ETD Collection
Permanent URI for this collectionhttps://wiredspace.wits.ac.za/handle/10539/104
Please note: Digitised content is made available at the best possible quality range, taking into consideration file size and the condition of the original item. These restrictions may sometimes affect the quality of the final published item. For queries regarding content of ETD collection please contact IR specialists by email : IR specialists or Tel : 011 717 4652 / 1954
Follow the link below for important information about Electronic Theses and Dissertations (ETD)
Library Guide about ETD
Browse
8 results
Search Results
Item Correlations between self-reported ethnicity and language with genetic clustering in Kenya(2024) Wolberg, Yonatan ArielKenya is a highly diverse country, where a combination of recent local migrations and admixture have contributed to a complex population structure. This structure creates a dilemma when trying to assess the allele frequencies of disease-associated variants within the country as different groups will show different frequencies. Additionally, ethnic groups in genetic studies are often defined on the basis of self-reported identity but certain individuals may align genetically to another ethnic group. It is necessary to properly characterize Kenyan diversity for population level risk estimation and the implementation of public health approaches. This study aimed to determine how self-reported ethnicity correlates to genetic clustering in a Kenyan cohort. The effect of the discordance between the two on the frequencies of key malaria- and trypanosomiasis-associated variants was then determined. This study leveraged Kenya AWIGen dataset, comprising 1,703 individuals (of the Kikuyu, Kamba, Luhya, Luo, Kisii and Somali ethnic groups) recruited in Nairobi. Combining a bootstrap approach for allele frequency estimation and centroid-based filtering, this study was able to show that small discordances are able to significantly impact allele frequencies of disease-associated variants. More robust approaches to compare genetic- and ethnicity-based clustering might reveal further differences. Overall, the results indicate that while self-reported identity can provide reasonably reliable categorization for the Kenyan dataset, inclusion of additional variables, such as language, geographic origin, and both parental and grandparental identity, might be necessary for more accurate estimates.Item Community health worker's perceptions (CHWS) of their role in Primary Health Care of Ga-Segonyana rural community(2019) Mkhondwane, AnnBackground: Primary Health Care (PHC) is globally recognized as one of the effective strategies for the implementation of Sustainable Developmental Goals (SDGs). The global shortage of health care workers weakens the health care system, which impacts negatively in the achievement of universal health coverage and the SDGs. Community Health Workers (CHWs) are recognized as an integral resource in addressing the shortage of health workers in health care. In the rural villages of Ga-Segonyana, access to healthcare services remains a challenge and the use of CHWs to address the problem is strongly advocated. Aim: The study sought to explore the perceptions of community health workers (CHWs) of their role regarding the services they render to the community and their contribution towards strengthening PHC services in Ga-Segonyana local municipality. Methods: This study utilised an exploratory research design to conduct semi-structured interviews with nine purposefully selected CHWs in the Ga-Segonyana. All the interviews were translated from Setswana to English language and transcribed verbatim. Directed content analysis was used to analyse data from the transcribed interviews. Atlas ti computer software, version 7.0, was used for data analysis. . Results: Despite their lack of a written scope of work, the CHWs were able to outline their roles and responsibilities as expected by the employers. In terms of their work as CHWs, the results indicated that they have had both good and bad experiences. CHWs perceived the training received to be related to the nature of their work. However, there were no support systems to assist them with issues like psychological trauma and other pertinent situations in which they find themselves. The perceived barriers and challenges to CHWs pertain to ill-treatment to which they have been subjected by patients, lack of support systems, lack of recognition for their contribution, lack of training, lack of co-operation and collaboration from the relevant departments and organisations and other stakeholders, lack of resources and late payment of stipends. Conclusion: The study successfully explored the CHWs’ perceptions of their role on the services they render to the community and their contribution towards strengthening PHC services in the rural district of Ga-Segonyana. Understanding CHW roles will assist in examining how their roles might determine how they perform their daily tasks. So the study managed to highlight the importance of investing in CHWs for the empowerment of impoverished areas in South Africa.Item Translating research evidence into clinical practice in relation to the implementation of early mobility programmes in South Africa and Zimbabwean government hospitals' intensive care unitst(2019) Tadyanemhandu, CathrineBackground: The early mobilisation of patients in the intensive care unit (ICU) is advocated as an intervention that may attenuate the consequences of critical illness. Recent evidence shows that the early mobilisation of patients in ICU is feasible, safe and is associated with improvement in the patients’ clinical outcomes. However, not all units have adopted an early mobilisation programme as the standard practice of care for every ICU patient. There remains a paucity of evidence to explain why studies supporting the early mobilisation of patients in ICU are not being translated into practice as only a small percentage of patients are being mobilised out-of-bed, and this has resulted in an evidence-practice gap. Purpose: The overall purpose of this study was to determine whether research evidence related to early mobilisation is being implemented in clinical physiotherapy practice in the ICUs of government hospitals in Zimbabwe and South Africa (SA); to identify the factors (barriers and facilitators) related to the implementation of such interventions; and the design strategies that may address the identified gaps at either the provider, patient or healthcare system level. Methods: A mixed methods approach was used to address the aims of the study. An explanatory sequential study design in which a cross-sectional survey of 18 hospitals (n=5 in Zimbabwe; n=13 in SA) was done; this was followed by in-depth interviews with 22 physiotherapists (n=4 from Zimbabwe; n=18 from SA) working in ICUs to determine the prevalence of early mobilisation practice in the units, the ICU organisational structures and the barriers and facilitators that influence the early mobilisation of patients in SA and Zimbabwean government hospital ICUs. Lastly, a Delphi study with a panel of 23 experts from SA and Zimbabwe was done to explore expert opinions and consensus on the strategies to be implemented in SA and Zimbabwean government hospital ICUs to overcome the identified barriers to early mobilisation practice. Results: The findings of the study suggest that there are very low rates of out-of-bed mobility activities performed in the ICUs in SA and Zimbabwean hospitals (19.5% and 25% respectively). Reasons why patients were not mobilised out-of-bed differed between the two countries with the majority of the patients from Zimbabwe not being mobilised on account of sedation and unresponsiveness (n=13; 32.5%), whilst the patients from SA were not mobilised as they were unresponsive (n=50; 24.4%, p<0.05). There was a significant difference in the indications for ICU admission between the two countries, with the majority of the patients from Zimbabwe being in the unit on account of acute respiratory failure (n=13; 30%) and for postoperative care (n=10; 25%), whilst traumatic injury (n=86; 41.9%) and postoperative care (n=54; 26.3%) were the main indications for ICU admission in the SA cohort (p=0.001). Predictors of out-of-bed activities were the type of ICU, the method of ventilation, and the number of days in ICU (p<0.05). Facilitators to early mobilisation identified by the physiotherapy clinicians included awareness campaigns of the benefits of early mobilisation in staff training and practice; the acceptance of the intervention as the standard of care; the availability of protocols on sedation, delirium assessment and early mobilisation in the unit; multidisciplinary team engagement; adequate staff numbers (especially physiotherapists); and, adequate mobilisation equipment (e.g. portable ventilators, walking frames and bedside chairs). Barriers to early mobilisation identified included variability in the manner of defining early mobilisation and the activities that constitute it; undefined roles within the multidisciplinary team responsible for the implementation of early mobilisation; negative perspectives of the clinicians about the intervention; the poor clinical reasoning skills of the clinicians; delayed consultations by specialists in the general ICUs; the high turnover rate of the ICU staff; the lack of protocols in the unit; patients in an unstable condition; inadequate staff numbers; and a lack of mobility equipment. The expert panel agreed that there is a need to standardise the practice of early mobilisation in units in SA and Zimbabwe by defining the specific activities considered as early mobilisation; through the development of detailed protocols and guidelines to assist with early mobilisation; by enlisting champion leaders in ICU who advocate for the early mobilisation of patients; by ensuring the timely management of orthopaedic fractures; by promoting the admission of patients into specialised units; by making mobility equipment available; through the creation of physiotherapy posts; and through skills training for all staff responsible for implementing early mobilisation activities for patients in ICUs. Conclusion: The rate of out-of-bed mobilisation activities in SA and Zimbabwean government hospital ICUs was found to be low and to be influenced by patient unresponsiveness, sedation and haemodynamic instability. The predictors of out-of-bed mobilisation activity included the type of ICU, the method of ventilation and the number of days in ICU. Overcoming the highlighted barriers will require a cultural change with regard to ICUs that prioritises the following: the early mobilisation of patients; developing standard operating procedures (clinical practice guidelines and protocols); multidisciplinary team engagement; coordinating the execution of early patient mobilisation; and effective communication among team members. These expert consensus strategies serve as the first step in guiding the development campaign to a focused approach and to use research evidence to promote better quality patient care in daily clinical practice in an ICU setting.Item Double sufficiency.requirements of justice healthcare distribution(2019) Mojanaga, Marije VersteegBillions of people worldwide cannot access the healthcare they need, giving impetus to global and local efforts to improve coverage of healthcare. How this can be done justly remains contested. In this dissertation I seek to make a contribution to current debate. I argue that a satisfactory account of justice requires a distinction between healthcare and social justice principles. Adapting Rawls’ notion of a “veil of ignorance”, I propose a way of thinking about prioritised packages of healthcare corresponding to intrinsic healthcare needs over a lifetime. I conclude that justice requires “Double Sufficiency”, which refers to sufficient access to prioritised packages through a threshold approach. While tragic cases remain unavoidable, this approach expresses equal concern for everyone’s healthcare needs.Item The relationship between practical hearing aid skills and patient satisfaction in the public health care setting(2016) Wentzel, TracyThe ability to handle a hearing aid may impact on satisfaction with and acceptance of hearing aids by individuals with hearing loss. Previous research has noted the correlation between hearing aid handling skills and effective hearing aid use. Although many studies have focused on the individuals’ satisfaction with their hearing aids there is a lack of information regarding the relationship between satisfaction with hearing aids and hearing aid handling skills. This is especially true for the South African context, where no studies have been conducted to explore this relationship. The main aim of the study was thus to determine the relationship between the ability to manipulate hearing aids and self-perceived satisfaction with hearing aids in individuals fitted with hearing aids in a public health care hospital. A non-experimental, cross-sectional, correlational research design was employed for the purpose of this study. The sample included 85 adults fitted with hearing aids in a public health care hospital. There was an equal distribution of gender and the mean age of participants was 66.27 years. Participants completed the Practical Hearing Aid Skills Test – Revised (PHAST-R) version and the Satisfaction with Amplification in Daily Life (SADL) questionnaire. The findings of the study indicate that the majority of participants were able to successfully manipulate their hearing aids (Mean score: 75.43%; Range: 10.71 - 100; SD: 21.58). The mean global score for satisfaction with amplification was 5.2 (Range: 3.1 - 6.8; SD: 0.84) indicating high levels of satisfaction with their hearing aids. Overall there was a significant correlation between hearing aid handling skills and satisfaction with amplification (rs= 0.22871; n = 85). Indicating participants who were better able to handle their hearing aids were more satisfied with them. The findings suggest that the majority of participants were satisfied with the hearing aids provided in a public health care hospital and that they were able to successfully handle their hearing aids. The use of the PHAST-R as part of the hearing aid orientation session is encouraged especially in light of the poor return rate for follow-up hearing aid orientation sessions at this public health care settings. The development of standard operating procedures for hearing aid fitting and orientation in the public health care sector is recommended to ensure that the best possible outcomes are ensured for all patients.Item Lessons for policy and regulation from mobile applications in public health: the case of community health work in Daspoort, South Africa(2014-02-18) Holeni, Khopotso CeciliaThe extraordinary growth in mobile telecommunications and advances in innovative application development has evolved into a new field of e-health, which includes mobile health (m-health) among others. m-Health is a new technology that is deployed in the Tshwane City health clinic named Daspoort as one of the national health insurance pilots. m-Health has revolutionised the way primary health care is administered in Daspoort in particular and in Tshwane City in general. The purpose of this case study is to establish lessons learned in the implementation of m-health as an alternative to bridging the health access gap. The study is meant to provide a library of lessons learnt and good practices in providing primary health services through the use of mobile technology, in this case m-health. The findings from this research suggest that m-health promotes efficiency and improves access. The results revealed that m-health poses challenges for practitioners in the absence of an e-health policy to fully cater for m-health. The implementation of m-health without a supportive legal framework is a risky exercise for both health professionals and community health-workers. Lack of clear guidelines from the National Department of Heajth in the implementation of m-health brings along a sense of vulnerability among health practitioners should things go unexpectedly wrong. In summary these are some of the key lessons learned: (i) Operating outside a mhealth policy and legal framework is very risky. (ii) Poor co-ordination of initiatives as a result of the lack of a collaborative policy and regulation results in silo efforts which lead to weak results. (iii) Community health workers, although they are part of the mhealth project are not covered by any legal framework; something that can expose them to criminal risk. (iv) m-health policy and legal vacuum result in a poor buy in of mhealth projects as managers are not accountable to take the project forward (v) Poor end of project planning as funded by donors leads to the death of m-health.Item The impact of a visit to Lesotho Water and Sewage Authority (WASA) on learner's knowledge about community health(2012-01-19) Molahloe, Maretsepile RelebohileThere is an increasing adoption of outdoor visits in high schools in Lesotho and this study was done to find out what students learn about community health as they visit Lesotho Water and Sewage Authority (WASA). Eighty Form D (equivalent to grade 11 in South Africa) learners were the participants in this study. In order to capture students‘ learning a qualitative study was designed. The study used observations, questionnaire (n=80) and semi-structured interviews (n=8) with learners. The data was analyzed inductively and deductively in order to answer questions about knowledge changes as a result of a visit to WASA, and about the aspects of the visit that influence learners‘ knowledge about community health. Analysis of the questionnaire and the interviews revealed that learners greatly gained knowledge as a result of the visit to WASA while others developed misconception and others did not change their conceptions at all. The forms of conceptual change identified from learners responses were enrichment and conceptual capture. Learners realized that water purification is not a minute-made activity since there are several steps involved in water purification and that taps are not the main water sources. Learners also became aware that boiling water is not the only effective way of treating water instead other purifying stations like WASA can purify water suitable for domestic use. However, some learners believed that water that has been treated by the sewage plant is not suitable to be purified and used for domestic purpose. The observation analysis indicated that the physical facilities, displays, prior knowledge and participation during the visit are some of the aspects that influence learners‘ knowledge about community health. The realism of concepts communicated during the visit enhanced learners‘ ability to acquire knowledge about community health. The physical facilities such as the machinery at WASA provided the concrete evidence that water is drawn from the rivers therefore rivers are the main water sources. Visual displays contributed much in learners‘ ability to gain knowledge during the visit to WASA. It has also been found that although manipulation of objects was minimal, learners still gained information communicated during the visit. With the stated findings above, a visit to WASA enhance learner‘s ability to acquire information about community health.Item Decentralized co-operative governance of the public health system in South Africa(2008-08-27T07:02:27Z) Plaatjies, DanielThe design of the decentralized co-operative governance system, conditioned and regulated by the South African constitution is of critical importance for policy design and implementation. The division of powers falls within a unitary form of government. This study, which is about the processes, mechanisms and modalities of public policies design and implementation uses the public finance and health sectors, as a case study or lens through which policy design and implementation is examined within a decentralized cooperative governance system. The study is per se not about the public health system, but rather a review and an analysis about how the decentralization and cooperative governance nature, practice and dynamic of government system, influences and condition the policy processes and practice on finance and health, separately and collectively within the public health system. In its attempt to unbundle the health function, but also reform the public health system, central and provincial governments have introduced a number of reforms. These reforms were ostensibly driven by different policies and programmes originating either from the public finance or public health sectors with significant consequences for the provinces. Moreover, these different policies also outlined structural and functional responsibilities and authority among the central and provincial government departments. The implementation of these policies was at times based on different interpretations of policy design and implementation responsibilities and authority between the central and provincial governments within co-operative governance system. The argument of this study is that despite intentions implicit to public policy, co-operative governance system is contested at a central government level within the public health system, as well as between levels of government and the public health and finance sectors. This dissertation explores the nature of the relationship between the central and provincial governments by exploring co-operative governance in the health sector on policy and financing processes and mechanisms. The central question is how does decentralized co-operative governance really work in the public health system? A case study method was used to conduct this research. Data was collected over a four and half year period using a variety of data collection methods, including semi-structured in-depth interviews; documents and reports analyses; policy content review and analyses; and revenue and expenditure reviews and analyses. The study’s findings are: a) the functional and structural decentralization of policy-making and implementation within the co-operative governance system contributes to undermining the cooperative governance relationship between the public finance and health sector and central and provincial governments; b) the central government is using its overriding powers to “impose co-ordinated solutions” to problems within the co-operative governance system, leading to situations where ‘imposed co-ordination’ is considered as ‘co-operative governance’; c) the theory provides a classical distinction between state control, supervision and interference models. This dissertation shows that, depending on the policy context and circumstances, the uniqueness of South Africa’s co-operative governance system allows the central government to mobilize any of these models to achieve its policy intentions, whether written or unwritten; and d) the classical arguments of decentralization, particularly within a devolved system of co-operative governance where greater autonomy and authority are given to subnational governments, are found wanting within the South African governance system, given both the policy-making and fiscal resource strength of the central government relative to the provinces. This dissertation leads me to conclude that the South African practice of co-operative governance in the health system is actually imposed co-ordination and that provinces are de facto administration outposts of central government policies, programmes and service delivery responsibilities. Therefore in reality there is no autonomy and independence of the provinces from the central government as envisaged in the Constitution of the Republic of South Africa. In fact, provinces only exist, in terms of their constitutional competencies as far the central government allows it to exist given its plenipotentiary powers over both micro and macro matters affecting institutions, fiscus and social policies.