School of Therapeutic Sciences (ETDs)

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Record review of patients with brain abscess and empyema.
(University of the Witwatersrand, Johannesburg, 2010-01-22T10:28:25Z) Schwenke, Katherine Linda
Studies of patients presenting with brain abscess (BA) and Empyema are not routinely focused on occupational therapy (OT). There is a paucity of literature on deficits other than hemiplegia. Aims of this study were to determine the relationship between BA, Empyema, motor and other deficits and whether an OT intervention protocol is needed. Record review was used to establish clinical presentation trends. Hemiplegia was the most common motor deficit and the majority scored below the norm on the Beery- Buktenika Developmental Test of Visual Motor Integration (VMI). Patients with Brain Abscess generally had more significant deficits than those with Empyema for both motor and process deficits. Part B followed up a small sample (n=8) which indicated clinical improvement on the VMI test with the score on the supplemental test of motor coordination remaining a concern. Occupational Therapy is recommended to address these issues based on the Occupational Therapy Practice Framework-II.
The effect of a scissor skills program on bilateral fine motor skills in preschool children in South Africa including skill improvement, equivalence, transferability of skills and skill retention
(University of the Witwatersrand, Johannesburg, 2010-01-27T12:43:24Z) Ratcliffe, Ingrid
The purpose of this study was to assess the improvement of scissor skills after a graded scissor skills program in preschool children in South Africa (SA). A bilateral fine motor skills assessment tool was developed for use in this research. This task-based assessment included every day activities required at school as well as personal management items. This research phase included the development of the test items and test instructions, scoring as well as validity and reliability testing of the assessment. A suitable scissor skills program was then developed for Grade 0 children in South Africa. The program was validated by a pilot study and also by a focus group of occupational therapists. Some changes were made to the picture selection, the grading of the program, as well as to teacher instructions on how to present the program before it was finalised and ready for use in the implementation phase of the research study. The implementation phase of the study included the individual assessment of 149 learners (mean age of 5 years 6 months), from three different schools in South Africa. The main aim was to establish the effectiveness of the scissor skills program by measuring skill improvement, transferability of skills and skill retention. A further aim was to compare the difference of skill levels of learners from various socio-economic backgrounds in South Africa. The results showed statistically significant improvement in scissor skills in all groups from the three different schools, as well as an ability to retain the learnt skills. Participants from lower socio-economic backgrounds demonstrated the least skill initially but made the greatest gains during the program, at times decreasing the gap between themselves and other participants. It was concluded that children benefited from a graded scissor skills program, which allowed them to improve and retain their scissor skills but improvement did not transfer to other fine motor tasks.
The impact of lower limb amputation on quality of life: a study done in the Johannesburg Metropolitan area, South Africa
(University of the Witwatersrand, Johannesburg, 2010-01-29T07:15:06Z) Godlwana, Lonwabo L.
Background: The impact of non-traumatic lower limb amputation on participant’s quality of life (QOL) is unknown. In an effort to provide better care for people with lower limb amputation, there is a need to first know the impact of this body changing operation on people’s quality of life. Aim of the study: To determine the impact of lower limb amputation on QOL in people in the Johannesburg metropolitan area during their reintegration to their society/community of origin. Objectives: 1. To establish the pre-operative and post-operative:  QOL of participants (including the feelings, experiences and impact of lower limb amputation during the time when they have returned home and to the community).  The functional status of participants.  Household economic and social status of these participants. 2. To establish factors influencing QOL. Methods: A longitudinal pre (amputation) test –post (amputation) test study utilized a combination of interviews to collect quantitative data and in-depth semi-structured interviews to gather qualitative data. Consecutive sampling was used to draw participants (n=73) for the interviews at the study sites pre-operatively. The three study sites were Chris Hani Baragwanath Hospital, Charlotte Maxeke Johannesburg General Hospital and Helen Joseph Hospital. Participants were then followed up three months later for post-operative interviews and key informants were selected for in-depth interviews (n=12). Inclusion criteria: Participants were included if they were scheduled for first time unilateral (or bilateral amputation done at the same time) lower limb amputation. The participants were between the ages of 36-71 years. Exclusion criteria: Participants who had an amputation as a result of traumatic or congenital birth defects were excluded from the study. Participants with comorbidities that interfered with function pre-operatively were not included. Procedures: Ethics: Ethical clearance was obtained from the Committee for Research on Human Subjects at the University of the Witwatersrand and permission was obtained from the above hospitals. Participants gave consent before taking part in the study. Instrumentation: A demographic questionnaire, the EQ-5D, the Modified Household Economic and Social Status Index (HESSI), the Barthel Index (BI) and semi-structured in-depth interviews were used. Data collection: Participants were approached before the operation for their preoperative interviews using the above questionnaires and then followed up postoperatively using the same questionnaires and some were selected to participate in semi-structured in-depth interviews three months later. Pilot study: The demographics questionnaire and the modified HESSI were piloted to ensure validity and reliability. iii Data analysis: Data were analyzed using the SPSS Version 17.0 and STATA 10.0. The significance of the study was set at p=0.05. All continuous data are presented as means, medians, standard deviations and confidence intervals (CI 95%). Categorical data are presented as frequencies. Pre and post operative differences were analyzed using Wilcoxon Signed-rank test. A median regression analysis (both the univariate and multivariate regression) was done to establish factors influencing QOL. Pre and post operative differences in the EQ-5D items and the BI items were analyzed using Chi square/Fischer’s exact depending on the data. Data were pooled for presentation as statistical figures in tables. Both an intension to treat analysis and per protocol analysis were used. A grounded theory approach was used to analyze the concepts, categories and themes that emerged in the qualitative data. Results: Twenty-four participants (33%) had died by the time of follow up. At three months, n=9 (12%) had been lost to follow up and 40(55%) was successfully followed up. The preoperative median VAS was 60 (n=40). The postoperative median VAS was 70. The EQ-5D items on mobility and usual activities were reported as having deteriorated significantly postoperatively (p=0.04, p=0.001respectively) while pain/discomfort had improved (p=0.003). There was no improvement in QOL median VAS from the preoperative status to three months postoperatively The preoperative median total BI score was (n=40). The postoperative median total BI score was 19. There was a reduction in function (median BI) from the preoperative status to three months postoperatively (p<0.001). The ability to transfer was improved three months postoperatively (p=0.04). Participants were also found to have a decreased ability to negotiate stairs (p<0.001). Mobility was significantly reduced three months postoperatively (p=0.04). During the postoperative stage (n=40), 38% of the participants were married. Most (53%) of the participants had no form of income. The highest percentage of participants in all instances (35%) had secondary education (grade10-11), while 25% had less than grade 5. Only one participant was homeless, 18% lived in shacks, 55% lived in homes that were not shared with other families. People with LLA in the Johannesburg metropolitan area who had no problem with mobility preoperatively (EQ-5D mobility item), who were independent with mobility (BI mobility item) preoperatively, who were independent with transfer preoperatively (BI transfer item) had a higher postoperative quality of life (postoperative median EQ-5D- VAS) compared to people who were dependent or had problems with these functions preoperatively. Being females was a predictor of higher reported quality of life compared to being male. Emerging themes from the qualitative data were psychological, social and religious themes. Suicidal thoughts, dependence, poor acceptance, public perception about body image, phantom limb related falls and hoping to get a prosthesis were reported. Some reported poor social involvement due to mobility problems, employment concerns, while families and friends were found to be supportive. Participants had faith in God. Conclusion: Participants’ QOL and function were generally scored high both preoperatively and postoperatively but there was a significant improvement in QOL and a significant reduction in function after three months although participants were generally still functionally independent. Good mobility preoperatively is a predictor of good QOL postoperatively compared to people with a poor preoperative mobility status. Generally, most participants had come to terms with the amputation and were managing well while some expressed that they were struggling with reintegration to their community of origin three months postoperatively with both functional and psychosocial challenges.
Identification of third year midwifery skills that could benefit from simulated practice prior to clinical midwifery placements
(2021) Singaram, Kerry-Ann
Neophyte midwifery students often feel anxious and inadequate during their clinical placements, as they are expected to perform midwifery skills as early as their first day in the clinical environment. Midwifery educators are seeking out creative ways to create practice opportunities for their students with regards to skills practice, and simulation as a teaching strategy offers a learning environment for safe practice of skills. The use of simulation in midwifery is a fairly new concept, and its future growth is dependent upon research to provide a sound base from which it may grow and develop to meet the needs of the students. The purpose of the study was to identify key midwifery skills that could be taught and practiced using simulation prior to student midwives’ clinical placements that would better equip student midwives to manage their midwifery clinical placements. Findings from the study could serve as a foundational basis for future midwifery simulated programs. The research design and method was qualitative in nature and data was collected from focus group discussions with fourth-year student nurses and their respective midwifery lecturers. Clinical facilitators who are based in the clinical environment and responsible for the training of third year midwifery students were invited to participate in the study, however, were unable to attend. The researcher felt that, this created a limitation to the study as they might have added additional information or a different perspective about novice midwifery skills training. Findings identified specific midwifery skills that could benefit from simulated practice as well as how best skills could be practiced within facilitation of simulation in third year midwifery practice. Summary of findings included the identification of the following midwifery skills that participants identified as being important with regards to simulated practice: completion of documentation; vaginal examinations; management of second stage of labour and offering of psychological support. IV, Participants together with the researcher gives suggestions on how best simulation can be facilitated for developing confidence in neophyte student midwives before their first clinical placement. Based on the findings of this research, recommendations were made to guide midwifery lecturers when planning simulation activities.
Experiences of professional nurses in providing support to student nurses in the clinical practice environment of a private hospital in Gauteng
(2021) Jones, Jennifer
Quality in nursing education is a global focus due to the many challenges facing healthcare the world over. Clinical learning is an important component in nursing training and nursing experiences during clinical placement are crucial to prepare the student to become safe, competent Professional Nurses. However recent studies have shown that the students’ clinical training is not always effective in preparing them for their future role. Support in the clinical environment by the Professional Nurse is crucial to assist the student to develop confidence and competence to transition into the Professional Nurse role. The objective of this study was to describe the experiences of Professional Nurses in providing support to student nurses in the clinical practice environment of a private hospital. An exploratory qualitative study using in depth interviews of fifteen Professional Nurses was done. The data collected was then analysed using thematic analysis. The identified themes and categories were discussed to offer meaning and insight. The study provided an understanding of how support of the student nurse is currently experienced and perceived by the Professional Nurse in the clinical practice environment with a view to identifying ways of improving support to the student nurse in the future. It was found that the clinical environment is unpredictable and whilst the Professional Nurses acknowledged they needed to support the student, it was often challenging to do this effectively leaving them feeling frustrated and disappointed. The study took place during the COVID -19 pandemic which caused major disruptions to the everyday functioning and operations of hospitals globally, and the study site was no exception. Recommendations to improve support to the student nurse were made in the areas of Clinical Practice, Nursing Education and Research.
Investigating the attitudes of physiotherapists about telerehabilitation and their opinions on its feasibility in South Africa
(University of the Witwatersrand, Johannesburg, 2022) Thomas, Tylla
Background: Telerehabilitation has not been a permitted nor been a focus in healthcare in South Africa. There is little awareness, knowledge, and skill amongst physiotherapists on how to conduct effective telerehabilitation. However, this is not the case globally, where telerehabilitation has been proven effective in the treatment of patients with various conditions. Advances in telerehabilitation worldwide are occurring daily but there is scarce literature on telerehabilitation in South Africa. Due to Covid-19, the HPCSA has granted permission to conduct telehealth, however, numerous barriers first need to be overcome for telerehabilitation to become a common therapeutic practice. The attitudes of physiotherapists on telerehabilitation and its feasibility have not been investigated and hence the current use, or willingness to use, is unknown amongst the South African population. Aim: To investigate the attitudes of physiotherapists and their opinions on the feasibility of telerehabilitation in daily practice in South Africa. Methods: This quantitative, cross-sectional study included 356 physiotherapists belonging to the SASP, recruited through convenience sampling. An electronic self-reported questionnaire was developed from existing literature and other exiting questionnaires e.g. the Physiotherapy Mobile Acceptance Questionnaire (PTMAQ) (Blumenthal, Wilkinson, and Chignell, 2018). The questionnaire was emailed to all physiotherapists belonging to the SASP and they could voluntarily answer it. Descriptive data analysis was conducted to describe the demographic profile of physiotherapists and to determine their attitudes on telerehabilitation as well as the feasibility thereof in South Africa. One-Way ANOVA (analyses of variance) was used to establish a relationship between participants’ demographics and their attitudes and feasibility 2 regarding the use of technology for rehabilitation in South Africa. The study obtained ethical clearance from the Human Research Ethics Committee (Medical), clearance number M200946. Results: Most participants were between the ages of 25-35 (170, 47.8%), working more than 20 years (101, 28.4%), mostly in orthopaedic manipulative therapy (137, 38%) and in outpatient practice (199, 55.9%). Most participants had positive attitudes regarding the perceived ease of use and perceived usefulness (Valdez et al., 2009). Only 18.3% of participants used telerehabilitation in their clinical settings and less than half of the participants state that they would be willing to use telerehabilitation in their clinical setting. Only 37.3% of participants thought that the South African population would be receptive to telerehabilitation. Most participants thought that there is not enough knowledge (308, 86.5%) and awareness (262, 73.6%) about telerehabilitation but do have the capacity and resources to conduct telerehabilitation sessions in their clinical settings (227, 63.8%). Participants in OMT and outpatient practice had a more favourable attitude toward telerehabilitation. No significant effects of age were found. Conclusion: Physiotherapists show positive attitudes on the use of telerehabilitation but are not willing to do it in their clinical settings due to numerous barriers that affect the feasibility thereof. This study is one of the first to investigate the attitudes of physiotherapists on the use of telerehabilitation, however, further studies need to be conducted to examine the effectiveness of telerehabilitation amongst physiotherapists in South Africa. It is the hope that the awareness, knowledge, and skill to conduct telerehabilitation increases among physiotherapists in South Africa so that use of telerehabilitation can become common practice.
The emergency management of patients who have experienced sexual violence: an integrative literature review
(University of the Witwatersrand, Johannesburg, 2023) Quiroga, Neil Dylan
Background: Sexual violence is endemic in many countries, and particularly in South Africa.. Over the past few years there have been several advancements in the care for patients who have experienced sexual violence. However, the care available in resource limited settings and in South Africa, remains inconsistent and often inadequate. Purpose of the Study: To synthesize the current evidence based practice in the emergency management of patients who have experienced sexual violence; and to review which advancements could be feasible in a resource limited setting, and in the South African context. Methods: This study conducted an integrative literature review on the emergency management of patients who experience sexual assault, in order to synthesise the current literature. The research is structured on Whittemore and Knafl’s framework, and utilizes their five stages of an integrative review: problem identification, literature search, data evaluation, data analysis, and presentation. The following databases were searched: Cochrane library, EBSCOhost (CINAHL; ERIC and MEDLINE), PubMed, ScienceDirect, Wiley online library and Psycinfo. 2142 articles were assessed fully for eligibility, and a total of 47 articles were included in the integrative review. The literature search was conducted over a period of 4 months. Thematic analysis of the 47 articles was then conducted using MaxQDA (Qualitative Coding Software). A conductive coding approach was used, based on grounded theory. Results: Eight main themes, and thirty four subthemes, emerged from the data that spoke directly to the research question and objectives. The eight major themes were: Screening patients for sexual violence; emergency medical care for survivors; forensic care; mental health care; follow up care and services; technological aids to augment care; structural or organization aspects affecting care; and health care worker factors that affect care for survivors. Conclusion: The study strongly recommends integrating trauma informed care into every aspect of care for survivors of sexual violence in South Africa. The study also recommends implementing: screening of patients for various forms of sexual violence; quality improvement drivers such as order sets and clinical pathways; and nurse driven innovations in pro-active follow up services and new mental health care interventions
Brain concentrations and the neurochemical effects of passively administered fluoxetine in Flinders sensitive line rat offspring
(University of the Witwatersrand, Johannesburg, 2023) Steyn, Stephanus Frederik
Background: Globally, 36 % of women who have recently given birth, experience symptoms of depression and anxiety. Effective antidepressant treatments are limited, with fluoxetine being a popular treatment option. Fluoxetine is expressed in the breast milk, yet it is unclear to what extent fluoxetine, or its active metabolite, norfluoxetine, reaches the brain of the developing child and what the effects of such exposure on the related neurobiological processes would be. Due to ethical considerations and practical restrictions, clinical investigations into the neurodevelopmental effects of passively administered antidepressants (via the breast milk) are problematic. Therefore, pre-clinical investigations into this topic are not only important but clinically relevant. Aims & objectives: We aimed to quantify the concentration of passively administered, i.e., via the breast milk during nursing, fluoxetine, and its active metabolite, norfluoxetine in the whole brains of exposed Flinders sensitive line (FSL) rats (an established rodent model of depression). We further aimed to establish if said exposure would associate with changes in whole-brain serotonergic function and redox status. Methods: Adult FSL dams received fluoxetine (10 mg/kg/day), or placebo for fourteen days, beginning on postpartum day 04. Offspring (n = 16 per exposure group; 1:1 male: female) were passively exposed to fluoxetine until postnatal day 18 and euthanized on postnatal day 22. Whole brain fluoxetine, norfluoxetine, serotonin, 5-hydroxyindoleacetic acid (5-HIAA), and reduced and oxidized glutathione (GSH and GSSG) concentrations were measured via liquid chromatography/mass spectrometry (LC-MS). Results: Fluoxetine, was undetectable in the brain of FSL offspring, while norfluoxetine concentrations, averaged 41.28 ± 6.47 ng/g. Neither serotonin, nor its metabolite (5-HIAA), was affected by passively administered fluoxetine in the juvenile brain. In terms of redox status, pups exposed to fluoxetine presented with a compromised antioxidant defence, as evinced by a lower GSH/GSSG ratio. Discussion and conclusion: Although fluoxetine and norfluoxetine concentrations have been measured in breast milk and infant plasma, to the best of our knowledge, it has not been quantified in the juvenile brain until now. Our results are in line with clinical findings, suggesting the infant norfluoxetine/fluoxetine ratio to be elevated, probably because of the prolonged half-life of norfluoxetine. Although only norfluoxetine was detected, this did not influence the central serotonin concentrations of offspring. However, it associated with increased oxidative stress, of which the pathophysiological significance remains to be established. Taken together, our findings confirm that passively administered fluoxetine does reach the infant brain in the form of norfluoxetine and may manipulate processes of oxidative stress regulation. Further studies into the long-term bio-behavioural effects are however needed to effectively inform breast feeding mothers on the safety of antidepressant-use during the postpartum period
Novel Design and Analysis of an Oral Cannabidiol (Cbd) Therapeutic Delivery System for Pain Management
(University of the Witwatersrand, Johannesburg, 2023-11) Khan-Flear, Faryal; Adeyemi, Samson A.; Kondiah, Pierre P. D.; Choonara, Yahya E.
Cannabidiol (CBD) is a non-psychoactive cannabinoid used for its antinociceptive, analgesic and anti-inflammatory properties in chronic pain. The endocannabinoid system (ECS) influences CBD: receptor binding to generate or regulate antinociceptive responses, producing centrally acting analgesia predominantly through Cannabinoid receptor 1 (CB1) abundant in the brain and spinal cord. In contrast, Cannabinoid receptor 2 (CB2) modulates inflammatory responses in immune system cells and tissues. Most oral medications can have inefficient absorption ability and insufficient therapeutic bioavailability due to the solubility of active ingredients and dosage form dissolution. Although the high lipophilicity of CBD enables it to cross the blood-brain barrier (BBB), which prevents the entry of most systematically administered drugs, the oil-soluble CBD is poorly soluble in water, resulting in erratic, incomplete absorption and poor drug bioavailability, preventing therapeutic doses from reaching specific receptors and regions in the brain. Directly ingested CBD also undergoes hepatic and intestinal metabolism, further contributing to therapeutic insufficiencies. Lipid-Based Drug Delivery Systems (LBDDS) can circumvent the drug's hysicochemical properties and the body's protective biological barriers to enhance drug-receptor interaction and elicit a biological response. Lipid combinations in self-emulsifying lipid formulations (SELF) create liposome nanocarriers that entrap and release CBD, providing a non-invasive, transitory, regionally selective delivery method. Nanoliposomes restrict therapeutic delivery to targeted areas, minimizing systemic toxicity and improving drug bioavailability. Manipulating the physical, chemical, and mechanical aspects of nano-liposomes and the material properties of their constituents concerning human anatomy and physiology can help or hinder therapeutic efficiency, drug safety, and delivery. Most therapeutic nanoliposome designs fall within 50–100 nm, facilitating passive transport across the BBB enabling drug receptor binding at brain and spinal cord receptor sites. Modulator uptake and interactions with host cells, enhanced uptake by target cells, and limits accumulation in specific tissues. Nanoliposomes smaller than 100 nm also extend blood circulation by evading renal, hepatic, and immunogenic sequestration and clearance by the mononuclear phagocyte system (MPS), the reticuloendothelial system (RES), opsonization, modulator uptake and interactions with host cells, limited accumulation in specific tissues, low uptake by target cells. This experiment used established system predictors such as HLB and LogP values, Poulton's Lipid Classification System (LCS), Biopharmaceutics Classification System (BCS), Lipinski's Rule of 5 (Ro5), FBDD Rule of 3 (Ro3), Biopharmaceutics Drug Disposition Classification System (BDDCS) to evaluate the critical quality attributes of two optimized formulations able to deliver CBD to the brain and spinal cord. Both formulations consisted of a phospholipid (soy lecithin), unmodified vegetable oils (coconut, olive/castor oil), surfactants (Span 80 and Tween 20), and a cosolvent (ethyl acetate) in the same ratios with the same ingredients, except that the olive oil in one formulation replaced castor oil in the other. These formulations molecularly dispersed CBD in the polymeric matrix of an unstable amorphous solid dispersion (ASD), improving drug solubility and bioavailability compared to crystalline forms. Thermodynamically unstable ASD must be assessed for quality, stability, and resilience to design helpful dosage forms. Both optimized validation batches successfully encapsulated CBD in liposomes in the eutectic ASD mixtures, as reflected in Fourier transform infrared spectroscopy (FTIR) spectrograms and the Differential scanning calorimetry (DSC). The olive oil-containing formulation produced self-micro-emulsifying drug delivery system (SMEDDS). At the same time, the castor oil preparation formed a self-nano-emulsifying drug delivery system (SNEDDS), accounting for the differences in particle size, size distribution, zeta potential, rheology, morphology, drug release and cell culture analysis. The differences arose due to the oils' unique fatty acid composition and chemistry. Drug release test results of each formulation loaded in hydroxypropyl methylcellulose (HPMC) capsules showed good timing for capsule dissolution and a burst release preceding sustained release over 48 hours. Drug release test results established cell viability in culture studies. The positive cell proliferation indicated that the CBD concentrations released by both formulations were non-toxic to mouse embryonic fibroblasts (NIH/3T3) and human embryonic kidney epithelial cell (HEK 293) cultures. Although both formulations yielded favourable results, the analysis indicated that the castor oil formulation was more robust and, therefore, suitable as a nanocarrier for CBD.
Contextually responsive support and development strategies for generalist occupational therapists delivering hand-injury care in South Africa
(University of the Witwatersrand, Johannesburg, 2024) Stormbroek, Kirsty van
Hand injuries are common in South Africa and safe and effective hand therapy is critical to appropriate care. By necessity, this care is delivered by non-specialist occupational therapists working in challenging settings, despite hand therapy commonly being considered a specialist area of practice. Safe and competent management of hand injuries by therapists is crucial for achieving a return to full participation in daily life. It is therefore necessary to describe what the support and development needs of these non-specialist occupational therapists are, and how these needs can be met effectively and sustainably. This project aimed to describe how the support and development needs of generalist occupational therapists delivering hand-injury care within the South African public health sector can be met in a contextually responsive manner. A multi-method approach was chosen, with a separate study design employed for each of the three studies. The policy context is an essential aspect of contextually responsive intervention; therefore the first study aimed to develop policy-based principles for hand rehabilitation services delivered by occupational therapists in South Africa. A descriptive qualitative approach was employed, and framework analysis, as a content analysis method, was undertaken. Local and international policies (n=29) were included in the analysis, and eighteen principles were generated that articulate the goal of rehabilitation (principle 1), prescribe the nature of rehabilitation (principles 2-6), and outline the enablers of rehabilitation (principles 8-18). These generic principles are applied to the practice of hand-injury care in South Africa. Contextually responsive intervention responds to the needs and experiences of service providers. Study two (which consisted of Study 2A and Study 2B) used a qualitative instrumental case-study design to describe generalist occupational therapists’ experience of delivering hand –injury care in order to identify their support and development needs and to describe how these can be met in a contextually responsive manner. Study 2A undertook this aim with a group of novice occupational therapists (n=9) completing a compulsory year of state service directly after graduation and made use of an online community of practice for data collection. Study 2B used site visits and in-depth interviews to collect data from fully registered occupational therapists (n=6) working in diverse public health settings in South Africa. Reflexive thematic analysis was used to generate rich themes, which informed recommendations for the support and development of therapists extrapolated from both studies. Study 3 sought to combine the evidence produced by Studies 1 and 2 with the diverse perspectives of service users, other service providers, local and international scholars, educators and professional bodies. The aim of the study was to identify capacity strengthening strategies for generalist occupational therapists responsible for delivering hand-injury care in the South African Public Sector. A hybrid consensus development conference was used to facilitate the presentation of relevant evidence. A stakeholder panel (n=14) followed a nominal group guided by a skilled facilitator. The panel generated and ranked ideas, which were developed into ten prioritized areas for action. Extensive ideas within each of these ten areas were recorded. These areas formed the foundation of the guidelines developed by the project. A pragmatist approach to evidence synthesis was used in the final stage of the project to systematically generate guidelines for the support and development of generalist occupational therapists delivering hand-injury care in South Africa. Eleven guidelines were developed, with the first guideline addressing the need to align hand-injury care services with professional values (1), including the mandate to improve participation and inclusion. Five guidelines address generalist occupational therapists’ direct need for support and supervision (2), resources (3), core competencies for hand-injury (4), the creation of a learning stratosphere to support this (5), as well as the imperative to nurture resilience (6). The final five guidelines address factors that are indirectly essential to therapists capacity to deliver hand-injury care: the need to strategize and operationalize (7), strengthen health systems (8), build stronger communities (9), strengthen human resourcing (10), and strengthen the medical and surgical management of hand injuries and conditions (11). Finally, key implications for practice, learning and development, leadership and management, policy, and research are proposed
Guidelines for the implementation of blended learning in a nursing college campus in Gauteng: a mixed methods study
(University of the Witwatersrand, Johannesburg, 2024) Maré, Magdalena Elizabeth; Armstrong, Sue
The purpose of the study is to develop guidelines on how a nurse educator can best be prepared to implement blended learning in a Nursing Education Institution in Gauteng. The readiness of nursing students and nurse educators in a nursing education institution in Gauteng was determined to serve as a point of reference for the development of guidelines to support nurse educators to implement blended learning in the institution. Blended learning is the thoughtful integration of different instructional methods that contain face to face on online components. It enhances the educational experience for nursing students, preparing them to meet the challenges of modern health care and promoting lifelong learning. The methodology used was a mixed method study, combining a quantitative survey using the Blended Learning Readiness Engagement Questionnaire (BLREQ®) to determine readiness for blended learning amongst nursing students and nurse educators, and two focus groups with nursing education managers and nurse educators respectively. The focus groups were done to determine how best nurse educators can be supported to offer blended learning in the Nursing education institution. The Community of Inquiry framework was used to analyse the data from the focus groups and the data from Section C of the BLREQ®. According to the survey, both nursing students and nurse educators perceived themselves as ready for the implementation of blended learning, although there are gaps in their technical abilities and ability to navigate online environments. The qualitative data revealed that both nursing students and nurse educators need support and guidance for the implementation of blended learning. Nursing education managers expressed that nursing educators are still using traditional methods of teaching and that they need to be supported to use innovative teaching methods such as blended learning through regular skills development sessions. Nurse educators and students also indicated that they are not confident in participating in online platforms and discussions and that they need orientation and support navigating online platforms and the current learner management system. Although both nursing students and nurse educators see themselves as having the basic digital skills, they indicated a need for training in spreadsheet, presentation, and online communication software as well as collaborative cloud computing. The availability of technology infrastructure and lack of resources for the successful implementation of blended learning in the Nursing Education Institution were identified by nursing education managers, educators, and students. Guidelines were developed to assist the nursing education managers, nurse educators and students to address the gaps identified and to orientate new students and nurse educators to navigate the blended learning environment to assist them to adapt to new technologies and ways of learning and teaching
Running-related injuries and risk factors among runners in Soweto township clubs, Johannesburg
(University of the Witwatersrand, Johannesburg, 2024) Masilana, Masocha Vusi; Kunene, Siyabonga
The surge in running's popularity globally has brought about an increase in running-related injuries (RRIs), particularly prevalent in sub-Saharan Africa, including South Africa's urban township of Soweto, where physical inactivity and non-communicable diseases pose significant public health challenges. This necessitates targeted research on RRIs in the region to understand the specific external and internal risk factors. The study aimed to determine the prevalence and risk factors for RRIs among recreational and professional runners in Soweto, Johannesburg. The study utilised a cross-sectional design to determine the prevalence and risk factors associated with RRIs, allowing for an efficient one-time data collection from a large sample. Runners from Soweto township was included in the study. A data collection tool in the form of a self-administered questionnaire was employed, utilising the RedCap online platform for administration. A structured analysis plan was implemented using STATA software, with an additional data processing phase in Excel to enhance the clarity and readability of results, including the customisation of charts and graphs to communicate the findings effectively. Descriptive and inferential statistics were obtained. Demographic analysis revealed a higher prevalence of female runners at the beginner level (55%, n=17), with a significant association between advancing age and injury risk. Among professional runners, the distance covered emerged as a significant risk factor, particularly for medium and long-distance runners (odds=2.07, p=0.05 and odd = 3.01, p =0.03, respectively). The frequency of training sessions demonstrated varying degrees of risk for both novice and professional runners. Additionally, terrain-specific analysis highlighted the elevated risk of injuries for beginners on varied terrain relative to professional runners. Statistical findings included significant odds ratios for female runners (odds = 0.75, p =0.05), age over 25 among beginners (odds = 1.56, p = 0.031), medium distance running among professionals (odds = 2.07, p = 0.050), and varied terrain among beginners (odds = 1.76, p = 0.006). This study provides critical insights for tailoring injury prevention and management techniques, particularly for runners of various levels. It emphasises the importance of individualised treatments by stressing nuanced damage patterns between beginners and professionals. The heightened risk on varied terrain for beginners and the unique implications of sports engagement on injury risk for professionals are noteworthy findings. These findings guide tailored prevention strategies, recognising the varied character of RRIs and addressing unique needs at various career stages, with possible policy and future research implications.
Mode of delivery, analgesic, and neuromusculoskeletal profile of women developing new onset lower back pain postpartum
(University of the Witwatersrand, Johannesburg, 2024) Steyn, Joretha
The aim of this cohort study, a longitudinal study that follows participants over a period, was to establish the profile of women developing lower back pain (LBP) postpartum by investigating the association between LBP and the mode of delivery, analgesia used and the neuromusculoskeletal structures involved. A baseline assessment was done on 16 participants, four were excluded as per the exclusion criteria, with outcome measures such as the Oswestry LBP disability questionnaire and the visual analogue scale (VAS) at 24 weeks gestation and a follow up assessment at six- and 12-weeks postpartum. Irrespective of the analgesia used during labour (epidural, combined spinal and epidural (CSE), general anaesthesia or no analgesia) or the mode of delivery, be it natural, an elective caesarean section or an emergency caesarean section, 50% (n=6) had pain at six weeks postpartum and 14% (n=7) at 12 weeks postpartum. The VAS and Oswestry LBP disability questionnaire averaging 4/10 and 12.6% respectively. It should be noted that the 14% (n=7) that had pain at 12 weeks had a scheduled caesarean section done under general anaesthesia which leads us to agree with Eisenach, et al., (2013) that labour itself does have a protective physiological mechanism against developing pain postpartum. It is recommended that a future study should extend the time frame of data collection to two to three years to ensure a larger sample size to get a more significant and clearer picture of the development of LBP postpartum and the factors or structures involved. This in turn can ensure a more comprehensive preventative strategy to be researched to decrease the development of LBP postpartum.
Impact of a rural context in Kwazulu Natal on primary caregiver's management of pain innon-communicating children with severe neurological impairment
(University of the Witwatersrand, Johannesburg, 2024) Pretorius, Jeanette; Franzsen, Denise
Untreated pain is known to have negative consequences on the development and wellbeing of “non-verbal” children with severe neurological impairment (SNI). Healthcare workers and caregivers must ensure that pain is managed in this population, even though pain may be difficult to assess. Occupational therapists need to understand how context affects the management of pain experienced by a child with SNI, as well as its impact on the care of the child. This study determined how a rural KwaZulu Natal context impacted how primary caregivers recognized and manage pain and the care of their child with SNI. Methods: A multiple descriptive, embedded case study design using a demographic and pain questionnaire, with cross sectional design. There were nine respondents’ qualitative and quantitative information content analysis and descriptive statistics were used to report. Results: Financial, environmental, emotional and physical strain factors associated with the rural context were identified may be adding to the burden of care and affecting the occupational performance of the child with SNI and their caregiver. Specific difficulties included limits in access to clean running water, the practice of bed sharing and poor infrastructure affecting access to healthcare facilities. Primary care givers also mentioned their other responsibilities in the house and the physical strain of caring for a child with SNI affected them and their child. Despite this, all primary care givers were able to recognise and act when their child was in pain and relied on crying duration and intensity as a reliable sign of pain in their child. All primary care givers were confident in their ability and method of recognising and addressing pain in their child with SNI. More experienced primary caregivers used fewer signs to recognise when their child with SNI was in pain. Conclusions: A rural African context is associated with barriers and opportunities for the care, the recognition- and management of pain in children with SNI. More research related to supporting participation and occupational performance by addressing the effects of pain in children with SNI on the child and the primary caregiver living in rural contexts is required
A psychosocial support programme for caregivers of children with developmental disabilities in Ghana
(University of the Witwatersrand, Johannesburg, 2024) Abeasi, Doreen asantewa; Nkosi, Nokuthula Gloria
Background: Informal caregivers, mainly family members of children diagnosed with developmental disabilities [DD], are often left with the responsibility of caregiving. Usually, they receive little or no training, have no time to prepare for the caregiving role, or do not have adequate resources to carry out their responsibilities as caregivers. The complex nature of care and its continuous nature make caregiving stressful, leading to adverse health effects on caregiver’s and child with DD. Aim: The current study’s main goal was to develop a psychosocial support programme for caregivers of children with DD in the Ghanaian context to improve their wellbeing. Methodology: A multi-method research design was employed in this study. This study was organized into three phases. In phase one, a qualitative study and scoping review were done. The phenomenological design was used to explore experiences and needs of caregivers, which influenced the components of the psychosocial support programme. A scoping review was conducted to inform the psychosocial support programme’s design and structure. Phase two consisted of developing the components of the psychosocial support programme by triangulating the results of phase one, guided by the Medical Research Council [MRC] framework for development of complex interventions. Phase three involved the pilot testing and evaluation of the support programme. Results: Phase one a of the study revealed that caregivers mainly saw caregiving as stressful and time-consuming. Five themes were generated, namely: perception of caregiving, stressors, caregiver needs, negative health outcomes and coping resources. Different caregiver support programmes were reviewed from included studies in the scoping review, which were varied in the scope of interest. All the studies were conducted in lower- and middle-income countries. A psychosocial support programme referred to as Caregiver Well-being Improvement [CaWELLIS] programme was developed, confirmed by a group of experts, and implemented for caregivers of children with developmental disabilities in Ghana. There was improvement in caregiver outcomes, namely; stress, burden, anxiety, depression, support, blood pressure, and cortisol levels. Conclusion: The study provided evidence that the CaWELLIS programme had a positive influence on stress, the primary outcome of the study, as well as on secondary outcomes like vanxiety, depression, burden, and blood pressure levels. The CaWELLIS programme is a comprehensive, context-specific programme that has the potential to respond to the needs of caregivers of children with DD. The use of a one group pre-test post-test design to evaluate the effectiveness of the CaWELLIS programme has some limitations, therefore the gold standard of randomised control trial is suggested for future research.
Sedentary behaviour in a sample of south african office-based workers
(University of the Witwatersrand, Johannesburg, 2024) Phaswana, Merling; Gradidge, Philippe
Background Sedentary behaviour is associated with cardiometabolic diseases amongst office- bound workers, primarily through extended sitting and engaging in low-energy- demanding activities during work hours. Similar to developed countries, South African workplaces are experiencing an increasing prevalence of obesity and related cardiovascular diseases, with sedentary behaviour and physical inactivity being the main contributors. However, there is limited data on the effectiveness of sedentary behaviour strategies in improving South African office-based workers' cardiometabolic risk markers. Objectives This study aims to assess the effectiveness of the height-adjustable sit-to-stand work on cardiovascular parameters in a cohort of office-based workers and to explore the perceptions of these workers about the feasibility and suitability of this intervention to reduce occupational sitting time. Methods A mixed-methods study design was used on office workers from the University of the Witwatersrand and a credit bureau company in South Africa. The qualitative papers used in-depth semi-structured interviews to explore office-based workers' perceptions and experiences using sit-to-stand workstations. The interview audio was recorded audio using Microsoft Teams (version 11, Microsoft Way, United States) and Phillips (DVT4010 Voice Tracer, Vienna, Austria). All transcripts were checked against the recordings to verify accuracy and credibility, and grammatical editing was adopted where necessary. For quantitative measures, participants were randomised into an intervention or control group to collect measures at baseline and 12 weeks in a cohort of South African desk-based workers. These biomarkers include anthropometry, sedentary behaviour and physical activity, sleep duration, blood pressure, glucose, glycated haemoglobin (HbA1c) and lipid profile. The cross- sectional paper quantified sedentary behaviour, overall physical activity, and the association with select cardiometabolic risk factors. The randomised control trial evaluated the short-term effects of height-adjustable sit-to-stand workstations on cardiometabolic risk markers. Descriptive and inferential statistics were used to describe and compare baseline and follow-up changes in the intervention. Results The height-adjustable sit-to-stand workstation was deemed feasible and well-accepted by our participants. Participants expressed that it motivated them to stand up and work and effectively alleviated discomfort associated with prolonged sitting. Most (68.0%) of the study participants were women, with a mean age of 40.2 ± 9.3 years. Our participants spend an average of 8 to 10 hours in sedentary behaviour. Both systolic (β: -0.234, p = 0.037 mmHg) and diastolic blood pressure (β: -0.250, p <0.001 mmHg) were inversely associated with accelerometery-measured light physical activity. However, there was no relationship between accelerometery- measured sedentary behaviour and cardiometabolic risk factors after analysis. The 12-week randomised control trial showed small improvements with blood pressure - 0.26 (d =1.10 mmHg) and Light physical activity -0.26 (d=3.57 min/day). We observed trivial effects, with most of our cardiometabolic outcomes including body mass index (BMI) -0.11 (d=1.07 kg.m2). Most participants withdrew early from workplace intervention due to the design and functionality of the height-adjustable sit-to-stand workstation. Conclusions This study adds to the limited evidence on environmental workstation modifications for reducing sedentary behaviour. Our findings show that South African office workers spend a substantial amount of time sitting during work hours and support the need for public health workplace interventions to mitigate the potential health risks associated with such sedentary behaviour. This study confirms that short-term height-adjustable sit-stand interventions effectively reduce workplace sitting time and promise to improve cardiometabolic health outcomes, suggesting that clinically significant effects might be noticed in long-term interventions. Therefore, future studies should consider individual preferences, workstation design, functionality, education, and motivation to ensure successful implementation, utilization, and compliance with sit-to-stand workstations
The wound healing effect of exosomes derived from Lobostemon fruticosus
(University of the Witwatersrand, Johannesburg, 2024) Rajcoomar, Yashmika; Somandi, Khonzisizwe
Exosomes are increasingly being researched and recognized as a novel mode of intercellular communication which can potentially play a significant role in many cellular processes, including immune responses, signal transductions and antigen presentation. Exosomes are membrane bound nanovesicles produced by both mammalian and plant cells. Developing research is mainly focused on their ability to act as a drug delivery vehicle. Other research interests around exosomes are their therapeutic effects for many common diseases including cancer and chronic inflammation. Plant-derived exosomes have emerged as potential candidates for many clinical and therapeutic applications. The aim of this project was to isolate exosomes derived from Lobostemon fruticosus leaves and to investigate the wound healing potential from this plant species. The plant-derived exosomes were isolated by ultracentrifugation and were characterised by means of scanning electron microscopy (SEM), ZetaSizer, Energy-dispersive Xray spectroscopy and the Pierce™ BCA Protein Assay Kit. The wound healing potential was assessed by In vitro scratch assay using human keratinocytes (HaCaT). The exosomes displayed a round, spherical shape and had diameters ranging from 41 to 67 nm – falling within range of nano-sized exosomes. The exosomes had a mean particle size of 166.2 d.nm. Chemical analysis of the samples using energy dispersive spectroscopy revealed the presence of carbon, oxygen, potassium, chloride, gold, palladium and sodium. The protein quantification results revealed the exosomes were rich in proteins. The cell viability results, using various concentrations of Lobostemon fruticosus exosomes, revealed non-cytotoxicity on HaCaT cells. The In vitro scratch assay demonstrated that the exosomes enhanced the migration ability of HaCaT cells in a time dependent manner. The findings suggest and reveal that exosomes derived from Lobostemon fruticosus could accelerate the healing process and can be employed as a future drug delivery platform. Further research is required to establish the exact mechanism of action of the healing potential of this plant specie's constituents. Overall results suggest that exosomes derived from Lobostemon fruticosus are promising as a potential agent for skin regeneration
Targeted nanosystems for tuberculosis pericarditis interventions
(University of the Witwatersrand, Johannesburg, 2024) Ayodele, Simisola Ayobami; Kumar, Pradeep; Choonara, Yahya Essop
Tuberculosis (TB) maintains its infamous status regarding its detrimental effect on global health, causing the highest mortality by a single infectious agent. It presents as the second most lethal infectious disease after HIV/AIDS. The presence of resistance and immune-compromising disease favors the disease in maintaining its footing in the health care burden despite various anti-TB drugs. The main factors contributing to resistance and difficulty in treating disease include prolonged treatment duration (at least 6 months) and severe toxicity, which further leads to patient non-compliance, and thus a ripple effect leading to therapeutic non-efficacy. The efficacy of new regimens demonstrates that targeting host factors concomitantly with the Mycobacterium tuberculosis (M.tb) strain is urgently required. Due to the huge expenses and time required of up to 20 years for new drug research and development, drug repurposing may be the most economical, circumspective, and conveniently faster journey to embark on. Host-directed therapy (HDT) will dampen the burden of the disease by acting as an immunomodulator, allowing it to defend the body against antibiotic-resistant pathogens whilst minimizing the possibility of developing new resistance to susceptible drugs. Repurposed drugs in TB act as host-directed therapies, acclimatizing the host immune cell to the presence of TB, improving its antimicrobial activity and time taken to get rid of the disease, whilst minimizing inflammation and tissue damage. Anti-TB drugs incorporated in nanosystems may reduce side effects by delivering the drug selectively into infection reservoirs such as macrophages, which may assist in clearing the TB bacilli faster and reducing the duration of therapy. Tuberculosis pericarditis (TBP) is a type of extrapulmonary tuberculosis caused by the retrograde lymphatic spread of the bacilli from lymph nodes. TBP is known to have a high burden in southern Africa due to the high prevalence of HIV and its contribution to TBP. Traditional anti-TB drugs have poor permeation across the pericardium, making TBP a difficult disease to treat with high mortality. Rapid HPLC methods were initially established for the detection and quantification of isoniazid and pyrazinamide at a physiological pH (pH 7.4). These methods were subsequently used for the detection and quantification of both compounds in the ex vivo pericardium studies. Although both drugs diffused across the pericardium, only isoniazid has anti-tubercular effects at physiological pH. Both drugs permeated across the pericardium at pH 7.4, but only isoniazid has anti-tubercular effects at this pH. Bedaquiline is known to shorten the duration of therapy but has limitations e.g., poor solubility and adverse effects such as prolongation of QT interval, causing careful use and close monitoring of its adverse effects and possible drug interactions. In this study, bedaquiline was incorporated into an inherently targeted nanosystem made of mannan (host-directed therapy) for improved permeation of the drug across the pericardium. The bedaquiline-loaded mannan-chitosan oligosaccharide lactate nanoparticles were prepared by a one-step ionic gelation probe sonication method. A PermeGear 7-in-line flow-through system was used for the ex vivo diffusion studies across porcine and human pericardium. The nano gel was loaded into the donor compartment. Phosphate buffer saline (pH 7.4 with 0.2% sodium lauryl sulphate) was pumped through the receptor compartments at 1.5 ml.h-1 (37 °C). Samples were collected every 2 h for 24 h and analyzed via HPLC. Bedaquiline loaded nanoparticles with particle size and potential of 192.4 nm and 40.5 mV, respectively, were synthesised. The chitosan-mannan bedaquiline loaded nanoparticles had an encapsulation efficacy of 98.7% and drug loading of 0.6%. Diffusion data of bedaquiline in the nanosystem indicated a flux of 2.889 and 2.346 μg.cm - 2. min -1 for porcine and human pericardium, respectively, as compared to 0.991 μg.cm-2.min-1 and 1.1578 μg.cm-2.min-1 for isoniazid and pyrazinamide, respectively. The permeation of the nanosystem indicated a consistent and linear diffusion pattern across both porcine and human pericardium, additionally approving the porcine pericardium as a great comparable tissue to human tissue for pericardial studies. The nanosystem, therefore, presents an exceptional direction for the treatment of tuberculosis pericarditis with prospectively minimized systemic side effects and host-directed therapy
Use of probiotics in community pharmacy in South Africa: a survey of pharmacist attitudes, perceptions and knowledge
(University of the Witwatersrand, Johannesburg, 2024) Kim, Yedam; Orchard, Ané
There has been a substantial increase in the consumption of probiotics in the last decade in South Africa. Pharmacists, as experts in the field of medicine, play a crucial role in educating both patients and other healthcare professionals on the appropriate use of probiotics in the healthcare setting. While there are several studies related to the use of probiotics, such as the study conducted among community pharmacists to explore their knowledge, attitudes, and practices regarding complementary and alternative medicines in South Africa, there is a gap in the literature regarding the knowledge, attitudes, and perceptions of qualified practicing pharmacists in South Africa regarding probiotic use. The findings of this study provide information for evaluating the current state of awareness and understanding regarding probiotics within the pharmacist community, offering a foundation for potential interventions and educational initiatives. A cross-sectional, descriptive-analytical study was conducted in community pharmacies across South Africa. Of the 476 study respondents, 237 were included in the final analysis, as 239 surveys were incomplete. Among the respondents, 18.5% demonstrated a good level of knowledge about probiotics, while 11.3% demonstrated a poor level of knowledge (Mean ± SD =13.81 ± 2.8). This finding demonstrated a lower knowledge level compared with similar studies conducted in other regions, such as Asia and the United States of America. These findings highlight a potential gap in knowledge among the respondents regarding the use of probiotics. Half of the respondents (49.9%) displayed positive attitudes toward probiotics (Mean ± SD = 43.33 ± 8.9) and 47.6% of the respondents displayed positive perceptions of probiotics (Mean ± SD = 32.14 ± 3.7). A significant association of knowledge of probiotics with biological sexes (X2 = 39.2132, p < 0.05) was found. There was a statistically significant difference in the demographics of respondents and their attitudes towards probiotics, including geographical region (X2 = 300.629, P<0.05), biological sex (X2 = 95.164, p < 0.05), age (X2 = 248.008, p < 0.05), highest degree obtained (X2 =191.428, p < 0.05), and the university from which they graduated (X2 = 417.775, p < 0.05). Statistically significant difference in the demographics of respondents and the perceptions of probiotics was found, including geographical region (X2 = 170.161, p < 0.05), age (X2 =52.378, p < 0.05), and the university from which they graduated (X2 = 238.514, p < 0.05. In this study, a significant but weak correlation between knowledge and attitude was identified (r = 0.1537, p = 0.0179). Correlation between attitudes and perception was also significant but weak (r = 0.3214, p = 0.000) and there was no statistically significant correlation between knowledge-perceptions variables (r = 0.0092, p = 0.8879). The study has identified limited knowledge regarding the use of probiotics among respondents, despite their positive attitudes and perceptions towards the use of probiotics. The study also has emphasized the complexity of factors influencing individuals' knowledge, attitudes and perceptions regarding probiotics. This study recommends further educational initiatives to investigate relationship between knowledge, attitudes and perceptions of pharmacists on the use of probiotics in South Africa
Antibacterial stewardship practices in South Africa during the COVID-19 era: A retrospective review
(University of the Witwatersrand, Johannesburg, 2024) Spinickum, Logan Jade; Leigh-de Rapper, Stephanie
Background: Several mechanisms may facilitate and steer the development of antibiotic resistance patterns. The most prominent driver associated with antibiotic resistance has been indicated as inappropriate use or consumption of antibiotics. The sudden emergence of Coronavirus Disease 2019 (COVID-2019) changed the conventional practices related to drug utilisation through the repurposing of antibiotics. Despite the implementation of antibiotic stewardship programs, the pressure that COVID-19 placed on healthcare systems resulted in poor prescribing and antibiotic review practices, potentially exacerbating antibiotic resistance. Moreover, the public health sector faces various challenges that make it difficult to consistently assess and quantify antibiotic usage; while providing quality review, feedback, and intervention, especially in low- and-middle-income countries like South Africa. As a result, there is a paucity of information concerning antibiotic utilisation in the public healthcare sector, even following the emergence of the COVID-19 pandemic. It is essential to determine the extent of antibiotic use to improve antibiotic utilisation, patient outcomes and stimulate viable policies and initiatives to strengthen public healthcare drug surveillance amidst the challenges of increased infectious diseases, resistance, and health personnel shortages. Aim of study: The aims of the study were to determine, analyse and compare antibiotic consumption amongst intensive care unit (ICU) patients admitted in a Gauteng public hospital during the pre-COVID-19 era and commencement of the COVID-19 era. Methodology: A retrospective cross-sectional data analysis of 335 medical files of ICU patients hospitalised in a Gauteng Provincial Tertiary Hospital (GPTH) between January 2017 and December 2021. Descriptive statistics were used to examine patient characteristics and antibiotic prescribing variables. Results: The study found that the more frequently prescribed antibiotics were amoxicillin/clavulanate (pre-pandemic = 31.99%; COVID-19 = 38.43%), followed by ceftriaxone (pre-pandemic = 15.44%; COVID-19 = 14.55%), piperacillin/tazobactam (pre-pandemic = 11.40%; COVID- 19 = 8.58%) and azithromycin (pre-pandemic = 7.73%; COVID-19 = 19.78%). Common bacterial pathogens detected in both periods included Acinetobacter baumannii (pre-pandemic = 29.2%; COVID-19 = 20.9%), Enterobacter cloacae (pre-pandemic = 10.4%;COVID-19 = 14.0%), Escherichia coli (pre-pandemic = 22.9%; COVID-19 = 25.6%), and Klebsiella pneumoniae (pre-pandemic = 25.0%; COVID-19 = 18.6%). Resistance was predominantly observed in ciprofloxacin (pre-pandemic = 11.4%; COVID-19 = 12.9%), piperacillin/tazobactam (pre-pandemic = 12.7%; COVID-19 = 0.1%), cefotaxime (pre-pandemic = 13.2%; COVID-19 = 14.7%), and cefepime (pre-pandemic = 12.7%; COVID-19 = 11.2). Resistance to commonly prescribed antibiotics observed a decrease trend moving from the pre-pandemic period into the COVID-19 pandemic. Conclusion: The macrolide and penicillin (in combination with beta-lactamase inhibitor(s)), classes demonstrated an increase in prescribing and use across the pre-pandemic period transitioning into the COVID-19 pandemic. While overall resistance observed a decline moving into the COVID-19 pandemic. However, “Watch” category antibiotic resistance increased slightly. An increase in prescribing and use of macrolides coupled with an increase in “Watch” category antibiotic resistance, highlights the need for improved antibiotic stewardship programs in public healthcare and pathogen-directed prescribing, to combat inappropriate and unnecessary use of antibiotics.

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