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An argument for a paid and regulated living-unrelated kidney donation system in South Africa
(2021) Ewing (Naude), Susan Lesley
One of the biggest challenges that global healthcare is experiencing is the shortage of kidney organ donors. Globally, the demand for organs is far greater than the supply and as a result, people who are on waiting lists will not get a chance to receive a kidney. Those who are waiting for transplants will require ongoing dialysis to survive (Nath & Fervenza, 2018). Dialysis is extremely costly and burdens the healthcare systems. Given the enormous gaps between supply and demand, this report seeks to answer the question: “Should South Africa follow the model of a paid and regulated living unrelated kidney donation system?” I begin with an analysis of South Africa’s current structure, the effects of this system and ultimately seeing the need for a different solution. I analyzed the various models globally in kidney donation, including the only country that allows for a paid system and the objections thereto. Currently, the sale of organs is prohibited in South Africa. My view is that our current South African model is lacking in solutions to the shortage of organ donors, particularly kidneys. There is a need for a better solution as the current system is failing to meet the needs of patients. In this paper, I use the principlism framework consisting of the four bioethical principles namely, autonomy, beneficence, non-maleficence and justice, to highlight the constitutional conflicts and the ethical dilemmas when considering a paid donation system. As I am arguing for a paid system in South Africa, I have included the ubuntu theory to show why objections to a paid and regulated system would fail. In conclusion, a paid and regulated living-unrelated kidney donation system is argued to be the most ethically and practically appropriate system in South Africa, to improve kidney donation rates and the livelihoods of the people
Audit of acute rejection in renal allografts
(2020) Thomas, Riju Mathew
Acute graft rejection is acknowledged to have a negative impact on graft survival in renal transplantation. South Africa provides for limited renal transplantation amidst the increasing burden of chronic kidney disease in the local context. Despite this suboptimal provision and limited resources, amongst many other concerns, the role of acute graft rejection on graft survival has not been characterized in the context of South Africa, as well as the African continent. This study is an audit, characterising acute graft rejection diagnosed at the Charlotte Maxeke Johannesburg Academic Hospital over a ten-year period (2003-2012). The study revealed the incidence of acute rejection in renal transplants to be 34.5%, similar to that reported in international studies. The majority of acute rejections occurred within the first year of transplantation (53.8%), which was lower than that reported in other studies, with 40% of patients having recurrence of acute rejection. The main form of rejection diagnosed was acute cellular rejection (predominantly BANFF grades 1A and 1B), followed by Borderline acute cellular rejection, the combination of which comprised the majority (86.9%) of all rejections diagnosed. This population was found to be a male dominant and Black African dominant study group, in keeping with the racial distribution of the dialysis population of South Africa, commonly influenced by treatment-seeking behaviour. Cadaveric donor grafts were engrafted in 77.7% of this population and 77.8% of the population had less than 40% of HLA antigens in common with their donor. Delayed graft function was observed in 22.4% of recipients with a significant association with more severe acute graft rejection. Hypertension was the most dominant primary aetiology leading to chronic kidney disease of native kidneys in this population. Immunosuppressive regimen, including cyclosporin, mycophenolate mofetil and prednisone, was used in 80% of recipients, with 97.6% of recipients on mycophenolate mofetil and prednisone. The five-year survival of grafts developing acute rejection was 61.7%. Graft function deteriorated more dramatically amongst recipients who progressed to graft loss, with recovery of graft function observed to be more prominent amongst recipients with surviving grafts. This study adds to the literature on this topic, and also describes the characteristics and outcomes of this entity.
Challenges faced by Gauteng nephrology nurses regarding implementing evidence based practice
(2020) Dube, Elizabeth Lerato
Introduction: Evidence-based practice is an expected core competence of all health care clinicians regardless of discipline. Melnyk and Fineout-Overholt (2014) noted that although there is an explosion of scientific evidence available to guide clinical practice, the implementation of evidence-based care by health professionals is typically not the norm in many healthcare systems across the globe. The researcher undertook this study to gain an understanding of what is preventing the nurses from implementing EBP in the nephrology nursing departments in Gauteng. Purpose of the study was to describe challenges related to EBP implementation that were faced by nephrology nurses in clinical practice and to describe the recommendations that will assist them to successfully implement. Methods. This study followed a qualitative, exploratory, descriptive and contextual approach and was conducted in nephrology units in Gauteng Province. The population of this study included trained nephrology nurses registered with the South African Nursing Council (SANC) and meeting the eligibility criteria. Data was collected from three phases and analysed using Hsieh and Shannon (2005) conventional data analysis method. Results: Sixteen sub categories emerged which were condensed to three categories of Management Practices, Perceived organizational support and leadership practices and Training and Development. Results included studies recommending the middle manager to be the link between nurses at the operational level and top management, who can successfully drive EBP and assist in alleviating experienced challenges. Recommendations were described
Dataset from: The effect of TNF-α inhibitor treatment on microRNAs and endothelial function in collagen induced arthritis
(2022-01-13) Gunter, Sulè; Michel, Frederic S.; Fourie, Serena; Singh, Mikayra; Le Roux, Regina; Manilall, Ashmeetha; Mokotedi, Lebogang.Palesa; Millen, Aletta M.E.; Millen, Aletta M.E.
The dataset consists of 129 datapoints. The data is taken across two-time points. The dataset comprises two components. A subset from a previous study (Le Roux R, Mokotedi L, Fourie S, Manilall A, Gunter S, Millen AME. TNF-α inhibitors reduce inflammation-induced concentric remodelling but not diastolic dysfunction in collagen-induced arthritis. Clin Exp Rheumatol. 2021. Epub Jan 2021.) and additional data were collected for this study. The codebook details 58 variables, with ranges, definitions and protocols. However, only complete data is available for only 7 variables: number, group, sex, time in weeks, bodyweight in grams, Systolic and diastolic blood pressure. Rats were randomly divided into the control (n=24, 9 females and 15 males), CIA (n=24, 12 females and 12 males) and CIA+etanercept (n=16, 8 females and 8 males) groups. Systemic inflammation was induced in the CIA and CIA+etanercept groups using bovine type II collagen dissolved in incomplete Freund’s adjuvant, as previously reported (Le Roux et al., 2021). Upon the first signs of inflammation, approximately 3-4 weeks after CIA was first induced. Rats in the CIA+etanercept group received intraperitoneal injections of etanercept (Enbrel) and a 10 mg/kg dose of TNF-α inhibitor (Roche, Basel, Switzerland) every three days for six weeks. The data reports on the experiment and its resulting markers of inflammation and responses in mesenteric arteries.
Factors influencing CD4+ T cell counts in people living with HIV with end-stage kidney disease
(2020) Pretorius, Melanie
Introduction: In South Africa, it is estimated that ~7 million people are living with Human Immunodeficiency Virus (HIV). HIV is associated with an increased risk of kidney disease. For people living with HIV (PLWH) who develop end-stage kidney disease (ESKD), access to renal replacement therapy can be difficult. Kidney transplantation is a cost-effective option, with improved overall survival and better quality of life. Eligibility criteria for kidney transplantation in Johannesburg includes a sustained CD4+ T cell count of >200 cells/μl and suppressed HIV replication. This study aimed to investigate the influence of hemodialysis on the lymphocyte subsets in PLWH with ESKD. Methods: Study participants and controls were recruited from renal dialysis centres in Johannesburg. Demographic data, social data, serial CD4+ T cell counts, serial HIV viral load measurements and blood samples were collected (before and after a haemodialysis session). Lymphocyte subsets were then measured. Results: Our cohort showed a statistically significant increase in the post-dialysis % of CD4+ T cells and the absolute CD4+ T cell counts. The longitudinal trend analysis for the % of CD4+ T cells revealed a significant increase in five participants and a single patient had a significant decrease in the longitudinal trend analysis for the absolute CD4+ T cell counts. The longitudinal trend analysis for HIV viral load revealed the majority of our participants were not virologically suppressed. Conclusion: This study showed that haemodialysis does not negatively impact CD4+ T cell count, suggesting that immunologic recovery is not impeded by treatment of the underlying ESKD.
Graft survival in South African renal transplant patients during the transition period at Charlotte Maxeke Johannesburg Academic Hospital (graft-sat study)
(2020) Chhiba, Priya Darshani
Introduction: In the developed world, studies performed on the transition of adolescent renal transplant patients have noted high rates of rejection, non-adherence and graft loss. However, there is paucity of data in developing countries, and none in a South African setting. Objectives: The purpose of this study was to assess the rates of acute and chronic rejection, graft and patient survival in adolescents at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methods:This study was a retrospective analysis of patients who received a renal transplant from 1 January 1990 to 31 December 2010, in the Paediatric Nephrology Department at CMJAH, in Parktown, Johannesburg, and entered the adolescent period (10 to 19 years old) with a functioning graft. Patients were included whether or not they were transferred to the Adult Nephrology Department at CMJAH.Results: 162 recipients were patients were transplanted during the study period, of which 80 (49.4%) were of black race, 63 (38.9%) were white, 10 (6.2%) were Asian and 9 (5.5%) were of mixed race. 65 (40.1%) were female and 97 (59.9%) were male. The median age at transplant was 13.8 years old (Interquartile range (IQR): 10.6 to 15.9). One hundred, twenty-eight (79.0%) patients received a renal transplant during the adolescent period and 34 (21.0%) were transplanted prior to adolescence. Fifty-four (33.3%) patients were transferred to the adult unit during adolescence. Graft failure occurred in 60 (37.0%) of the patients during the adolescent period, of which 54 (90.0%) occurred in the paediatric unit and 6 (10.0%) occurred in the adult unit. The median age at graft failure in the adolescent period was 16.1 years old (IQR: 14.5 to 17.9). Kaplan-Meier curves were used to analyse graft and patient survival. The following factors were identified as statistically significant in contributing to graft failure: if the transplant occurred during adolescence, previous renal transplant,non-compliance and rejection episodes in the adult unit, (p value <0.05). The 1, 3, 5, and 10-year patient survival rates were 98.8%, 97.6%, 95.1% and 93.9% respectively. Conclusion: This study revealed high rates of graft rejection and loss in South African renal transplant recipients in the adolescent period highlighting the vulnerability of this population group. Consideration should be given to the creation of transition clinics to potentially improve the graft outcomes of this vulnerable group. Further studies are needed on the transition period of adolescent renal transplant patients.
The influence of dialysis modality on post-transplant outcomes
(2020) Boosi, Reece
Introduction: Renal transplantation is the therapy of choice for end stage kidney disease, offering mortality risk reduction and improved morbidity over dialytic therapies. Limited data is available evaluating the effect of pre-engraftment dialysis modality on transplant outcomes. Methods: A retrospective review was conducted of all adult patients undergoing renal transplantation at Charlotte Maxeke Johannesburg Academic Hospital for the period 01/01/2006 – 31/12/2011 (n=103). Transplant outcomes were assessed by dialysis modality. c2 testing was used to compare dialysis modalities; Cox proportional hazard modelling was used to assess effect on graft outcomes. A p < 0.05 was deemed statistically significant. Results: Antecedent dialytic modality was as follows: 55 patients (53.4%) received haemodialysis (HD), 35 (34%) received peritoneal dialysis (PD), and 13 (12.6%) received a combination of both (HD+PD, defined as either modality for > 3 months). Acute rejection (AR) was documented in 43.7% of patients; 54.3% of PD patients developed AR compared to 38.2% of HD patients and 38.5% of HD+PD patients (p=0.29). No significant difference in the number of episodes of AR was detected between modality groups (p=0.44). Chronic rejection (CR) developed in 22.3% of patients overall; 21.8% of HD patients, 25.8% of PD and 15.9% of HD+PD patients (p=0.74). PD was associated with an increased risk of developing any rejection (HR=2.4, 95% CI 0.9–6.4, p=0.02). Whereas dialysis modality did not affect graft survival (for HD b= 0.57, SE=0.5, Wald=1.2, 95% CI -0.4-1.6, p=0.27; for PD b=0.58, SE=0.5, Wald = 1.4, 95% CI -0.4-1.6, p=0.24), AR was found to be associated with futuregraft loss (b=1.29, SE=0.3, Wald = 18.1, 95% CI 0.7-1.9, p<0.001).Conclusions: Antecedent PD is associated with an increased risk of graft rejection. Although AR is associated with graft loss, antecedent dialysis modality does not directly predict graft survival, likely reflecting the multifactorial nature of cumulative allograft injury.
Kidney transplant related knowledge and health education needs of patients with chronic kidney failure in two academic hospitals in Gauteng
(2021) Nkadimeng, Mmabje Calvin
Background: Patients living with chronic kidney failure endure a lot of stress, as they have to adjust their lifestyle, stop smoking, eat a healthy diet, and refrain from self-medication. Currently, South Africa has dearth in literature regarding the knowledge of these patients about kidney transplant, which is so far the best treatment for chronic kidney failure. Patients are provided with health education before any transplant, this is done to equip them with adequate knowledge regarding the disease and its management. However, there are no methods to examine whether the patient comprehended the information or not. Purpose: The purpose of this study was to describe the kidney transplant related knowledge and health education needs of patients with Chronic Kidney Failure on haemodialysis awaiting kidney transplant in two hospitals in Gauteng. Methods: The study was a quantitative, descriptive and cross-sectional survey and data was collected using a kidney transplant understanding tool (K-TUT) questionnaire. Data analysis: Data was analysed using the statistical package for Social Science computer Programme and quantitative content analysis. Setting: The setting for this study was the renal units at two academic hospitals in Gauteng, South Africa. Results: Of the n=124 aimed sample size, n=70 patients gave consent to participate in the study, based on the set objective of describing the knowledge of patients on dialysis about their knowledge on kidney transplant, a large number n=58 (82.86%) scored above 50% indicating adequate knowledge and n=12 (17.14%) scored below 50%, which is regarded as inadequate knowledge. However, at the mean score of 55%, only half (n=35; 50%) of the participants had adequate knowledge. When considering the 55% as adequate knowledge indicator, half of the participants had inadequate knowledge regarding kidney transplant. The health education needs revealed three themes: firstly, the health education needs related to kidney transplant (quality of life, reproductive health and risks and side effects). Secondly the additional information needs to understand kidney transplant process such as donors and support system and lastly the family member involvement theme which entailed their family member understanding of the risk of rejection and infection
Moringa Study (20151151B)
(2020-12-15) Muhammad, Nasiru; Ibrahim, Kasimu Ghandi; Ndhlala, Ashwell; Erlwanger, Kennedy; Erlwanger, Kennedy
Cleaned data from the experiement conducted with 21-day old male Sprague-Dawley rats . These rats(n=50) were randomized to six treatment groups (n=8-9) with unlimited access to commercial rat feed. Either plain water (C) or 20% fructose solution (Fr) were provided to drink. 400 mg.kg-1 M. oleifera methanolic leaf extract (Mo) or 100 mg.kg-1 fenofibrate were also administered daily for ten weeks. Growth, circulating metabolites, visceral and epididymal fat pads mass, hepatic lipids and general health markers were assessed. Liver samples were histologically examined using H&E stain. Analysis of the data was done with GraphPad Prism 5.0v for windows (GraphPad Software, Inc. CA), and the data were expressed as mean ± standard deviation and analysed by means of a one-way analysis of variance (ANOVA). Statistical significance was considered at P < 0.05.
Outcomes of paediatric liver transplant for biliary Atresia
(2021) Gamiet, Yentl Leigh
Background: Despite the widespread use of Kasai Portoenterostomy (KPE) for biliary atresia, more than two thirds of these patients require liver transplant. Liver transplantation is not widely available in South Africa, and Wits Donald Gordon Medical Centre is one of two centres performing paediatric liver transplantation in the country, and the only centre performing living related donor transplants. The study aims to outline the experience with liver transplant for biliary atresia in terms of the post-operative complications and one-year survival outcomes, with the goal to ascertain the factors which govern those outcomes. Methods: A retrospective review was performed at the centre. Demographic data was collected, and tabulated. Survival analysis was performed using Kaplan Meier curves. Complication rates were categorised into biliary, vascular and enteric complications, and classified as early and late. Mortality was analysed according to cause and timing which was categorised as early and late. Results: Sixty-seven first time liver transplants were performed for biliary atresia, at WDGMC from 2005 to 2017. Sixty-nine percent were female patients and thirty-one percent were male patients. Forty-eight percent of patients under the age of 5 years, had a z-score of -2 or worse for mid upper arm circumference (MUAC). The rates of biliary complications, enteric complications and vascular complications were 34%, 12% and 12%, respectively. One-year overall survival of the cohort is 84.5%, and overall graft survival is 82.9%. Overall mortality was 22% but cause of death was difficult to corroborate. Conclusion: Complication rates and survival outcomes are comparable to international single centre studies despite the high rates of malnutrition in our study cohort. Early referral of all patients with biliary atresia to a paediatric liver transplant centre is essential for early detection of indications, and medical and nutritional optimisation of patients
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.
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.
The use of chronic dialysis in a resource-poor environment: demographic features and transplant readiness at Helen Joseph Hospital renal unit
(2019) Parbhoo, Dinen
Background Chronic kidney disease (CKD) places a considerable economic strain on health care systems. In South Africa resource limitations in the public sector mandate that patients with end stage renal disease (ESRD) are only offered dialysis if they qualify for renal transplant. Thus, chronic dialysis serves as a bridge to transplantation. Objectives The primary objective of this study was to describe the patients on the chronic dialysis program with regards to demographic features, aetiology of renal failure, associated chronic comorbidities and transplant readiness. Secondary objectives included the determination of the type and duration of dialysis used and the documentation of any possible differences between the haemodialysis (HD) and peritoneal dialysis (PD) groups and the HIV positive and negative patients. Methods A cross-sectional record review was conducted of all patients receiving chronic dialysis at the Helen Joseph Hospital’s Renal Unit as at September 2016. Information regarding demographic features, disease profile, year of initiation of dialysis, year of presentation, Human Immunodeficiency Virus (HIV) status and transplant readiness was collected. All data was analysed at a 95% confidence interval and a p value of <0.05 was considered significant. Results There were 92 patients on chronic dialysis, 46 each on PD and HD. The mean (SD) age of patients in this study was 43.8 years (10.8). There was a slight female predominance (51.1%). The predominant ethnic group was African (64.1%). The leading causes of ESRD were hypertension (35.9%) followed by diabetes mellitus (10.9%). The most frequent comorbidity was hypertension (98.9%) followed by HIV infection (36.1%). The median time that patients spent on dialysis before presentation for transplant listing was 2 years (range 0-9 years). At the time of analysis, 27 patients (29.4%) were eligible for transplant and 38 patients (41.3%) were in the process of transplant eligibility evaluation. Twenty-seven patients (29.4%) were ineligible for transplant. Of those eligible for transplant, 21 were listed for transplant and 6 were awaiting presentation for listing. There were no differences between the HD and PD groups or the HIV positive and negative groups with regards to qualification for transplant. Conclusion The demographic features and underlying aetiologies of our cohort are similar to national figures with only the racial composition being different. The proportion of patients listed for transplantation (22.8%) and median time for work-up (2 years) are both sub-optimal. Improved efficiency in the evaluation of transplant eligibility is required in order to optimize the appropriate allocation of dialysis in a resource-limited setting.

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