Knowledge, Attitudes and Perceptions Towards HIV Testing Among IsiXhosa-Speaking Men in The Zithulele Catchment Area of The Rural Eastern Cape Province, South Africa
- Authors: Scotcher, Philippa Claire
- Date: 2021-10
- Subjects: HIV infections
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/6842 , vital:51017
- Description: BACKGROUND South Africa carries the largest burden of Human Immunodeficiency Virus (HIV) in the world, with over 7.9 million people infected and over 70 000 HIV-related deaths in 2019. Men are 25% more likely to die from Acquired Immune Deficiency Syndrome (AIDS) compared to women, even though women are more likely to be infected. Despite these numbers, only 24.1% of HIV-positive men compared to 64.8% of HIV-positive women were aware of their status. Statistics indicate that men in South Africa are not testing for HIV until it is too late. In order to focus efforts on the prevention of HIV transmission, there is a need to understand why men are not accessing HIV testing and treatment services earlier. This study aims to explore the knowledge, attitudes, and perceptions towards HIV testing of isiXhosa-speaking men in the Zithulele catchment area of the rural Eastern Cape. METHODS This was a qualitative study using the phenomenological approach. It was conducted among a purposive sample of isiXhosa-speaking men from the Zithulele catchment area, in the OR Tambo district of the Eastern Cape Province. Ten semi-structured interviews and one focus group were conducted in isiXhosa. Interviews were audiorecorded, transcribed, and translated into English. The interviews were thematically analysed using an inductive approach. RESULTS Participants from the study had a good understanding of HIV and HIV transmission. They perceived HIV infection as a death sentence, a consequence of immoral behaviour and an indication of failure as man. Reluctance to test for HIV was due to the perception that testing hastens the onset of symptoms and death, whereas disclosure of an HIV-positive status was described as difficult due to the fear of stigmatization. Some of the barriers to accessing HIV testing services included masculine norms, the belief that sickness is equated with weakness, a perceived lack of confidentiality at health facilities and how female-dominated clinics were not male-friendly spaces. Suggestions to improve HIV testing among men included improving targeted education, home-based testing services and utilizing traditional meetings to address men. CONCLUSION The findings of this study may suggest that healthy men in the Zithulele catchment area of the rural Eastern Cape are not accessing HIV testing and treatment services. The reasons behind this reluctance include false beliefs around HIV and testing, the fear of discrimination, disruption of masculine norms and reluctance to access care at female-dominated health facilities. Further research is needed to explore ways to reach, educate and encourage men to test earlier for HIV. , Thesis (Masters) -- Faculty of Health Sciences, 2021
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- Date Issued: 2021-10
Assessing South African Medical Interns’ Experience and Confidence in Managing Obstetric Emergencies
- Authors: Miller, Andrew
- Date: 2021-02
- Subjects: Obstetrical emergencies
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/6882 , vital:52352
- Description: Background: Medical doctors in South Africa are required to complete a two-year internship at training hospitals, including a four-month rotation in obstetrics and gynaecology. Following this, doctors are allocated to community service posts; many of which are at district and primary level facilities where supervision is limited. The latest triennial Saving Mothers Report identified district hospitals as the second leading site for maternal deaths of all causes. District hospital were also the leading site for maternal deaths secondary to obstetric haemorrhage and the most likely site for the lack of a skilled doctor to be identified as a factor in deaths associated with caesarean delivery. Methods: This cross-sectional descriptive study aimed to describe the self-perceived readiness of medical interns completing their training to independently manage obstetric emergencies, based on the ESMOE modules in the HPCSA internship logbook. The research assessed medical interns in the last three months of their training, using a self-administered online questionnaire, with data collection between October and December 2019. Cluster sampling of interns at training facilities throughout the country resulted in a total of 182 respondents from 17 hospitals in seven provinces in the country, with an overall response rate of 34.1%. Results: Most interns had experience with, and confidence in, the management of miscarriage and hypertension in pregnancy. However, gaps in labour ward management, pregnancy related sepsis and surgical skills were identified. Only 42.3% of respondents were confident in their ability to diagnose obstructed labour, 26.3% had performed an assisted delivery, 39.0% were confident in their knowledge of the indications and contraindications of assisted deliveries and 35.7% had been involved in the delivery of a baby with shoulder dystocia. Regarding pregnancy related sepsis, 54.4% had experience with managing a wound abscess and 29.7% were confident managing puerperal endometritis. While 78.0% felt confident to perform a caesarean section, only 28.6% had performed uterine compression sutures for uterine atony at caesarean section. Additionally, there was a statistically significant variation in scores between training hospitals. Conclusion: A gap exists between the shortcomings in district hospital obstetric services, the prioritisation of placement of community service doctors at primary care and district hospitals, and the self-perceived readiness of medical interns completing their training to safely manage obstetric emergencies. This highlights the importance of clinical support for junior doctors at district hospitals and standardisation of intern training at accredited facilities across the country. , Thesis (Masters) -- Faculty of Health Sciences, 2021
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- Date Issued: 2021-02
Outcomes of Drug Resistant Tuberculosis in Two Rural District Hospitals, Eastern Cape Province, South Africa
- Authors: Lotz, John-D Knipe
- Date: 2021-02
- Subjects: Medicinal plants
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/6834 , vital:51018
- Description: Tuberculosis (TB) is still rampant in South Africa, and drug resistant tuberculosis (DR-TB) forms a significant part of this burden on both the health care system and economy. A number of interventions have recently been introduced to help curb the growing epidemic of DR-TB, including increasing access to novel and repurposed drugs, decentralisation of care, and a new shorter (9-11 month) treatment regimen recently endorsed by the World Health Organization (WHO). Significantly, this new regimen has now also become injectable-free (also known as an all-oral regimen). However, at the time of implementation in 2017, the shorter regimen was yet to be proven effective in a programmatic setting in South Africa. This is a retrospective cohort study to describe the outcomes in patients on short and long DR-TB treatment regimens, over five years, at two treatment sites in a rural setting in the Eastern Cape province of South Africa. It is the hope that elucidation of factors involved in affecting outcomes in DR-TB may direct future interventions in these two facilities, and the wider DR-TB program in South Africa , Thesis (Masters) -- Faculty of Health Sciences, 2021
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- Date Issued: 2021-02
An Investigation on the Clinical Experiences of Newly Qualified Professional Nurses in Hospital Facilities of the Alfred Nzo District Municipality in the Eastern Cape
- Authors: Hloba, Siyathemba Prince
- Date: 2021-00
- Subjects: Nurse practitioners
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/7942 , vital:55856
- Description: The study aimed to explore and describe the clinical experiences of newly qualified professional nurses in hospital facilities of the Alfred Nzo District Municipality in the Eastern Cape. The newly qualified professional nurses may face difficulties in the hospital facilities when it comes to the execution of duties. The newly qualified professional nurses are expected to display knowledge, skills and to have a positive effect on patients, the relatives of patients and their colleagues to alleviate diseases. This challenge may create emotional distress if newly qualified professional nurses receive inadequate guidance from the senior staff members of the hospital facility. The objectives of this study were to explore and describe the clinical experiences of newly qualified professional nurses, to explore how the newly qualified professional nurses were affected emotionally by clinical experiences and to explore the support system to enhance the performance of the newly qualified professional nurses. A qualitative, explorative, descriptive and contextual design was used to explore and describe the experiences of the newly qualified professional nurses in hospital facilities of the Alfred Nzo District Municipality in the Eastern Cape. A purposive sampling of newly qualified professional nurses, with less than two years of experience after completing the community service in the clinical practice, was used. The data were collected through face-to-face and semi-structured interviews. The interviews were conducted until the data were saturated. A pilot study was done before the main study to prove the adequacy and suitability of the methods to conduct the main study. The participants‟ interviews and results of the pilot study were incorporated into the interviews and results of the main study. Tesch‟s method of thematic analysis and an independent coder were used to analyse the data and to draw meaning from the content. The study used Guba and Lincoln‟s criteria of measures to ensure trustworthiness, which included credibility, confirmability, dependability and transferability. Ethical standards were maintained throughout the study as the researcher complied with ethical principles, namely, respect for persons, beneficence, justice and autonomy. The key considerations to curb the spread of the Covid-19 pandemic, as stipulated by the World Health Organisation, were followed during the data collection. On data interpretation, three themes were developed with eight subthemes on the first theme, two subthemes on the second theme and three subthemes on the third theme. The research findings revealed that the participants experienced negative attitudes from colleagues and multidisciplinary team members. The shortage of staff and resources made participants feel ineffective in their work environment. Clinical exposure to different units and procedures in various units added value to the development of the participants. The recommendations were made with regards to three divisions. They were the hospital facilities‟ personnel, future nursing research personnel and nursing schools personnel. In hospital facilities, the recommendations included that all novice professional nurses should be made aware of the emotional impact at work. An annual plan for workshops and in-service training should be implemented. Professional counselling is required for the novice professionals who were exposed to Covid-19 isolation units. A need to increase staff coverage in the clinical units was identified as the workload is too big. Management is encouraged to be more sensitive about the newly employed nurses‟ challenges in their facilities and the most experienced nurses are encouraged to mentor and coach the novice nurses. In the future nursing research, recommendations included that more studies need to be conducted in South Africa and the Eastern Cape province to verify the findings of this research. A specific research study that will focus on the supportive needs of nurses in clinical facilities should be done institutionally to provide evidence-based practice. The research culture on the nurses‟ experiences in clinical facilities needs to become a norm. In nursing schools, the recommendations motivated that the nursing students should be exposed to all clinical units before completing the training xiv course. Further studies need to be conducted to evaluate the balance between theory and clinical learning on duly performance. The nursing education institutions should use quality improvement suggestion boxes for students to consider their experiences and opinions about their learning. Key words : clinical experiences, newly qualified professional nurses, Alfred Nzo district municipalities , Thesis (Masters) -- Faculty of Health Sciences, 2021
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- Date Issued: 2021-00
Women’s perceptions, beliefs and lived experiences of postpartum intrauterine contraception at a District Hospital in the Eastern Cape Province of South Africa – a qualitative study
- Authors: Gibson, Dylan
- Date: 2021-00
- Subjects: Postpartum contraception
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/6833 , vital:51015
- Description: Background There is a significant unmet need for family planning in South Africa where long acting reversible contraceptives (LARC), including intrauterine contraceptive devices (IUCD) are underutilised. The situation is no different in the Amathole District in the Eastern Cape where high rates of unintended pregnancies continue to be a problem. The postpartum period presents a unique opportunity for providing effective contraception. It has been established that immediate post-placental insertion of a copper IUCD is a safe, effective method that has the potential to reduce unintended pregnancy rates. A Post placental intrauterine contraceptive device (PPIUCD) refers to an IUCD that is placed into the uterine fundus immediately after delivery of the placenta after caesarean or vaginal delivery. The understanding of women’s perceptions, beliefs and lived experiences of the PPIUCD in this community has the potential to improve uptake of this method. The aim of the study was to fully explore the phenomenon of postpartum intrauterine contraception as a means of family planning at Madwaleni District Hospital in the Amathole District within the Eastern Cape, South Africa. Methods A qualitative, phenomenological study design was used in gathering data through a combination of three focus group discussions and in-depth individual interviews with three different groups of peripartum women. Data was collected from perinatal women at three snapshots in time, namely prior to labour, during the postpartum admission and at 12 weeks postpartum with the aim to fully explore the phenomenon of post-placental IUCD use in the study population. III Results The data was analysed using the framework method and five themes were derived iteratively from the text. These themes included the perceptions of perinatal women towards a PPIUCD, the origins of these perceptions, the reasons why women would or would not choose the method for themselves and lastly, the experiences of those women who chose the method. The findings of this study showed that PPIUCD was a novel method in this community and that misinformation, largely driven by deficiencies in antenatal counselling, led to hesitancy to adopt the method. These deficiencies extended to those women who consented to a PPIUCD insertion at caesarean section who did not fully understand what they had consented to. Despite this, women were open to a more effective, convenient contraceptive and the overall experiences of those women who chose to use a PPIUCD was positive. Conclusions Post-placental IUCD insertion was a relatively new method in the study population. Deficiencies in antenatal contraceptive counselling created uncertainty and scepticism which in turn contributed to low uptake of the method among perinatal women. Despite this, there was a strong desire amongst perinatal women to access effective, convenient family planning and prevent future unwanted pregnancies. The overall experiences of women who did choose the method was positive. This suggested that with the right counselling and support, there would be an increase in uptake of PPIUCD in the population. Recommendations from this study include the need to explore healthcare workers perspectives on this topic, to further explore the lived experience of PPIUCD users over a longer period of time and to explore the effectiveness of various antenatal counselling strategies to equip women to make peripartum contraceptive choices. , Thesis (Masters) -- Faculty of Health Sciences, 2021
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- Date Issued: 2021-00
Evaluating the Prevention of Mother to Child Transmission (PMTCT) of HIV Services in the Eastern Cape: subtitle if needed. If no subtitle follow instructions in manual
- Authors: Sigovana, Khuthala
- Date: 2019
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/3176 , vital:43182
- Description: Abstract text To effectively reduce HIV transmission to newborns requires a reduction of HIV prevalence among pregnant women and a full understanding of its epidemiology. There is however, a literature gap: few recent HIV studies focus on women attending antenatal care in rural areas in South Africa. A Cross-sectional study of women attending antenatal care in four Primary Care facilities was conducted. An interviewer-administered questionnaire to collect information on socio-demographic characteristics and medical history was used. Binomial logistic regression analyses were used to determine factors associated with HIV and to estimate the prevalence ratio (PR). The 95% confidence interval (CI) is used for precision of estimates; p≤0.05 for statistical significance. A total of 343 participants were recruited. Most participants (n = 341 or 99.42%; CI: 97.91 – 99.93) knew their HIV status. The antenatal HIV prevalence was 38.19% (CI: 33.17 – 43.48). Participants older than 40 years were 3.99 and 3.81 times more likely to be HIV positive compared to teenagers (PR = 3.99; CI: 1.11 – 14.30; pstxvalue = 0.034) and those in the 20-29 age group (PR = 3.81; CI: 1.07 – 13.60; pstxvaluevalue = 0.039) respectively; and this was statistically significant. Unemployed participants were 34% (PR = 1.34; CI: 1.16 – 1.55; p-value less than 0.0001) and 41 percent (PR = 1.41; CI: 1.23 – 1.61; p-value less than 0.0001) more likely to be HIV positive when compared to tertiary students and self-employed individuals respectively. The antenatal HIV prevalence remains high and is increasing in this population. However, findings suggest a changing and maturing epidemic. , Thesis (MMED) -- Faculty of Health Sciences, 2019
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- Date Issued: 2019
Exploring Teacher Assessment Practices in The General Education and Training Level in Junior Secondary Schools in Mthatha Education District
- Authors: Novukela, Cawe Sandys
- Date: 2019
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/3460 , vital:43409
- Description: Diabetes mellitus is one of the largest and most important public health emergencies of our time that has resulted in human suffering and huge financial implications for organisations, governments and individuals (IDF Atlas, 2015). Furthermore there is growing evidence that a number of employees are overstretched in their work environments and this has resulted in stress and burnout (McCormack and Cotter, 2013). This study investigated the effects of diabetes mellitus on burnout among WSU employees as well as the prevalence of diabetes mellitus and burnout. A mixed method research design using quantitative and qualitative approaches was employed in order to explore the effects of diabetes on burnout as well as the prevalence of diabetes and burnout at WSU. A cross-sectional survey was used to gather quantitative data and semi-structured interviews were used for the qualitative data collection. A total number of 169 participants were involved in this study. This included 154 participants and 15 participants who were selected for the quantitative and qualitative respectively using random sampling technique and purposive sampling method. The quantitative data was analysed using Stata version 13. The study findings indicated that the prevalence of diabetes at WSU was 16% and 57% participants were burned out. It was further found that the majority of participants (58%) who were diabetic also suffered from burnout. The relationship between diabetes and burnout was found to be significant. Qualitative data analysis involved coding data and analysing the emerging themes to form the basis of the findings. The results of the study found an emerging problem of high level of burnout and also a significant number of employees who were diabetic. A combination of these two conditions poses a challenge to the continued uninterrupted functioning of WSU. It is recommended that the university should educate its employees about diabetes and burnout as well as create an environment that promotes healthy lifestyle. A model has been developed that could help deal with diabetes and burnout. , Thesis - Faculty of Health Sciences, 2019
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- Date Issued: 2019
Comparison between Endothelin, Nitric Oxide and their Association to Blood Pressure and Body Composition in HIV Patients, in Mthatha
- Authors: Zono, Sinethemba
- Date: 2015
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/2909 , vital:43105
- Description: Background: Dysfunction of the vascular endothelium is an early finding in the progression of cardiovascular disease and is closely related to clinical events in patients with obesity and hypertension. Vascular function is mediated by nitric oxide (NO) and endothelin (ET-1) which serve as natural counterparts. The aim of the study was to determine the physiological effects of HIV infection, blood pressure and body composition on the changes of ET-1 and NO and association between ET-1 and NO. Methods and results: This was a descriptive and comparative study. A Quota sample method was used. The study population consisted of 154 participants categorized into the following groups: 57 HIV negative participants (A), 40 HIV positive not on treatment participants and 57 HIV positive on treatment participants. Enzyme immunoassay kit was used for the quantitative determination of ET-1 and Nitrate/nitrite colorimetric assay kit was used for the determination of NO. Anthropometric measurements, body composition were determined. Hemodynamic measurements were also taken into account. Results: Resting metabolism, waist circumference (WC) and hip circumference had low mean levels in both HIV positives groups compared to HIV negative group. On lipid profiles visceral fat (VF), whole fat (WF) had low mean levels but skeletal muscle fat (SMF) showed the highest mean levels in both HIV positive groups. All the blood pressures between HIV groups were on a normal range scale. Mean values of endothelin and nitric oxide are increased in HIV positive not on ART and HIV (+) on ART compared with the HIV negative group. Conclusion: NO, ET-1, ART and HIV itself were associated with the pathogenesis of endothelial dysfunction in persons with HIV infection. Elevated endothelial markers namely ET-1 and NO can lead to improvement of endothelium dependent relaxation to some extent but not completely. Although these markers have deleterious effect on the endothelium but can also serve as up-regulator of hypertension. Key words: HIV-infection, antiretroviral therapy, endothelial dysfunction, Endothelin1 (ET-1), nitric oxide (NO), blood pressures (BPs). , Thesis (MSc) -- Faculty of Health Sciences, 2015
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- Date Issued: 2015
Degradation of Paracetamol and other constituents in Perfalgan®: subtitle if needed. If no subtitle follow instructions in manual
- Authors: Curran,Catherine
- Date: 2014
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/3165 , vital:43181
- Description: Abstract text. 5.1 Background Paracetamol (acetaminophen) is useful for the treatment of mild to moderate pain as well as being opiate–sparing. In recent years the problem of poor solubility of paracetamol in water has been overcome and an intravenous formulation of paracetamol developed. In South Africa this is marketed by Bristol-Myers Squibb as Perfalgan®. Each 500 mg or 1g ampoule of Perfalgan® is recommended for single use only and is to be discarded once opened (Medicines.org, n.d.). This is most likely due to concerns about degradation of paracetamol or other ingredients in the solution once exposed to air and sterility issues. However in South Africa where this drug is expensive, some centers use one ampoule for multiple cases over the course of 12-24 hours. No obvious clinical adverse effects have been reported. 5.2 Objective of study The aim of this study was to examine the practice of using a single vial of Perfalgan® in divided doses over the course of a day for different patients by way of assessing the stability of Perfalgan® on exposure to air. The study has three components, namely: 1. In vitro assessment of paracetamol levels on exposure to air and stressors over time. 2. In vitro assessment of levels of the excipients, namely mannitol and cysteine on exposure to air and stressors over time. 3. Assessment of the lipid permeability of paracetamol in Perfalgan® on exposure to air and stressors over time. C Curran 2014 Degradation of paracetamol and other constituents in Perfalgan® 8 5.3 Methodology High performance liquid chromatography (HPCL-UV) was used to determine the concentration of paracetamol and the presence of degradation products in samples taken at set time periods following exposure of Perfalgan® to air and stressors. Initial work was done using pure paracetamol to determine optimal measurement conditions prior to analysing Perfalgan®. The concentrations of the additives and their degradation products were measured using nuclear magnetic resonance (1 H NMR). Appreciable changes in these could indicate a safety hazard or decreased bioavailability. Finally ultraviolet spectroscopy was performed to assess samples at a wider spectrum of wavelengths, instead of the single wavelength used in HPLC. This was used to assess for degradation products which absorb at different wavelengths and therefore may be missed if HPLC was used alone. Ultraviolet spectroscopy was also used to test bioavailability of the drug via the octanol:water partition coefficient under stressed and unstressed conditions. 5.4 Results The paracetamol in Perfalgan® did not degrade on exposure to air over 24 hours. Neither did it degrade on exposure to acid, alkali, oxidative or heat stress. The HPLC retention time was constantly between 3.17-3.29 minutes. 1 H NMR revealed no change in the formulation of Perfalgan® except for the conversion of the oxygen scavenger cysteine to cystine. The octanol:water partition coefficient likewise stayed constant and was in agreement with the value of 0.46-0.49 quoted in the literature (International Programme on Chemical Safety, 2008; McNeil Consumer Healthcare, 2010). 5.5 Conclusion The paracetamol in Perfalgan® did not degrade on exposure to air and other stressors over 24 hours. The formulation as Perfalgan® was likewise found to be stable. The drug retained its lipid permeability over this period. , Thesis (MMED) -- Faculty of Health Sciences, 2014
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- Date Issued: 2014