information exists on the socio-economic factors influencing the incidence and outcomes. This study aims to fill the gap by exploring the socio-economic factors from both the health care professional and patient perspective in particular settings to gain insights into developing context-specific strategies against the burden of DR-TB. Methodology The study applied a qualitative method to explore the socio-economic factors influencing MDR-TB through key-in-depth interviews (KIIs) and focus group discussions (FGDs). The study enrolled a total of thirty-two (32) consenting participants. The KIIs was conducted for ten (10) healthcare workers and nine (9) MDR-TB patients. Two focus group discussions were done involving seven (7) MDR TB patients and six (6) MDR-TB patients, respectively. The study targeted healthcare workers working in the MDR-TB field and TB patients with the following: GeneXpert Rifampicin resistance and patient confirmed as MDR TB. Eligible participants were selected using a purposive sampling technique from the hospitals` routine data electronic records (EDR-WEB database) and hardcopy registers (drug-resistant TB register) on MDR-TB patients enrolled in care at the study site. Informed consent was obtained from all study participants after thoroughly explaining the purpose. No personal information of participants was used. All responses from respondents were coded during analysis for autonomy and the respondents were not identifiable in any published or unpublished work following this research. The interviews were transcribed, some translated into English, where necessary, and analysed until saturation was reached. Data was coded and analysed using both thematic and content analysis technique. Results There were 3 main themes identified in the study: social factors, economic factors, and other contributing factors. 7 sub- themes were recorded under social factors and 2 subthemes under economic factors. Two independent factors that were also considered to impact MDR-TB were the attitude of healthcare workers, as well as the current COVID-19 pandemic. Conclusion MDR-TB is a major public health concern in the Makana Sub-district of the Eastern Cape. The findings of this study highlight the impact of socio- economic factors on the incidence, spread, defaulter rate and outcomes of MDR-TB. The social areas highlighted by the study participants as affecting the incidence and outcomes of MDR TB were housing and relocation, decreased immunity, stigma, patients’ attitude and lack of support, alcohol and other substance usage and prison/ incarceration. The economic factors identified by the participants were unemployment and job loss and health related expenses. Other factors are those factors contributing to the increased incidence and possible poor outcomes of MDR TB. Healthcare workers impact and attitude and the effects of the covid-19 pandemic were highlighted as additional factors influencing the incidence and outcomes of MDR TB. The management of MDR-TB requires rigorous efforts that should be directed at addressing the socio-economic factors. Therefore, future quantitative studies and important programmatic strategies should be considered to tackle the socio-economic challenges that contribute to the burden of MDR-TB infection in the Makana community. , Thesis (MPA) -- Faculty of Health Sciences, 2022
- Full Text:
- Date Issued: 2022-02
Exploring socio-economic factors influencing incidences and outcome of multidrug resistance tuberculosis among patients and facility staffs in Makana Sub-District, Eastern Cape
- Authors: Cannon, Lesley-Ann Lynnath
- Date: 2022-02
- Subjects: Multidrug resistance , Multidrug-resistant -- tuberculosis
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/23471 , vital:57896
- Description: Drug-resistant Tuberculosis (DR-TB) is one of the main causes of global public health crisis, due to the morbidity and mortality rates associated with the disease. This DR-TB is a complex illness having direct and indirect impact on finances, social functioning, and quality of life of infected individuals. Major research advances have been made in the diagnosis and treatment of DR-TB. However, minimal information exists on the socio-economic factors influencing the incidence and outcomes. This study aims to fill the gap by exploring the socio-economic factors from both the health care professional and patient perspective in particular settings to gain insights into developing context-specific strategies against the burden of DR-TB. The study applied a qualitative method to explore the socio-economic factors influencing MDR-TB through key-in-depth interviews (KIIs) and focus group discussions (FGDs). The study enrolled a total of thirty-two (32) consenting participants. The KIIs was conducted for ten (10) healthcare workers and nine (9) MDR-TB patients. Two focus group discussions were done involving seven (7) MDR-TB patients and six (6) MDR-TB patients, respectively. The study targeted healthcare workers working in the MDR-TB field and TB patients with the following: GeneXpert Rifampicin resistance and patient confirmed as MDR TB. Eligible participants were selected using a purposive sampling technique from the hospitals` routine data electronic records (EDR-WEB database) and hardcopy registers (drug-resistant TB register) on MDR-TB patients enrolled in care at the study site. Informed consent was obtained from all study participants after thoroughly explaining the purpose. No personal information of participants was used. All responses from respondents were coded during analysis for autonomy and the respondents were not identifiable in any published or unpublished work following this research. The interviews were transcribed, some translated into English, where necessary, and analysed until saturation was reached. Data was coded and analysed using both thematic and content analysis technique. There were 3 main themes identified in the study: social factors, economic factors, and other contributing factors. 7 sub- themes were recorded under social factors and 2 subthemes under economic factors. Two independent factors that were also considered to impact MDR-TB were the attitude of healthcare workers, as well as the current COVID-19 pandemic. MDR-TB is a major public health concern in the Makana Sub-district of the Eastern Cape. The findings of this study highlight the impact of socio- economic factors on the incidence, spread, defaulter rate and outcomes of MDR-TB. The social areas highlighted by the study participants as affecting the incidence and outcomes of MDR TB were housing and relocation, decreased immunity, stigma, patients’ attitude and lack of support, alcohol and other substance usage and prison/ incarceration. The economic factors identified by the participants were unemployment and job loss and health related expenses. Other factors are those factors contributing to the increased incidence and possible poor outcomes of MDR TB. Healthcare workers impact and attitude and the effects of the covid-19 pandemic were highlighted as additional factors influencing the incidence and outcomes of MDR TB. The management of MDR-TB requires rigorous efforts that should be directed at addressing the socio-economic factors. Therefore, future quantitative studies and important programmatic strategies should be considered to tackle the socio-economic challenges that contribute to the burden of MDR-TB infection in the Makana community. , Thesis (MPA) -- Faculty of Health Sciences, 2022
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- Date Issued: 2022-02
Waste keratinous biomass valorization and characterization of keratinases produced by exiguobacteria species
- Authors: Dlume, Tutuka
- Date: 2021-02
- Subjects: Factory and trade waste -- Biodegradation , Bioremediation
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/20695 , vital:46438
- Description: Keratinous wastes are emanating in a million tons, as by-products, from various agro-industrial processing plants. Consequently, they create a serious solid waste problem in the environment due to poor handling. Microbial keratinases are proteolytic enzymes that effectively participate in keratin-rich biomass hydrolyses such as feathers, nail, hair, hooves, and horns. Therefore, proper management of these wastes via recycling into useful products is ecologically imperative. Biodegradation of keratin-rich biomass has been identified as an economical and environmentally friendly way of transforming these recalcitrant agro wastes into useful products, hence the motivation for this study. Feather degrading bacterial strains previously isolated from a municipal dumpsite and coded as SSB-02 and SSB-03 was identified through 16S rDNA sequencing and phylogenetic analysis. The fermentation conditions for keratinase production were optimized. The protein and amino acids constituents of the hydrolyzed chicken feather were analyzed. The biochemical properties of the keratinase produced were determined. Also, the effect of laundry detergents on the stability of the keratinase was studied. The isolates coded as SSB-02 and SSB-03 showed a high percentage of sequence homology with Exguobacterium spp., hence they were identified as Exiguobacterium sp. FBH5 and Exiguobacterium acetylicum FHBD, respectively. Exiguobacterium sp. FBH5 showed the highest extracellular keratinase production of 934.58 ± 27.27 U/mL at 72 h of incubation; in optimized fermentation conditions that included pH (5.0), temperature (30 oC), and chicken feather (0.5percent, w/v). Similarly, E. acetylicum FHBD displayed optimal keratinase production of 1023.64 ± 25.71 U/mL at 120 h of fermentation and improved fermentation conditions that involved pH (3.0), temperature (35 oC) and chicken feathers (0.5-1.5percent; w/v). The amino acid analysis showed that arginine, aspartic acid and glutamic acid were the most abundant amino acids cleaved from the degradation of chicken feathers by Exiguobacterium sp. FBH5 at a respective concentration of 1.16, 1.28 and 1.45 (g/100g sample). Additionally, hydrolysate that emanated from E. indicum FHBD degradation of feather showed high concentrations of arginine, serine, aspartic acid, glutamic acid, and glycine at the respective concentration (g/100g sample) of 1.2, 1.12, 1.34, 1.58 and 1.29. The keratinases were optimally active at pH and temperature of 8.0 and 50 oC, respectively. EDTA and PMSF did not highly repress keratinolytic proteases' activity, and this inhibitory pattern suggests that they may belong to a mixed protease family. Keratinase from E. acetylicum FHBD was highly stable in the presence of SDS, with 99percent residual activity and displayed variable stability in other chemical agents tested. A similar stability pattern was observed with keratinase from Exiguobacterium sp. FBH5, although the enzyme lost about 40percent of its original activity in the presence of SDS. Evaluation of metal ion stability indicated that E. acetylicum FHBD keratinase was remarkably stable in the presence of Fe3+, Mg2+, Cu2+, Zn2+, and Ba2+, with residual activity of 94percent, 88percent, 89percent, 90percent, and 97percent, respectively. Similarly, Exiguobacterium sp. FBH5 keratinase was considerably stable after treatment with Co2+, K+, and Zn2+ as it displayed a residual activity of 85percent, 84percent and 93percent, respectively. The study of the keratinases stability in laundry detergents showed that E. acetylicum FHBD keratinolytic proteases was activated in the presence of Omo, Surf, Sunlight, and Pro wash after 60 min of pre-incubation compared to 30 min, with residual activity of 94 ± 2.94percent, 91 ± 2.53percent, 95 ± 2.89percent and 87 ± 2.89percent respectively. Likewise, Exiguobacterium sp. FBH5 keratinase activity was promoted after 60 min of incubation compared to 30 min, with a residual enzyme activity of 79percent, 84percent, 101percent, 103percent and 105percent and 106percent for Ariel, Surf, Prowash, Freewave, Sky and Evaklin, respectively. Therefore Exiguobacterium spp., demonstrated excellent keratinolytic potentials that could be exploited for sustainable development of bio-innovative products. The study keratinases' properties suggest their industrial and biotechnological application potentials, especially as bio-additive in the formulation of laundry detergents. , Thesis (MSc) -- Faculty of Science and Agriculture, 2021
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- Date Issued: 2021-02