Faculty of Health Sciences (ETDs)

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Mathematical representation and analysis of articular surfaces: application to the functional anatomy and palaeo-anthropology of the ankle joint
(University of the Witwatersrand, Johannesburg, 1990) Webb, Christie Peter; Tobias, Phillip Vallentine
This thesis is a study of quantifiable variation in the geometric shape of the superior articular surface of the talus of higher primates, with special reference to fossil tali of Plio-Pleistocene hominids. (Abbreviation abstract).
The role of increased gastrointestinal alcohol production in patients with the metabolic syndrome: Implications for the pathogenesis of non-alcoholic fatty liver disease
(University of the Witwatersrand, Johannesburg, 2006) Menezes, Colin Nigel; Immelman, Ronnie; Raal, Derick
Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease with hepatic histology that resembles alcoholic liver disease. It is a frequent cause of chronic liver disease and is attracting increasing scientific attention worldwide. I explored the possibility that increased gastrointestinal alcohol production may have a role as a “second hit” in the pathogenesis of NAFLD in study subjects with the metabolic syndrome. In an attempt to investigate this hypothesis, this study looked at blood, urine and breath levels of alcohol in patients with the metabolic syndrome versus matched age and ethnic group healthy controls. Of the twenty study subjects, 80% had dyslipidaemia, 60% had hypertension and 70% had type 2 diabetes mellitus. Their mean BMI was 35.1±8.2 kg/m² (mean ± SD, P < 0.0001 versus controls). The serum aminotransferases were significantly elevated in the study subjects, their ALT levels being 57.4±44.79 U/L versus 17.4±4.60 U/L in the controls (95% CI 18.02 – 61.42, P < 0.001), and their AST levels 52.5±36.21 U/L versus 23.4±4.86 U/L in the controls (95% CI 11.99 – 46.20, P < 0.01). Seventy five percent of the study group had sonar features suggestive of fatty liver disease. Two adipocytokines, adiponectin and leptin, mediators of insulin resistance, an important factor in the development and progression of NAFLD, were also measured. Adiponectin levels were significantly lower (6875 ng/L versus 15475 ng/L; median value, P < 0.01), and leptin concentration levels significantly higher (13.56 ng/L versus 3.05 ng/L; median value, P < 0.05) in the study subjects than in the control group. Alcohol was detected in 60% of the study subjects, of which 35% tested positive for ethanol, 55% tested positive for methanol, and 30% tested positive for both ethanol and methanol. This was a statistically significant result, as none of the control group tested positive for any of the alcohols. The ethanol concentration in the study subjects’ blood was 7.14±3.28 mg% (mean ± SD), in their urine 3.71± 12.87 mg% (mean ± SD) whilst none was detected in their breath. The methanol concentration in the study subjects’ blood was 16.17±17.95 mg% (mean ± SD), in their urine 6.8± 13.58 mg% (mean ± SD) while their breath level was 2.05±3.19 mg (mean ± SD). This study therefore suggests that endogenous alcohol production may be indeed be involved in the pathogenesis of NAFLD in subjects with the metabolic syndrome. Not only ethanol but also methanol was detected in the subjects tested. endogenous alcohol may therefore be responsible for the ‘second hit’ theory in the pathogenesis of NAFLD, and it is likely that formaldehyde, the metabolite of methanol may be a more potent toxin of the patocyte injury as opposed to acetaldehyde, the metabolite of ethanol. The most likely source of the alcohol is from intestinal bacterial flora. These findings provide further insight into the pathogenesis of NALFD, suggesting other therapeutic alternatives such as the use of antibiotics and probiotics as a potential treatment strategy for NAFLD.
The effect of all-trans retinoic acid on the migration of avian neural crest cells in vitro an in vivo
(University of the Witwatersrand, Johannesburg, 2007-02-15T11:43:45Z) Tshabalala, Vincent Abie Thabiso
Retinoic acid, the active metabolite of Vitamin A is known to play a major role in embryonic growth and differentiation during development. It has been shown that either excess or deficiency of retinoic acid during embryogenesis can be teratogenic. In order to study the teratogenic effects of retinoic acid, the aim of the present study was therefore to investigate the effect of all-trans retinoic acid on the migration and fate of neural crest cells in vitro and in vivo. In addition, the study investigated the effect of retinoic acid on the cytoskeletal elements of neural crest cells and on Rac and Rho, two members of the Rho family of GTPases. The neural tubes containing neural crest cells of quail embryos were removed at cranial levels and cultured on fibronectin as a substrate. The neural tubes were cultured in either Dulbecco’s minimal essential medium (DMEM) or in DMEM+Dimethylsulphoxide (DMSO) as controls. In order to test the effect of retinoic acid, the neural tubes were cultured in 10⁻⁵M all-trans retinoic acid (RA) which was reconstituted in DMSO. The distance of migration of the cultured quail neural crest cells was measured and compared between the controls and the experimentals. To study the effect of RA on the cell actin cytoskeleton in vitro, cultured neural crest cells were stained with rhodamine phalloidin. In addition, following 24 hours of culture, the quail neural crest cells were brought into suspension and micro-injected into 36 hour-old chick hosts. While the migration of neural crest cells was extensive in the control cultures in vitro, migration was inhibited in the retinoic acid-treated neural crest cells. In addition, retinoic-acid treated neural crest cells showed pigmentation and neuronal processes earlier than did the control neural crest cells. Retinoic acid-treated neural crest cells showed a disarray of the cytoskeletal elements as they were devoid of stress fibres and focal adhesions. In addition, retinoic acid appears to decrease the expression of Rac and Rho of cultured quail neural crest cells. Following micro-injection of cultured control and RA-treated quail neural crest into the cranial region of chick hosts, the control cells populated the beak area, whereas the retinoic acid-treated quail neural crest cells migrated to the retina of the eye, a region they normally do not populate. These results suggest that retinoic acid disturbs the migration of neural crest cells. It appears to do this by affecting the cytoskeletal elements of neural crest cells and the genes that are involved in forming these elements.
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 role of regulatory T cells in adults in South Africa with active tuberculosis
(2010-01-28T10:11:24Z) Mayne, Elizabeth Sarah
Introduction: Regulatory T cells (Tregs) are increasingly being recognized as key immunological players in immunosuppression and have been seen to be permissive for certain infections. Aim: This study aimed to elucidate the role that Tregs play in symptomatic infection with Mycobacterium tuberculosis (TB), both with and without co-infection with human immunodeficiency virus type 1 (HIV 1) by quantification of these cells at ex vivo. It was then attempted to characterise the behaviour of FoxP3 positive cells in culture with stimulation. Methods: Peripheral blood mononuclear cells were purified from uninfected controls, patients with active TB, patients with HIV infection and patients with HIV infection and active TB. The frequencies of Tregs were assessed by flow cytometry at ex vivo and again after four days of culture with stimulation with anti-CD3, Purified protein derivative, tetanus toxoid and HIV peptide superpools (gag and nef). These frequencies were compared between the four groups of patients. The ability of Tregs and effector T cells to proliferate was also assessed. Interferon-γ secretion was used as a measure of effector T cell response to stimulation. vi Results: Frequencies of Tregs were significantly reduced in patients with active TB as compared with HIV infected patients and uninfected controls. Co-infected individuals showed a broad range of frequencies which were not significantly different from controls. These frequencies remained stable in culture with the exception of those individuals infected with HIV who showed a decline in the frequency of those cells expressing FoxP3 over the period. Cells expressing FoxP3 were not anergic and responded to stimulation. HIV specific proteins, in addition, resulted in specific effects on the Tregs with a positive interferon response to gag correlating with increased Treg frequencies and FoxP3 expression in CD4+ T cells correlated with the proliferative response of CD4+ T cells to Nef in HIV infected individuals. Conclusions: This study shows significant differences of frequencies of FoxP3 positive producing cells in the peripheral blood at ex vivo in patients with active TB. The function of these cells in this population is uncertain and further functional data and long-term clinical follow-up is required. In addition, the frequencies of these cells remained constant over time and showed proliferative response to stimuli (most notably CD3) suggesting that these cells may be generated in the periphery.
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.
Understanding intimate femicide in South Africa
(2010-09-22) Mathews, Shanaaz
When a woman is killed she is most likely to be murdered by an intimate partner. This form of homicide known as intimate femicide is conceptualised to be the most extreme consequence of intimate partner violence. Not much is known about such killings in South Africa or in other developing settings. This thesis studied intimate femicide using two complimentary studies from two methodological perspectives. The first study was quantitative with the aim of describing the incidence and pattern of intimate femicide in South Africa. The second study used qualitative methods and explored the social construction of the early formation of violent masculinities. Five papers written from these two studies are presented in this thesis. Study one was a retrospective national mortuary-based study and collected data on all female homicides, 14 years and older, who died in 1999 from a stratified, multi-stage sample of 25 mortuaries. Data was collected from the mortuary file, autopsy report, and a police interview. The second study used a cluster of qualitative in-depth interviews with 20 incarcerated men in prison who have been convicted for the murder of an intimate partner, as well as interviews with family and friends of both the perpetrator and the victim. Overall it was found that 50.3% of women murdered in South Africa are killed by an intimate partner, with an intimate femicide rate of 8.8/100 000 and an intimate-femicide suicide rate of 1.7/100 000 females 14 years and older. Blunt force injuries were shown to be associated with intimate killings, while gun ownership was associated with intimate femicide-suicides. vi elevated Blood Alcohol Concentration (BAC) combined with unemployed status was also found to be associated with intimate killings. The qualitative study showed that traumatic childhood experiences such as violent and neglectful parenting practises particularly by mothers made these men feel unloved, inferior and powerless with this found to be a pathway to violent models of masculinity used as a means to attain power and respect. This study shows that such traumatic experiences can lead to a suppression of emotions. It is argued that cognitive dissonance act as a protective mechanism which allows these men to perpetrate acts of violence without consideration of its impact. These findings suggests that intimate femicide is a complex phenomenon with a “web” of associated and mediating factors which all contribute to it excessive levels in South Africa. It shows that intimate femicide is an extension of intimate partner violence and as such has to take into account the unequal gender relations in society. Building gender equity and shifting patterns of femininity and masculinity is a key strategy in reducing this form of violence.
Levels and factors associated with homicide-related deaths in a rural South African population
(2011-03-25) Otieno, George Omondi
Background: World Health Organization (WHO) estimates that more than 1.6 million people die every year because of violence and out of these deaths, homicide accounts for almost one third. Ninety percent (90%) of homicide are thought to occur in low and middle income countries. South Africa has one of the most disturbing rates of homicide in the world. These high homicide rates besides resulting in reduced life expectancy also have serious health, social and economic consequences. Aim: The study aimed at quantifying the burden as well as and identifying factors associated with homicide deaths in rural KwaZulu-Natal in South Africa during the period of 2000 to 2008. Objectives: To estimate a 9 year period (2000-2008) homicide incidence rates as well as identify factors associated with homicide-related deaths. Further, the analysis described spatial distribution of homicide-related deaths in a rural South African population. Design: Analytical longitudinal study. Methods: Using data drawn from the Verbal Autopsies (VAs) conducted on all deaths recorded during annual demographic and health surveillance over a 9-year period (2000-2008), Kaplan-Meier (K-M) survival estimates of incidence rates were used to estimate the cumulative probability of death until the end of the period. Estimates were reported by sex and residency. Weibull regression methods were used to investigate factor associated with homicide deaths. Kulldorff spatial scan statistics was used to describe homicide clustering. Results: With 536 homicide-related deaths, and 814, 715 total Person Years of contribution, the study found an overall incidence rate of 66 (95% CI= (60, 72) per 100, 000 Person Years of v Observation (PYOs) for the period studied. Death due to firearm was reported the leading cause of mortality (65%). Most deaths occurred over the weekends (43%), followed by Friday (16.2%).The highest homicide incidence rates were recorded in 2001 (90; 95% CI= (71, 111) per 100,000 person years at risk and 2004 (86; 95% CI= (68, 108) per 100,000 person years at risk. Males had a rate that was about six times more than females 115 (95% CI=105,127) per 100,000 PYOs. Age-specific homicide rate were highest among males aged 25-29 years (209.90 per 100,000 PYOs) and females aged 50-54 years (78 per 100,000 PYOs). Resident, age, sex, education, socioeconomic status, and employment independently predicted homicide risk. The study identified two geographical clusters with significantly elevated homicide risk. Conclusion: A significant six fold difference in homicide rate existed between males and females. Sex differential increases with age, with males aged 15-54 years the most likely to be killed, and females aged 55 years and above having the highest homicide rate. Increase in wealth status and level of education increases one‘s risk of homicide. Employment per se was protective from homicide risk. Firearm was the leading cause of mortality. Most deaths occur over the weekend. Two geographical areas with elevated homicide risk were observed. These findings underscore the need to have timely information and strategies for effective violence prevention program to subgroups and areas at risk.
The demographic profile, substance use, competence to stand trial and criminal responsibility among “ Observation Patients” admitted for forensic psychiatric evaluation at Sterkfontein Hospital, Gauteng, South Africa.
(2011-10-19) Pillay, Anben
A review of the literature indicates that young males, who are unemployed with low levels of education, predominate in populations of pre-trial criminal offenders suspected of having a psychiatric illness, also known as “Observation Patients” according to the Criminal Procedures Act of 1977 in South Africa. Other contributory factors include a history of mental illness and non-compliance on psychiatric medication, a previous forensic history, co-morbid substance abuse and being intoxicated at the time of the offence. Dual diagnosis is considered a key contributor to criminal behaviour in this group of patients. The review of the literature also shows a significant proportion of co-morbid intellectual disability among offenders found to be psychiatrically ill at the time of the criminal event. A previous study conducted 20 years earlier, in 1986 at the Sterkfontein Forensic Psychiatric Unit by Vorster (1986) showed that the typical profile was a single, unemployed, poorly educated male in his twenties, usually with a history of psychiatric treatment. This typical profile confirmed the evidence in the literatures at the time of the study.
Unmasking serial murder: a comparison of a South African murder series with characteristics from the Federal Bureau of Investigation Serial Murder Database
(2015) Holland, Shakeera
The term ‘serial killer’ brings to mind notorious criminals whose crimes are so heinous as to test the limits of the most vivid imagination and make us question their humanity. What is the reality of serial murder? In 2005, the Federal Bureau of Investigation (FBI) hosted a symposium on serial murder, which brought together international experts in the field of serial murder with the aim of clarifying and understanding this multifarious crime. On the 12th of March 2008, Gcinumzi Richman Makhwenkwe, ‘The Moffat Park Serial Murderer’ was convicted of 5 counts of murder, 3 counts of rape and 3 counts of robbery with aggravating circumstances. The Department of Forensic Medicine and Pathology of the University of the Witwatersrand, based at the Johannesburg Forensic Pathology Service (FPS) Medicolegal Mortuary Facility performed the medicolegal investigations of death in all the victims. This research report explores the characteristics of serial murder and serial murderers as documented in the literature; documents the features and characteristics of the Moffat Park murder series; compares the features of this South African murder series to those from the findings of the FBI serial murder symposium; explores the role of the forensic medical practitioner in the investigation of the Moffat Park series and serves to educate and inform forensic medical practitioners of the features of serial murder as awareness may potentially lead to earlier identification of a murder series. This could ultimately lead to earlier implementation of specialist investigative methods, earlier apprehension of the serial murderer and most importantly fewer victims.
The effect of temperature on the vector competence of culex univittatus theobald (diptera : culicidae) for West Nile and Sindbis viruses
(2015-02-13) Cornel, Anthony John; Swanepoel, R.; Jupp, P.G.
The relationship between awareness of violence against women prevention campaigns and gender attitudes and talking about violence among women in Gauteng
(2016-10-12) Mataba, Rumbidzayi B.
Introduction: Gender based violence (GBV) is a public health problem with as many as 35% of women having been subjected to either physical and or sexual violence globally. Gender attitudes and silence around gender based violence, are factors that exacerbate GBV. Global and local awareness campaigns are means for preventing violence against women. Campaigns have the potential to challenge women and men’s underlying gender beliefs and attitudes that contribute to unequal power relations between women and men. The overall objective of this study was to examine the association between awareness campaigns and gender attitudes or talking about domestic violence among women in Gauteng, South Africa. Materials and Methods: This study is a secondary analysis of data from a cross-sectional study conducted in Gauteng, South Africa from April to July 2010. The study aimed to describe the prevalence and patterns of experiences of GBV, HIV risk, gender attitude and awareness of GBV prevention campaigns in Gauteng. The main exposure variable in this study is having heard about 16 Days of Activism for No Violence Against Women and Children campaign and the 365 Days National Action Plan to End Gender Based Violence. The two primary outcomes are gender attitudes and discussing about domestic violence. Gender attitudes were measured using three scales: the Gender Equitable Women’s Scale, the Ideas about Gender Relations Scale and the Ideas about Rape Scale. Univariate analysis was conducted to describe the socio-demographic characteristics, awareness of campaigns, gender attitudes and talking about domestic violence among the participants. Multivariate analysis was conducted to examine the associations between awareness of campaigns and the outcomes while adjusting for age, education, employment, nationality, race and relationship status. Results: The results show that only a minority of the participants had heard of the 16 Days of Activism for No Violence Against Women and Children campaign (32.6%) and the 365 Days National Action Plan to End Gender Based Violence (9.2%) campaigns. Most of the participants had progressive gender attitudes; GEWS (71.7%), IGRS (82.1%) and the IRS (88.1%) while less than half (48.7%) had spoken about domestic violence to someone else. Women who were exposed to the 16 Days of Activism for No Violence Against Women and Children campaign were twice as likely to have progressive gender attitudes measured by the Gender Equitable Women’s Scale (aOR 2.2, 95% CI 1.2-3.8) compared to those who had not been exposed. Education, relationship status and nationality were found to be significantly associated with gender attitudes on the same scale. No association was found between awareness of 16 Days of Activism for No Violence Against Women and Children campaign and gender attitudes measured through the Ideas about Gender Relations Scale and the Ideas about Rape Scale. Awareness of 16 Days of Activism for No Violence Against Women and Children campaign was also associated with talking about domestic violence (aOR 1.9, 95% CI 1.2 - 3.0). Age and education were also significantly associated with talking about domestic violence. Gender attitudes were also significantly associated with talking about domestic violence (aOR 1.2 95% CI 1.1 – 3.6). No association was found between exposure to the 365 Days National Action Plan to End Gender Based Violence and gender attitudes or talking about domestic violence. Conclusions: From this study, the majority of the women interviewed had progressive gender attitudes. However, the majority of the women had never spoken about domestic violence to someone else. Women exposed to GBV campaigns had more progressive gender attitudes and spoke about domestic violence more than those who were not exposed. These findings are evidence to the need for wider coverage and different messaging approaches in the implementation of GBV campaigns in South Africa. Wider coverage of campaigns is only possible with more funding for national, provincial and local GBV programmes. Key messages in GBV campaigns need to include a priority focus on addressing the underlying social and cultural norms that contribute to the imbalances of power due to gender difference.
Caries prevalence amongst pre-school children in Windhoek, Namibia
(2020) Aluteni, Moses
Background: Early Childhood Caries (ECC) has been recognised as a disease of serious consequences in both industrialised as well as undeveloped nations of the world. Its widespread prevalence among children makes it ideal for assessing the risk factors and identifying specific strategies that could be implemented to prevent the disease. Aim: The aim of the present study was to determine the prevalence of dental caries and its untreated consequences among 2-6-year-old preschool children in Windhoek, Namibia. Objectives: The objectives were; (i)To determine the prevalence of caries amongst 2-6-year-old children attending selected crèches in Windhoek, Namibia. (ii)To assess the clinical consequences of untreated tooth decay amongst 2-6-year-old children attending selected crèches in Windhoek using the pufa index.(iii) To investigate the strength of correlation between the dmft and pufa indices amongst 2-6years-old children attending selected creches in Windhoek, Namibia. (iv)To evaluate the correlation between oral hygiene practices and early childhood caries amongst 2-6-year-oldchildren attending selected crèches in Windhoek, Namibia. Methods: The study design used was cross-sectional and descriptive. A random sample was used to select children between the age group of 2-6 years attending selected creches represented within the 9 urban constituencies of Windhoek, Namibia. The sample size comprised 250children whose parents had consented to be part of the study. Data was collected by means of a dental clinical examination which focused on the diagnosis of dental caries using a World health organization (WHO) criteria for caries through the dmft and pufa indices. The dental examination was conducted at the respective crèches of the participants. An accompanying complementary oral health questionnaire was completed by the parents/care givers of the participants prior to the clinical dental examination and data was collated accordingly. The examinations were done by a single examiner and the examiner was calibrated by a team from the Department of Community Dentistry at the Wits Oral Health Sciences School. Ten percent of each examination sample was randomly selected and re-examined as a means of ensuring intra examiner reliability and consistent clinical judgment. Results: The caries and pufa prevalence amongst the study cohort was established at 55.77% and 6.54% respectively. The mean age of the children was 4.7 years, the mean dmft index score was 2.38 and the mean pufa score was 0.11. There was an increase in caries prevalence from 30.77% amongst the 2-year-old children to 66.67% amongst the 6-year-old children thus indicating an increase in caries prevalence with increasing age in both girls and boys. Conclusion: The caries and pufa prevalence of 55.77% and 6.54% for pre-school children of Windhoek is high compared to similar studies from other countries and it was directly proportional to increasing age
Maternal and child oral health status: investigation of the effect of parity and socio-behavioural factors
(2020) Obhioneh, Oziegbe Elizabeth
Background: Reproduction in women is associated with physiologic, metabolic and nutritional changes due to adjustments during pregnancy, breastfeeding and childrearing. These changes are thought to be potentially cumulative when parity is high and may have negative effects on the general health of women. It is likely that maternal oral health is affected as well, as ‘a tooth for every child’ is a common adage in many cultures. Even so, there is limited information on the relationship between parity and maternal oral health status. The available evidence is largely from European populations. Most research investigated tooth loss in women of fairly low parities and failed to consider caries and periodontal disease or the behaviours that are likely confounders affecting oral health status. Furthermore, there are no studies on the beliefs of high parity mothers regarding parity and tooth loss. Aim: The aim of this study was to determine the relationship between parity level and oral health status in a high parity population. Age, nutritional status, socio-economic status and oral health practices (frequency of consumption of refined sugar and tooth brushing, use of fluoridated toothpaste and number of dental visits) were considered when investigating tooth loss, dental caries and periodontitis levels in Nigerian Hausa mothers. Early childhood caries was evaluated for mother-child dyads. Women participated in focus group discussions to elicit qualitative data used to contextualise the study for the Hausa cultural environment. Materials and methods: This was a cross-sectional study with a mixed methods design. A total of 635 married Hausa women of all parity levels aged 13-80 years and 346 accompanying children aged less than 72 months were recruited. Women with 5 or more children were considered high parity while those with less than 5 children were regarded as low parity. Information on the socio-demographic status and oral health behaviour/practices of the women was obtained using a structured interviewer-administered questionnaire. A separate questionnaire was used to obtain information from the mother on the child’s socio-demographic profile and oral health behavior/practices. The weight and height of the participants were measured to calculate their BMI status (kg/m2). The oral hygiene status of the mothers and their children was assessed using the Simplified Oral Hygiene Index (OHI-S) of Greene and Vermillion. All teeth present in the mouth excluding the third molars were recorded, and all missing teeth were recorded regardless of the reason for tooth loss. Women’s caries status was determined using the Decayed Missing Filled Tooth (DMFT) index. Periodontal status was assessed with a lightweight periodontal probe using the Community Periodontal Index (CPI). Caries in the children was also assessed using the dmft index. Women’s beliefs on causes of tooth loss and any link between parity and tooth loss were explored through a qualitative analysis using a grounded theory approach through focus-group discussions with 33 women of differing parities. Data were analyzed using SPSS (version 16) software for Windows. Analyses included frequencies, cross-tabulations and regressions. Statistical significance was inferred at p<0.05. Associations between categorical variables were determined using chi-square tests while those between continuous variables were tested with Student’s t-tests and ANOVA. The mean DMFT scores and tooth loss with standard deviation were computed for the different age cohorts, parity levels, parity groups (high and low) and nutritional statuses. Comparisons between parity groups were done using Student’s t-tests, while comparisons between age cohorts and nutritional statuses were tested using ANOVA. In addition, the mean number of sextants with CPI scores of 0-3 and 4 was determined for the different age groups, parity levels and nutritional status. Comparisons across age groups, parity levels and nutritional status were done using ANOVA. Linear regression was performed to predict the factors that best contribute to caries, periodontal disease and tooth loss in the women with caries, periodontal disease and tooth loss modeled as dependent variables (each in separate analyses) and socio-demographic variables, oral health behaviour/practices, reproductive parameters and nutritional status as independent variables. Information obtained through focus group discussions on causes of tooth loss, parity and tooth loss were analyzed thematically using ATLAS-ti. Associations between caries experience in mother-child dyads were tested using Fisher’s exact tests. Binary logistic regression was done to predict factors that best contribute to early childhood caries (ECC) in the children. Results: Women in the earlier reproductive stages (18-37 years) characterize the study population (65.1%) with 55.7% of them of low parity. The mean parity (4.33±3.04) was slightly below what is regarded as high parity. There was limited variability in the SES and BMI of the participants. Both measures were associated with age, as older women were typically of middle SES and higher BMI. SES and BMI were not associated with caries experience, periodontal disease or tooth loss Hausa women generally had low prevalences of caries, serious periodontal disease and tooth loss, despite their poor oral hygiene and limited use of dental care facilities. A traditional diet that is low in refined sugars, along with good enamel quality, may contribute to this oral health profile. While tooth loss in the Hausa women was generally low, older and higher parity women experienced significantly more tooth loss. In addition, increased duration of reproduction was significantly related to fewer remaining teeth. The contributory weights of age, duration of reproduction and parity to tooth loss were 13.6%, 1.2% and 1.0%, respectively. Caries experience in the women was also low, yet higher parity women were found to experience significantly more caries. Women’s age contributed 8.5%, while parity accounted for 0.8% of their caries experience. The prevalence of some level of periodontal disease in the participants was very high. The majority had calculus deposits (code 2), although those with periodontal pockets (codes 3 and 4) were few. Age, level of education and frequency of tooth cleaning were significantly associated with periodontal disease. Notably, parity was not significantly associated with periodontal disease. The caries frequency (ECC) in the children was very low. Binary logistic regression analysis revealed that only the age of the child was significantly associated with ECC. The mother’s caries experience was not related to ECC in the child. The focus group participants did not associate parity per se with tooth loss, although they believed that payar baka (vomiting during childbirth) resulted in loss of teeth. The women perceived other causes of tooth loss to be dirty mouth, tooth worm, ageing and sugar cravings. Conclusion: The cumulative effects of high parity, as observed in older women, were associated with maternal oral health status (caries and tooth loss) in a fairly homogenous sample of Hausa women with low variation in oral hygiene status, diet, oral health practices, SES and BMI. Thus, reproductive history is an important determinant of oral health conditions in Hausa women.
Prehypertension and target organ changes in an African population
(2021) Mokwena, Caroline Motheo
Hypertension (HT) remains the leading risk factor for cardiovascular diseases (CVDs) and a leading cause of death globally. It is estimated that HT causes 10.4 million deaths annually. Studies showed that even individuals who are in the normotensive( NT) range show indications of target organ damage. This gave rise to a new category of HT called pre-hypertension(pre-HT). Prior 2017, HTwas defined as a blood pressure (BP) ≥ 140/90 mm Hg and pre-HT was defined as a BP of 120 mm Hg to 139 mm Hg. In 2017 these guidelines were revised by the American College of Cardiology (ACC) and the American Heart Association (AHA). According to these new guidelines, HTis defined as BP≥ 130 mm Hg and pre-HTas BP of 120 mm Hg to 129 mm Hg. However, both the South African Hypertension Society (SAHA) and European Society of Cardiology/European Society of Hypertension (ESC/ESH) do not recommend these new guidelines. Both organisations still recommend the definition of HTas a BP ≥ 140/90. Even though the ESC/ESH guidelines are accepted by the SAHA, there is no evidence to indicate which of the guidelines are more appropriate for African communities since all the studies were conducted in western countries like the United States of America (USA) and the United Kingdom (UK). Therefore, in this study we recruited South African peoplefrom South Africa, determined the prevalence of HT and pre-HT assessed cardiovascular target organ changes.We recruited 1211 participants of African ancestry and measured both conventional and ambulatory blood pressure (ABP). To asses cardiac changes we used echocardiography to measure early-to-late diastolic filling and left ventricular wall thickness. To measure vascular changes we used the SphygmoCorto measure pulse wave velocity (PWV). Blood samples were collected to measure plasma hormone concentrations and 24-hour urine samples were collected to measure urinary electrolyte excretion. Anthropometric measurements were taken and body mass index (BMI) was calculated as weight divided by height squared. A standardised questionnaire was administered to determine intake of medication and lifestyle habits like alcohol intake and cigarette smoking. Our results indicate that the average age of the population was 44.05±18.29 years. There were more female(65%) participants than male (5%). The overall population was overweight with a BMI of 29.47±8 kg/m2. Fifteen percent (15%) of the sample population were smokers. Participants who consumed alcohol were 21%. When the AHA guidelines were used, more participants were hypertensive (41.5%) compared to those who were pre-hypertensive (18.6%). On the other hand when the ESC/ESH guidelines were used, more participants were pre-hypertensive (34.2%) compared to those who were hypertensive (25.9%). The night-time BP of the pre-hypertensives and grade-1 (HT1) was within normal range while the night-time BP of the grade 2 (HT2) and grade 3 (HT3) was elevated. The pre-hypertensives and the three HT groups had an attenuated decline in nocturnal BP. Compared to the NT, the PWV and left ventricular mass index (LVMI) of all the HT groups, including the pre-HT were significantly higher. As the HT stages progressed there was a reduction in diastolic function observed.In conclusion our results indicate that according to the SAHS/ESH that are currently applied in SA, pre-HT is overestimated while HT is underestimated. Furthermore, using the AHA guidelines, our findings indicate that cardiovascular target organ changes increase significantly fromthe pre-HTto the HT1 stage. Since both stages (pre-HT and HT1) are considered NT according to the SAHS/ESC/ESH guidelines, by the time they reach HT2 stage which is the first stage considered as hypertensive, target organ damage may have progressed significantly. Therefore, these results indicate that the AHA/ACC guidelines are more appropriate for the SA population. If these guidelines can be adopted for HT treatment, CVD target organ damage can be significantly reduced.
A morphometric analysis of the growth of the immature and sub-adult human palate
(2021) Onwochei-Bolum, Nkemakonam Vincent
Postnatal nutrition in humans is associated with advancement in the mode of feeding from the neonatal and infancy period of growth to adulthood. During the neonatal and infancy periods, the palate functions in suckling, tongue manipulation and swallowing, while in adulthood and with dental eruption, the palate participates in both mastication and in the production of sound. It is anticipated that the transition in the role of the palate due to alterations in its function over time will cause morphological changes. Thus, the aim of this study was to analyse alterations in the shape and dimensions of the human palate from birth through the stages of dental eruption to the complete emergence of the permanent dentition in the sub-adult stages of life. Crania from 72 South African individuals were sourced from the Raymond A. Dart Collection of Human Skeletons, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand. The sample was divided into three age groups to correspond with the age ranges of the eruption of the deciduous dentition (birth to 5 years of age), mixed dentition (6 to 12 years of age) and the permanent dentition (13 to 20 years of age) respectively. A series of 14 osteological landmarks were digitized across the oral surface of the palate using an Immersion MicroScribe G2 unit. Landmark data were converted to linear distances and the length, width and elevation of the palate were assessed in relation to the state of the dentition. Analysis included both quantitative (linear measurements) and qualitative (wireframes) methods. The length and width of the palate in the permanent dentition group was significantly larger when compared to the mixed and deciduous dentition groups. While elevation of the palatal dome in the permanent dentition group was significantly greater than that of the palate in the mixed dentition group, no further significant differences were observed. Thus, changes in the morphology of the palate appear to be progressive with dental eruption and development across the different states of the dentition. By establishing the nature of the changes in the functional environment of the palate during development and growth, abnormalities in the postnatal development of the palate could be diagnosed.
The association between skeletal lesions and tuberculosis in a South African sample
(2021) Masiu, Rethabile
Tuberculosis is an infectious disease. Skeletal TB is the extra-pulmonary manifestation of Mycobacterium tuberculosis infection and occurs in about 1-5% of all TB cases. The aim of this study was to assess the sensitivity and specificity of skeletal lesions to accurately diagnose TB in a pre-antibiotic South African skeletal sample. For this purpose, 23 skeletal lesions were assessed on 436 skeletons from the Raymond A. Dart Skeletal Collection. These skeletons were divided into three groups: individuals where TB was recorded as cause of death (n=177), individuals where other pulmonary diseases were recorded as cause of death (n=109) and individuals where a variety of diseases, excluding TB and other pulmonary diseases, were recorded as causes of death (n=150). Chi-squared and Fisher’s Exact tests were used to assess differences between groups. The skeletal lesions’ respective sensitivities and specificities were also calculated and compared to a similar study by Dangvard Pedersen et al. (2019a). Lesions on the ventral surface of thoracic and lumbar vertebral bodies were observed significantly more in TB cases than in controls. This lesion type was also found to be the most valuable indicator with a high sensitivity and 55% probability of a true TB diagnosis if observed. An association between skeletal lesions and TB could only be found for rib and vertebral lesions. Distinct differences between this study and the study by Dangvard Pedersen et al. (2019a) indicated that TB-related changes were likely to be observed in a South African skeletal sample even when individuals were not documented to have died of the disease.
Correlation between ocular surface disease index and tear meniscus height in dry eye disease at a Johannesburg tertiary eye hospital
(2021) Erasmus, Daniel
Background: Dry eye disease is a common, and potentially vision-threatening problem. The Ocular Surface Disease Index is a well-established method of subjectively assessing dry eye disease. Objective means of diagnosing dry eye disease suffer from poor reproducibility, low sensitivity and specificity, are invasive, time consuming and often require specialized equipment. It is hypothesized that optical coherence tomography of the tear meniscus may address these problems. Aim: The primary aim of this study was to describe the correlation between the Ocular Surface Disease Index © and tear meniscus height in dry eye disease measured by optical coherence tomography. The secondary aim was to determine a useful diagnostic cut-off value for tear meniscus height in the diagnosis of dry eye disease. Setting: The study was conducted at St John Eye Hospital, Soweto, South Africa. Methods: This was a prospective, cross-sectional study of adults at a tertiary level eye clinic. Participants were included if they were older than 18 and excluded if they were contact lens wearers, had an established diagnosis of dry eye disease, or were known to have (or be taking any treatment for) any ophthalmological or medical condition that has the potential to influence dry eye disease. A control and investigative group was determined using the Dry Eye Ocular surface disease index. The inferior tear meniscus height of both groups was imaged using optical coherence tomography. Results: A total of 36 right eyes of 36 patients was included in this study. Patient ages ranged from 20 – 64 years, with a median age of 43 years. Overall there were more females (n = 27) than males (n = 9). There was a moderate negative correlation between the normal/dry eye group and tear meniscus height (rb = - 0.452, p = 0.032). Optimizing sensitivity and specificity yielded a diagnostic cut-off tear meniscus height of 296um. Conclusion: Tear meniscus height tends to decrease between Ocular Surface Disease Index classifications of ‘normal’ and ‘dry eye disease’. However, tear meniscus height performed poorly as an objective measure of dry eye disease in our study population limiting recommendations to adopt it as a diagnostic test. Keywords: Dry eye disease, Ocular Surface Disease Index , Optical Coherence Tomography, tear meniscus height.
An audit of the presence of coeliac disease associated human leukocyte antigen haplotypes in renal and bone marrow transplant donors and recipients from the South African National Blood Services
(2021) Mrubata, Kitso-Lesedi
Introduction: Coeliac Disease (CD) is an autoimmune condition occurring in genetically predisposed individuals exposed to an environmental trigger. The Human Leukocyte Antigen (HLA) haplotypes HLA DQ2.5 and HLADQ8 bear the strongest association with CD, and 90 -95% of patients with CD bear these haplotypes. The absence of these haplotypes has high negative predictive value. The susceptibility of the South African population to CD has not been studied previously. Methods The South African National Blood Services database was used to analyse the prevalence of HLA DQ2.5 and DQ8 in potential donors and recipients of organ transplants. Results The overall prevalence of HLA DQ2.5 and HLA DQ8 was 19.8%. The prevalence was lower in Black subjects (15%) than Caucasians (28%). Mixed race (22%) and Indian (17%) subjects had intermediate prevalence. The was no significant difference between potential transplant donors and recipients. Conclusion The prevalence of HLA DQ2.5 and HLA DQ8 differed among South African study participants of different ethnicities and was lower than the reported world-wide prevalence of 30-40%.

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