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Item A survey of the professional quality of life of pharmacists and rehabilitation therapists at three public sector hospitals in Gauteng, South Africa(2024) Moyo, NonkazimuloBackground- The global goal of Universal Health Coverage (UHC) cannot be achieved without a wellmotivated and productive health workforce. Central to their motivation and productivity is the notion of professional quality of life (ProQOL) that captures both the positive and negative emotions of caring work. However, there is a dearth of empirical studies on the ProQOL of pharmacists and rehabilitation therapists, especially in an African setting. Study aim -The aim of the study was to examine the self-reported ProQOL of pharmacists and rehabilitation therapists at three public sector hospitals in the Gauteng Province of South Africa. Methodology- During 2021, a cross-sectional analytical study was conducted at three public sector hospitals in the Gauteng Province of South Africa. Following informed consent, all eligible pharmacists, pharmacist assistants, occupational therapists, physiotherapists and speech therapists and audiologists completed a self-administered questionnaire electronically. In addition to sociodemographic information, the questionnaire obtained information on compassion satisfaction, burnout, and secondary traumatic stress using the ProQOL scale (version 5) and work-related experiences during the COVID-19 pandemic. STATA® 17 was used for descriptive and multivariate analysis of the survey data. Results- A total of 118 pharmacists and rehabilitation therapists completed the survey. The majority were female (83.00%), single (63.46%), with mean age 30.77 years (SD=9.08). The results revealed moderate mean scores for compassion satisfaction (39.62; SD=5.48), burnout (24.26; SD=5.12) and secondary traumatic stress (23.03; SD=6.31). The predictors of compassion satisfaction were moderate positive COVID-19 experiences score (β=+2.61;95% CI 0.54; 4.68; p=0.014) and high positive COVID-19 experiences score (β =+ 2.68; 95%CI 0.40; 4.96; p=0.021); moderate overall job satisfaction score (β =+ 3.17; 95% CI 0.16; 6.18; p=0.039) and high overall job satisfaction score (β =+ 7.26; 95% CI 4.06; 10.47; p<0.001). The predictors of burnout were being single (β=+2.02 95% CI 0.07; 3.97; p=0.042), full professional registration (β=+4.23; 95% CI 1.79; 6.67; p=0.001), direct involvement in patient care (β=+3.24; 95% CI 0.22; 6.26; p=0.036) and reporting a heavy workload (β=+ 2.61; 95% CI 0.75; 4.48; p=0.007). The predictors of secondary traumatic stress were being male (β=+ 3.26; 95% CI 0.36; 6.15; p=0.028), and full registration (β=+ 5.72; 95% CI 2.41; 9.03; p<0.001). Conclusion- The ProQOL of pharmacists and rehabilitation therapists is influenced by a combination of individual, workplace, and health system factors, suggesting the need for a multifaceted approach to optimise their contribution to the achievement of UHC. Such approach should include provincial health, hospital management, and peer support as well as self-care activities.Item Activity and time spend patterns of residents in low-income settlements in the City of Johannesburg, South Africa(2024) Bhuda, Hope Prudence BoipeloBackground: Human health risk assessment is concern about estimating the population exposure (HHRA) for environmental pollutants or contaminants. Exposure assessment for population-level require time-activity pattern distributions in association to microenvironments where individuals reside and spend their time. Time-activity patterns in South Africa have not been adequately explored, which may lead to wrong dose estimation for health risk assessment. No in-depth and systematic analyses of time-activity patterns in low-income communities have been done to date in South African context. Aim: The aim of this study was to describe variations on time-activity patterns based on age, sex and socioeconomic status amongst residents of low-income communities in South African township (Matholesville informal settlement). Methodology: A cross-sectional study design was adopted to assess time-activity patterns amongst lowincome residents in South African townships. One Hundred and Thirty (130) households were selected randomly to participate in the study. A questionnaire survey comprising of key questions including demographics, type of household, type of activities conducting indoor, time spent on activities indoor and outdoor in a microenvironment, preferred season of the year and mode of transport commuting to different areas was administered to the study participants. In addition, diaries were used to get information on daily activity time pattern for seven (7) days. Completion of questionnaire were based on interviews with the study participants while diaries were self-administered by the participants daily over seven days. Results In this study, a total of 130 participants aged 18-35 and 36-75 years were included. Approximately 33% and 67% of the respondents were < 35 years and >35 years, respectively. This suggests that most of the households are headed by adults outside the youth age category. About 30 houses were found to be erected using bricks while 100 houses were made of corrugated iron. About 75%, 14%, 8% and 2% of the study respondents were found to fall into the following race, black, coloured, Indian and white. Approximately (83% brick, 71% shacks) of the study respondents attained secondary education the remainder of the respondents attained primary education. The most performed activities inside brick type dwellings are sleeping (100%), cooking (77%), cleaning (70%) and watching television (TV) (60%). While most performed activities indoors for shack dwellings are cleaning (87%), cooking (70%), sleeping (68%) and TV (37%). There is a high prevalence of none employed household heads at 53% for the brick dwelling and 63% for the shack dwellers. The average monthly income was found to be R4 304 and R3 650, for brick and shack type dwellings, respectively. Females were found to perform a larger proportion of indoor household activities than males. A total of 36% was spend on cooking and cleaning followed by 29% of the time watching TV in the brick type dwellings. For the brick dwellers spend 67% indoors and 33% outdoor while for the shack dwellers about 31% of the time is spend indoor. Conclusion: The study had hypothesised that females above 18 years old residing in low-income communities are likely to spend most of their time at home carrying out domestic duties compared to their male counterparts, who are expected to spend most of the time outside the residential spaces. Therefore, the hypothesis for this study is partially confirmed, meaning that women spend most of their time indoor performing household chores than males. It was also found that the time spent indoor is relatively lower than what is globally reported as known to be >80% of the time, people are said to be indoors. This implies that the variation on the socio-economic status and sub-population including country’s dynamic might be the biggest influencer of time-activity pattern. Data obtained from this study can be used to account variability in human health risk assessments and reduce uncertainty in the derived exposure dosage where time spent pattern is considered an important variable. Recommendations: ✓ Future studies may be carried out covering a larger population density to gain more detailed time activity patterns. ✓ This study focused on a low-income settlement which has different characteristics to semi-formal, rural, high tax yield settlements in South Africa. Therefore, a larger study focusing on different socio-economic classes need to be carried out to have a comprehensive time activity pattern dataset for South African population. ✓ The current project focused only on adult age group without considering vulnerable groups (toddlers, and elderly person) time activity pattern. An additional study focusing on children time activity pattern is required in order to gain an understanding on what activities children spend most time.Item Bayesian spatio-temporal analysis of malaria prevalence in children aged 2-10 years between 2000-2015 in Gabon(2024) Mougeni, Fabrice LotolaAbstract Background: In Gabon malaria still threatens the health of children and the country’s economy. In order to contribute in the estimation of malaria burden, in the endemic risk classification, and help in the design of the effective intervention, it is necessary to identify hot spots and cold spots, and to provide policy makers with good estimates of malaria prevalence at the national level with appropriate methods. It is also important, to understand, at a small spatial scale, how some factors are affecting the variation of malaria prevalence. This includes mainly geo-climatic factors, since malaria is related the meteorological conditions. This study focused on the effect of space and time in the distribution of malaria prevalence, and the effect of ecological variables in its variation for children between 2-10 years of age living in Gabon. Method: This study used successive cross-sectional data carried out in four time points: 2000, 2005, 2010, and 2015, using a stratified two-stage sampling method. The survey data provided information on malaria prevalence for children aged 2-10 years, and cluster-level ecological variables. Descriptive analysis such as the mean of the prevalence and the covariates with their standard deviation, on average, overtime, by province and type of residence was carried out, followed by more advanced models for the estimation of the prevalence. Considering the weighting scheme, the prevalence was obtained via the space and time Horvitz and Thompson estimator. This was then smoothed using the Besage York Mollié (BYM) model with space-time interaction, to reduce uncertainty due to the small area. The spatial autocorrelation was determined using the Moran’s I index, and hot spots with the local statistic Getis-Ord General Gi. The relationship between malaria prevalence and predictors was analyzed nationally. Ordinary Least squared (OLS) was used to see if the covariates can explain the spatial autocorrelation observed in the prevalence, Geographically Weighted Regression (GWR) or Spatial Varying Coefficient (SVC) to evaluate if the relationship between prevalence-covariates was not varying by location. Spatio-temporal model for OLS (SPTOLS) was used to account for the effect of time and space, and Geo-Additive Model (GAM) for considering the non-linear relationships. Lastly, Spatial Lag Model (SLM), Spatial Durbin Error Model (SDEM) or Spatial Error Model (SEM), were used for identifying the spillover effects. These were implemented in the Integrated Nested Laplace Approximation (INLA) using Stochastic Partial Differential Equation approach (SPDE). The different methods were compared to find the best one fitting well the data by using the DIC. Results: In total, 336 clusters were used, with 153 (46%), and 183 (54%) in rural and urban areas, respectively. On average, Estuaire province has the highest prevalence, followed by Moyen-Ogooue and Woleu-Ntem, 29% (±16%), 22% (±13%), 21% (±10%), respectively before the estimation using the smooth space-time model with sampling design. On average, after using the space-time smoothing model and the sample design, it was found that the prevalence decreased with year, and then showed a rebound from 2010. The highest value of the prevalence overtime was 46% in the Estuaire province in the year 2000 and the lowest value overtime was 6% in Ogooue-Maritime province in the year 2010. However, the effect of year was not significant. When the weight scheme was introduced, the variance of the estimate was reduced, and the contribution of the space in the variation of malaria prevalence was 46% during 2015. A strong spatial autocorrelation of the prevalence was found. Hot spots changed in magnitude by space and time, often in the north-west and the western part of the country. Cold spots were found mostly in the southern part. The spatial effect became almost null after 290 km (95% Credible Interval (CI): 230;360). The model including only the ecological variables was better in reducing the spatial variation. Using the SDEM, it was clearly seen how the prevalence can be influenced by the change of some risk factors in the nearby clusters or in the same cluster. The increase of malaria prevalence in a cluster was slightly and significantly associated with one-unit increase of: wet days (3%, 95% CI: [1%, 5%]) in the same cluster, and mean temperature (2%, 95% CI: [1%, 3%]) in the nearby clusters. It decreased slightly and significantly with a one-unit increase of day land surface (-2%, 95% CI: [-2%, -1%]) in the same cluster, but only slightly in the nearby clusters (< 1%). For a particular cluster, malaria prevalence decreased (-21%, 95% CI: [-40%, -5%]) greatly with the Insecticide Treated Bed Nets (ITNs) coverage increases in the nearby clusters. In contrast to GAM using SDEM for ITNs coverage only, the relationship between malaria revalence and ITNs coverage was clearly non-linear decreasing after 20% of coverage. Overall, malaria prevalence had non-linear relationship with mean temperature, night land surface temperature, enhanced vegetation index and rainfall. Conclusion: Substantial progress has been made to slow down the spread of malaria in Gabon. However, malaria prevalence is still high, with important spatial variation and hotspots in its distribution. The distribution of hot spots was showing some changes overtime in the cluster of households. Including the spatial effect allowed to obtain more accurate estimate of the prevalence, hence a better estimation of the clinical burden of P.falciparum. This can allow a better allocation of resources. From our findings, results may apply in two aspects: Firstly, in research focused on estimation in malaria. Such research trying to obtain an estimation of malaria outcomes, such as incidence, in different areas are encouraged to check on the spatial or spatio-temporal component in their estimation based on small area estimation with Bayesian approach due to the small level of unit to obtain more accurate estimate. Secondly, in strategies to reduce the prevalence. It is necessary to find strategies to increase, at the cluster of households level, the ITNs coverage to at least 20%, by taking into account some ecological variables implied in the decrease of the prevalence and to improve access to all health care interventions in the rural areas throughout the country. Monitoring the vector control intervention and those ecological variables can contribute to strengthen the action of interventions in public health, because of the spillover effect, which can spread the benefit of intervention over long distance to reach several areas not targeted in the neighborhood. This effect contributes in the cost-effectiveness of the interventions. The national direction of meteorology (DGM) and the NMCP need to work together to mitigate or control adverse climatic change effect on malaria if possible by developing early warning system for malaria. These results can be considered as a baseline for future surveys investigating the malaria distribution in Gabon and elsewhere.Item Breast cancer survival to 5 years among young (<40 years) women in the sub-saharan African breast cancer-disparities in outcome (ABC-DO) cohort study(2024) Abioye, Oyepeju F.Introduction: Breast cancer remains a key global health challenge, accounting for most prevalent cause of cancer-related deaths worldwide. The impact of age at diagnosis on breast cancer survival has not been extensively investigated within the African context. Therefore, this study’s objectives were to estimate the breast cancer survival time among women 40 years) women in the ABC-DO Cohort Study in SSA. Methods: Secondary data analysis of breast cancer patients from the multi-country ABC-DO Prospective Cohort Study of 5 African countries was carried out. Baseline characteristics of study participants were summarized using descriptive statistics. Kaplan Meier curves were generated to evaluate breast cancer survival time by age group “<40 years, 40-64 years, 65+ years”. With the aid of Cox Multivariate Regression Modelling, factors correlated with a 5-year survival differential between younger and older women were investigated and Hazard Ratios were calculated adjusting for confounders. Results: This study had a total number of 2158 participants, 462 (21.41%) were <40 years at diagnosis, 1314 were between 40-64years (60.89%), while 382 patients were 65 years and above (17.70%). A total of 1211 deaths were recorded at 5 years. The total time at risk and incidence rate at 5 years was 6086.73 person years and 33 per 100 women respectively. The lowest overall survival at 5 years was found among women <40 years (33.46%; CI = 0.28-0.38), followed by women aged 65 years+ (37.63%; CI = 0.32-0.42), and highest overall survival was among women in the 40-64 years age group (42.66%; CI=0.39-0.45). For each country, the 5-year probability of survival was higher among women aged 40-64 compared to women under 40. On Cox multivariate analysis, a 20% rise in mortality was reported among women < 40 years (aHR 1.20; 95% CI= 1.03- 1.36) compared to women between 40-64 years in the final model, at p<0.05. The variables significantly associated with 5-year survival differential between younger and older women were: HIV status, Residence, and Stage at Diagnosis. Conclusion: This study reports that breast cancer survival among women in sub-Saharan Africa is age-specific, with lower 5-year overall and country-specific survival among women < 40 years in comparison to older women. Factors associated with lower survival include stage at diagnosis, HIV status, and area of residence. Young women (<40 years) in SSA remain at risk of increased mortality from breast cancer, hence there is an urgent need for targeted strategies to achieve a more favorable stage at diagnosis and improved survival in this populace.Item Characteristics of clients presenting for substance abuse treatment at cosup centresin the City of Tshwane(2024) Manyane, Tabea ThamaBackground: Substance abuse is a growing public health challenge in South Africa. It contributes significantly to the burden of disease. Integrated treatment approaches are required to address the substance abuse problem. The aim of this study was to determine the of risk of harm associated with substance use in subjects enrolled in the community-oriented substance use program (COSUP) in the City of Tshwane, South Africa, using the World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) tool and determine the demographic characteristics that might be associated with the changes in the ASSIST risk scores and the levels of risk of harm in those subjects. Methodology: A cross-sectional study design was used to retrospectively analyze secondary data collected from subjects enrolled into COSUP at time of enrolment and three-months follow-up from time of enrolment. Descriptive statistics were used to analyze the demographic characteristics. Univariate and multivariate logistic regression analyses of moderate- to high-risk opioid use in relation to demographic characteristics were done. Results: Most subjects were males (91.2%), single (79.8%), black (85.6%) and they were relatively young (median age 31+6.4 years). The high level of risk was found with the use of opioids (74.5%, 607/805), cannabis (28.8%, 232/805), and tobacco (16.1%, 130/805). Moderate levels of risk were found with tobacco (63,9%, 514/805), cannabis (25.6%, 206/805) and opioids (5.1%, 41/805). Moderate and high level of risk was found to be more in males (p=0.03) and in the black race (p=0.02). Multivariate analysis found moderate- to high-risk of opioid use to be positively associated with being married (adjusted odds ratio (aOR) 11.90, 95% confidence interval (CI) 1.30 – 108.20). Conclusion: Hazardous and harmful use of substances was found among users of opioids, cannabis and tobacco. Screening and harm reduction treatment interventions for substance use should be integrated within primary health care. Further research on the perceptions of substance users about harm reduction treatment interventions is required.Item Cost utility analysis of long acting muscarinic antagonists (LAMAs) as an alternative to long acting beta agonists (labas) for treatment of severe COPD in the South African public sector(2024) Thompson, PeggyObjective- The study purposed to estimate the cost-effectiveness of Tiotropium, compared with Salmeterol and Indacaterol for chronic obstructive pulmonary disease (COPD) patients within the South African public sector. Methods- A global Markov model was adapted for the local setting and developed in Microsoft Excel. Transition probabilities and data on costs, resource use and effectiveness were obtained from literature. Outcomes were calculated for 3-years in the base case, then extrapolated over a 10-year and lifetime time horizon. A 5% discounting rate was applied according to local guidelines. Cost-effectiveness was estimated as the incremental cost per quality adjusted life year (QALY). One-way and probabilistic sensitivity analyses were conducted to consider model uncertainty. Results- When compared with Indacaterol (300µg), Tiotropium was dominant (less costly and more effective) across all time horizons. Conversely, Tiotropium was not cost-effective when compared with Indacaterol (150µg) and dominated by Salmeterol over the 3- and 10-year time horizons. The resulting ICURs exceeded the estimated willingness to pay thresholds for all scenarios. The deterministic sensitivity analysis revealed the new intervention cost and utility for mild COPD impacted most on intervention cost effectiveness. Conclusion- Tiotropium was deemed not cost-effective at the proposed price, when compared to usual care for COPD. A price reduction should be considered, to determine the feasibility of displacing existing maintenance therapies. Indacaterol 150µg appeared more cost-effective at the current price and effectiveness demonstrated.Item Determinants of mortality in children younger than five years admitted with severe acute malnutrition to three hospitals in Vhembe district, Limpopo(2024) Fakudze, DakaloBackground: In 2014, one-third of child deaths occurring in South African hospitals were attributed to severe acute malnutrition. This study sought to determine demographic, family, socio-economic, clinical, and case-management factors contributing to mortality in severely malnourished children younger than 5 years admitted to three hospitals in Vhembe district, Limpopo, South Africa. Methods: A retrospective record review of children aged 6 to 59 months admitted with severe acute malnutrition over 30 months was conducted. Bivariable and multivariable regression analyses of determinants of mortality were undertaken. Results: Two hundred and forty-five children with severe acute malnutrition were identified. Their median (interquartile [IQR]) age was 14 (10, 18) months. The overall mortality was 26.9% (66/245). Determinants of mortality, based on the multivariable analysis, included diarrhoea on presentation (odds ratio [OR]=3.34, 95% CI 1.38, 8.10); anaemia (OR=3.30, 95% CI 1.28, 8.50]); a raised CRP (OR=9.29, 95% CI 2.81, 30.76]); and hyponatraemia (OR=6.64, 95% CI 2.70, 16.31). HIV status and a diagnosis of shock were not significant determinants of mortality. Conclusion: Severe acute malnutrition mortality was high, particularly for a high middle-income country setting. Factors that may be amenable to intervention include better management of the presenting illness, particularly diarrhea, a focus on electrolyte imbalance correction, and treatment of anemia.Item Educational programmes used in teaching nurses mechanical ventilation in adult intensive care units: a scoping review(2024) Davis, Daniele RuthIntroduction Mechanical ventilation is a common form of life support intervention and nurses are the key personnel in providing safe and specialized care to these patients. Their education determines whether patients receive optimal quality care and attain the best possible outcomes. Purpose: To identify the available evidence on invasive mechanical ventilation educational programmes developed for teaching all nurses working in adult intensive care units; regardless of their level of qualification or years of experience. It includes the content taught and the method of instruction used. Methods: Due to the breadth of the review topic, a scoping review methodology was considered appropriate and guided by The Joanna Briggs Institute (JBI) Scoping Review methodology. Eligibility criteria using the PCC framework, and relevant keywords and phrases originating from these criteria were used to search five databases in July and August 2022 (PubMed, EBSCO CINAHL, Wiley Online, Scopus and ProQuest). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were used to report the results. Results: Nine studies fulfilled the inclusion criteria for full review. Four studies were relevant to invasive mechanical ventilation; two studies were specifically related to ventilator associated pneumonia and one each on weaning, endotracheal tube cuff pressure management and the development of a programme for nurses transitioning into the intensive care unit. Conclusion: There is limited evidence of comprehensive educational programmes on invasive mechanical ventilation for all nurses working in the intensive care unit.Item Efficacy of water suppression method for controlling the emissions of submicron particles at a quarry, Boksburg, South Africa(2024) Mkwanazi, D. D.Background: Respiratory diseases has contributed 70% to worldwide occupational disease mortality in all industrial sectors since over a decade ago. Pneumoconioses occur as a result of accumulation of dust in the lungs. Silicosis, one of the most common forms of pneumoconioses, presents in three different forms namely acute, accelerated, and chronic silicosis. Quarrying and open cast mining are responsible for different workplace hazards including noise, trauma, vibration, ultraviolet radiation, and dust exposure, which may cause silicosis. Lung deposition of particulate matter depend on the particulate matter surface characteristics, aerodynamic size, and weight. Quarrying and stone crushing activities are associated with high levels of crystalline silica release. Water suppression has been proven to effectively control dust in mining and construction industries, but not enough attention has been paid on effects of water suppression on fine particulate matter. Purpose: To evaluate efficacy of water suppression as a dust control measure for submicron particles for the primary, secondary and tertiary treatment processes during the production of stone aggregates in a quarry. Methods: In this cross-sectional study data was collected using a Nanozen dust sampling device to monitor dust emissions in 0.300µm to 10.658µm bin sizes across 4 different sampling points namely primary, secondary, tertiary treatment area, and office complex at a quarry in Boksburg, South Africa. In the primary treatment area big rocks are crushed into 150mm smaller rock without dust suppression, the secondary area breaks them further into 57mm stones with water supperssion applied, and tertiary breaks them into 19mm and smaller stone products under further water suppression conditions. Primary treatment area and office complex were sampled as dry areas, while secondary and tertiary treatment areas were sampled as water suppression areas. Data was analysed based on mass and number concentrations for different bin sizes, and comparisons were made between dry and wet areas. The effect of water treatment (suppression) on submicron bin ranges (0.300-0.915µm) in terms of mass concentration and number concentration was analysed to determine its efficacy in reducing dust emissions in this range. Results: The total average mass concentration of 460.2 µg/m3 (±486.3) was emitted from the primary area without dust suppression with average of 2.22E+08 (±136958.7) number concentration. This was reduced to 6.02µg/m3 and 60.9 million (±552879) mass and number concentration respectively in secondary treatment area with water suppression. In tertiary area emissions were 10.52µg/m3 and 54.8 million particles/cm3 (±828126) respectively for mass and number concentrations following further water suppression, while in office area (no water suppression) 6.07µg/m3 and 44.4 million/cm3 mass and number concentrations were recorded respectively. Conclusions & Recommendations: Data showed reduction of emissions between primary and secondary area by 98.7% (mass concentration) and 72.5% (number concentration). Further treatment in tertiary treatment showed a further decrease in total average number concentration compared to secondary treatment. Emissions at the office block as a control site were consistent with emissions from secondary and tertiary treatment areas, demonstrating possible dispersion by wind. Water suppression was demonstrated to be effective against particle bin sizes larger than 1 micron, with progressively less effect on submicron particles as they became smaller. More research is recommended on suppression of submicron dust particulate matter emission and consideration of number concentration as a key dose matrix to determine exposure.Item Evaluation of implementation fidelity to national guidelines on management of tuberculosis in paediatric patients in Homa-Bay County, Kenya(2022) Kiptoon, Sharon CheronoBackground: Tuberculosis (TB) has been a major public health concern for a long time. Infection in children has not been given a lot of focus as in adults despite children being a vulnerable population with weaker immunity. Prognosis is worse when there is HIV/TB coinfection. The WHO rolled out guidelines for the management of TB in pediatric patients which were adopted by the Kenya Government. Health care workers then implement the guidelines. The Objectives of this study were to measure adherence to national guidelines on the management of Tuberculosis in Pediatric patients (up to 14 years) and to identify moderators affecting implementation fidelity. Methods: A convergent parallel mixed method design was used to collect information from TB treatment sites in Homa bay County. The study was conducted during the months of August, September and October 2018.Quantitative data collected focused on Pediatric patients between ages zero and 14. A checklist based on the guidelines was designed to review 442 records in the clinics for a four-year period (2014 to 2018). Qualitative data was collected through in-depth interviews with eight Sub-County TB coordinators. Interview moderators were based on Carrol et al Implementation Fidelity framework. Summation of "yes" and "No" responses were tallied to get an adherence score for the County as a whole and for the sub-counties individually. The qualitative analysis used the thematic method in excel spreadsheets. Results: Results showed high adherence for the County with a median of 80% (IQR 66.66-93.33%). Four of the sub-counties with normally distributed scored had a mean score of 79% and while the other four had a median score of 80% (66.66 – 93.33). Guidelines which had low implementation fidelity scores were those involving follow up tests i.e., sputum, gene X-pert and X-ray during duration of treatment. In the qualitative aspect good facilitation strategies were found to be in place from both the County and national TB programs. An attitude of fear, lack of knowledge on infection prevention, lack of skills to produce specimens for TB testing and staff shortages affected quality of treatment delivery. The health care workers reported ease in following the guidelines especially with the roll out of new guidelines which simplified diagnosis of TB in children, drugs which are dispersible and in fixed dose combination. Participant’s response to the intervention was poor with both health care workers and patients expressing difficulties with direct observed therapy schedule which required frequent visits and frequent follow up tests. Conclusion and recommendations: In conclusion, implementation fidelity to guidelines on management of tuberculosis is high. Good facilitation strategies is a positive moderator towards achieving high implementation fidelity. The national TB program in Kenya is doing well so far in monitoring the process of guideline implementation once rolled out, however, to be able to achieve the sustainable development goal eradicating TB, further follow up is needed in the facilities to improve the levels of adherence from 80% to 100%. Use of the conceptual framework by Carroll has proved to be a good guide in evaluating healthcare worker’s performance in implementing treatment guidelines It is recommended that health workers should undergo more sensitization on why certain guidelines have been put in place e.g., repeating sputum samples at different phases of treatment in order to improve quality of care. More training on vital procedures e.g., gastric aspirate should also be done to improve health workers' confidence and ease diagnosis of TB at younger age. Further research on implementation fidelity on other evidence based interventions would go a long way to improve service delivery and ensure other program goals are met.Item Evaluation of osayidelera, a campaign addressing risk perceptions of COVID-19 in Blantyre, Malawi(2024) Maganga, Chiyembekezo FocusBackground- Osayidelera COVID-19 was a national campaign that was implemented as part of Malawi’s Risk Communication and Community Engagement response for the pandemic. The campaign was designed to address low COVID-19 risk perceptions and enhance compliance to preventive behaviours. Despite massive resources that were channeled towards the campaign, there were no studies that had evaluated the effectiveness of Osayidelera in addressing low risk perception in Malawi, and that had measured the association between the risk perceptions and preventive behaviours in Malawi. This study set out to change that, by testing associations between exposure to the campaign and both risk perceptions and protective behaviours in the context of Blantyre, one of areas hardest hit by COVID-19 in Malawi. Methods- A cross-sectional survey was conducted in Blantyre from 6 to 20 May, 2022. A sample of 224 adults (18 and older) were drawn from rural, peri-urban and urban locations in Blantyre using a multi-stage sampling technique. Data were cleaned in Microsoft Excel and analysed in STATA. Descriptive statistics were used to characterise the study sample, campaign exposure, risk perceptions and behaviours. Logistic regression models were used to test associations between campaign exposure and risk perceptions, and risk perceptions and protective behaviours. Results- Overall, 63% of the sample reported low COVID-19 risk perceptions. The only sociodemographic variables associated with low risk perception in the multivariate logistic vi model were those who were divorced (aOR=0.20, p=0.046 CI=0.04-0.97) and widowed (aOR=0.10, p=0.009 CI=0.02-0.57); they had significantly lower odds of low risk perceptions than those who were single. Exposure to COVID-19 campaign was generally low, with only 27% of the respondents reporting high levels of exposure. The proportion of respondents who could recall exposure to the name “Osayidelera” was even lower, at 16%. In the multivariate logistic model, males had higher odds of high exposure to the campaign as compared to females (aOR=3.75, p=0.001 CI=1.66-7.69) with those odds even higher among respondents in periurban areas versus rural areas (aOR=6.15, p=0.043 CI=1.06-35.71). High COVID-19 knowledge was also significantly associated with exposure to the COVID-19 campaign (aOR=2.48, p=0.013 CI=1.21 - 5.06). The results showed no significant association between campaign exposure and risk perceptions (p>0.05). In the adjusted multivariate logistic regression model, only those living in Blantyre urban had significantly higher odds of low risk perceptions as compared to those living in Blantyre rural (aOR=4.83, p=<0.001, CI= 2.15- 10.85) All other factors were non-significant. Finally, we found that adherence to preventive behaviours was generally poor, with only 29% reporting high levels of adherence, regardless of their COVID-19 risk perceptions. Risk perceptions were not associated with preventive behaviours. Conclusion- This study established that there was low reach of the campaign in Blantyre, and that the relationship between risk perceptions and adoption of preventive behaviours was not as strong and positive as hypothesized by the campaign. Campaign designers may need to revisit assumptions about their theory of change. The study contributes to growth of scholarship on health promotion campaigns and risk communication by showing factors associated with the reach of the campaign and with risk perceptionsItem Exposure and risk assessment of benzene, toluene, ethyl benzene and xylene (btex) in a petrochemical depot at Heidelberg, South Africa(2022) Mdlalose, Richard JohnBackground: The International Labour Organization estimated 2.2 million workers are dying yearly from work-related accidents and occupational diseases, whilst about 270 million suffer serious injuries, and 160 million become ill due to their work. It is further estimated that work-related accidents and diseases cause 4% of annual Global Gross Domestic Product or US $1.25 trillion due to lost working time, workers’ compensation, the interruption of production, and medical expenses. In 2005, the ILO estimated that 440 000 people died throughout the world because of exposure to hazardous chemicals. In 2018 chemicals production was the second largest production sector in the world. Chemicals are indispensable and critical part of life. Their visible positive outcomes are quite palpable. They are well recognized for instance pesticides improve the quality of food production, pharmaceuticals cure illness, cleaning products help to establish hygienic living conditions. Chemicals are key development of final products that make life little easy for human beings, etc. Controlling employees ‘exposure to chemicals and preventing or minimizing emissions remains a significant challenge in workplaces throughout the world. The production, storage, and handling of petrochemical products particularly BTEX emissions are known and associated with potential harm to human and aquatic organisms. Some of the health effects associated with exposure to BTEX are the health effects on hematopoietic system, including pancytopenia. The benzene exposure leads to an acute myelogenous leukemia. The exposure to toluene, ethylbenzene, and xylene have been linked to the damaging the central nervous system and irritation of the respiratory system. Benzene and ethylbenzene are confirmed carcinogens (Benzene is classified as a Group 1 and ethylbenzene is a Group 2 B carcinogens). Purpose: To characterize, assess exposure and health risk assessment to benzene, toluene, ethylbenzene, and xylene (BTEX) at the petrochemical depot at Heidelberg in Gauteng, South Africa. Methods: Exposure sampling was done using a MiniRAE 3000 Photoionization detector (PID). The PID (equipment) was calibrated before the commencement of the monitoring program following the manufacturer’s operating manual. The PID equipment was used to collect the BTEX samples. The PID was mounted on a marked tripod stand at 1.5 m above ground and approximately 0.2 m to 0.5 m in the microenvironment (Exposure scenario) of the depot workers (Controllers and/or laboratory assistant) with the probe extended or placed within 30cm of the breathing zone of the depot workers. Sampling was conducted at three different exposure scenarios (workstations) i.e., density huts, laboratory, and during plant equipment cleaning in the plant (strainer removal) over three days period. The sampling started from 08h00 to 17h00. One workstation was sampled per day. The sampling of BTEX per workstation took 30 minutes per hour over ten hours, every hour BTEX was sampled for a duration of 30 minutes and in totality ten samples were collected per 12- hour shift, a total of 30 BTEX samples were collected over the 3 days period. Additionally, the measured BTEX concentrations were used to obtain dose estimates. Data from the equipment was exported to a Microsoft Excel spreadsheet. All outliners were removed from the data and a correction factor was applied to derive the final concentration. Thereafter, statistical tests using student F-test and Test were performed to evaluate for significant differences amongst paired comparisons. Results : The highest average BTEX concentrations were measured in the laboratory, followed by density huts and the least was measured during the removal of the strainer (plant equipment cleaning). The activity areas (exposure scenarios) served as direct sources for the BTEX vapours. The average benzene concentrations measured in three activity areas ranged from 469 ppm to 542 ppm. The highest benzene concentration was found to be 542 times higher than the current South African Occupational Exposure Limits of 1ppm. The average toluene concentrations measured ranged from 1335 pm to 1542 pm; the highest toluene concentration was found to be more than 30 times above the South African Occupational Exposure Limits of 50 ppm. The average ethylbenzene concentrations measured ranged from 433 ppm to 500 ppm; the highest concentration was found to be 5 times above the South African Occupational Exposure Limits of 100 ppm. The average xylene concentrations measured ranged from 1372 ppm to 1584 ppm, the highest concentration was found to be more than 15 times above the South African Occupational Exposure Limits of 100 ppm. All the measured BTEX compounds were found to be above their respective South African Occupational Exposure Limits. The cancer risk was determined to be 13 x 10-2 (male) and 10 x 10-2 (female), 14 x 10-2 (male) and 11x 10-2 (female), 16 x 10-2 (male) and 13 x 10-2 (female), 12 x 10-3 (male) and 10 x 10-3 (female) for the workers in the density huts, laboratory, strain remover (plant equipment cleaning), respectively. In all exposure scenarios (male and female) the cancer risk was found to be higher than the acceptable risk levels of 1E-4 . There were 13 males and 10 females in the population of 100 controllers who were likely to develop cancer when working density huts environment. In the laboratory work environment, 14 males and 11 females in a population of 100 controllers were likely to develop cancer, whereas 16 males and 13 female laboratory workers were likely to develop cancer in a population of 100 laboratory workers, and during plant equipment cleaning 12 males and 10 female controllers were likely to develop cancer in a population of 1000. Therefore, the potential of developing cancer was heightened by working in the laboratory and density huts. The risk of the number of employees who were likely to develop cancer was reduced when doing plant equipment cleaning. In all three activity areas, cancer risk for males was higher than for their female counterparts. This finding denotes that male were more vulnerable than females even though the exposure concentration is the same. The higher number of males who were likely to develop cancer in all the activity areas were influenced by two factors i.e., males have a shorter average life expectancy and higher average body weight versus their females’ counterparts. A hazard quotient was used to determine the non-carcinogenic health effects, a hazard quotient of greater than 1 was used as a reference value. A value greater than 1 denoted a higher possibility that depot workers will get health effects from exposure to the Toluene, ethylbenzene, and xylene (TEX). The hazard quotient for males ranged from 4.6 to 577.5, the highest hazard quotient was more than 577 times above the HQ reference value. The lowest was at density huts for xylene and the highest was at the laboratory for a chemist for xylene. The hazard quotient for females ranged from 3.15 to 399.00, the highest hazard quotient was more than 399 times above the HQ reference value. The lowest was at density for xylene and the highest was at the laboratory for laboratory assistant. From the results, both males and females had a hazard quotient far above 1 which means health effects arising from TEX exposure were anticipated. Conclusion: The results showed highest constant BTEX concentrations in the three exposure scenarios over the 12 hours shift. The BTEX emissions were generated by activities that were performed by the depot workers. Highest BTEX concentrations were measured at laboratory, followed by density huts and the least was measured during the removal of the strainer (plant equipment cleaning). The lack of effective vapour recovery system and natural ventilation in the laboratory and in density huts also contributed to the high BTEX concentrations measured in these areas. Individual BTEX component results measured in the three activity areas indicated concentrations that were far above the South African Occupational Exposure Limits for individual BTEX. The cancer risk score was found to be far above the reference USEPA cancer risk value and denoting that depot workers were likely to develop cancer. The hazard quotient for the three exposure scenarios was also found to be greater than the reference value of 1 which indicates the potential to develop non-carcinogenic health effects due to exposure in three exposure scenarios. Recommendations: The following recommendations are made to assist management of the depot to control employees’ exposure to BTEX emissions per activity area: Density huts: The practicality of introducing a vapour recovery system on workbenches to extract the VOCs generated during sample collection and from density measuring jugs should be investigated or alternatively, the introduction of an online fuels and density analysis should be investigated or the practicality of introducing sample bombs to collect fuel samples should be investigated. Keep the windows opened to promote an ingress of fresh air and allow BTEX emissions to escape. A practicality of introducing a controlled mechanical ventilation to blow vapours away from the breathing zone of the depot workers should be investigated. Laboratory: The practicality of automating or modifying the GC equipment in the laboratory to be able to conduct an online petrochemical analysis to control employees’ exposure should be investigated. The tasks that require rinsing of testing tubes with fuels, refilling of the testing tubes, and discarding of superfluous samples should be performed under controlled conditions, the practicality of introducing a vapour recovering system to control vapours emissions should be investigated. The current practice of keeping the decanting drum open should be discontinued to prevent the accumulation of vapours in the laboratory or alternatively, it should be kept under a vapour recovery system. The practicality of keeping the retained fuel samples under the vapour recovery system in the laboratory storage should also be investigated. The fume hood and two extraction units should be serviced on a regular basis. Cleaning of plant equipment (strainer removal): The practicality of automating the removal and lifting the strainer to be cleaned to increase the distance between the strainer and receptors (controllers) should be investigated. The practicality of putting the clogged-up strainer in degreaser bath to remove and clean the strainer with the view of automating the task to prevent employees ‘exposure to VOC emissions. Recommendations applicable to all activity areas: Employees exposed to BTEX including the other petrochemicals should undergo a risk-based medical surveillance program including biological monitoring to evaluate the efficacy of the existing controls and as part of a preventative medical surveillance program. Provide information, instruction, and training at regular interval about: - petrochemicals (BTEX) that employees are potentially exposed to at workplace and duties of persons who are likely to be exposed to VOCs vapour. The names and potential harmfulness of the BTEX at the workplace and the employees who are likely to be exposed. Significant findings of the BTEX exposure assessment (an occupational health risk assessment survey). Information on how to access the relevant safety data sheets and information that each part of an SDS provides. The work practices and procedures that must be followed for the use, handling, storage, transportation, spillage, and disposal of samples, in emergency situations, as well as for good housekeeping and personal hygiene. The necessity of personal exposure air sampling, biological monitoring, and medical surveillance; The need for engineering controls and how to use and maintain them. The need for personal protective equipment, including respiratory protective equipment, and its use and maintenance. The precautions that must be taken by an employee to protect themselves against health risks associated with exposure, including wearing and using protective clothing and respiratory protective equipment. The necessity, correct use equipment, maintenance and potential of safety facilities and engineering control measures provided. Supervisor/Line Manager must give written instructions of the procedures to be followed in the event of spillages, leakages, or any similar emergency situations to employees. Once the aforementioned information, instruction and training have been provided, enforce the wearing of the prescribed PPE including ABEK respirator and no employee should be allowed to enter and remain in respiratory zone without the prescribed PPE and respiratory protection equipment (ABEK respirator).Item Facilitators and barriers influencing implementation of interventions to eliminate silicosis in the South African mining industry(2024) Patrick, Chinyelu JosephineBackground Silicosis is an occupational disease that affects workers, their life, livelihoods, families and communities. Poor workers’ health and wellness impact negatively on company efficiency, productivity and profits leading to major economic losses to the whole society. Silicosis is an added burden to the health service in South Africa. The disease is caused by exposure to respirable crystalline silica (RCS) dust. In the South African mining industry, there is an increased risk of tuberculosis among mineworkers exposed to RCS dust and those who develop silicosis. Silicosis is incurable but preventable and RCS dust control is the key. Extensive efforts have been deployed globally and nationally toward the elimination of silicosis. In South Africa, the mining industry set milestones for RCS dust reduction and silicosis elimination by 2013, now extended to 2024. The National Programme for the Elimination of Silicosis in South Africa has only been partially successful due to poor implementation of interventions, the complexity of interventions, and non-compliance with enacted policies. This may account for the fact that novice, current and former mineworkers are still being diagnosed with silicosis in the country. This study aimed to describe the existing implementation strategies and explore the facilitators and barriers to implementation of silicosis elimination interventions in the mining industry, South Africa. Methods A cross-sectional exploratory qualitative study was conducted using in-depth interviews among 18 participants selected purposively based on knowledge and experience in the mining industry. The Consolidated Framework for Implementation Research (CFIR) guided the development of the interview guides, data collection and analysis. Framework analysis was conducted and the transcribed data were coded using a hybrid of inductive and deductive coding to derive themes and sub-themes. Results 18 participants consisting of representatives from DMRE, Minerals Council South Africa, MHSC, MOSH, mining companies, unions and an academic researcher were interviewed. The five main themes identified in this study were intervention-related factors, implementation related factors, human-related factors, health-related factors and contextual factors. The strategies identified in the study were found to be part of the facilitators for implementation. The facilitators identified in the study were technological advancement, communication and dissemination of strategies, the Minerals Council’s role, industry milestones, legislation, enforcement of regulations, monitoring and evaluation, and compensation benefits. The major barriers were the lack of implementation practices and inadequate enforcement. Conclusion In the study, CFIR framework was used to guide a systematic process that looked at the strengths and weaknesses of silicosis elimination in the larger mines under the leadership of the Minerals Council South Africa. A lot of work has been done in terms of communication, legislation, enforcement, provision of interventions and efforts from all stakeholders. There a is need to improve communication and feedback with mineworkers on the message of silica dust reduction, enforcement of legislation and policies.Item Factors associated with burnout among healthcare workers in a rural context, South Africa: a cross-sectional study(2024) Moses, AlexandraBackground. Healthcare providers (HCP) were at risk of burnout related to high levels of occupational stress in the workplace. However, there was little research in rural and primary care settings in subSaharan Africa. This study aimed to describe the individual and workplace factors of public sector HCP working in Mpumalanga province, their experience of burnout and to examine the factors associated with burnout.. Methods. A quantitative study design using a cross-sectional survey was employed. The research site was Nkomazi Local Municipality in Mpumalanga Province. All HCPs (n=1 139) working at the primary healthcare clinics, community health centres and district hospitals were invited to participate in the survey. Data were collected between April and September 2022 via a selfadministered, electronic questionnaire. A demographic and occupational questionnaire, the General Help Seeking Questionnaire and the Health and Safety Executive (HSE) indicator tool were used to assess individual and workplace factors. Burnout was assessed using the Maslach Burnout Inventory– Human Services Survey. Univariate and multivariate regression analyses were used to examine factors associated with burnout. Results. Just over a quarter (n=302; 26.5%) of HCP participated. Participants were aged between 23 and 61 years, mostly female (n=252; 83.44%) and nurses (n=235; 77.81%). Most participants (n=215; 71.19%) would seek help if they had an emotional problem, most likely from mental health professionals, and least likely from traditional healers. Increased work-related stress was present due to the demands and roles of HCP. High levels of burnout were observed for Emotional Exhaustion (Median score 26 (IQR: 18)) and Personal Accomplishment (median score 29 (IQR: 9)) but not for Depersonalisation (median score 7 (IQR: 9)). On univariate regression analysis, the individual factor of being married and the workplace factor of increased years of experience were statistically significant to all three subscales of burnout. HSE factors of demands, control, management support, peer support, relationships, role and change were highly statistically significant to Emotional Exhaustion, Depersonalisation and Personal Accomplishment. On multivariate regression analysis, no individual demographic, occupational or HSE factors were significantly associated with Emotional Exhaustion or Depersonalisation. Personal Accomplishment ii improved by 0.49 (95%CI: 0.10-0.89) for every one point increase towards improved work demands, by 0.84 (95%CI: 0.01-1.67) for every point score increase towards improved management support, and by 1.19 (95%CI: 0.48-1.90) for every point score increase towards having improved role. Conclusions. During 2022, HCPs working in a rural area in South Africa displayed high levels of burnout for Emotional Exhaustion and Personal Accomplishment but not for Depersonalisation. Improvements in work demands, managerial support and role were significantly associated with an increase in the experience of Personal Accomplishment. Further research is recommended to better understand the nuances of the work environment. Solutions should be explored and implemented to prevent burnout, with special consideration given to work demands, managerial support and role clarity as part of the effort to retain rural HCP in the public health system.Item Factors associated with pre-exposure prophylaxis (PrEP) uptake and continuation among adolescent girls and young women in the uMhlathuze Municipality, KwaZuluNatal South Africa(2024) Methazia, Jewelle Joanna SardisBackground Despite the notable advancements in preventing human immunodeficiency-virus (HIV) globally, South Africa (SA) continues to report the largest epidemic of HIV in the world. Furthermore, adolescent girls and young women AGYW) in SA carry the unequal burden of infection in SA. Studies have reported that AGYWs find it difficult to negotiate condom use placing them at a direct risk of contracting HIV. Pre-exposure prophylaxis (PrEP) was identified as a novel preventative intervention with uptake and continued use offering the potential to decrease HIV incidence. In SA, guidelines, and strategies to provide of PrEP to high-risk groups, which include AGYW have been developed. This study aimed to describe the characteristics of the AGYW initiating PrEP services and determine the factors associated with PrEP uptake and continued use among AGYW enrolled in an HIV prevention combination program in the uMhlathuze Municipality in KwaZulu-Natal South Africa. Methods This is a retrospective cohort study involving secondary data analysis of programmatic data from an HIV combination prevention program for AGYW in 5 Department of Health community primary health clinics the uMhlathuze Municipality in KwaZulu-Natal. We sampled participants from a population of HIV uninfected AGYW between the ages 15 -24 that initiated the program between the 1st of June 2020 and the 31st of June 2021. Our primary outcome of interest was PrEP initiation at baseline defined as the number of AGYW who were offered PrEP and initiate its use during at their first visit. Our secondary outcome of interest was PrEP continuation at follow-up visit defined as having at least 1 record of follow up after PrEP initiation. Categorical variables were expressed as frequencies and proportions. Bivariable analysis was carried out to determine associations between PrEP initiation and the categorical variables using the Chi-squared (χ2) test. Log-binomial regression was utilised to evaluate risk factors associated with our primary outcome (PrEP initiation) and our secondary outcome (PrEP continuation). Risk ratios (RRs) and their 95% CI were used as the measure of effect. Variables with p<0.1 were included in the multivariable analysis for both PrEP initiation and PrEP continuation to ascertain factors associated with each outcome. A cut off p<0.05 was used in the multivariable model to identify factors associated with both the primary (PrEP initiation) and secondary outcome (PrEP continuation). All statistical analyses were performed using Stata (V.15) statistical software and RStudio. Results Between the 1st of June 2020 and the 31st of June 2021, 3324 AGYW were enrolled in the HIV prevention combination program and were offered PrEP services. Overall, 1609 (48%) initiated PrEP services. Majority (71%) were aged 19 - 24 and 6.5% of PrEP initiates reported having an STI in the 6 months prior to initiating PrEP pills. Among those that initiated PrEP only 8% (N=125) had at least 1 record of follow-up post initiation. Factors that remained significantly associated with PrEP initiation in the multivariable analysis were had STI in the last 6 months (RR:2, CI: 1.5-2.8, p<0.001); currently on STI treatment (RR:1.6, CI: 1.2-2.3, p=0.004); used condom at last sexual encounter (RR:1.8, CI: 1.2-2.8, p=0.007). For our secondary outcome of interest PrEP continuation, factors associated with continued use of PrEP in our univariable analysis were age category 19-24 (RR:0.7, CI:0.5-1.0, p=0.036); used condom at last sex (RR: 1.7, CI:0.9-3.2, p=0.092). However, none of these factors remained statistically significant predictors of PrEP continuation in the multivariable model. Conclusion This study had moderate uptake of PrEP and poorer continuation than other studies. It is possible that lockdown restrictions implemented to curb the transmission of COVID-19 at the time of the study may have hampered the success of the PrEP intervention for AGYW enrolled in the HIV combination prevention program. This finding calls for more innovative PrEP service delivery models for programs and interventions in real clinic settings to ensure AGYW have uninterrupted access to PrEP when access to clinics is restricted. Our findings demonstrate important differences between PrEP uptake and key sexual and HIV risk behaviours. Our unadjusted analysis showed positive associations between PrEP uptake and the use of condoms at last sexual encounter, current STI diagnosis and STI diagnosis in the last 6 months, pregnancy, HIV discordant relationships, and having heterosexual anal sex. We continued to observe positive associations between the PrEP uptake and the use of condoms at last sexual encounter, current STI diagnosis and STI diagnosis in the last 6 months in our adjusted analysis. Condom use at last sexual encounter was common among PrEP initiates, and many AGYW currently taking STI treatment and those who had an STI in the last 6 months also elected to use PrEP pills. Our findings indicate programs offering PrEP should also integrate STI services with appropriate testing approaches and targeted vaccination for AGYW.Item Knowledge, attitudes, and referral practices regarding animal bites and prevention of human rabies among traditional health practitioners in Ethekwini district in Kwazulu-Natal province, South Africa, 2022(2024) Mabona, Maxwell MusaBackground: Despite the availability of effective post-exposure prophylaxis (PEP), South Africa records about 10 human rabies deaths each year. Many animal bite victims initially seek help from Traditional Health Practitioners (THPs) before considering conventional healthcare facilities. Prompt referral of animal bite victims for PEP initiation by THPs can be lifesaving. Our study aimed to assess the knowledge, attitudes, and referral practices regarding human rabies and the associated factors among THPs in eThekwini District, KwaZulu-Natal. Methods: We conducted a cross-sectional study among registered THPs consulting patients in the eThekwini District. We used a structured standardized questionnaire to collect data. The questionnaire was administered through physical and telephonic interviews. We described socio-demographic characteristics using summary statistics. Multivariable logistic regression was used to analyze factors associated with knowledge, attitudes, and referral practices of human rabies. Odds ratios (OR) were used with a 95% confidence interval, and a probability (p)-value of ≤0.05 was considered statistically significant. Results: We interviewed 204 THPs, and 74% (150/204) were female. The median age was 43 years (inter-quartile range: 22-75 years) and 31% (64/204) had over 10 years of experience. The majority of THPs had inadequate knowledge (80%, 163/204), and poor referral practices (73%, 149/204). However, 91% (186/204) had positive attitudes toward human rabies prevention. Having more experience was associated with adequate knowledge (p<0.01), and positive attitudes (p=0.02). THPs who had adequate knowledge (aOR:2.30 95% CI: 1.12-4.75) and positive attitudes (aOR:1.21 95% CI: 0.37-3.89), had higher odds of having good referral practices. Conclusion: Despite THPs in eThekwini District having positive attitudes towards rabies prevention, gaps exist in their knowledge and referral practices. The study highlights that improving their knowledge and attitudes might lead to better referral practices of animal bite victims for PEP initiation. A multidisciplinary approach that includes THPs is recommended to decrease human rabies deaths in eThekwini District.Item Nurses’ experiences in implementing Nurse Initiated Management of Anti-Retroviral Therapy (NIMART) in primary health care facilities in Dr Ruth Segomotsi Mompati District, North West Province(2024) Sibisi, NthabisengAim of study- This study aimed to explore the nurses’ experiences in the implementation of NIMART in Dr Ruth Segomotsi Mompati District since its inception in 2010 to 2017. Methods This study employed an exploratory qualitative research design. The study setting included nine PHC facilities in three sub-districts. The study included only those nurses who had been trained to implement the NIMART in the district PHC facilities from 2010-2017. The final sample included Sixteen (16) nurses, comprising of three males and thirteen females from the three eight-hour operational clinics and six 24-hour Community Health Centres (CHCs). Data were therefore collected using in-depth interviews lasting thirty-five minutes (minimum) one and half hours 1h30 minutes (maximum). These interviews were guided by a semistructured interview guide. Data were later transcribed verbatim using an electronic software O’ Transcribe, and then analysed using MAXQDA 2018v, where inductive coding was applied. Thematic analysis was employed to interpret and represent data, which was finally presented as themes based on participants’ dominant narratives. Results- There were five key themes that emerged from this study. These included: perceptions about the NIMART programme mostly related to it being a task-shifting strategy when managing HIV and Aids and the programme benefits; contextual elements affecting access and adherence to NIMART, and challenges such as socio-cultural factors, social norms, socio-political and governance factors; facilitators of NIMART implementation in terms of functional health information management system and clinical guidelines, multidisciplinary team and skilled personnel, impactful counselling services, and intrinsic nurse motivators. Challenges of NIMART implementation included insufficient human resources for health, services integration, poor management and health-service support systems, lack of capacity building, ART unavailability and poor patient compliance to ART, and nurse demotivation. The proposed interventions by the nurses included provision of training, increasing staff to curb workload, management support, and debriefing, health service support resources and patient support improvement. Conclusion Task-shifting and successful NIMART implementation are complex notions, which can be successful if accompanied by training, reorganisation of services, mentoring, supervision, and ongoing support from existing health-service system structures. The rural health context must be considered as unique, and policies should be tailored to suit the needs of rural healthcare workers and patients. Dr RSM case-study has shows the plight of farm labourers and the need for a multisectoral approach to address patient related issues in this context. The challenges to successful NIMART implementation suggest a need for reorientation of health-services to fit rural contexts.Item Occupational noise exposure among groundskeepers at a public university in Gauteng, South Africa(2024) Mokone, MosesBackground- There is sufficient scientific evidence indicating that excessive and prolonged exposure to noise causes noise-induced hearing loss (NIHL), also known as permanent hearing loss and other non-auditory effects such as sleep disturbance, hypertension, and interference with the nervous and cardiovascular systems. The World Health Organization (WHO) estimated that NIHL costs approximately 0.2% to 2% of the gross domestic product (GDP) of the developed nations in terms of compensation and economic burden on society. It also estimated that more than 16% of the NIHL in adults is attributable to occupational noise exposure. Although preventable, NIHL is one of the most widespread irreversible occupational disease worldwide and thus was declared as a serious occupational hazard. Worldwide, occupational noise exposure is widely regulated and most countries, including South Africa, use 85 dBA as the occupational exposure limit for noise exposure and has adopted the 3-dB exchange rate, with the exception of the US and Brazil, amongst others, which use the 5-dB exchange rate rule. Exchange Rate is the increase in noise level that corresponds to a doubling of the noise level. A few countries around the world such as the US, Japan and India use 90 dBA as a regulated limit for noise exposure. Acute hearing loss can also occur suddenly if a person is exposed to very high impact noise (above 140 dBC) for a short duration such as explosion and gun shots. Research shows that 8-hour average daily noise exposure levels between 75 dBA and 80 dBA are unlikely to cause hearing loss. The International Organization for Standardization (ISO 1999) “Acoustics - Determination of Occupational Noise Exposure and Estimation of Noise-Induced Hearing Impairment” provides damage risk criterion information that enable the prediction of NIHL at various audiometric frequencies and for varying exposure durations. Attempts to limit human exposure to noise are based on damage risk criterion. For example, the National Institute for Occupational Safety and Health (NIOSH) estimates a risk of NIHL after a 40-year working lifetime of 1% at 80 dBA, 8% at 85 dBA, and 25% at 90 dBA. This shows that the 85 dBA limit does not guarantee safety, since 85 dBA is already indication 8% excess risk. The WHO has indicated that workers employed in sectors such as manufacturing, transportation, construction, mining, utility, agriculture and military have the highest risk of 2 | P a g e NIHL. In the Services sector, which include Garden and Landscaping services, the extensive use of powered lawn maintenance machines results in widespread exposure to high levels of noise. The employees employed in the garden and landscaping sector such as groundskeepers, are in charge of maintaining general landscape of public and private areas such as sporting grounds, community parks and learning institutions grounds. Their main tasks involve a variety of outdoor activities such as clearing leaves, mowing lawns, cutting trees, trimming hedges, applying fertilizer, removing dead or unwanted plants and other general garden maintenance work. Noise exposure, which is one of the main health hazards that severely affect the health of these employees during operation of powered lawn maintenance machines such as leaf blowers, riding and push lawnmowers, brush-cutters and chainsaws can be a significant source of workplace noise exposure among groundskeepers. Although the literature on occupational noise exposure has concentrated on large industrial sectors (mining, construction, manufacturing and transportation), the problem extends to smaller operations such as lawn maintenance. Recent literature suggests that noise generating activities in small-scale operations, such as lawn maintenance, use high noise emitting machinery. Purpose- The purpose of this study was to evaluate occupational noise exposure levels of groundskeepers who operate different types of powered lawn maintenance machines at three campuses of a public university in Gauteng and estimate their risk of NIHL. Methods- A quantitative, cross-sectional study design conducted among groundskeepers following a nonprobability convenience sampling strategy was used. Personal and area noise exposure levels were evaluated in accordance with the South African National Standard (SANS) Code of Practice 10083:2013. The measurements for personal noise were conducted using a type 2 Casella dBbadges (personal noise dosimeters), which were placed on the groundskeepers’ shoulders, close to the ear adjudged as receiving the highest noise levels covering sufficient time representative of daily (task-based) exposure. Area noise measurements were performed using a type 1 Quest integrating sound level meter (SLM), which was mounted on a tripod stand and placed at approximately 1.5 meters above the floor and 1 m from the noise generating machine. In each measurement position, one-minute measurements were completed, and Aweighted equivalent noise levels (LAeq) were recorded. To ensure accuracy of measurements, the noise measuring instruments were calibrated before and after each series of measurements v using a calibrated portable acoustic calibrator as per the manufacturer’s instructions. The SLM and personal noise dosimeters (PNDs) were calibrated using a type 1 acoustic calibrator (Model QC-10, Quest Technologies, USA) and type 2 acoustic calibrator (Casella CEL 110/2, Regent House, Bedford, U.K) respectively. No significant shift in calibration was detected for any individual measurement. All the noise measuring instruments were externally calibrated by a South African National Accreditation System (SANAS) 17025 accredited laboratory. A questionnaire constructed by the primary researcher was utilized to record groundskeepers’ demographic information, work processes pertaining to tasks performed and noise exposure levels, including certain elements of hearing conservation practices such as information and training, audiometric testing, and use of hearing protective devices (HPDs). A total of 18 PND measurements and 17 area noise measurements were conducted at three university campuses i.e. Campus A, Campus B and Campus C. The noise measurements were conducted over a period of five (5) days (1-3 September 2021 and 3-4 November 2021). Data/ readings from the noise monitoring instruments were manually recorded on predesigned field sheets and manually entered onto Microsoft Excel spreadsheet. Thereafter, a statistical analysis using a one-way analysis of variance (ANOVA) was carried out to determine whether a significant difference existed between the mean personal and area noise exposure levels measured at three university campuses. Formulas from the SANS 10083 standard were used to calculate measured noise levels for comparison with the regulated noise rating limit of 85 dBA using Microsoft Excel spreadsheet Results- The results of this study showed that majority, 78% (14 out 18), of groundskeepers’ personal noise exposure levels (task-based) in the three campuses exceeded the legislated noise rating limit of 85 dBA, thus increasing groundskeepers’ risk to NIHL. Groundskeepers in campus A were exposed to the highest eight-hour equivalent continuous A-weighted sound pressure level (LAeq, 8h) with mean noise levels of 91.5 dBA ±4.7, followed by campus B and C with mean noise levels of 89.1 dBA ±4.0 and 86.9 dBA ±2.9 respectively. Peak noise exposure levels (LCpeak) measured as part of personal noise exposure in the three campuses ranged from 115.6 dB to 140.0 dB. These excessive peak noise exposures are attributed to the types of machines used during lawn maintenance activities. The overall statistical difference in the mean personal noise exposure levels (LAeq, 8h) and peak levels (LCpeak) between the three campuses were found to be not significant for both the LAeq, 8h (P = 0.304) and LCpeak (P = 0.607). vi Furthermore, majority, 71% (12 out 17), of area noise levels measured on specific lawn maintenance machines had equivalent continous A-weigted sound pressure level (LAeq) above the noise rating limit of 85 dBA. Machines measured in campus A had the highest area noise levels (LAeq) with mean noise levels of 98.8 dBA ±6.9, followed by campus B and C with mean noise levels of 92.9 dBA ±8.3 and 91.6 dBA ±5.1 respectively. The overall statistical difference in the mean area noise levels (LAeq) between the three campuses were found to be not significant (P = 0.135). The findings of this study demonstrated that the study participants comprised a total of 18 males across the 3 campuses, with mean working experience in the current job of five (5) years (ranging 2 – 11 years). Majority (9 out of 18 or 50%) of the participants were aged between 36–45, while only 16% (3 out of 18) were above the age of 56. The distribution of the participants according to their education was 100% secondary school. This may have positive implications for understanding of information and training material used for noise exposure awareness. The results of groundskeepers’ awareness to certain elements of hearing conservation program, with specific focus to information and training, audiometric testing, and use of hearing protection devices (HPDs) revealed that majority (95%) of groundskeepers were not trained about the noise rating limit and its meaning as required by Regulation 4 of the NIHL Regulations. Furthermore, it was found that, 50% of groundskeepers indicated that they never received information and training on the health effects of noise exposure while working at the university. In terms of audiometric testing, 78% of groundskeepers indicated that they were given audiometric testing while employed at the university. The study further indicated that majority (63%) of groundskeepers reported that, they use hearing protection devices (HPDs) while operating noisy machines. Notably, 90% of groundskeepers reported that, there is no one who is checking and supervising if they wore HPDs while operating lawn maintenance machines. The analysis further shows that, 47% of groundskeepers reported that, their HDPs were not comfortable when worn. Conclusion- The findings of this study have highlighted that, although the university had hearing conservation programs in place, there were shortcomings in the implementation of some elements of the program, in particular with regard to information and training, noise exposure monitoring and use of hearing protection devices. Most groundskeepers were exposed to noise vii levels exceeding the noise rating limit of 85 dBA and were at risk of acquiring NIHL. When considering the peak noise levels, the results of the study showed that there was only one groundskeeper from campus A who was exposed to noise levels exceeding the peak limit of 140 dBC. In all cases, employees should never be exposed to peak noise levels in excess of 140 dBC. Prevention, by reducing the noise exposure via engineering measures should be prioritized. The peak noise exposure limit of 140 dBC is regulated in the European Union Physical Agents (noise) Directive 2003/10/EC (2003) as an upper exposure action value. This EU noise directive is adopted by most European countries. Currently in the South African NIHL Regulations and SANS 10083 standard, peak noise exposure levels are not regulated. No significant differences were found in the mean area and personal noise levels measured in the three campuses. However, the use of certain machines such as backpack leaf blower and chainsaw were shown to be associated high noise exposure levels. Therefore, it is essential to ensure that noise levels on the lawn maintanance machines are significantly reduced by implementing good maintenance practices and buy quiet program. Information and training interventions should be aligned to target potentially exposed groundskeepers to modify their perceptions, noise control adherence approaches and continual motivation to sustain and improve an implemented hearing conservation program. This is the first study in South Africa to evalaute occupational noise exposure among groundskeepers in a public univeristy. Findings from this study may contribute to existing knowledge on occupational noise exposure among groundskeepers and may be investigated by other universities where lawn mainteance machines are used. However, the findings of this study may not be generalized to other universities because the study was only conducted in one university. Lessons drawn from this study are that there is a greater need to enhance hearing conservation measures in gardening and landscaping services within the universities.Item Percentage positivity and determinants of cytomegalovirus infection and immunity in the public sector of south africa, 2007–2021: a time series analysis(2024) Mhlabane, Nelisiwe LynnethCytomegalovirus (CMV) infection is common in all age groups but is more prevalent in women of childbearing age and neonates. If left untreated, CMV can cause birth defects, recurrent infections, and death. Understanding the burden of CMV disease and its risk factors is important to instigate preventive measures. Despite global research conducted on CMV, there is still a paucity of studies conducted in South Africa that focus on CMV current infection and its determinants as well as immunity to CMV. The goal of this study was to determine the prevalence of CMV infection and immunity and the factors that influence them in South Africa’s public sector between 2007 and 2021. Methods: An analytical cross-sectional study was conducted using the results of CMV tests carried out on patient samples. The included test results were obtained from the National Health Laboratory Services and included results from all South African provinces from 2007 to 2021. The data were extracted from the National Health Laboratory Services Corporate Data Warehouse. Records of participants of all age groups whose data were available at the National Health Laboratory Services Corporate Data Warehouse were obtained. Patient demographic details and laboratory results were extracted into data collection tables. Data was cleaned and analysed using Stata 17. The CMV results considered in the analysis were serological (immunoglobulin M [IgM] and Immunoglobulin G [IgG] and molecular polymerase chain reaction tests carried out for routine CMV diagnosis. Immunoglobulin M, 2 polymerase chain reaction, and IgG seroconversion are markers of current CMV infection. A positive IgG antibody result is a marker of immunity (previous infection). A current CMV infection was defined as a positive CMV immunoglobulin M result, a CMV IgG seroconversion from negative to positive within three months of testing, or a positive CMV polymerase chain reaction result. Descriptive statistical analysis along with multivariable logistic regression analyses was used using age, sex, province, year and HIV. Results: A total of 432,170 records were analysed for CMV infection from 2007 to 2021. Among those with available CMV IgG test results, 97.84% (190,933/197,157) tested positive. For those with available CMV immunoglobulin M test results, 5.85% (16,850/288,267) tested positive. Overall, 4.40% (19,006/432,170) of records had evidence of a current CMV infection. Stratified analysis by sex showed similar proportions of current CMV infection for men (4.48%; 7,534/155,515) and women (4.08%; 10,649/261,310). Individuals aged 0–1 year had the highest proportion of current CMV infection at 7.35% (7,682/104,510), while those aged 2–15 years had the lowest proportion at 2.74% (979/35,686). Limpopo had the highest proportion of current CMV infections with 5.23%, (1,586/30,340), and the Western Cape had the lowest CMV current infection with 2.24% (788/35,114). In adjusted analysis, age and province were significantly associated with current CMV infection. Using individuals 0–1 year as the reference, all other age groups were less likely to test positive for CMV; the age group 2–15 years had the lowest CMV current infection (AOR = 0.34; 95% CI = 0.32–0.36). Limpopo (AOR = 1.91; 95%CI = 1.76–2.0; p = <0.0018) had the highest odds of current CMV infection while Western Cape had the lowest odds (AOR = 0.66; 95%CI = 0.60–0.73; p = <0.001). HIV infection, sex, and season were not associated with current CMV infection in the adjusted analysis. Regarding CMV immunity, the age group 26–35 years had the highest number of individuals who were IgG positive (99.18%; 45,845/46,223). The Northern Cape province had the highest concentration of IgG-positive individuals (98.81%; 407/4,460), and the year 2012 had the largest percentage of IgG-positive individuals (98.29%; 11,607/11,809). Conclusion: Age and place of residence (province) were associated with current CMV infection. Cytomegalovirus seroprevalence did not differ by gender. We found that a significant proportion of children are not susceptible to CMV infection. More recent 3 data would be useful to evaluate CMV infection in the South African populace and to give a clearer idea of the epidemiology of CMV infection. Meantime, without an effective CMV vaccine, the major preventive measure is educating people about CMV risk mitigation measures. Cytomegalovirus infection vaccines are still in the early phases of development, and our study contributes to identifying a potential target age for vaccination.Item Predictors of resilience among adolescents living in rural Mpumalanga in 2018: a cross sectional study(2024) Snijder, MichelleLiterature suggests that resilience can be reached by practicing behaviours, thoughts and attitudes that promote resilience. To understand which behaviours, thoughts and attitudes foster resilience, predictors of resilience should be studied. This study aimed to examine predictors of resilience among adolescents living in the rural Mpumalanga Province, South Africa. Data were collected using a questionnaire from a sample of 245 adolescents between 13.1 and 15.2 years (median age 14.1 (13.1- 15.2); sex 52.7% female and 47.4% male). The questionnaire included questions from depression, stress and resilience scales as well as additional questions relating to communication with parents, and socio-demographic characteristics. The 20 question Centre for Epidemiological Studies Depression Scale (CES-D) measured depression, the 10-item Perceived Stress Scale (PPS-10) measured stress while the 25-item Connor Davidson Resilience Scale (CD-RISC-25) measured resilience. The prevalence of resilience was estimated at 46.1%. The findings suggest that perceptions of stress did not significantly predict resilience. Experiencing depressive symptoms and healthy interpersonal relationships significantly predicted high resilience. Although healthy relationships with parents predicted high resilience, adolescents relied more on relationships with friends to build resilience. However, regularly meeting with friends predicted low resilience, while always meeting with friends decreased the chances of low resilience. Thus, the study suggests that healthy relationships with both parents and friends may predict high resilience. However, when relationships with friends replaces that of parents, low resilience results. Finally, this study supports the need for further studies on the validity and acceptability of the PPS-10 and CES-D scales in the South African context.