Lived experiences of people living with HIV and hypertension with regard to disease management in the Eastern Cape
- Authors: Tokwe, Lwandile
- Date: 2019
- Subjects: HIV-positive persons -- South Africa -- Eastern Cape , Hypertension -- South Africa -- Treatment Chronic diseases -- Treatment Patient compliance Public health
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10948/43765 , vital:37045
- Description: Globally, approximately 36.9 million people in 2017 were reported to be living with the human immunodeficiency virus (HIV) across the world. In South Africa, 7.52 million people in 2018 were reported to be living with HIV. In light of the increased life expectancy among people living with HIV (PLWH), which is attributed by availability and enrolment to Highly Active Antiretroviral Therapy (HAART), chronic noncommunicable diseases (NCDs) compound the management of HIV in PLWH. South Africa is encountering a burden of communicable diseases and NCDs, in particular, the co-morbidity of HIV and hypertension (HTN). The aim of the study was to explore and describe the lived experiences of people living with HIV and HTN with regard to disease management in the Eastern Cape. Qualitative research design was used and amongst its methods, Husserl’s descriptive phenomenological method was utilized to explore the lived experiences of the participants. The Health Belief model was the theoretical framework that underpinned the study. The study was conducted at Sakhisizwe sub-district located in the Eastern Cape Province, South Africa. The target population were adults living with HIV and HTN who were accessing care from Primary Health Care (PHC) clinics and who met the researcher’s inclusion criteria. A purposive sampling method was used and nine participants were interviewed using semi-structured interviews. The data was analysed using Giorgi’s (1985) phenomenological method of data analysis which facilitated the emergence of the themes from the data. Four themes and 14 subthemes emerged. The participants reported that they experienced illness-related stigma, support of different influential people, self-love in the form of taking ownership of the diseases, experience of creating self-care practices and transforming lifestyle modification behaviours. Recommendations for clinical practice were made to support the professional nurses in the management of the HIV and HTN in the PHC setting. The study findings reflected the lived experiences of the patients of the selected setting and was conducted only in one province rather than in the entire South Africa.
- Full Text:
- Date Issued: 2019
- Authors: Tokwe, Lwandile
- Date: 2019
- Subjects: HIV-positive persons -- South Africa -- Eastern Cape , Hypertension -- South Africa -- Treatment Chronic diseases -- Treatment Patient compliance Public health
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10948/43765 , vital:37045
- Description: Globally, approximately 36.9 million people in 2017 were reported to be living with the human immunodeficiency virus (HIV) across the world. In South Africa, 7.52 million people in 2018 were reported to be living with HIV. In light of the increased life expectancy among people living with HIV (PLWH), which is attributed by availability and enrolment to Highly Active Antiretroviral Therapy (HAART), chronic noncommunicable diseases (NCDs) compound the management of HIV in PLWH. South Africa is encountering a burden of communicable diseases and NCDs, in particular, the co-morbidity of HIV and hypertension (HTN). The aim of the study was to explore and describe the lived experiences of people living with HIV and HTN with regard to disease management in the Eastern Cape. Qualitative research design was used and amongst its methods, Husserl’s descriptive phenomenological method was utilized to explore the lived experiences of the participants. The Health Belief model was the theoretical framework that underpinned the study. The study was conducted at Sakhisizwe sub-district located in the Eastern Cape Province, South Africa. The target population were adults living with HIV and HTN who were accessing care from Primary Health Care (PHC) clinics and who met the researcher’s inclusion criteria. A purposive sampling method was used and nine participants were interviewed using semi-structured interviews. The data was analysed using Giorgi’s (1985) phenomenological method of data analysis which facilitated the emergence of the themes from the data. Four themes and 14 subthemes emerged. The participants reported that they experienced illness-related stigma, support of different influential people, self-love in the form of taking ownership of the diseases, experience of creating self-care practices and transforming lifestyle modification behaviours. Recommendations for clinical practice were made to support the professional nurses in the management of the HIV and HTN in the PHC setting. The study findings reflected the lived experiences of the patients of the selected setting and was conducted only in one province rather than in the entire South Africa.
- Full Text:
- Date Issued: 2019
Environmental flows, health and importance of macrophytes in the estuaries of water management area 11
- Authors: Cowie, Meredith
- Date: 2015
- Subjects: Estuarine ecology -- South Africa , Estuaries -- South Africa -- Management , Aquatic plants -- South Africa
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/7930 , vital:24324
- Description: Estuaries require sufficient quantity, quality and appropriate timing of freshwater inflow, referred to as environmental flow requirements, to ensure adequate health and functioning. In South Africa the environmental flow requirements of estuaries is determined using Resource Directed Measures (RDM). The present health and importance of an estuary must be considered when determining the ecological flow required to maintain an estuary in its desired state. An Estuarine Health Index that quantifies changes in abiotic and biotic components from natural conditions to present day is used. Health of biotic components is assessed according to changes in species richness, abundance and community composition. There has, however, been debate regarding the calculation of these attributes. In particular, for macrophytes, the inclusion of all habitat within the Estuarine Functional Zone (i.e. 5 m topographical contour) would affect the health and changes over time determined in past assessments. This is due to different areas being included as different areas would be included The aim of this study was to test the validity and suggest improvements to South Africa’s RDM macrophyte health score determination. The health of macrophytes were assessed at varying levels of intensity from desktop studies to thorough field studies. Rapid field studies provided a visual estimate of macrophyte health; while the intermediate and comprehensive assessments quantified change by mapping the distribution of macrophyte habitats from aerial photographs. These approaches were applied to the 64 estuaries within the Mvoti-Mzimkulu Water Management Area (WMA 11), situated in KwaZulu-Natal (KZN) on the subtropical east coast. Historically, these estuaries have supported restricted macrophyte habitats. Consequently, estuaries that presently or historically supported range limited habitats such as mangroves and swamp forest are considered important. Submerged macrophytes are scarce in KZN estuaries due to siltation and low turbidity and thus estuaries supporting this macrophyte habitat are also important. Based on available literature important estuaries were highlighted and selected for field studies. Transects spanning from the estuary water channel to the boundary of the EFZ provided a generalised distribution of KZN vegetation along an elevation gradient. The transition from estuarine to terrestrial vegetation can be used to improve the current EFZ boundaries, as estuarine area has been found to occur outside of the 5 m contour in some estuaries. Results from the desktop assessment indicated that most of the estuaries are moderately modified. There was a 50 % similarity in the macrophyte health scores determined by the desktop assessment to the 2011 National Biodiversity Assessment (NBA). Field studies mostly confirmed the desktop assessment aside from seven estuaries that had different scores. There has been a significant loss of macrophyte habitat with 100% loss of certain habitats from 9 of the 22 estuaries for which there were field assessments. Submerged macrophytes were not found at any of the estuaries that were assessed in the field. Black mangroves, Bruguiera gymnorrhiza (L.) Lam., were rediscovered at Ngane Estuary, however the few individuals could not be considered a ‘mappable’ community (i.e. <0.5 ha). Mtamvuna and Mkomazi estuaries both supported small stands of mangroves that, compared to data from 2006, appeared healthy. Macrophyte habitats and surrounding coastal forest matched the species composition described in the Vegetation Map of South Africa. The freshwater mangrove or Powder puff tree, Barringtonia racemosa (L.) Roxb, was not abundant in the estuaries. It was only found at four (Damba, Fafa, Little Amanzimtoti and Mvoti) of the estuaries that were assessed in the field. Important estuaries, from a botanical perspective, included some of the larger estuaries such as Mgeni, Durban Bay and Sipingo. Smaller, healthier estuaries that presently support mangrove and swamp forest habitat were also identified as important from a botanical perspective. Macrophyte habitats have mainly been lost due to non-flow related pressures. Sugarcane cultivation occurred within the floodplain of 25% of the estuaries. Nutrient enrichment was evident for 12.5% of the estuaries and reed encroachment was evident for 27% of estuaries for which there were field assessments. Development, aside from the N2 road bridges, was evident for 40% of the estuaries assessed in the field. Invasive plant species, including aquatic invasive plants, were present in all estuaries assessed in the field. The extent of invasive plant species was related to the degree of disturbance and surrounding land use pressures. The Mkomazi and Mvoti estuaries that were assessed at a comprehensive level, as they have earmarked for further water abstraction, had the poorest macrophyte health scores. The macrophyte health of these estuaries was much lower than previously determined by the NBA. The decline in health was attributed to the removal of macrophyte habitat for sugarcane cultivation and development as well as displacement by invasive plant species. The areas covered by the macrophyte habitats also differed from the NBA highlighting the importance of updated mapping and ground truthing. Largely differing macrophyte health scores were produced when attributes were calculated using different combinations of macrophyte habitats. Results indicate that only macrophyte habitats and no other floodplain vegetation should be included when calculating abundance. All macrophyte habitats, physical habitats and floodplain should be incorporated when calculating community composition. The minimum of these attributes is used as the overall macrophyte health score as a precautionary approach is followed. Scoring of health is subjective and the only benchmark for determining the most appropriate method is comparion with previous RDM studies. This study illustrates the need for a standardised RDM scoring method that is presented in a manner that ensures the same results irregardless of the speciliast conducting the study. The updated estuary health and importance scores for WMA 11 are necessary to inform management, particularly as few of the estuaries receive formal protection. In conclusion, this study contributed to the limited knowledge of the estuaries of WMA 11 and assisted in determining appropriate methods for assessing the health and importance of estuary macrophytes.
- Full Text:
- Date Issued: 2015
- Authors: Cowie, Meredith
- Date: 2015
- Subjects: Estuarine ecology -- South Africa , Estuaries -- South Africa -- Management , Aquatic plants -- South Africa
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10948/7930 , vital:24324
- Description: Estuaries require sufficient quantity, quality and appropriate timing of freshwater inflow, referred to as environmental flow requirements, to ensure adequate health and functioning. In South Africa the environmental flow requirements of estuaries is determined using Resource Directed Measures (RDM). The present health and importance of an estuary must be considered when determining the ecological flow required to maintain an estuary in its desired state. An Estuarine Health Index that quantifies changes in abiotic and biotic components from natural conditions to present day is used. Health of biotic components is assessed according to changes in species richness, abundance and community composition. There has, however, been debate regarding the calculation of these attributes. In particular, for macrophytes, the inclusion of all habitat within the Estuarine Functional Zone (i.e. 5 m topographical contour) would affect the health and changes over time determined in past assessments. This is due to different areas being included as different areas would be included The aim of this study was to test the validity and suggest improvements to South Africa’s RDM macrophyte health score determination. The health of macrophytes were assessed at varying levels of intensity from desktop studies to thorough field studies. Rapid field studies provided a visual estimate of macrophyte health; while the intermediate and comprehensive assessments quantified change by mapping the distribution of macrophyte habitats from aerial photographs. These approaches were applied to the 64 estuaries within the Mvoti-Mzimkulu Water Management Area (WMA 11), situated in KwaZulu-Natal (KZN) on the subtropical east coast. Historically, these estuaries have supported restricted macrophyte habitats. Consequently, estuaries that presently or historically supported range limited habitats such as mangroves and swamp forest are considered important. Submerged macrophytes are scarce in KZN estuaries due to siltation and low turbidity and thus estuaries supporting this macrophyte habitat are also important. Based on available literature important estuaries were highlighted and selected for field studies. Transects spanning from the estuary water channel to the boundary of the EFZ provided a generalised distribution of KZN vegetation along an elevation gradient. The transition from estuarine to terrestrial vegetation can be used to improve the current EFZ boundaries, as estuarine area has been found to occur outside of the 5 m contour in some estuaries. Results from the desktop assessment indicated that most of the estuaries are moderately modified. There was a 50 % similarity in the macrophyte health scores determined by the desktop assessment to the 2011 National Biodiversity Assessment (NBA). Field studies mostly confirmed the desktop assessment aside from seven estuaries that had different scores. There has been a significant loss of macrophyte habitat with 100% loss of certain habitats from 9 of the 22 estuaries for which there were field assessments. Submerged macrophytes were not found at any of the estuaries that were assessed in the field. Black mangroves, Bruguiera gymnorrhiza (L.) Lam., were rediscovered at Ngane Estuary, however the few individuals could not be considered a ‘mappable’ community (i.e. <0.5 ha). Mtamvuna and Mkomazi estuaries both supported small stands of mangroves that, compared to data from 2006, appeared healthy. Macrophyte habitats and surrounding coastal forest matched the species composition described in the Vegetation Map of South Africa. The freshwater mangrove or Powder puff tree, Barringtonia racemosa (L.) Roxb, was not abundant in the estuaries. It was only found at four (Damba, Fafa, Little Amanzimtoti and Mvoti) of the estuaries that were assessed in the field. Important estuaries, from a botanical perspective, included some of the larger estuaries such as Mgeni, Durban Bay and Sipingo. Smaller, healthier estuaries that presently support mangrove and swamp forest habitat were also identified as important from a botanical perspective. Macrophyte habitats have mainly been lost due to non-flow related pressures. Sugarcane cultivation occurred within the floodplain of 25% of the estuaries. Nutrient enrichment was evident for 12.5% of the estuaries and reed encroachment was evident for 27% of estuaries for which there were field assessments. Development, aside from the N2 road bridges, was evident for 40% of the estuaries assessed in the field. Invasive plant species, including aquatic invasive plants, were present in all estuaries assessed in the field. The extent of invasive plant species was related to the degree of disturbance and surrounding land use pressures. The Mkomazi and Mvoti estuaries that were assessed at a comprehensive level, as they have earmarked for further water abstraction, had the poorest macrophyte health scores. The macrophyte health of these estuaries was much lower than previously determined by the NBA. The decline in health was attributed to the removal of macrophyte habitat for sugarcane cultivation and development as well as displacement by invasive plant species. The areas covered by the macrophyte habitats also differed from the NBA highlighting the importance of updated mapping and ground truthing. Largely differing macrophyte health scores were produced when attributes were calculated using different combinations of macrophyte habitats. Results indicate that only macrophyte habitats and no other floodplain vegetation should be included when calculating abundance. All macrophyte habitats, physical habitats and floodplain should be incorporated when calculating community composition. The minimum of these attributes is used as the overall macrophyte health score as a precautionary approach is followed. Scoring of health is subjective and the only benchmark for determining the most appropriate method is comparion with previous RDM studies. This study illustrates the need for a standardised RDM scoring method that is presented in a manner that ensures the same results irregardless of the speciliast conducting the study. The updated estuary health and importance scores for WMA 11 are necessary to inform management, particularly as few of the estuaries receive formal protection. In conclusion, this study contributed to the limited knowledge of the estuaries of WMA 11 and assisted in determining appropriate methods for assessing the health and importance of estuary macrophytes.
- Full Text:
- Date Issued: 2015
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