Electronic Theses and Dissertations (Masters)

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A survey of the professional quality of life of pharmacists and rehabilitation therapists at three public sector hospitals in Gauteng, South Africa
(2024) Moyo, Nonkazimulo
Background- 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.
A visual analytics approach to characterising disease progression among adults with chronic diseases in rural Agincourt northeast South Africa
(University of the Witwatersrand, Johannesburg, 2024) Nhlapho, Mapule Dorcus; Kabudula, Chodziwadziwa
Chronic diseases pose a significant challenge to the healthcare systems in South Africa, calling for innovative approaches for comprehensive understanding and management. This research study utilizes the Agincourt HDSS-Clinic dataset to design and implement a visual analytics system using the R Shiny web application framework. Focused on adults with chronic diseases, the tool employs dynamic visualizations to show patterns of healthcare utilization and disease progression. Through the R Shiny platform, the system provides a user-friendly interface for exploring and interpreting complex data, offering valuable insights into patient healthcare behaviours and the dynamics of chronic illnesses. The study used data from a total of 26 426 patients consisting of 19 265 (73%) females and 7 161 (27%) males. The study revealed previously unrecognized associations between specific chronic conditions including the existence of a substantial intersection between HIV, Hypertension, and Diabetes with 101 patients experiencing the coexistence of all the three conditions. Notably, the visual analytics system facilitated the identification of distinct healthcare utilization patterns across different demographic groups highlighting the most frequently visited health facility accounted for 5 912 patient visits overall while the least visited health facility accounted for 1 447 patient visits. The findings underscore the effectiveness of visual analytics in uncovering trends within complex datasets. The implications of these findings extend beyond the immediate research scope, influencing healthcare strategies and contributing to the ongoing discussions on innovative solutions for chronic disease management. This study contributes to the evolving field of visual analytics in healthcare, demonstrating the potential for such tools to inform decision-making and enhance patient outcomes
Activity and time spend patterns of residents in low-income settlements in the City of Johannesburg, South Africa
(2024) Bhuda, Hope Prudence Boipelo
Background: 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.
Assessing the potential interaction between CBD and TBR1 CBD and T-box domain
(University of the Witwatersrand, Johannesburg, 2024) Blignaut, Chanel; Sylvia, Fanucchi; Adeyemi, Samson
In 2020, Cannabidiol (CBD) emerged as the most commonly used recreational substance among pregnant women and was perceived as a natural and safer option for alleviating pregnancy- related symptoms, yet its potential effects on foetal neurodevelopment remain uncertain. With varied results from existing literature on the association between prenatal cannabis use and Autism Spectrum Disorder (ASD) development, this study focuses on filling these knowledge gaps. It investigates the potential interaction of CBD with the T-box domain of TBR1, a transcription factor implicated in ASD. CBD may cross the placenta and distribute throughout the developing foetal organs, including the brain, where it may interact with TBR1. This study's objective is to lay the groundwork for future research into the impact of CBD binding on TBR1 functionality, whose dysregulation is implicated in ASD. The study aims to use in vitro and in silico methods to identify and characterise the interaction between CBD and TBR1 T-box Domain. Initially, predictive models were utilised to determine the structure of the TBR1 T-box domain and its binding domains. Subsequently, the ADMET properties of CBD are assessed to determine its potential interaction with TBR1 T-box domain within the body. Through the optimisation of the TBR1 T-box domain and CBD structures, induced fit docking and molecular dynamics simulations, the study aims to predict the potential interaction sites, dynamics and stability of this interaction. The study confirms the computational results using in vitro methodologies. After expressing and purifying the TBR1 T-box domain, a pull-down assay (PDA), thermal shift assay (TSA) and Time-resolved Fourier-transformed infrared spectroscopy (TR-FTIR) are used to evaluate the potential binding, stability and physiochemical properties of the interaction. Computational analysis, using Maestro Schrödinger Induced Fit Protocol, predicts that CBD binds stably within a hydrophobic pocket of TBR1 T-box domain, away from its DNA-interacting residues. Pose 2 and 3 from molecular docking shows the highest binding affinity and molecular dynamics simulations, using Maestro Schrödinger Desmond Molecular Dynamics System, reveal that the TBR1 T-box domain stabilises upon interaction with CBD. Specifically, the interaction is facilitated by hydrophobic interactions and hydrogen bond formation with residues Ser238, Pro335, Thr360, Glu363 and Asn240. Experimental validation through PDA and TSA provided inconclusive results, but TR-FTIR confirmed the dynamic nature of the CBD-TBR1 interaction, characterised by time-dependent spectral changes. While the results do not directly indicate an impact of CBD on TBR1 functionality, further DNA binding studies are necessary for confirmation. This study suggests caution in using CBD during pregnancy due to its complex and largely unexplored interaction with TBR1, underscoring the need for more comprehensive research to conclusively understand its influence on neurodevelopmental disorders and its therapeutic potential
Association between serum zinc level and dynamics of Group B Streptococcus colonisation among pregnant women in South Africa
(University of the Witwatersrand, Johannesburg, 2024) Dhar, Nisha; Madhi, Shabir A
Background Maternal colonisation by Group B Streptococcus (GBS) is a major risk factor for early onset invasive GBS disease among newborns. Zinc micronutrient plays a critical role in several biological processes that are essential to prevent bacterial colonisation and/or invasion. The aim of this study was to investigate the association of serum zinc levels with GBS rectovaginal new acquisition and clearance from 20 to 37+ weeks gestation in pregnant women. Methods Vaginal and rectal GBS colonisation was determined at 20–25 weeks (visit-1), followed by 3 subsequent visits at 5–6 weeks intervals, until 37–40 weeks gestation (visit-4). Serum was collected at visit-1 and visit-4 and serum zinc was estimated by inductively coupled plasma mass spectrometry. “New acquisition” group was defined as participants for whom GBS culture was negative at visit-1 and acquired GBS in one of the subsequent visits. Participants not colonised with GBS at any visits were categorized as GBS “persistently uncolonised”. Participants who remained colonised throughout all study visits were defined as “persistently colonised” group. GBS “clearance group” included participants who were colonised at enrolment (visit-1) and in whom GBS colonisation cleared by last visit (visit-4). Results Participants in persistently un-colonised group had significantly higher zinc geometric mean concentration (GMC) at visit-1 compared with those who had new acquisition (20.18 µmol/L; 95%CI 17.99-22.64 vs 13.68 µmol/L; 95%CI 12.59-14.87, p=0.03). Higher zinc concentration in the persistently un-colonised group when compared with new acquisition group was significantly associated with lower odds of GBS rectovaginal acquisition [Odds ratio (OR) 0.15, p=0.001]. The lowest zinc threshold significantly associated with 45% lower odds of new acquisition was ≥15 umol/L (27.2% in new acquisition vs 40.5% in persistently un-colonised; OR 0.55; 95%CI 0.31- 0.96; p=0.03). Furthermore, zinc concentration was higher among women in clearance group compared with those in persistently colonised group (20.03 µmol/L; 95%CI 16.54-24.27 vs 16.45 µmol/L; 95%CI 13.32-20.31, p=0.04). Conclusion There was an inverse association between serum zinc levels in pregnant women and odds of GBS acquisition in those not initially colonised. Zinc supplementation in early pregnancy could reduce risk of invasive GBS disease in their newborns
Bayesian spatio-temporal analysis of malaria prevalence in children aged 2-10 years between 2000-2015 in Gabon
(2024) Mougeni, Fabrice Lotola
Abstract 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.
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.
Characteristics of clients presenting for substance abuse treatment at cosup centresin the City of Tshwane
(2024) Manyane, Tabea Thama
Background: 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.
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, Peggy
Objective- 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.
Determinants of mortality in children younger than five years admitted with severe acute malnutrition to three hospitals in Vhembe district, Limpopo
(2024) Fakudze, Dakalo
Background: 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.
Determinants of sub-optimal glycaemic control among patients enrolled in a medicine dispensing programme in Kwazulu-Natal: A cohort study, 2018 – 2021
(University of the Witwatersrand, Johannesburg, 2023) Johnston, Leigh Clare
Background: In South Africa, type 2 diabetes mellitus (T2DM) is a growing public health problem, thus, by 2030, 50% of T2DM patients, receiving treatment, must achieve optimal glycaemic control (haemoglobin A1c (HbA1c) ≤7%). The CCMDD (Central Chronic Medicines Dispensing and Distribution) programme allows glycaemically-stable patients to collect their medication from community-based pick-up points. While the CCMDD is a large public health programme, there is a paucity in stakeholder’s knowledge of T2DM patients glycaemic control over time. We determined glycaemic control for CCMDD-enrolled T2DM patients in eThekwini, South Africa from 2018-2021, as well as the rate and predictors of becoming sub-optimally controlled. Methods: We performed a cohort study, linking HbA1c data from the National Health Laboratory Service to CCMDD-enrolled patients in eThekwini, South Africa from 2018–2021. We included patients optimally controlled at their baseline HbA1c, and having ≥1 repeat test available. We used Kaplan Meier analysis to assess survival rates and Cox regression to determine associations between time to sub-optimal control (HbA1c > 7%) and several factors. Adjusted hazard ratios (aHR), 95% confidence interval (95% CI), and p-values are reported. Results: Of 41145 T2DM patients enrolled in the CCMDD, 7960 (19%) had an available HbA1c result over the study period. A quarter of patients (2147/7960; 27%) were optimally controlled at their baseline HbA1c. Of those controlled at baseline, 695 (32%) patients had a repeat test available, with 35% (242/695) changing their status to sub-optimal control. Patients prescribed dual-therapy had a higher risk of sub-optimal glycaemic control (aHR: 1.503; 95% CI: 1.16–1.95; p-value=0.002) compared to those on monotherapy. HbA1c testing frequency per national guidelines (aHR: 0.46; 95% CI: 0.24–0.91; p-value=0.024) was associated with a lower hazard of sub-optimal glycaemic control. Conclusions: HbA1c monitoring, in line with testing frequency guidelines, is needed to flag sub- optimally controlled patients who become ineligible for CCMDD enrolment. Patients receiving dual-therapy may require special consideration. Addressing these shortfalls can assist planning and implementation to achieve 2030 targets.
Early life factors associated with childhood trajectories of violence among the birth to twenty- plus cohort in Soweto, South Africa
(University of the Witwatersrand, Johannesburg, 2024) Muchai, Lilian Njeri; Kagura, Juliana; Naicker, Sara
Introduction Violence against children has devastating and long-term negative consequences on individuals' and society's health, social and economic well-being. There is limited research on the life course experience of violence especially in Africa. This study aimed to identify sub-groups of physical & sexual violence victimization patterns separately in childhood, and evaluate early life factors predicting these violence trajectories. Methods This study used data from age 5 to 18 years from the ongoing prospective Birth to Twenty Plus cohort (Bt20+). Children within the Bt20+ cohort with data on physical and sexual violence in at least 2-time points between 5 and 18 years were included in the analyses. Group-based trajectory modelling was employed to identify groups of children with similar patterns of violence over time. Descriptive statistics was used to summarize study variables by violence trajectory group membership, while multivariable logistic regression was used to identify early life factors measured between birth and 5 years, associated with violence trajectory group membership. Results Two trajectory groups were identified for both physical and sexual violence victimization. For physical violence victimization, the majority of participants fell into the adolescent limited group (65.1%) and just over a third (34.9%) of the children were in the chronic increasing group. For sexual violence victimization, most participants fell into the adolescent limited group (74.1%, with a quarter in the late increasing (25.9%) group. Early life factors associated with a higher risk of chronic increasing physical violence victimization trajectory group membership, after adjusting for covariates, were being male (aOR 1.67, 95% CI 1.31; 2.10) and having a mother with at least secondary education compared to higher education (aOR 1.73, 95% CI 1.08; 2.76). In addition, residing in middle, compared to low, socioeconomic households (aOR 0.68, 95% CI 0.50; 0.92) was protective against membership in this group. Residing in high compared to low socioeconomic households, was the only early life factor with marginally significant (aOR 0.63, 95% CI 0.42; 0.95) association with membership in the late-increasing sexual violence victimization trajectory group, with those in better-off households less likely to experience sexual violence victimization with this pattern. Conclusion Children within the same community can follow different patterns of both physical and sexual violence victimization across childhood. Identification of early factors that predict membership to sub-groups of violence trajectories provides key violence prevention intervention points that can preempt or mitigate children’s exposure or experience of violence. Future research should explore a larger variety of early life factors proximal to the child as well as those more distal at the community and school levels
Educational programmes used in teaching nurses mechanical ventilation in adult intensive care units: a scoping review
(2024) Davis, Daniele Ruth
Introduction 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.
Efficacy of noise control measures at high noise zones from a copper mine in Zambia
(University of the Witwatersrand, Johannesburg, 2024) Nchimunya, Bbautu; Hayumbu, Patrick; Masekameni, Masilu Daniel
Noise exposure is a global problem, it is estimated that about 30 million workers in the United States of America (USA) are exposed to high noise levels while across Europe, 28% of the workers are exposed to high noise levels. Hazardous noise exposure is associated with a wide range of health effects that include noise induced hearing loss (NIHL), stress, poor concentration, communication difficulties and fatigue due to lack of sleep. The mining industry worldwide is struggling with hearing loss due to noise overexposure and in a copper mining set-up, the concentrator section is assumed to be among high noise zones exposing workers to noise above the occupational exposure limit (OEL) of 85 dB(A). This study aimed at evaluating the efficacy of noise control measures at various sections at Konkola Copper Mine concentrator section in Zambia. This quantitative cross-sectional study was conducted at Konkola Copper Mines (KCM) Konkola Business Unit (KBU) in Chililabombwe District in the Copperbelt Province of Zambia. A walk through survey was conducted to collect information to describe the operations, identify noise sources, understand noise release mechanisms and describe noise control measures. Quality control was achieved by triplicate noise measurement per location using an instrument with a valid annual calibration certificate. Raw data was pre-processed by cleaning to make it ideal for use. An ethical waiver W-CBP-230428-01 was granted as this study did not involve animal or human subjects but only area noise samples using CR: 172B SLM. The study identified the noise sources, described noise release mechanisms, described the noise controls and assessed the efficacy of noise controls in four sections within the concentrator of a copper mine in Zambia. Seventeen noise generating equipment were identified with about 53% of the equipment operated at the crushing section, 18% operated at the Flotation and Filtration section respectively and 11% at Milling section. A substantial portion (65%) of the identified noise sources in the concentrator are not housed, and among these, 36% are mobile in nature. It was also found that none of the noise areas were demarcated There are three types of noise controls (enclosure, silencer & HPD) that are in use at the concentrator and they fall in two categories of the hierarchy of controls (engineering & PPE). Out of the nine noise sources at the Crushing section, 56% (5 of the 9) utilized enclosure as control, 33% (3 of the 9) had HPDs as control and 11% (1 of the 9) source was installed with a silencer as a control. Enclosure is utilized to control noise from the two sources found in the Milling section while HPDs and enclosure are the noise control measures in use at both Flotation and Filtration sections of the concentrator. Enclosure is the most available control in the concentrator at 53%, followed by HPDs at 41%, and the least available is silencer at 6 %. About 76.5% (13) of the noise controls at the concentrator had efficacy strong enough to reduce noise levels to below the OEL while 23.5% (4) of the controls had weak efficacy that failed to reduce noise levels to below the OEL. This has prompted the need to strengthen efficacy in areas where controls were found to be weak. There is need to sustain controls that were found to be strong to maintain their efficacy. About 75% (3 of the 4) of the controls with lower efficacy were from the Crushing section while 25% (1 of the 4) was from Filtration section
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.
Evaluation of implementation fidelity to national guidelines on management of tuberculosis in paediatric patients in Homa-Bay County, Kenya
(2022) Kiptoon, Sharon Cherono
Background: 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.
Evaluation of osayidelera, a campaign addressing risk perceptions of COVID-19 in Blantyre, Malawi
(2024) Maganga, Chiyembekezo Focus
Background- 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 perceptions
Exploring inter-professional collaboration between community health workers and health care providers in two clinics in the City of Johannesburg district
(University of the Witwatersrand, Johannesburg, 2024) Bokaba, Dorah Dorothea; Nxumalo, Nonhlanhla
Background: Large-scale community health worker (CHW) programmes gained renewed interest over time. This was more pronounced during the emergence of the Coronavirus disease 2019 (COVID-19) pandemic, with CHWs exemplifying the role of task-shifting to alleviate already fragile and resource-scarce health systems. Many low- to middle-income countries (LMICs), including South Africa, implemented CHW programmes to complement health workforce. Thus, health care providers (HCPs) including professional nurses, health promoters, allied health workers, operational manager clinic, social workers, and CHWs are expected to collaborate with CHWs to provide health care service. Aim: The aim of the study was to explore inter-professional collaborations (IPC) between CHWs and HCPs in two primary health care (PHC) facilities in the City of Johannesburg, Gauteng Province. Methodology: This study used an exploratory qualitative design. In-depth semi-structured interviews were conducted with purposively sampled CHWs (n=12) and HCPs (n=10) in two PHC facilities from two sub-districts. All interviews were transcribed verbatim. Thematic content analysis was used to analyse the data. Results: Team structures were reported to be centred around the CHWs and Outreach team leader (OTLs), however other HCPs like nurses, health promoters, and social workers also played a role. Reporting procedures were hierarchical, with CHWs reporting to OTLs, who reported to operational managers (OPMs). CHWs were at the bottom of the hierarchy with the reporting structures being described as challenging as they were related to power dynamics. Communication was poor and with unplanned meetings. Participants suggested the need for improved support and communication to strengthen IPCs. Conclusion: IPC between the HCPs and CHW is critical in ensuring patient care continuity. Some dimensions of IPC, such as shared responsibility and mutual understanding of roles by team members, were evident. The communication processes showed some weaknesses, including the consequences in power relations. In order to enhance the contribution of CHWs in PHC and universal health coverage (UHC), it is necessary to explore ways to strengthen IPC between HCPs and CHWs
Exposure and risk assessment of benzene, toluene, ethyl benzene and xylene (btex) in a petrochemical depot at Heidelberg, South Africa
(2022) Mdlalose, Richard John
Background: 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).
Facilitators and barriers influencing implementation of interventions to eliminate silicosis in the South African mining industry
(2024) Patrick, Chinyelu Josephine
Background 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.

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