3. Electronic Theses and Dissertations (ETDs) - All submissions

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The accuracy of the denver developmental screening test II in identifying developmental delay in high risk newborns at Charlotte Maxeke Johannesburg Academic Hospital
(2020) Madini, Katlego Babo Boitumelo Jostinah
Background: The Denver Developmental Screening Test II (Denver II) is used to assess the development of high risk newborns at a tertiary hospital in Johannesburg. Aim: This article aims at assessing the accuracy of the Denver II in identifying developmental delay 6 in high risk newborns. The Bayley Scales of Infant and Toddler Development III (BSID III) is used as a gold standard test, to determine the level of agreement between the two tests. Method: This is a retrospective descriptive study. The study population consisted of both normal and high 10 risk neonates born between 1 July 2013 and 31 December 2015. The results of infants that had both a Denver II and a BSID III were assessed. Results: The sensitivity of the Denver II in identifying developmental delay was .8% and 44.0% for a 14 BSID III composite score cutoff of <85 (“at risk”), and <70 (“handicapped”) respectively. The Denver II had a specificity greater than 90%.for both BSID III composite cutoff values. The agreement between the results of the two tests were represented by a Kappa value of 0.111 for the BSID III assessed as “at risk” (p = 0.014), and 0.423 for the BSID III assessed as “handicapped” (p < 0.000). Conclusion: The Denver II is not accurate in identifying developmental delay. There is a slight to moderate agreement between the Denver II and the BSID III tests. The Denver II is not a suitable screening test for use in South African infants, and further research is required.
Adult intracranial neoplasms: radiologic and histopathological correlation
(2024) Mojapelo, Besley
Background: Imaging plays an important part in the management and prognosis of an intracranial neoplasm. MRI and its advancement with the addition of DWI/ ADC, PWI and MRS have greatly enhanced the diagnostic accuracy of MRI in that there is better characterisation and differentiation of intracranial neoplasms. Aim: To document and evaluate the histopathological diagnoses and the MRI imaging findings of intracranial neoplasms in adult patients at CHBAH. Method: A retrospective study was conducted using MRI and histopathology reports from January 2017 to September 2019. Statistical significance was met when p-value <0.05. Results: The study included 53 (N=53) adult patients with confirmed intracranial neoplasms. There were 26 (49%) males and 27 (51%) females with an age range of 18 to 71 years. The most frequent anatomical sites were the sellar/suprasellar region 22 (42%) and the frontal lobe 8 (15%). Pituitary adenoma 18 (34%) was the most common neoplasm followed by meningioma 14 (26%) and glioblastoma 7 (13%). Low-grade (WHO I/II) neoplasms were more frequent 37 (70%) than the high-grade neoplasms (WHO III/IV) [16 (30 %)]. The overall concordance between the MRI and the histopathology diagnoses and grading demonstrated a good agreement with Kappa values of 0.63 and 0.71, respectively. Conclusion: Conventional MRI constitutes the most utilised MRI technique in the characterisation of intracranial neoplasms. Due to limitations thereof, advanced MRI techniques may improve the diagnostic accuracy. Conventional MRI, advanced MR techniques and histopathology are complementary diagnostic modalities for the classification of intracranial neoplasms.
Analysis of the thickness of the cortices along the course of the inferior alveolar nerve
(2024) Seleke, Kgothatso Morake
Introduction Surgical procedures performed around the course of the inferior alveolar nerve (IAN) accounts for 63% of neuropathy reported2 . These surgical procedures include dental implant placement, surgical extractions around the lower molar area, internal fixation, mandibular ramus graft and bilateral sagittal split osteotomy. Failure to pay attention to detail while performing these surgical procedures may result in inferior alveolar nerve injuries, developing in neurological deficit which are characterized by either paraesthesia or anaesthesia. Aim -The aim of this study was to analyse the buccal and lingual cortical bone thickness along the course of the inferior alveolar nerve. Objectives To analyse the thickness of the buccal-lingual cortical bone along the inferior alveolar canal (IAC). To determine whether there is association between position of the IAC and thickness of the cortices. To determine the factors (age and gender) associated with buccal-lingual position of the nerve. Materials and Methods This was a retrospective study based on analysing radiographic records of patients who took CBCT at Wits Oral Health Centre (W.O.H.C) from January 2015 up to December 2018. The estimated sample size was 132 quadrants of CBCT images which was determined with 95% confidence level, 5% margin of error, 50% population proportion and 200 population size. CBCT images were taken using SIDEXIS next Generation software. The IAN was identified and highlighted along its course to the mental foramen. Results- The male and female buccal-lingual cortical measurements at all points were approximately the same. The lingual right cortical thickness increased with an increase in age, and the buccal right cortical thickness decreased with an increase in age. There was no association between gender and IAC position. The width of the buccal cortex was greater on the left than the right side and the lingual cortical thickness was also greater than the right. In the present study it was found that the males had a thicker buccal cortex posteriorly and a thinner cortex anteriorly compared to females. Females had thicker buccal cortex on the right side at point posteriorly whereas anteriorly it was thicker on the left. The left and right buccal cortices show the median increase in all age groups. The IAC was close to the lingual cortex at the molar region and buccal cortex at the premolar region. The position of the IAC whether buccal, lingual or inferior can be attributed to the type of the IAC as; straight projection, catenary-like projection and progressive descent. It was also determined by the type and depth of impaction, position of the roots of the third molar and the width or thickness of the buccal-lingual cortices. Conclusion- CBCT play an integral role in diagnostic imaging due to details of the images. The position of the IAC that houses IAN is influenced by various factors including but not limited to gender and age as well as the surrounding anatomy. By understanding the surrounding anatomical influences on the position of the IAN, any surgery to the area would minimize complications associated with the IAN especially with the use of detailed imaging such as CBCT.
Ethical management of Gold mine workers with early and mild silicosis in South Africa
(2024) Mojakwana, Angeline
The South African Gold Mining industry is an inherently risky working environment, with frequent accidents and crystalline silica dust exposure that causes silicosis and other cardiorespiratory and autoimmune complications. These diseases can considerably impact the gold mining industry and potentially lead to public health disasters by exacerbating existing tuberculosis (TB) burden in communities and the public health sector. It is of utmost importance to control silica dust exposure and to protect mineworkers from the impact of silicosis. In this study, I interrogate the morality of issuing certificates of fitness to already affected mineworkers to continue risk work underground where they are further exposed to silica dust, which leads to accelerated progression of their illness and its complications. Specifically, the study defends the thesis statement that mineworkers with early and mild silicosis ought not to be certified to continue risk work underground in the gold mining environment where they are further exposed to silica dust. A normative principle derived from the combination of key principles in welfarism and Afro -communitarian solidarity was used to defend the claim. This mostly evaluative study – that draws on desktop-based research – outlines many recommendations, including a revision of Occupational Diseases of Mines and Works Act ODMWA (given that the Act is insufficient and not adequately inclusive), continuous evaluation, monitoring and improvement of control processes to mitigate the impact of silica dust exposure and silicosis and alternative reasonable accommodation of mineworkers with silicosis to protect them from further exposure to silica dust.
Factors associated with mortality in very low birth weight neonates treated with invasive mechanical ventilation at a tertiary hospital in South Africa
(2024) Goldstein, Rowan Clive
Introduction: Respiratory support with invasive mechanical ventilation (IMV) is a critical intervention available to neonates, especially amongst very low birthweight (VLBW) neonates. Since its introduction in the 1960s it has been associated with an increased survival amongst VLBW neonates. Objectives: To describe the characteristics and outcomes of VLBW neonates who received IMV in the neonatal intensive care unit (NICU) at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methods: This was a retrospective, descriptive study of neonates who required IMV admitted to the NICU at CMJAH, between 1 January 2013 and 31 December 2019. The characteristics and outcomes of these neonates were described using univariate analysis. The NICU is combined with the paediatric ICU and comprises of 15 beds. Results: There were 3 484 VLBW neonates admitted during the study period of which 849 required IMV (24.4%). Of the 849, 445 survived (52.4%). 44 infants required high frequency oscillatory ventilation, 16 of whom survived (16/44, 36.4%) making the need for HFOV one of the factors strongly associated with a poor outcome (p<0.001). Other significant associations with poor outcomes were lower birth weight (p<0.001), lower gestational age (p=0.003), the presence of metabolic acidosis (p<0.001), the diagnosis of NEC (p<0.001), pathological cranial sonar findings (p<0.001), and longer length of hospital admission (p<0.001) Conclusion: One quarter of VLBW neonates admitted at CMJAH required IMV during their hospital admission. We demonstrated a survival rate of 52% for ventilated VLBW infants. The only predictive factor for mortality was the presence of metabolic acidosis, likely a surrogate for severity of illness
From the onset: impact of nutrition and lifestyle during the preconception period in urban South African young adults
(2024) Mukoma, Gudani G.
Background- In South Africa, 22% of adolescents are overweight or obese, the onset of tobacco smoking is shown to peak between the ages of 15 and 22, 1 in 3 adolescents watch more than 3 hours of television per day, and nearly half of all adults are insufficiently active. Physical inactivity, poor diet, risky alcohol use, illicit drug use are among the behavioural risk factors associated with obesity and mental health problems, all of which have morbidity and mortality implications for adult health. Risks in later life include premature death, long-term disability, childbirth complications, gestational diabetes, diabetes and cardiovascular diseases. However, there is data paucity showing the personal, social, and environmental factors that are determinants of health, especially diet, physical activity (PA), obesity, and associated NCDs in South African adolescents and young adults. Aim- To investigate the individual, household, and environmental factors that influence adolescents' dietary and physical activity habits and to identify ways in which these factors can be leveraged for interventions to better ensure the health of future generations, especially during the crucial preconception years. Methods- This thesis was purposely designed to use a sequential mixed-methods approach that integrates quantitative (Chapter 3 paper 1: cross-sectional and Chapter 6 paper 4: longitudinal) and qualitative (Chapter 4 paper 2: longitudinal and Chapter 5 paper 3: crosssectional) analyses in order to meet the four specific objectives of my research. The methods selected for this series of investigations were primarily influenced by the substantive research questions that arose, as opposed to methodological and epistemological concerns alone. I utilized three pre-existing data sources, including the "Birth-to-Twenty Cohort," the "Determinants of Type 2 Diabetes Mellitus (T2D)" study, and the "Soweto household enumeration survey." I have gathered new prospective data that is quantitatively and qualitatively longitudinal and cross-sectional. Results- The findings of this thesis in the context of Soweto show that the relationship between dietary patterns and nutritional status (BMI) is independent of socioeconomic status (SES). Adolescents and young adults face a variety of intersecting barriers resulting from personal preferences and their living conditions, which influence their dietary and physical activity habits while occurring at the time; this is important to consider when designing interventions to promote healthy behaviour change. Unexpected stressors, such as the outbreak of the COVID-19 pandemic, contributed to exacerbating adolescents' and young adults' poor health conditions, and as a result, the prevalence of poor nutrition intake, a lack of physical activity, and mental health issues increased. Although the nutrient patterns of adolescents and adults were comparable over time, their associations with BMI were not. The associations with BMI of the "plant-driven nutrient pattern," "fat-driven nutrient pattern," and "animal-driven nutrient pattern" revealed sex differences. Conclusion- Adolescent diet and lifestyle continue to be important research areas in the intent to enhance preconception health and reducing maternal and infant mortality
Investigating knowledge, attitudes and perceptions of COVID-19 vaccines among young people in Soweto, South africa
(2024) Muthoni, Jelioth
Vaccination against SARS-CoV-2 is the most prominent strategy in the global fight against COVID-19. Studies continue to show that vaccines are one of the most dependable and cost-effective public health interventions available as they save life every year. However, World Health Organization (WHO) has identified vaccine hesitation as one of the primary threats to global health. Little is known, however, about the causes and nature of vaccine hesitancy in Africa. Moreover, in South Africa a significant drop of COVID-19 vaccine when it was rolled out the youth. The age group is of critical importance as they are becoming productive people who would be essential in the development of any country hence the need to protect them. Furthermore, understanding why youth are hesitant to get vaccinated is critical if we are to increase and sustain public demand for vaccination and preserve the tremendous achievements of vaccination programs on the continent. Unfortunately, there are limited studies that have investigated vaccine hesitancy among the youth populations and precisely looking at their knowledge, attitudes, and perceptions of the COVID-19 vaccine. Hence, the study aims to investigate knowledge, attitudes and perceptions of COVID-19 vaccine among young people in Soweto. The study employed a quantitative method, whereby closed ended questionnaires were administered using Redcap a very power tool for collecting data. Quantitative method was the best fit for the study for it accommodates a large sample size. SowetoThembelihle Health Demographic Surveillance System database was in the identification of the samples. STATA version 13.0 was used for statistical analysis. Out of a sample size of 380, the study recorded a 79.2% (301/380) hesitancy levels. The study population recorded to be knowledgeable on COVID-19 disease and vaccine. However, negative attitudes and perceptions based on the study participants responses in some important elements. The elements included ‘COVID-19 is a hoax’ (p=0.011), ‘I prefer to gain immunity by being sick rather than by having a vaccine ‘(p=0.000) and ‘COVID-19 vaccine has serious side effects’ (p=0.000) The study found out that infordemic has played a significant on the knowledge levels precisely among the youth. The study participants were well- informed, but they had poor attitudes and perception towards COVID-19 vaccine. These insights could help to reinforce national efforts to contain the pandemic across South Africa in particular Soweto and lessen other important consequences of the pandemic well-being.
Moral justification of continued exceptionalism of HIV care in South Africa
(2024) Maserumule, Letjie Charmain
South Africa has the largest population of people living with HIV (PLWHIV) in the world, and specialized HIV clinics to treat them are unsustainable. Decentralisation of care to primary health care (PHC) facilities reduces the burden on HIV clinics, but the PHC facilities are already overburdened with limited human and infrastructure resources. My aim is to defend that it is morally and legally justified to temporarily continue exceptionalism of HIV care in South Africa while strengthening health systems. My arguments are based on patients’ right to healthcare, the bioethical principles of beneficence and non-maleficence, and deontological moral theory. I contend that the complete abandonment of HIV clinics would burden PHC facilities even more, thus affect rendered care negatively, and violate patients’ intrinsic dignity. The complete decentralization of HIV care will be morally and legally justified when PHC facilities are improved for the progressive realisation of access to quality healthcare for all.
Morphological evaluation of the heart, kidney and liver following simvastatin treatment of a mouse model of adolescent alcoholism
(2024) Nchodu, Makgotso
Individuals that begin drinking during adolescence are more likely to become alcohol addicts, resulting in the development of alcohol-related diseases such as alcoholic cardiomyopathy, renal tubulointerstitial fibrosis and steatohepatitis. This study investigated the protective capabilities of simvastatin against alcohol-induced damage on the heart, kidney, and liver of adolescent mice administered chronic alcohol. Fifty four–week old C57BL/6J mice (F = 5; M = 5) were assigned to each experimental group: (i) NT; no treatment; (ii) ALC; 2.5 g/Kg/day of 20% alcohol (iii) SIM; 5 mg/Kg/day (iv) ALC+SIM5; 5 mg/Kg/day of simvastatin followed by 2.5 g/Kg/day of 20% alcohol (v) ALC+SIM15; 15 mg/Kg/day of simvastatin followed by 2.5 g/Kg/day of 20% alcohol. Lower dosage of simvastatin was more effective against alcohol-induced myocardial hypertrophy in females while a higher dosage of simvastatin was more effective in males. Both simvastatin concentrations significantly reduced alcohol-induced myocardial fibrosis in the females but only the low simvastatin dosage was effective in the males. ALC+SIM5 improved inflammation only in the females. Alcohol increased the area of the renal corpuscles and glomeruli, the collagen and TNF-α distributions. 5 mg simvastatin was more effective against renal hypertrophy in both males and females. Both doses of SIM were effective against renal inflammation. Both concentrations of simvastatin were not beneficial in stimulating hepatocyte regeneration except for 15 mg simvastatin in males. Only a higher dose of simvastatin prevented alcohol effect on hepatic collagen distribution. Both concentrations of simvastatin following a chronic alcohol were not beneficial against alcohol-induced inflammation in the liver.
Pathological complete response in early-stage HER-2 positive breast cancer patients, receiving neoadjuvant chemotherapy/trastuzumab, in a single breast unit in Johannesburg
(2024) Bellomo, Alessandro N
Background HER-2 positive breast cancers receiving neoadjuvant therapy containing Trastuzumab show higher rates of pathological complete response, correlating to better clinical outcomes. Trastuzumab is not available in the neoadjuvant setting in the public healthcare system in South Africa. Methods This study evaluated factors affecting pCR in early-stage HER-2 positive breast cancers. We retrospectively analysed data of 102 patients with early-stage HER-2 positive breast cancer who completed neoadjuvant trastuzumab/chemotherapy. The cohort was analysed for total pCR and looked at factors that may affect pCR (tumor size, menopausal status, hormone receptor status, Ki-67 levels, and nodal status). Results The pCR rate for the entire cohort was 58.82%. Factors associated with a higher pCR were ER receptor status (ER negative= 82.05%, ER positive 44.4%, P<0.00018), PR receptor status (PR negative=75.41% vs PR positive 34.15%, P< 0.00003). The Ki67 <14% was 46.15%, Ki67 14-30% was 51.11% and Ki67> 30% was 70.45% (P<0.037). Univariate analysis showed a significant difference in pCR relating to ER/PR/HER-2 grouping (ER/PR positive= 63.64%, Triple positive= 34.15%, Enriched= 82.05%; P<0.00007). Conclusions: This data highlights the importance of characterising the different subtypes of HER-2 positive early breast cancers and the association with pCR, in keeping with the international guidelines. Higher pCR rates were attained in HER-2 enriched subtypes. Currently, in South Africa, trastuzumab is not readily available in the public healthcare sector. This study emphasizes the need for trastuzumab to be made available to all patients with HER-2 positive breast cancers in the neoadjuvant setting in South Africa.
Rate of neonatal birth HIV positive tests and description of related risk factors in Johannesburg: can point of care testing be targeted effectively?
(2024) Wannenburg, Elzette
Background Prompt diagnosis of Human Immunodeficiency Virus (HIV) in South Africa and early initiation of antiretroviral therapy in infected newborns remains a challenge in South Africa. Point of Care Testing could expedite this process. This study describes the rate of, and risk factors associated with birth detectable HIV infection in a South African setting. Methods A secondary data analysis of infant HIV polymerase chain (PCR) reaction results was done at Rahima Moosa Mother and Child Hospital in Johannesburg between June 2014 to June 2019. Annual positivity rates were calculated and association tested against characteristics (maternal, delivery and infant) using descriptive statistical methods. Results 12466 infants had a final HIV result. The yearly positivity rate did not show significant fluctuation, ranging from 1.2-1.7%. Maternal risk factors for infant infection included adolescent age (3.6% vs 1.8% for mothers aged 20-30) (p1000 (8.9% vs 1.3% if 50-1000) (p<0.001); CD4 count <200 (3.3% vs 0.75% at CD4 200- 300) (p<0.001); antiretroviral therapy for less than a month (5.1% vs 2.3% after 1 month) (p<0.001); HIV diagnosis within a month of delivery (10.1% vs 1% preconception) (p<0.001) and those with viral loads >1000 (8.9% vs 1.3% if 50-1000) (p<0.001). Infant risk factors for infection were prematurity (2.3% vs 1.4%) (p=0.012); low birth weight (2.2% vs 1.4%) (p=0.009); ill infants warranting admission (3% vs 1.5%) (p<0.001) and infants born in cold seasons (1.8 vs 1.3%) (p=0.016). Conclusion Various maternal and infant factors were associated with HIV infection at birth while the birth positivity rate remained relatively constant across the study period. While universal birth point of care testing is ideal, high risk infant groups could be identified and targeted in resource constrained settings to expedite HIV diagnosis and treatment
School dietary habits and the dental health status of primary school learners in Johannesburg, South Africa
(2024) Lebele, Octavia
Childhood caries remain a public health problem largely as a result of dietary and lifestyle behavioural factors. In addition, a partially monitored school health environment can potentially alter children's eating patterns and food choices, as family decision-making can be influenced by caregivers and peers, and the school food environment. In an attempt to curb malnutrition, the Department of Education runs a National School Nutrition Programme (NSNP), where meals are served to learners who come from disadvantaged backgrounds. Despite this initiative, learners are still exposed to sugar-rich foods contained in their lunchboxes or from school vendors or tuckshops. These unhealthy eating patterns contribute to non-communicable diseases, such as dental caries, obesity, and diabetes, later in life. Aim: To assess the dietary habits and oral health status of Grade 3 primary school learners aged between 9 and 11 years in a public school that are part of the NSNP and in a non-NSNP schools. Methodology: This was a cross-sectional study that assessed the school dietary habits, oral health status, and BMI of the learners that were part of the NSNP and those that were non-NSNP. Correlation analysis as well as univariate and multivariate logistic regression was applied to seek an association between oral health status and independent variables such as age, gender, sugar consumption and BMI. Results: The main findings were that frequent consumption of foods and beverages rich in sugar was associated with dental caries. Learners from the NSNP school were the major contributors to higher mean DMFT/ DMFT of 1.91 (2.21); 3 (3.39) respectively compared to those of the learners from the non-NSNP school, which were 0.59 (1.42); 1.4 (2.84) respectively. However, a statistically significant mean difference was only found for DMFT with a p-value of 0.018. A significant decrease was observed in the overall Gingival Index (GI) score at both schools with regard to an increase in sugar consumption (p=0.039). About 45.21% of learners from the NSNP 3 school also presented with a mild GI oral health status compared to 17.64%of learners from the non-NSNP school. The majority (64.44%) of the learners at both schools were found to be healthy with 35.51% being unhealthy learners. However, the overall mean BMI score was 18.2(3.59) which falls within the overweight (unhealthy) category. When comparing the association of BMI scores to oral health status at school level, no statistical significance was found. Conclusion: Based on the findings of this study a conclusion can be made that the learners at both the NSNP school and non-NSNP school consumed a high concentration of sugary foods and drinks, mainly found in their lunchboxes, and frequently purchased food items and beverages. The NSNP provided an environment where underprivileged learners had daily nutritious meals which ensured that schoolchildren do not suffer from malnutrition. However, the school food environment did not promote healthy eating habits. As a result, the caries experienced among the learners was also cause for concern as evidenced by the findings of this study. An increased DMFT and GI scores that are associated with increased consumption of sugar rich foods in public primary schools, was apparent in both schools.
Socioeconomic determinants of early health care utilisation and association with malaria hospitalisation among under five years children in Manhiça, Mozambique
(2024) Chauque, Alberto Aniceto
Introduction Malaria is one of the significant health problems in the world, and the greatest burden of the disease is concentrated in Africa, which accounts for about 95% of cases. The WHO (World Health Organization) indicates that early seeking for treatment is crucial to avoid worsening the disease and, consequently, death. This work, was evaluated the factors that influence early health care seeking in children under five years old and the effect of early health care seeking on hospitalisations. Methods It was conducted a health facility-based observational longitudinal study where malaria cases were identified in an ongoing surveillance database. Using the first visit for all children that visited a Health Facility with fever and malaria and defined early health care seeking as a visit to a health centre within 48h after the onset of fever. Multilevel logistic regression was used to identify the factors related to early health care seeking and the association between early health care seeking and hospitalisation. Results A total of 66 620 children aged 0 to 15 years were screened. Excluding all children who did not meet the study criteria, ending up with 2 299 children with malaria and fever, but only 1 603 children had demographic information. A kilometre increase in the distance to a health facility reduces the odds of early health care seeking (aOR = 0.89; CI: [0.83-0.95]; p=0.001). Early health care seeking reduces the odds of hospitalization (aOR = 0.56; 95% CI: [0.34 -0.93]; 0.024) and year increase in the year of the visit also increases the odds of hospitalization (aOR = 1.66; 95% CI: [1.41-1.93]; p<0.001). Conclusions Increasing the distance to health facilities reduces the likelihood of early health seeking, whereas early health care reduces the risk of hospitalisation. Maluane and calanga lead the hospitalisation cases in the study area in children with malaria and cases of delay in health-seeking

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