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For queries relating to content and technical issues, please contact IR specialists via this email address : openscholarship.library@wits.ac.za, Tel: 011 717 4652 or 011 717 1954

 

Recent Submissions

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Adherence to the Standard Treatment Guidelines in managing patients with hypertension at Chiawelo Community Health Centre, Gauteng, South Africa
(University of the Witwatersrand, Johannesburg, 2022-04) Dawduth, Nikkeeta; Torlutter, Michele
Background: Hypertension is a highly prevalent chronic disease, causing significant morbidity and mortality and is poorly managed and controlled in primary care, with only 24.5 to 56% of patients being controlled. Aim: The aim of the study was to determine health care worker adherence to the Standard Treatment Guidelines in managing hypertensive patients in primary care. Methods: The study was conducted at Chiawelo Community Practice Johannesburg. A retrospective file review was done on 261 hypertensive patients and information extracted to determine whether health care workers performed correct baseline tests at diagnosis; correct investigations were done on ongoing basis; lifestyle modification was addressed; and correct pharmacological therapy was prescribed and titrated. Data analysis included descriptive statistics and bivariate analysis. Results: A total of 77% of participants were female and 23% were male of which 80.5% participants had co-morbidities. Patients were treated by a doctor in 97% of cases; 84.3% by clinical associate, and 0.6% by a nurse only over time. Baseline findings recorded in the file at diagnosis were: weight 65.9%, height 73.2%, potassium 32.2%, BMI 50.2%, abdominal circumference 51.7%, and urine dipsticks 47.9%. Vitals and investigations recorded in the file: BP 99.6%, weight 19.5%, blood glucose 86.6%, creatinine 95.4%, eGFR 94.3% and urine protein 3.4%. Lifestyle modification was recorded for 23.7% and medication adherence was checked and recorded for 36.4% of patients. The correct antihypertensive medications were prescribed in 96.5% of patients but titrated correctly in only 73.5% of patients. 52.8% of patients were controlled on treatment. Conclusion: Adherence to guidelines by health care workers was suboptimal and several aspects of care warrants quality improvement processes.
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A Review of the Patterns of Clinical Presentation, Histopathological Classes and Outcomes of Lupus Nephritis Patients at Helen Joseph Hospital
(University of the Witwatersrand, Johannesburg, 2023-09) Rajoo, Sarisha Devina; Davies, Malcolm; Cassimjee, Zaheera
Background: Lupus nephritis (LN) is a significant factor in the burden of secondary glomerular disease in South Africa. It can be the presenting feature of SLE, carrying a worse prognosis in people of African descent. Early identification and treatment are required to meaningfully affect patient outcome. This study aimed to evaluate the potential of presenting features in identifying patients at risk for adverse lupus nephritis outcomes. Methods: A retrospective review of biopsy-proven LN diagnosed over a 10 year period at Helen Joseph Hospital was undertaken. Clinical, histopathology and renal outcomes data was extracted from 48 patient records. The variables were tested with logistic regression and general discriminant analysis. Kaplan-Meier survival curves of renal outcomes were compared using Cox-Mantel F test. Effect of clinical and histological parameters on renal outcomes was determined by multifactorial Cox and multifactorial linear regression. Results: 72.7% of patients were of Black African ancestry with median age at diagnosis of 26.5 years. The majority of lesions were proliferative LN (66%);class III was most common (25.5%). Proliferative lesions were associated with higher creatinine (p=0.007); an eGFR below 90mL/min/1.73m2 increased the odds of proliferative LN (OR=5.60; CI 1.06-29.59; p=0.043). Proliferative LN was associated with a trend towards poorer renal outcomes (p=0.057); higher baseline eGFR was associated with better preserved kidney function at follow up (p=0.003). Baseline urine WCC was inversely related to eGFR and directly related with creatinine at follow up (p=0.041 and p=0.001 respectively). Conclusion: The present study demonstrates a possible role for baseline eGFR and leukocyturia in predicting the presence of proliferative LN. Since proliferative LN is associated with poorer kidney survival, these investigations may identify patients likely to benefit from empiric high-dose immunosuppression when access to biopsy confirmation may be delayed.
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COVID-19 and health care worker exposure at Chris Hani Baragwanath Academic Hospital
(University of the Witwatersrand, Johannesburg, 2021-12-05) Glatt, Sara Chaya; Menezes, Colin; Winchow, Lai ling; Tsitsi, Merika
Background: Health care workers (HCWs) are at an increased risk of acquiring coronavirus disease 2019 (COVID-19). Appropriate risk assessments and testing are essential to reduce transmission and avoid workforce depletion. Objective: Investigate the risk of COVID-19 infection among HCWs at Chris Hani Baragwanath Academic Hospital who fulfil the Person Under Investigation (PUI) case definition or had exposure to a confirmed COVID-19 contact. Methods: A retrospective review of HCW records was conducted over a two month period. Data collected included demographics, exposure type, risk level, and COVID-19 test result. Frequency distribution tables, bivariate analyses and univariate and multivariate analyses were conducted. Results: Among the 1111 HCWs reviewed, 643 were tested with 35.6% positive results. PUI’s accounted for 62.4% of positive cases. Symptomatic HCWs with no known contact were at a greater risk of infection than those with a patient exposure (p=0.000). Risk of testing positive was higher after a patient exposure (p=0.000) compared to a co-worker contact. Conclusion: There is a higher positivity rate among HCWs than the general population. The presence of symptoms warrants testing. Nosocomial transmission was derived from patient more than co-worker contacts.
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An assessment of the hospital learning environment within the University of Witwatersrand obstetrics and gynaecology registrar training programme
(University of the Witwatersrand, Johannesburg, 2023-11) Masukume, Rumbidzai; Chauke, Lawrence; Odell, Natalie
Background: The hospital educational environment is a critical component of a health professionals’ education. It influences clinicians’ professional development, well-being, academic success and ability to provide high-quality healthcare services. There is limited data on the postgraduate clinical learning environment (CLE) in obstetrics and gynaecology (Obgyn) in South Africa. Research objectives: (1) to evaluate obstetrics and gynaecology registrars’ perceptions of their CLE utilising the modified Postgraduate Hospital Educational Environment Measure (PHEEM) questionnaire, (2) to assess factors influencing these perceptions; (3) to evaluate the impact of the learning environment on academic outcomes, and (4) to use the results to recommend targeted improvements of the registrar training programme in Obgyn at the University of Witwatersrand (WITS). Methods: A prospective cross-sectional study involving a convenience sample of doctors enrolled for the four-year Obgyn training programme at WITS. The modified PHEEM questionnaire was electronically sent to 80 participants between January and April 2022. Categorical variables were described using frequencies and percentages. Continuous variables were summarised by measures of central tendency. Factors associated with the PHEEM scores were evaluated using the Student’s t-test and analysis of variance (ANOVA) tests. A p-value of <0.05was considered statistically significant. Results. Of the 80 participants, 46 (57.5%) responded to the questionnaire. The mean total modified PHEEM score (SD) was 74.9 (16.4) out of a possible 160. The mean scores in this study were as follows: perception of autonomy 27.4/56 (5.3), perception of teaching 30.2/60 (4.0), and perception of social support 17.3/44 (7.1). The overall perceptions of the educational environment were influenced by sex (p<0.001), supernumerary status (p= 0.0036), and marital status (p=0.001). Only two individuals did not complete the four-year training programme. A total of 81.8% of those who completed the four-year training programme passed their Fellowship of the College of Obstetricians and Gynaecologists (FCOG) of South Africa qualifying exams (FCOG 2) on their first exam attempt, however, 34.1% wrote the FCOG 2 exams after completing the four-year training. Conclusion: During the study period, the educational environment within the Obgyn WITS circuit was perceived to be more negative than positive, indicating that all three domains of the modified PHEEM require attention to enhance the educational environment.
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