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
5 results
Search Results
Item Occupational needle stick injuries amongst prehospital emergency medical service personnel in South Africa(2019) McDowall, Jared RyanPrehospital personnel are frequently exposed to challenging situations that place them at increased risk of sustaining a needle stick injury (NSI). Blood borne infections such as HIV and Hepatitis B or C may be transmitted from a NSI. Sub-Saharan Africa has the largest number of people living with HIV globally. There is no data pertaining to NSI among Emergency Medical Service (EMS) personnel in South Africa. This study aimed to investigate the cumulative incidence, knowledge, attitudes and practices pertaining to NSI’s amongst a select group of prehospital EMS personnel in Johannesburg. Methods: This was a prospective, questionnaire based, cross-sectional survey of personnel employed at three EMS service provider in Johannesburg. Results: Of the 240 subjects that participated in the study, there was a total of 93 NSI’s amongst 63 (26.3%) subjects. Of these, 41 (65.1%) had sustained only one previous NSI, 16 (25.4%) had two previous NSI’s, 5 (7.9%) had three previous NSI’s and one (1.6%) had five previous NSI’s. Almost two-thirds (n=60; 64.5%) of NSI’s were sustained during intravenous line insertion. Most of the study subjects were male (n=145, 60.4%), between the age of 25-29 years (n=67, 27.9%), had a BLS qualification as the highest level of training (n=89, 37.1%), had >10 years of EMS experience (n=69; 28.8%) and were up to date with their Hepatitis B vaccination at the time of the study. HIV post exposure prophylaxis (PEP) was initiated in 82 (88.2%) out of the 93 NSI incidents. However, the recommended 28-day course of therapy was only completed in 68 (82.9%) out of the 82 cases where PEP was initiated. Conclusion: Prehospital personnel are at high risk of sustaining a NSI. There is a need to promote awareness with regards to the risks, preventive measures, awareness of PEP protocols and the timely initiation and completion of HIV PEP amongst EMS personnel in Johannesburg.Item Molecular characterization and genotyping of hepatitis B virus (HBV) from sudanese end stage renal disease (ESRD) patients with overt and occult HBV infection(2018) Nekhwevha, KhudaniHepatitis B virus (HBV), which causes infection globally, is endemic in sub-Saharan Africa. Currently, nine genotypes (A to I), distributed geographically, are recognised. In Sudan, located in north-east Africa, HBV prevalence ranges from 4% to 26%, and genotypes D and E predominate. Patients suffering from end-stage renal disease (ESRD) exhibit poor kidney function and require regular haemodialysis. HBV exposure in haemodialysis patients in Sudan is high, as the immunosuppressive nature of renal disease increases risk from HBV infection. The aim of this study was to molecularly characterise HBV from ESRD patients in Sudan undergoing haemodialysis and also to use phylogenetic analysis to determine if HBV infection was occurring in the four haemodialysis centres from which HBV DNA was successfully amplified. We undertook polymerase chain reaction (PCR) amplification and DNA sequencing of the basic core promoter/pre-core (BCP/PC) and the complete S (preS1/preS2/S) regions of 68 HBV DNA positive ESRD patients undergoing haemodialysis in four different treatment centres (Salma, Ibn Sena, Elturki and Alnaw) in Khartoum. In Hepatitis B surface antigen (HBsAg) positive (overt) HBV-mono-infected samples, PCR amplicons from the BCP/PC region were obtained from 28/46 (60.9%) of samples, with DNA sequences obtained from 24/46 (52.2%). Results for the S region were 23/46 (50%) and 15/46 (32.6%), for PCR amplification and sequencing, respectively. BCP/PC PCR amplification from 12 occult HBV-mono-infected samples resulted in 2/12(16.7%) amplifications of low density bands. Hence no DNA was obtained for sequencing. However, 4/12 (33.3%) of these samples yielded S region amplicons, with DNA obtained from 3/12 (25%). Ten HBV/HCV co-infected samples yielded 4/10 (40%) positive samples in the BCP/PC, with 3/10 sequenced (30%) in the complete S, 2/10 (20%) amplified with low DNA quality. Neighbour-joining phylogenetic analysis using 1000 bootstrap indicated that genotype D predominated at 11/15 (73.3%), followed by genotypes E and A, at 3/15 (20%) and 1/15 vi (6.7%), respectively. Genotype D was found in all centres and mostly detected at Salma 6/15 (40%), whereas genotype A was only detected at Elturki. Moreover, Genotype E was only detected in Salma and Ibn Sena. We identified a six nucleotide insertion occurring in the core region of HBV from four individuals from Salma centre. This was a novel finding in genotype D isolates as this insertion was previously found in genotype A. The preS1 mutation, ps1I48V, which occurs mostly in genotype A isolates, was found in one genotype A isolate from Sudan. We further identified a preS2 deletion in one genotype E isolate. The deletions in the pre S contribute to the development of hepatocellular carcinoma (HCC). The HBV reactivation marker, S174N was found in one HBsAg negative (occult) individual. We further identified HBV drug resistance mutations, rtS213 and rtQ215H occurring in two different individuals from Ibn Sena centre. Both of these individuals were not vaccinated. In conclusion, in Sudanese ESRD patients, genotype distribution varies between treatment centres, although genotype D predominates. In addition, drug resistance and vaccine escape similar to the ones found in South Africa exist in Sudan. The small sample size did not allow us to compare the mutations found in HBV isolates from individuals with overt or occult infection. Hence, further studies to identify distinguishing mutations between occult and overt samples, as well as in HBV/HCV co-infected individuals in Sudan are still needed.Item Hospitalization among adultd resident in the Africa centre demographic surveillance area in Rural KwaZulu Natal: South Africa(2017) Azindow, Irene TampuriSouth Africa bears a quadruple disease burden: communicable and non-communicable diseases, as well as perinatal and maternal and injury related disorders. Serious morbidity resulting in hospitalizations are costly to the individual, to the health sector and society. Adults constitute more than half of the population in SSA and survival of children depends to a large extent on the health of the adults. In this analysis, hospital and population based data was used to describe the causes of and factors associated with hospitalization among adults 15 years and older resident in the Africa Centre Demographic Surveillance area. Methods All resident adults of Africa Centre Demographic Information System (ACDIS) as at 1st January, 2011 and followed till 31st December, 2013 were eligible for inclusion in the study. Cause of hospitalization was based on discharge diagnosis based on ICD10 coding. Factors associated with hospitalization were assessed using Cox proportional hazard regression model. Results The cohort consisted of a total of 41,477 individuals with 24,068 (58.03%) females and a median age of 29 years (Inter quartile range 20-45). 1,172 (2.83%) individuals contributed to 1,375 episodes of hospitalization. The top five causes of hospitalization for the period were maternal conditions 335(24.96%), tuberculosis 248(18.48%), injuries 126(9.39%), infectious and parasitic diseases 104(7.75%) and cardiovascular diseases 88(6.56%) with variations in causes of hospitalization by gender. The risk of hospitalization for males increased with age with the exception of the 20-24 year age group. The risk of hospitalization for males increased by 72% among participants on disability iv (aHR 1.72 95%CI: 1.15-2.56) ) compared to those who did not receive grants whilst married males had a 48% reduction in the risk of hospitalization compared to unmarried males (aHR 0.52 95%CI: 0.38-0.73). Females on disability grant had a 55% (aHR 1.55 95%CI: 1.13-2.12) increase in the risk of hospitalization whilst those on old age pension had a 65% (aHR 1.65 95%CI: 1.15-2.37) increased risk of hospitalization compared to those whose did not receive grants. There was a protective effect in the risk of hospitalization among married (aHR 0.57 95%CI: 0.44-0.73) and widowed (aHR 0.68 95%CI: 0.52-0.90) compared to unmarried females whilst females in the poor (aHR 1.37 95%CI: 1.07-1.76) wealth index had increased risk of hospitalization in comparison to those in the poorest wealth index. Exclusion of maternal causes slightly altered the risk of hospitalization estimates for the above factors in addition to which there were varied increases in the risk for age with the exception of the 20-24 year age group Conclusion The analysis suggest that maternal conditions, tuberculosis, injuries and infectious and parasitic as well as cardiovascular disease were the main causes of hospitalization during the study period. Age, grants and marriage was associated with the risk of hospitalization among males whilst grants, marriage and wealth index was associated with the risk of hospitalization among females. Exclusion of maternal causes slightly altered the risk of hospitalization estimates in addition to which age was associated with increased risk of hospitalization. These should be considered for efficient planning and implementation of health programs to reduce morbidity.Item Analysing the national notifiable diseases surveillance system in South Africa(2018) Benson, Frew GeraldBackground Outbreaks of infectious diseases contribute to premature mortality and underscore the importance of effective disease surveillance and response systems. There is limited knowledge on the performance of the South African notifiable disease surveillance system (NDSS). Objective The aim of this PhD study was to analyse the NDSS of South Africa. The specific objectives were to: analyse key informants’ perspectives on system attributes of the National NDSS; analyse the NDSS attributes through comparing notifications with laboratory surveillance; determine the factors influencing provider compliance with the NDSS; and make policy recommendations to improve the effectiveness of the NDSS. Methods This thesis combined a novel comparative analysis of laboratory and notification records for three tracer conditions of measles, meningococcal meningitis, and typhoid with two cross-sectional, analytical studies among NDSS key stakeholders (n=169) and health care providers (n=1050) respectively. STATA® 14 was used to conduct quantitative, statistical analyses. Results The key stakeholders’ survey had an 84% response rate: 25% perceived the system to be acceptable; 51%, flexible; 45%, timely; 61%, useful; and 74%, simple. Stakeholders with more experience were less likely to perceive the NDSS as acceptable (OR 0.91, 95 % CI: 0.84–1.00, p = 0.041); those in disease detection were less likely to perceive it as timely (OR 0.10, 95 % CI: 0.01–0.96, p = 0.046) and those participating in National Outbreak Response Team were less likely to perceive it as useful (OR 0.38, 95 % CI: 0.16–0.93, p = 0.034). vii For all three diseases, fewer cases were notified than laboratory confirmed. Completeness for the laboratory system was higher for measles (63% vs. 47%, p<0.001) and meningococcal meningitis (63% vs. 57%, p<0.001), but not for typhoid (60% vs. 63%, p=0.082). Stability was higher for the laboratory (all 100%) compared to notified measles (24%, p<0.001), meningococcal meningitis (74%, p<0.001), and typhoid (36%, p<0.001). Representativeness was also higher for the laboratory (all 100%) than for notified measles (67%, p=0.058), meningococcal meningitis (56%, p=0.023), and typhoid (44%, p=0.009). The sensitivity of the NDSS was 50%, 98%, and 93%, and the PPV was 20%, 57%, and 81% for measles, meningococcal meningitis, and typhoid, respectively. The response rate for the health care provider (HCP) survey was 90%. In the year preceding the survey, 58% diagnosed a notifiable disease; 92% of these HCPs reported the disease, but only 51% notified correctly to the Department of Health. Factors influencing notification were HCPs perceptions of workload (OR 0.84, 95% CI 0.70 - 0.99, p=0.043) and that notification data are not useful (OR 0.84, 95% CI 0.71 - 0.99, p=0.040). Conclusion The NDSS in South Africa performed poorly on most of the system attributes. In addition, HCP compliance with the NDSS was suboptimal. The study generated new knowledge on the performance of the NDSS in South Africa, which should inform the revitalisation and reforms of the system.Item The pattern of needle-stick injuries in academic hospitals in Johannesburg(2016) Lai, Anita Pui ChingNeedle-stick injury is a common problem among health care workers (HCWs) all over the world. Globally, in 2000, there were an estimated 1000 HCW-acquired human immunodeficiency virus (HIV) infections through occupational exposure. Limited data are available in South Africa. This descriptive study documents the pattern of needle-stick injuries among registrars in the Academic Hospitals in Johannesburg, South Africa. A total of 150 registrars across different disciplines in the three Academic Hospitals in Johannesburg were interviewed, using a standardised questionnaire in 2013. The majority of the registrars interviewed (n=123, 82%) had reported a needle-stick injury. Most of the needle-stick injuries occurred during internship. Most of the doctors were working in the Departments of Surgery and Internal Medicine at the time of their injuries. The most common mechanisms of needle-stick injuries were during insertion of a drip (22%) and suturing (21%). The majority (83%) of the doctors with needle-stick injuries took post exposure prophylaxis (PEP). The combination of zidovudine and lamivudine was the most commonly used regimen. Over half (53%) of the doctors with needle-stick injuries completed the 28 days course of PEP, while the remaining doctors (47%) discontinued PEP due to side-effects and/or because they considered the treatment unnecessary. The findings in this study are similar to those reported in other studies done previously in different parts of South Africa. Adherence to PEP following needle-stick injury remains a major problem.