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Factors associated with delayed presentation among patients with oral cancer in Malawi central hospitals
(University of the Witwatersrand, Johannesburg, 2023-10) Lungu, Nathan; Sekhoto, M.G.; Turton, M.
Background: Oral cancer patients are prone to delays in visiting healthcare facilities resulting in delayed diagnosis, poor prognosis, disfigurement of patients, and increase in management costs. Objective: The aim was to assess factors related to health-seeking delay among patients with oral cancer in Malawi's central hospitals. Methodology: This research was a descriptive cross-sectional study of patients with oral cancer. The study was conducted in all Malawi referral hospitals' dental clinics from April to June 2023 using a closed-ended, structured questionnaire. Results: Thirty-six (52.94%) patients visited the hospital when in pain, and 66.18% (n=45) were not aware of oral cancer. A significant, statistical relationship (p=0.042) was identified between the delay and reporting to the nearest health care facility. Conclusion: Lack of awareness, pain and distance to the nearest health care facility were associated with delays. Education and awareness in primary health care can help prevent treatment delays.
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The contribution of common genetic variants to breast cancer risk in South African black populations
(University of the Witwatersrand, Johannesburg, 2023-08) Hayat, Mahtaab; Brandenburg, Jean-Tristan; Ramsay, Michèle; Mathew, Christopher
Breast cancer is the second most common cancer in South African black women. The contribution of common genetic variants to breast cancer risk is well studied in non-African populations, but little is known about their role in resident African populations, and there are no published genome-wide association studies (GWAS) on breast cancer in Africa. This PhD thesis aimed to determine the contribution of common genetic variants to breast cancer in a South African black population. A GWAS was carried out in 2,573 black female breast cancer patients from the Johannesburg Cancer Study and 744 population-matched, female controls from the AWI-Gen study. All participants were from Soweto, Johannesburg, South Africa. Samples were genotyped on the H3Africa SNP array. Replication testing was done of existing loci from European and African American (AA) populations in the resident African data, and loci from the resident African data in European and AA populations. A meta-analysis was carried out with an AA population. Finally, existing polygenic risk scores (PRSs) were tested in the resident African dataset. Three variants at two loci were strongly associated with breast cancer in this study. Two variants (rs77422433, p-value=2.89x10-08, odds ratio (OR):0.46, 95% confidence interval (95%CI): 0.40-0.52 and rs112410019, p-value=3.01x10-08, OR: 0.47, 95%CI: 0.41-0.53) were located within the DNA repair gene XRCC5. These variants were not previously associated with breast cancer, suggesting that it may be an African specific risk locus. The second locus is on chromosome 16 in CES5A (rs3859109, p-value=4.54x10-08, OR=0.70, 95%CI: 0.68-0.73), and had not previously been associated with breast cancer. None of these SNPs were replicated in European and AA populations. The meta-analysis with AA data revealed strong association of an intergenic SNP with breast cancer (rs139299680, pmeta=7.25x10-08) on chromosome 3. A polygenic risk score (PRS) developed in European populations demonstrated poor transferability to this African dataset. This GWAS is the first to be conducted in a resident black African population. This study suggests that there may be African-specific genetic risk factors for African breast cancer, and that large genome-wide studies in African populations are essential to develop a comprehensive understanding of the genetics of breast cancer in Africa.
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A retrospective study of histologically diagnosed intra-oral lesions within Ugu district, KZN, South Africa
(University of the Witwatersrand, Johannesburg, 2023-10) Reddy, Larisha Yashoda; Premviyasa, Vinayagie
Introduction: The oral cavity is exposed to a magnitude of physical and chemical trauma, carcinogenic agents and microbial pathogens that may cause a wide spectrum of oral lesions. These oral lesions may appear as benign, potentially malignant, or malignant thereby requiring biopsies to determine histopathological features to confirm a diagnosis. Oral lesions have the potential to hinder the quality of life for the afflicted patient. The patients’ speech, mastication, swallowing may be affected with the occurrence of oral dysesthesia. With the confirmation of a positive malignant biopsy, the afflicted individual will have to endure the possible side effects of chemotherapy and radiation. In global studies, the prevalence of oral lesions may vary amongst different countries, geographical areas, ethnicities, cultural practices, and social habits. Aim: To identify the different types of intra-oral lesions and the prevalence of malignant oral lesions within UGU district, Kwa- Zulu Natal (KZN). Objectives: 1. To identify the different types of intra oral lesions and characterise by demographics. 2. To determine the prevalence of malignant oral lesions within UGU district, KZN. 3. To determine the association between patients’ social habits and the development of the most common intra oral lesions, with the differentiation of malignant vs non-malignant oral lesions. 4. To assess the concordance of a clinical differential diagnosis and histopathological diagnosis. Study design and Methodology: A quantitative, retrospective case review of dental patient files and histopathological reports of the four selected hospitals in UGU were analysed from January 2016 to August 2022. One hundred and thirty-four patient records were reviewed. Data collected included patients’ age, gender, comorbidities, social habits, differential diagnosis, and histological diagnosis. The data was analysed using a free open-source statistical software program called “R”. Study results: One hundred and thirty-four patients met the criteria of this study. The age of patients ranged between seven and eighty-seven (M= 46.37; SD= 20.77). There were 81 females (60.4%) and 53 males (39.6%). Benign lesions had represented 67.2% (N: 90) of the intra oral biopsies, with the remaining 32.8 %, (N:44), representing malignant lesions. The most common lesions presenting in UGU district were fibrous epulis (N: 15, 11.2%), pyogenic granuloma (N:36, 26.9%) and squamous cell carcinoma (N:37, 27.6%). No statistical relation was proven between ethnicity, sex, and social habits with the benign lesions of fibrous epulis and pyogenic granuloma. Statistical relation was proven between squamous cell carcinoma and ethnicity, gender, and social habits. A substantial level of concordance (agreement) was proven with the Kappa Statistic of 0.7437, hereby indicating a good general knowledge of intra-oral lesions amongst the dentist performing the intra oral biopsies within UGU district. Conclusion: Fibrous epulis, pyogenic granuloma and oral squamous cell carcinoma had been identified as the three most common lesions in UGU, KZN, representing 65.7% of the confirmed biopsy results. Fibrous epulis and pyogenic granuloma had shown no statistical association to ethnicity, gender, alcohol consumption and smoking. In this study, oral squamous cell carcinoma had shown statistical association to white males and consumption of alcohol and smoking. This study has demonstrated the diversity and prevalence of intra-oral lesions within the rural district of UGU, KZN, South Africa as compared to global studies.
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Exploring employees’ resistance towards the creation of an executable process model for innovation adoption in mining
(University of the Witwatersrand, Johannesburg, 2024) Xheko, Sibongile Amos
Background: Mining is one of the oldest and most essential industries in the world, but it is also one of the most conservative and resistant to change. Despite the potential benefits of modern technology innovation, such as improved productivity, safety, efficiency, and environmental performance, mining companies face significant challenges in adopting and implementing them. In this document, we will identify the biggest challenge for mining companies when they introduce modern technology innovation and suggest some workable solutions to overcome it. Objective: The purpose of this comprehensive research study is to identify how change management process facilitate the adoption of modern technology like collision avoidance systems (CAS level 9) in the South African mining industry? There has been known and unknown challenges, strategies, and unusual decisions related to implementation of modern technology in the mining sector. Methods: The study applied a qualitative research approach dissection based on organizations' readiness to implement modern technology, while putting emphasis on change management. In total, 16 individuals were interviewed with four questions posed on each group. The records were obtained from 2015 which was the first year of introducing proximity detection systems, until December 2022 after the pronouncement of the collision avoidance system level 9. Then, we updated the search to the 2023, which was the first year of full implementation of CAS level 9. After removing duplicates and reviewing articles according to inclusion and exclusion criteria, 16 interviewees were used for the study. Finally, the study proposed a conceptual framework of technology implementation executable process model for implementation of new technology based on the literature findings to fight against the loss of life on the mining industry due to collision of vehicle to vehicle or vehicle to man. Results: The failure of proper technology implementation posed numerous adverse consequences, such as organisational cultural shock, safety crisis, change in user/operator behaviours, and challenges at the organization level to continue business operations. Besides, the strategies included flexibility, strengthening internal efficiency, talent acquisition, and making innovative changes based on organizational assessment and needs for smooth business activities. v Conclusion: The appropriate modern technology strategies implementations would increase employees’ well-being, satisfaction, productivity, and health safety at the workplace. Resistance to change was pointed as one of the key factors that leads to failure to implement modern technology innovations in the mining sector. Proper change management process is one of the key factors that will assist the mining industry in the implementation of modern technology
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Assessing the effect of Covid 19 on selective SMEs in South Africa Jacques Vassard
(University of the Witwatersrand, Johannesburg, 2024) Vassard, Jacques; Chipeta, Eleanor Meda
The COVID-19 pandemic has brought forth a myriad of challenges for small and medium-sized enterprises (SMEs), particularly in South Africa. These challenges include financial instability, fluctuations in market demand, supply chain disruptions, government policy changes, and consumer behaviour modifications. This study aims to delve into these unique circumstances and challenges faced by SMEs in South Africa during this unprecedented global health crisis. For my study, I will be analysing the factors that affect the performance of Small and Medium Enterprises (SMEs) in South Africa during the COVID-19 pandemic. I will use a qualitative research approach to examine the impact of COVID-19 on the performance of fifteen SMEs in South Africa. Qualitative research can provide valuable insights into the challenges faced by these enterprises. This research method focuses on understanding SMEs' experiences, beliefs, and personal interpretations, allowing for a thorough investigation of the subject. Based on the data collected, 60% of these businesses experienced a negative impact on their revenue generation ability. The lockdown restrictions compelled SMEs to cease operations, resulting in significant losses. Among the SMEs, 47% reported declining demand for their products or services during the pandemic. Additionally, 47% of the SMEs experienced supply chain problems. Furthermore, 53% of SMEs reported that the policies put in place had caused harm to their businesses. The latest factor studied was the purchasing behaviour of small and medium-sized enterprises (SMEs) and how the COVID-19 pandemic affected their customers' habits. 40% of these SMEs reported decreased client purchases during this period. The study underscores the resilience and adaptability of small and medium-sized enterprises (SMEs) in South Africa amid the multitude of challenges posed by the COVID-19 pandemic. The insights derived from this qualitative research highlight the critical need for targeted support and interventions to strengthen the sustainability and growth of SMEs in the face of such unprecedented disruptions