Integration of HIV/ AIDS, Tuberculosis and Patients’ Services into the General Health Care Systems: Implementation Challenges and Impact on TB Control Programme in O.R. Tambo District, Eastern Cape, South Africa.
- Authors: Dlatu, Ntandazo
- Date: 2024-08
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/11260/12987 , vital:76186
- Description: Tuberculosis (TB), a disease of poverty and inequality, is a leading cause of severe illness and death among people with human immunodeficiency virus (HIV). In South Africa, both TB and HIV epidemics have been closely related and persistent, posing a significant burden for healthcare provision. Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with fully integrated, people-centered models of care. Studies have observed that TB and HIV integration reduces mortality. However, the operational implementation of integrated services is still challenging. Gaps exist between the challenges of combining TB and HIV control with evidence-based knowledge, affecting the implementation process of this highly recommended strategy. Despite the policy, frameworks for integration exist; integration of TB and HIV services is far from ideal in many resource-limited countries, including South Africa. Few studies have examined the advantages and disadvantages of integrated TB and HIV care in public health facilities, and even fewer have proposed conceptual models for proven integration. Objectives: The goals of this study consisted of: (i) investigating the associations between socio-economic deprivation and tuberculosis (TB) treatment outcomes, alongside well-known TB risk factors. The effects of healthcare expenditures and their growth on trends in TB incidence from 2009 to 2013 were also assessed. (ii) Exploring patients’ and healthcare workers’ perceptions of TB and HIV integration as well as a strategy for integrating these programs. (iii) Describing patients’ perceptions on barriers to scaling up of TB-HIV integration services at selected health facilities; and (iv) Developing a paradigm for integrating TB, HIV, and patient services in a single facility and highlighting the importance of TB-HIV services for greater accessibility under one roof. Methods: In Phase 1 of the study, secondary data analysis was performed on data obtained from various sources including governmental, non-governmental, and research institutions. Indicators for TB treatment outcomes included TB death rate, TB rate among the household contacts of the Index TB cases, TB treatment failure, HIV-associated TB death rate, TB defaulter rate, and new TB smear-positive cases. Analysis of variance (ANOVA) and Turkey’s tests for post-hoc analysis were used to P a g e xvii | compare means of variables of interest considering a type I error rate of 0.05. , Thesis (PhD) -- Faculty of Medicine and Health Sciences, 2024
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- Date Issued: 2024-08
Exploring the experience of clients on fixed-dose combination antiretroviral drugs at Ngangelizwe Community Health Centre, Eastern Cape
- Authors: Macozoma, Wanda
- Date: 2024-07
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/12963 , vital:76182
- Description: Fixed dose combination antiretroviral drugs are multiple retroviral drugs combined into a single pill, commenced in South Africa on 01 April 2013 after it was announced by the Minister of Health. The main reason for this change of treatment was to reduce pill burden and make the lives of people living with HIV and who are on ARVs simpler and easier. The purpose of this study was to describe experiences of clients on fixed dose combination antiretroviral drug at Ngangelizwe Community Health Centre, Eastern Cape. The study used a qualitative research approach and descriptive phenomenology as a research design. The target population for this study were clients initiated on a fixed dose combination antiretroviral drug. Purposive sampling was done and semi-structured individual interviews conducted to collect data, audiotape was used and field notes taken. Data saturation was reached after interviewing 12 participants. Data analysis was done guided by Tesch’s 8 steps of the coding process. Ethical principles were adhered to and informed consent obtained from participants. Findings revealed that there were physical, psychological and social experiences, from the period of first diagnosis, disclosure and medication compliance. It is recommended that health education campaigns be intensified since there is still stigmatization of HIV/AIDS that affects compliance. Also, there is need for continuing education and training for healthcare providers to encourage a supportive attitude towards clients. , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2024
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- Date Issued: 2024-07
Exclusive breastfeeding up to six months in very and extremly low birth weight infants and determinants of breastfeeding practices at the Frere Hospital in the Eastern Cape, South Africa
- Authors: Haughton, Anna-Marie
- Date: 2024-03
- Subjects: Brestfeeding Practices
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/11065 , vital:75881
- Description: INTRODUCTION: Breastmilk provides adequate nutrition for the optimal growth and development of infants globally. Breastfeeding is an incomparable practice that cannot sufficiently be replaced by any other substance. Breastmilk and breastfeeding offer numerous medical and non-medical advantages that influence the welfare not only of infants, but also of women, their families and society. The last few decades have shown a worldwide increase in the birth and survival rate of preterm, very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. These infants have an increased risk of adverse outcomes, thus necessitating optimal management including best feeding practices of this vulnerable population. AIM: This study assessed the exclusive breastfeeding (EBF) rate in VLBW and ELBW infants at their corrected six months of age and aimed to identify reasons for premature cessation of EBF as well as appraising the association between maternal socio-demographic variables and breastfeeding practices. This study also investigated the type, volume and preparation of replacement feeds given to infants that were not EBF. iii METHOD: This retrospective, cross sectional descriptive study was conducted between December 2017 to November 2018 at Frere Hospital in the Eastern Cape. A comprehensive database was compiled with all the infants’ demographics and relevant maternal socio-demographic variables at birth. Information on the changeover of primary caregiver, feeding practices, reasons stated for premature discontinuation of EBF, and the infant’s anthropometry were documented at each follow up visit and included in the database. RESULTS: The prevalence of EBF at the corrected six month follow up was 22%. Insufficient breastmilk supply (23%, 43% and 13% at one, three and six months respectively) and maternal commitments to school or work (35%, 33% and 50% at one, three and six months respectively) were the predominant reasons stated by mothers for discontinuation of EBF. The number of other children a mother had was significantly related to EBF practices at months one and six (p = .029 and .025, respectively), and EBF was also significantly related to the level of maternal education at month three (p = .006). The percentage of mothers who breastfed exclusively was proportional to the number of other children they had, and inversely proportional to the level of their education. The volume of replacement feeds was known to be incorrect in over a third of cases at months one and three (35% and 34%, respectively), and in almost half of cases at month six (48%). Replacement feeds were being prepared most incorrectly at the three month follow up with almost half (46%) of these feeds being prepared iv inaccurately. These replacement feeds comprised of exclusive formula feeds (EFF) for 95% of cases that were not EBF at month one, 88% at month three, and 97% at month six. CONCLUSIONS: The prevalence of EBF in VLBW and ELBW infants at six months in this study remains sub-optimal compared with other low- and middle-income countries (LMICs) and is much lower than the target set by the World Health Organisation (WHO). Factors that affected EBF practices in this study include mother’s perception of insufficient breastmilk supply, maternal commitments to work/school, the number of other children in the household as well as the level of maternal education. A combination of various interventions is urgently needed to effectively increase EBF rates in this population. , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2024
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- Date Issued: 2024-03
Knowledge, attitudes and perceptions towards hand hygine practice amongst students at a nursing colledge, Lesotho
- Authors: Ntaote, Malehlohonolo
- Date: 2024-02
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/13000 , vital:76187
- Description: Hands are critical vectors for microorganisms that cause hospital acquired infections, hand hygiene, being done the right way, at the right time and being given the right priority at health care setting is an effective strategy to reduce hospital acquired infections and costs. Different strategies have been put in place to help improve hand hygiene compliance among health care workers, amongst them; continuous training is advised at all levels of care. This study aimed to describe the knowledge, attitudes and perceptions towards hand hygiene in nursing students in Maluti College Berea Lesotho Methods This study was a quantitative cross-sectional study; 114 questionnaires were distributed and 103 were filled and returned by available willing students in Maluti College, that was 90% response rate. Results Females were more than males at 88% (91). Age range of the respondents were 18-35 years, with a mean of 22 years, 57% (59) were between ages 20-24 years. The students were distributed in four different class levels, lowest was third years at 19% (19) and highest was the nurse midwives at 32% (33). 75% (77) had hand hygiene training in the past three years. 62% (64) had moderate knowledge, all had positive attitudes and 61% (63) had a positive perception towards hand hygiene. There was a significant (p value=0.012) association between knowledge and training. Conclusion and recommendations The study has demonstrated a significant association between knowledge and training, indicating the pivotal role of education in shaping practices related to hand hygiene among healthcare workers. These findings underscore the importance of integrating insights garnered from this study into the existing teaching curriculum for healthcare 3 professionals. Furthermore, the results provide valuable input for enhancing the World Health Organization's (WHO) hand hygiene multimodal strategy, emphasizing the need for targeted interventions that address knowledge and training gaps. Additionally, the study findings advocate for incorporation of evidence-based practices into initiatives such as the SAFE LIFE Clean YOUR HAND campaign, thereby reinforcing the importance of continuous education and training to promote effective hand hygiene practices and mitigate the spread of healthcare-associated infections. This calls for a concerted effort from policymakers, healthcare institutions, and educational stakeholders to implement strategies that prioritize knowledge dissemination and training programs to improve hand hygiene practices among healthcare workers worldwide. , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2024
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- Date Issued: 2024-02
An assessment of the cost effectiveness and impact of introducing a laboratory electronic gatekeeping system at an academic hospital in Mthatha, Eastern Cape, South Africa
- Authors: Mayekiso, Zoliswa
- Date: 2024-00
- Subjects: Medicine and Health Scienes
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/11260/13042 , vital:76864
- Description: Monitoring laboratory expenditure is crucial to ensure that laboratory services remain sustainable and affordable. In South Africa, the National Department of Health (NDoH) and its partner, the National Health Laboratory Services (NHLS) collaborated to introduce Electronic Gate Keeping (EGK) systems across the country. Countries across the globe report an increase in expenditure associated with medical laboratory testing. In 2020, the United States Department of Health and Human Services reported that laboratory test expenditures increased by $459 million from $7.1 billion in 2018. In South Africa, laboratory testing expenditure in the public sector increased from $415 million (R4.5 billion) in 2014 to $723 million (R10.7 billion) in 2021. Many countries, including South Africa, are developing, and testing new methods to reduce the excessive demand for medical laboratory tests for patient investigations to reduce the burden of rising laboratory costs on national budgets. The aim of the study is to assess the cost-effectiveness and impact of introducing a laboratory electronic gate keeping system at an academic hospital in Mthatha, Eastern Cape, South Africa. Objectives: This study addressed four goals which are: (i) Evaluated the impact of the EGK intervention by obtaining the number of inappropriately requested test investigations averted and cost associated (cost savings) at Nelson Mandela Academic Hospital (NMAH), Eastern Cape, between 1st June 2015 to 31st May 2017. (ii) Determined the costs associated with inappropriately requested test investigations analysed prior to the implementation of EGK at NMAH, Eastern Cape, from 1st June 2013 to 31st May 2015. (iii) Determined the costs associated with inappropriately xxxiii requested test investigations analysed during the implementation of EGK at NMAH, Eastern Cape, from 1st June 2015 to 31st May 2017. (iv) Evaluated the costs and cost effectiveness analysis of introducing and implementing EGK at NMAH, Eastern Cape, between 1st June 2015 to 31st May 2017. Methods: In addressing the four objectives, this study was undergone in four phases, making use of secondary data on laboratory expenditure, primarily collected electronically by the NHLS and supplied to NMAH on monthly basis. In objective 1 and phase 1 of the study, a cross sectional study design to retrospectively audit EGK subjected tests at the NHLS in Mthatha by Nelson Mandela Academic Hospital over 24 months was employed. In objective 2 and 3 and phase 2 of the study, a cross-sectional study using an interrupted time series analysis (ITSA) to determine the impact of the EGK intervention was employed. In this phase, two periods comparing laboratory expenditure before and during the EGK intervention were analysed over a period of 24 months. In objective 4 and phase 3 of the study, a cross-sectional study that used cost effectiveness analysis (CEA) to evaluate a cost effectiveness of EGK intervention over 24 months was done. Results: In the first phase, we found that out of 448 028 tests requested, 17,480 (3.9%) were rejected after being identified as unnecessary through the EGK system. This rejection rate of 3.9% generated cost savings of $51,967.07 (R807,110.95). The top three tests that generated the most savings were the c-reactive protein with $6,077.68 (R94,393.59), free thyroxine with $5,199.92 (R80,760.94) and hepatitis A IgM with $3,813.61 (R59,229.98). In the second phase, our results demonstrated that xxxiv there was a significant reduction (211,928 fewer tests) in the number of tests performed during the intervention (434,790) compared to before the intervention (646,718). Laboratory test expenditure was $1,663,756.72 (R24,823,250.26) before the intervention period and $1,105,036.88 (R1,567,150.25) during the intervention period, demonstrating a cost savings of $558,719.84 (R8,336,100.01). In the last phase 3, results showed that implementing EGK resulted in lower costs - $515,114.96 (R7,685,515.20) and 212 fewer tests, resulting in an Incremental Cost Effectiveness Ratio (ICER) of USD 2,430.00 (R36,255.60) which is evidence is needed to evaluate the cost effectiveness of EGK in South Africa from a societal perspective. , Thesis Phd -- Faculty of Medicine and Health Sciences, 2024
- Full Text:
- Date Issued: 2024-00
Association of antiretroviral therapy adherence and Development of cardiovascular desease risk
- Authors: Fihla, Qhayiya Mteto
- Date: 2023-12
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/12894 , vital:76176
- Description: IAntiretroviral therapy (ART) is the standard treatment for human immunodeficiency virus (HIV). The treatment reduces HIV load to low level, relegating the disease from an acute infection to a chronic condition. Of late, there have been increased reports associating ART with increased cardiovascular disease (CVD) risk, further reducing the possibility of complete positive health outcomes for people living with HIV (PLWH). Poor adherence to the ART has been implicated in the development of some CVD risk factors but levels of adherence is not well known in the Eastern Cape. Thus, this study was designed to determine the level of ART adherence and associated cardiovascular risk factors. A cross-sectional study of a 100 participants was conducted to determine ART adherence and prevalence CVD risk factors in Mthatha. Both Male and female participants above 18 years of age were selected and ART adherence was determined using the adherence in chronic diseases scale (ACDS). The lipid profile, anthropometric measurements, and clinical parameters were used to determine CVD risk factors. Regression models were fitted to determine the association between adhrence and CVD risk factors in PLWH. All statistical analysis was performed using the statistical package for social sciences (SPSS) version 28, and the statistical significance was set at The average adherence rate was found to be 90.35% population of PLWH sampled, and 30% participants were found to have the optimum adherence rate ≥95%, which considered be adequate to effect viral progression. The prevalence of CVD risk factors was found to be 97%, with 46% of the participants having CVD. Although it was not statistically significant, the regression analyses indicated that non-adherent patients were more likely to report presence of CVD risk factors. This suggests that sub-optimal adherence to ART may be a contributing factor towards CVD risk development in patients on ART. It is possible that the results are clinically significant but there is a need to collect more data to increase the statistical power of the study , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2023
- Full Text:
- Date Issued: 2023-12
Screening medical plants for potential immunomodulatory action on macrophages in the fight against mycobacterium tuberculosis.
- Authors: Shauli, Mathulo Mthabiso
- Date: 2023-12
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/11260/12744 , vital:76161
- Description: Pulmonary tuberculosis remains the leading cause of death in developing countries, it is an ancient disease that was discovered in the eighteenth centuries. The World Health Organization (WHO) tuberculosis (TB) regimen entails the first line drugs, rifampicin, isoniazid, ethambutol, and pyrazinamide. These drugs are taken for long periods and the load is high, they carry some side effects like liver damage and peripheral neuropathies, hence pyridoxine that is administered with TB treatment to mitigate the toxic effects to peripheral nerves. Drug resistance has emerged because of unbearable side effects of TB treatment in TB patients. In view of all these collective challenges of TB drugs, this study draws its motivation towards exploring natural products in the form of medicinal plants toward inventing new therapies that could be easily available and safer, and the macrophages were considered the therapeutic target for this study as they are the primary cells that get infected by Mycobacterium in the lung. Therefore, the study aimed at screening medicinal plants used by traditional healers and herbalists for the management and control of signs and symptoms related to pulmonary tuberculosis, for potential immunomodulatory activity on RAW 264.7 cells, and the objectives were; to obtain information on indigenous plants used to treat pulmonary tuberculosis (PTB) from traditional healers and herbalist, to test the cytotoxicity of crude extracts on macrophages and hepatocytes (C3A cells), to determine the polarizing effects of crude extracts on macrophages, to determine the polarizing effect of the crude extract fractions on macrophages and to finally isolate and characterize the compounds in active fraction. vii All medicinal plants investigated in this study were collected through ethnobotanical survey, authenticated in Botany Department, dried, and extracted in 70% ethanol solvent. The dried crude extracts were screened for toxicity using 3-4,5-dimethylthiazole-24-25 diphenyl tetrazolium bromide (MTT) technique on RAW264.7 macrophages and dual fluorescence staining technique on C3A cells at concentration 50, 100 and 200μg/ml in cell culture system. Seven medicinal plants displayed dose dependency toxicity, while three plants did not show any signs of toxicity with cell viability maintained at 100%. The three medicinal plants (Anthrixia phylicoides, Lippia javanica and Sanicula elata) were further investigated for immunomodulatory activity (Griess method) and antioxidant activity (CellROX® Orange and Hoechst 33342). Lippia and Anthrixia were found to be anti-inflammatory with low amounts of nitric oxide (NO) production, while Sanicula displayed a considerable amount of nitric oxide when compared to the lipopolysaccharides (LPS) control. NO was the biological marker measured that demonstrated the immunomodulatory effect of plants on macrophages. Furthermore, the two plants showed antioxidant activity on liver cells at higher concentration (100 and 200μM) while Sanicula exhibited antioxidant activity across all tested concentrations. Compound profiling for Sanicula was therefore determined by UPLC-MS hyphenation technique and the major compounds profiled were phenolic compounds. The crude extracts of Sanicula were further partitioned into five fractions using partition solvent technique (n-hexane, Dichloromethane, ethyl acetate, N-butanol, and water). Anti-inflammatory activity was repeated on the five fractions, and Dichloromethane fraction and water fraction drove the macrophage switching towards the M1 phenotype viii with considerable amount of NO produced. Compound isolation and identification was conducted through chromatography techniques, and ten samples (S1-S10) were isolated. The samples were further subjected to NMR-Spectrometry analysis for elucidation and characterization of isolated compounds, and S1, S7, S9, S10 were final compounds. RAW 264.7 cells were again treated with the four compounds and results indicated absence of NO production, the opposite of the two previous outcomes where there was clear evidence of immunomodulation. The results obtained from the compounds has indicated that drugs work in synergy, and in combination, like TB treatment which is taken as combination of all drugs. We therefore conclude that indeed Sanicula immunomodulated RAW264.7 macrophages, and we present a strong observation of macrophage polarization from M0 phenotype to M1 phenotype which is capable of degrading and destroying Mycobacterium, and the antioxidant activity of the crude extracts of this medicinal plant. We therefore recommend further studies in the animal disease model. , Thesis (D.Ed) -- Faculty of Medicine and Health Sciences, 2023
- Full Text:
- Date Issued: 2023-12
COVID-19 in Psychiatric Inpatients: A South African Descriptive Study Conducted at Fort England
- Authors: Gwanya-Mdletye, Sisikelelwe Sylvia
- Date: 2023-11
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/12977 , vital:76184
- Description: Psychiatric patients are known to have an increased risk of adverse outcomes from COVID-19. Some psychiatric medications are known to have cardiometabolic and immune system-related side effects and have been found to either protect from or worsen outcomes in COVID-19 illness. The interaction of COVID-19 with the cardiometabolic and immune-related aspects of psychiatric illness and treatment has not been sufficiently studied in people with mental illness. Aim: To describe the clinical and demographic characteristics, and clinical outcomes of adult inpatients at Fort England Psychiatric Hospital who contracted SARS-CoV-2 during the first wave of the COVID-19 pandemic, including statistical and case analyses of COVID-19 related deaths. Methods: The study was conducted at Fort England Hospital (FEH). Data were obtained from patient files, treatment charts, and the hospital's COVID-19 reporting schedules. Sixty-four patients were diagnosed with COVID-19 during the first wave of infections in the hospital, and five of them died. A cross-sectional research design was adopted, in which the COVID-19 outcomes of the 64 patients were described alongside their psychiatric disease and treatment factors. Descriptive statistics were used to describe the characteristics of the participants. Fisher’s exact test for contingency tables and Cramér's V effect size were computed to identify possible associations between death and specified clinical variables. Additionally, case analyses were carried out on each patient who died based on participant case notes. Results: The incidence of SARS-CoV-2 infections was 21.8% during the first wave of infections, and the case fatality rate was 7.8%. A significant association was ii found between higher age and COVID-19 related death (Fisher’s exact test p = 0.010). Two-thirds (68%) of the patients who recovered were younger than 45, whereas one of the five patients who died (20%) fell in this age group. Race was also strongly related to COVID-19 outcomes, with coloured comprising 80% of the participants who died compared to 80% of black African patients in the recovered group (Fisher’s exact test p = 0.012). All patients who died had co-morbid medical conditions compared to 58% of those who recovered, although this relationship was weak (Fisher’s exact 1-sided test p = 0.076). However, case analyses for the patients who died revealed recurring themes of multiple psychiatric comorbidities, proneness to psychotropic treatment side effects, and a history of frequent relapses among most of these patients. All who died were faced with adversity and dire life circumstances. Conclusions: This study contributes to a better understanding of clinical, demographic and social variables that impacts COVID-19 outcomes in an in-patient psychiatric population. first wave of the COVID-19 pandemic in patients with serious mental illness in an inpatient population. More studies of a larger scale are needed to describe the COVID-19 pandemic among psychiatric populations and to investigate factors that contribute to the vulnerability of psychiatric patients to adverse outcomes of COVID-19. , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2023
- Full Text:
- Date Issued: 2023-11
A Comparative Analysis of PSA Trends of Conventional vs Hypo-fractionated External Beam Radiotherapy for the Treatment of Localised Prostate Cancer at Frere Hospital
- Authors: Mistry, Himal
- Date: 2023-10
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/12906 , vital:76177
- Description: External beam radiotherapy with a moderate hypofractionated regimen has largely replaced conventional schedules. The change in regimen is based on the premise that prostate cancer, due to its low the alpha/beta ratio, demonstrates a higher sensitivity to a larger dose per fraction of radiation. Prostate Specific Antigen (PSA) is a specific indicator of prostate cancer treatment outcomes. The serum PSA trend is an indication of treatment response and risk for relapse. The time to nadir and the value of the PSA nadir are important predictors of biochemical control or failure. The lower the PSA level, the more durable the probability of maintained biochemical disease free survival. This study focuses on the biochemical control of patients treated with two different fractionation regimens at Frere Hospital. Aim To illustrate that the use of a moderate hypofractionated regimen for the treatment of intermediate and high risk prostate cancer is non inferior to a conventional regimen. Methodology The study took place at the department of radiation oncology, Frere Hospital, East London, Eastern Cape, South Africa. The study population consisted of 26 patients treated with conventional fractionation (2.00Gy x 36 fractions) in 2018 and 36 patients treated with the newly adopted hypofractionated regimen (3.00Gy x 20 fractions) in 2019. A comparison is made of the post treatment PSA trend over a 24 month period. Impact of study The study is projected to support the change in fractionation regimens at an institutional level. 2 Results: 41.9% of patients were enrolled in the conventional regimen, 58.1% were enrolled in the moderately hypo-fractionated arm. The participants were classified into high risk and intermediate risk in the two treatment arms and these were distributed equally. There was a clear decline in the serum PSA values over the two-year follow-up period. All four groups showed a similar pattern in that from the baseline to the first quarter, there was a sharp decline in the serum PSA values and this was significant for all four groups , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2023
- Full Text:
- Date Issued: 2023-10
A delphi study tp build consensus on the ultrasound skills required for effective healthcare service delivery at distict hospitals in South Africa
- Authors: Mans, Pierre Andre
- Date: 2023-07
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/12923 , vital:76178
- Description: ABSTRACT Background: Despite increased access to ultrasound machines across the country, there are no guidelines on the required competency level in point of care ultrasound (POCUS) for medical doctors working in district hospitals in South Africa. Through a Delphi process involving nominated experts across the country, this study aimed to develop and achieve expert consensus on the POCUS skillsets required for medical doctors working at district hospitals in South Africa. Methods: A Delphi method of consensus development was performed, comprising several iterative rounds of skillset selection that continued until consensus was achieved on all items. We started this process using the existing American Academy of Family Physicians’ ultrasound curriculum (93 skillsets) as the starting point in the questionnaire. Experts were drawn from across the country; two from district hospitals in each province and two from each academic Family Medicine Department (N=36). In each iterative round, participants were asked to identify which POCUS skillsets were essential, optional (region specific) or non-essential for South African district hospitals. Results: Overall, five iterative rounds were required before consensus was attained on all skillsets (>70% agreement among the experts). In the first round, consensus was reached on 14 skillsets, followed by 21 skillsets in the second and third rounds. In the fourth round, consensus was reached on 26 skillsets, and in the fifth and final round, consensus was reached on the remaining eight skillsets. Of the starting 93 skillsets, three skillsets could not achieve consensus , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2023
- Full Text:
- Date Issued: 2023-07
A single centre study evaluating adherence to methotrexate monitoringguidelinesin patients with rheumatoid arthritis
- Authors: Genevieve, Olivier
- Date: 2023-00
- Subjects: Medicine
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/9690 , vital:74612
- Description: Introduction: Methotrexate (MTX) is considered a first-line agent for the treatment of rheumatoid arthritis (RA) and regular blood test monitoring is advised in treatment guidelines to identify potential toxicity. Failure to adhere to monitoring guidelines for methotrexate use may compromise patient care. Identifying and correcting variability in care may optimise the safe use of this medication and improve patient outcomes. Aims: This study aimed to evaluate adherence to guidelines on methotrexate safety monitoring in rheumatoid arthritis patients at an Eastern Cape hospital and to establish whether a dedicated rheumatology outpatient department (OPD) performs this task more effectively than a general medical outpatient department (MOPD). Method: This retrospective cross-sectional single-centre study was conducted at Frere Hospital in the Eastern Cape over one year from 1 January 2019 to 31 December 2019. Adult patients over the age of 18 years who received methotrexate for rheumatoid arthritis during the study period and attended either the rheumatology OPD or the MOPD at Frere Hospital were included in the study population. Permission to undertake this study was obtained through the Faculty of Health Sciences Research Ethics and Bio-safety Committee at Walter Sisulu University and the Cecilia Makiwane and Frere Hospitals Research and Ethics Committee. The random sample generator tool on Microsoft Excel was used to select patients from the Frere Hospital Pharmacy Database who was prescribed methotrexate for rheumatoid arthritis. Laboratory test results were accessed through the Labtrak system of the National Health Laboratory Service (NHLS). The number and type of blood test done as recommended in a South African Methotrexate use guideline by Hodkinson et al, was documented on a data collecting sheet. Two or more blood tests done within a three-to six month period was considered adherent to the guideline. The hospital management system version two (HMS2) was used to see which clinic the patient attended. iii Results: There was 53% adherence (95% Confidence Interval 42-65%) overall to guideline. In the study sample, 64% of patients were from Rheumatology OPD and the remainder were from MOPD. There was 78% (95% CI 62-89%) adherence in the Rheumatology OPD compared to 22% (95% CI 11-38%) in MOPD. No significant association was found between the number of FBC tests and the site of testing (p-value = 0.346) or for Creatinine tests (p-value = 0.078). However, a significant association was found with ALT tests and the site of testing (MOPD or rheumatology OPD) with p-value = 0.010, although this is likely a chance finding. Conclusion: Adherence to a South African guideline for methotrexate safety monitoring was found to be suboptimal at the study centre. Adherence was better in the dedicated Rheumatology OPD compared to a general medical OPD. Education regarding the correct use of guidelines in different health settings by medical professionals is advised. , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2023
- Full Text:
- Date Issued: 2023-00
An audit of patients with new onset stroke and associated barriers to thrombolysis of hyperacute strokesat a tertiary level hospital in the Eastern Cape
- Authors: Pasio, Roswyn Claire
- Date: 2023-00
- Subjects: Medicine
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/9891 , vital:74639
- Description: Globally and in South Africa stroke is a leading cause of morbidity and mortality. In 2006, the Joint World Congress of Stroke declared stroke a ‘catastrophic illness’ in South Africa. This declaration aims to focus the attention of policymakers on the impact of stroke and engage with them to intervene. Local stroke data is needed to make informed and relevant policy changes. Data is also required to start multi-level initiatives regarding stroke prevention and care. This study aims to analyse the demographic profile of stroke and assess the quality of stroke care using time-based performance measures at Livingstone Tertiary Hospital in the Eastern Cape. Methodology The study is a descriptive, retrospective chart review of patients presenting with an acute stroke to Livingstone Tertiary Hospital Emergency Department over a 12 month period. Demographic data, stroke risk factors, patient comorbidities and mode of transport were collated and analysed. Time parameters were used to ascertain delays within the stroke care pathway of patients and factors precluding patients from thrombolysis were identified. Results The study included 403 eligible patients, 54% of the patients of whom were female. The majority of those were of Mixed-race ethnicity (49%) and aged between 50 and 79 years. Hypertension (71%) was the most common comorbidity followed by smoking (31%) and diabetes mellitus (24%). The median time from onset of symptoms to presentation to hospital was 12 hours 23 minutes (I.Q 20hrs 34min). The average time from arrival to being III seen by a doctor was 1 hour 57 minutes (I.Q 1hr 59min) and the time from arrival to radiological imaging was 17 hours 6 minutes (I.Q. 8hrs 28min). 375 patients had radiological imaging, 58% (n=217) had evidence of an ischaemic stroke compared to 21% (n=80) who had signs of an intracranial haemorrhage. Of the study cohort, 99 (25%) of all stroke patients presented within the 4.5hr thrombolytic window, 68 (32%) of which were ischaemic strokes. However, in-hospital time delays precluded 35% of these patients from thrombolysis. A further 33% of patients had other contraindications to thrombolysis and 32% were not offered thrombolysis based on the clinical discretion of the doctor. Conclusion This study highlights the burden of stroke within Port Elizabeth, located in the Western Region of the Eastern Cape. Risk factor modification and disease control is imperative in reducing the prevalence and impact of stroke. The major precluding factor in stroke patients not being offered thrombolysis is a delay in arrival to hospital. Public education and awareness initiatives need to focus on addressing this issue. The clinical discretion of the treating physician significantly influences the decision to thrombolyse patients with an acute stroke. In-service training can address physicians’ perceptions regarding the benefits of thrombolysis as a treatment option. , Thesis (Masters) -- Faculty of Medicine and Health Sciences in brach of emergency medicine, 2023
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- Date Issued: 2023-00
Arterial stiffness in pregnant women with preeclampsia and HIV infection at Nelson Mandela Academic Hospital
- Authors: Flatela, Mlungisi
- Date: 2023-00
- Subjects: Medicine
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/9832 , vital:74631
- Description: Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2023
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- Date Issued: 2023-00
Effects of the timing of initiation of maternal anti-retroviral therapy, cd4 count and viral load on birth out comes in South Africa
- Authors: Siqithi, Sisanda
- Date: 2023-00
- Subjects: Medicine
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/9849 , vital:74633
- Description: Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2023
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- Date Issued: 2023-00
Knowledge, Attitudes and Perceptions of Breaking Bad News Among Paediatric Doctors in a South African Hospital
- Authors: Thaver, Linesri
- Date: 2023-00
- Subjects: Paediatrics and Child Health
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/12709 , vital:76151
- Description: Breaking bad news to patients is a difficult but regular task for doctors in clinical practice (Alshami et al. 2020). In paediatrics, doctors have the additional complexity of communicating difficult information with their young patients and their families (Mǎrginean et al. 2017). Despite this essential skill, clinicians are inadequately prepared, which can contribute to poor patient satisfaction and outcomes, litigation and negatively impact the treating clinician (Brown et al. 2009; Alshami et al. 2020). Aim: The study aimed to assess the knowledge regarding breaking bad news, as well as the attitude and perceptions towards breaking bad news among doctors working in the paediatric department at Dora Nginza Hospital, a regional teaching hospital in Gqeberha, South Africa, and compare the findings to the international literature. Approach: A mixed methods knowledge, attitudes and perceptions study using a self-administered questionnaire was conducted at the paediatric department at Dora Nginza Hospital. The survey population ranged from junior doctors to senior specialist paediatricians in the department. Data were analysed using descriptive statistics and compared to literature available from similar international studies. Impact of study: Despite the importance of this topic, there are limited studies based in South Africa and specifically in paediatrics, which creates a unique context for this study. The setting of Dora Nginza Hospital, with its diverse cultural background of both doctors and patients, provides vital insight into the local 3 challenges of breaking bad news in this context. The further impact of the predominantly junior staff in an overburdened system and the strategies implemented to break bad news in this context provided useful information to adapt protocols to be utilised in this setting. , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2023
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- Date Issued: 2023-00
Prevalence and risk factors of imaging confirmed neurological complication amongst patients withhypertensive disorders in pregnancy admitted at Nelson Mandela Academic Hospital
- Authors: Sabona, Ncumisa
- Date: 2023-00
- Subjects: Medicine
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/9868 , vital:74635
- Description: Hypertensive disorders in pregnancy (HDP) are the world's second leading cause of maternal mortality and morbidity, with sub-Saharan Africa taking the lead. The prevalence of HDP in Africa is 10%, remarkably higher than the reported global range of 5.2-8%. This study aimed to determine the prevalence and associated risk factors of CT-confirmed neurological complications in patients managed at the labour ward at Nelson Mandela Academic Hospital (NMAH) over two years. Methodology: A retrospective cross-sectional study was conducted on obstetric patients with clinical files at NMAH from January 2018 to December 2020. We tracked and merged hospital admission data and radiological (brain CT) findings in patients managed for HDP at the labour ward at NMAH within the specified period. Descriptive analysis, bivariate and multivariate logistic regression analysis was performed to identify associated clinical risk predictors of neurological complications. Major findings: Of the 5119 patients with HDP, 153 underwent CT scans. Our study found that 78.2% of the scanned patients with HDP were between 18 and 34 years old. Patients younger than 18 years accounted for 10% of the 154 patients who underwent CT-scan. We found that 81.1% had abnormal CT-brain findings, while 18.9% were normal. The most common abnormal finding was posterior reversible encephalopathy syndrome (PRES) (25.1%), followed by cytotoxic oedema (16,5%), neurocysticercosis (15.1%), and dural sinus thrombosis (7.9%). The most common neurological findings on admission were headache (82%), low GCS (60.1%), fits (55.6%), blindness (28.8%), and focal signs (11.5%). In addition, the following risk predictors were statistically associated with PRES: post-partum onset ( aOR=6.26,95% CI 1.02-38.83, p-value0.049 ), blindness (aOR=3.19, 95% CI; 1.07-9.59, p=0.038) and fits (aOR=0.20, 95% CI: 0.64-0.63, p-value=0.006. Recommendations and clinical implications: The most common radiological finding among obstetric patients with HDP in this study is PRES. The most significant risk predictors for PRES are the post-partum onset of symptoms and blindness. As PRES is | 3 associated with significant morbidity and mortality, vigilance and aggressive management should be continued and include the post-partum period. , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2023
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- Date Issued: 2023-00
Prevalence and Risk Factors of Traumatic Lumbar Puncture in Children at Nelson Mandela Central Hospital, Mthatha, Eastern Cape Province, South Africa
- Authors: Ghu, Pumza
- Date: 2023-00
- Subjects: Medicine
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/9879 , vital:74636
- Description: Traumatic lumbar puncture signals improper procedural and proceduralist factors working on existing patient attributes. Occurrence is very common though believed to be overestimated and cut-off definitions are vague. Complications that follow incurs economic implications to the hospital setting due to high admission rate, long hospital stay and unnecessary use of antibiotics. None of these concepts around this topic is known in the present setting thus necessitating this research. The findings thereof would cause a fundamental change in the manner in which this procedure is performed in the present setting. Aim To determine the prevalence and risk factors of traumatic lumbar punctures, with the secondary goal of developing a protocol for performing appropriate lumbar punctures in order to reduce the rate of traumatic lumbar punctures. Methods An analytical cross-sectional data using retrospective data of 82 lumbar punctures performed over a four (4) month period from March to June 2022 at the paediatric emergency department of Nelson Mandela Central Hospital. Results Demographics characteristics: The median age was two (2) years (IQR = 0.83 – 3.35 years) and the highest proportion (53.66%) was observed for the age group two years and younger. Males constituted more than half (63.41%) of the population. Clinical features: Most of the children presented with seizures (56.10%) and high fever (46.34%). The top three conditions diagnosed were febrile seizures (40.24%), meningitis (17.07%) and acute gastroenteritis (9.78%). More females (20% p=0.047) suffered from acute gastroenteritis than males (3.8%). , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2023
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- Date Issued: 2023-00
Transmission Dynamics and Public Health Impact of Clonal Composition and Mixed Strain M. tuberculosis Infections among Patients in Rural High TB Incidence Settings Of Eastern Cape Province
- Authors: Faye, Lindiwe Modest
- Date: 2023-00
- Subjects: Medicine
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/9702 , vital:74615
- Description: Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2023
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- Date Issued: 2023-00
Factors leading to Complications following Traditional Male Circumcision among Initiates reporting at Mthatha Regional Hospital, South Africa
- Authors: Zokwe, Mendi Prince
- Date: 2022-00
- Subjects: Medicine
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/9923 , vital:74643
- Description: Traditional male circumcision, a prestigious practice, and pathway to a sense of belonging and manhood among AmaXhosa has left unforgettable pains in the same society that admires it. The pains are due to the irreversible aftermaths such as death and loss of the penis that often accompanies it. Anecdotal evidence suggests that an increasing number of AmaXhosa males though still prefer TMC, only partakes in the cultural lessons at the initiation schools then go for medical male circumcision. But, who is to be blamed? The news reports of the deaths following traditional male circumcision (TMC) are heard and the fears for sure are real. This study was carried out to provide evidence-based knowledge on the prevalence of complications following TMC and factors that lead to such complications. Aim: To find out the types of complications and medical outcomes following TMC among initiates reporting at Mthatha Regional Hospital. Method: A retrospective study design was used. The study population included 23 initiates who sought medical intervention at Mthatha Regional Hospital from June to December 2018. The variables of interest were collected from the admission records and analysed. Results: The mean age of participants was 18.5 years (standard deviation = 1.4 years). The majority (65.2%) of the participants were in the age group 18-21 year, were circumcised in summer (52.2%), waited for 10-20 days before seeking medical intervention (47.8%), and were admitted in the male surgical ward (69.6%). xiv The mean and standard deviation of length of hospital stay was 22.2±20.3 days. During hospitalisation, antibiotics were given to 33.3% and wound dressing to 60.5%. Other medico-surgical interventions wee rehydration therapy (28.1%), analgesics (26.3%), penile reconstruction with a skin graft (23.7%), re-circumcised (5.3%) or had a dorsal slit (5.3%). Grade 3 septic circumcision was the most prevalent (43.5%) among the initiates and 26.1% had Grade 4 septic circumcision. The three main factors leading to TMC-related complications were wound sepsis (32.4%), dehydration (21.1%), and septic shock (12.7%). No variables were associated with TMC complications in the study population. Most (78.3%) of them were treated and discharged. Two (8.7%) participants died, one from septic shock and the other from severe dehydration. Though 82.6% were alive with no deformity at discharge, 4.8% had an artificial penis and another 4.8 percent loss of the penis. Conclusion: Complications following TMC are real. Severe septic complications were common following TMC. There is a need to explore how to transform the harmful aspects of the initiation ritual while promoting the positive ones. There is a need to also determine possible ways of interaction and partnership between traditional leadership and the Department of Health. , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2022
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- Date Issued: 2022-00
perception of male university students regarding the relationshinship between masculinity and gender based violence: A health promotion enquiry
- Authors: Fosi, Mziwabantu
- Date: 2022-00
- Subjects: Medicine
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/9637 , vital:74606
- Description: Globally, Gender Based Violence (GBV) refers to harmful act directed at an individual based on their gender, power and positions within a given society. According to Statistics South Africa report 2021, one in five women (21%) had experienced physical violence by a partner. GBV is rooted in gender disparities, the abuse of power and harmful norms. Both men and women to some extent experience GBV and suffer from discrimination if they deviate from societal expectations of masculinities. Men’s violence, whether directed at women, people with diverse sexual orientations and gender identities or other men, is inextricably linked to hegemonic and toxic masculinity. The aim of the study was to investigate perception of male university students regarding the relationship between masculinity and gender-based violence. This study adopted qualitative phenomenological approach. The research was conducted at WSU, Mthatha campus, Eastern Cape, South Africa. Purposive sampling was used to select 24 participants. Semi-structured, in-depth, face to face interviews were used to gather data. The collected qualitative data was analysed utilizing thematic analysis method with the assistance of NVIVO software. Ten overarching themes were identified using thematic method and reported and categorised as factors associated with GBV and suggested action plans to fight against GBV and these includes: (1) Gender discrimination as a contributing factor towards GBV; (2) Impact of association on GBV; (3) Perception of males on how the law handles GBV cases; (4) Dark figures and unreported cases escalate GBV (5) Influence of materialistic things on “blesser/blesse” relationship; (6) Social norms or community common practices misconception that still promote gender differences; (7) Poor decision making based on wrong assumptions about what other people thinks or do (8) Sexual education gaps on deciding when to start sex in a relationship; (9) Suggested preventative actions to prevent GBV. This study concluded with discussion and recommendations of further study to support participants recommendations for continuous health education and strengthen increase on youth friendly GBV programs to empower males in the university and further suggested development of comprehensive health promotion strategies to reduce gender-based violence. This study concluded with discussions and recommendations of the required comprehensive health promotion program to curb GBV and as well suggestions for further research studies to focus on developing health promotion intervention to prevent causes of GBV. , Thesis (Masters) -- Faculty of medicine and Health Sciences, 2022
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- Date Issued: 2022-00