Electronic Theses and Dissertations (Masters)

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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.
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.
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.
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.
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.
The relationship between mental health and work stress in healthcare workers during COVID-19 in Gauteng, South Africa (2020)
(2024) Butao, Themba Archiford
Background: Research into the 2003 severe acute respiratory syndrome (SARS) outbreak in Toronto, by Maunder et al (2006), revealed that health care workers (HCWs) experienced high “levels of burnout (p=0.019), psychological distress (p<0.001) and posttraumatic stress (p<0.001)” compared to HCWs that were working in Hamilton at hospitals that were not treating SARS infected patients. In June 2012, the Middle East Respiratory syndrome (MERS) had high nosocomial transmissions, and this led to increased distress among HCWs. Coronavirus Disease 2019 (COVID-19) is the most recent global pandemic, and it is has led to a negative impact on the healthcare sector and its employees. The impact of pandemics such as COVID-19 on the mental health of HCWs in low-middle income countries like South Africa is not fully known. Previous studies have shown that low-middle income countries, such as South Africa experience higher stress and burnout levels due to their limited resources such as access to personal protective equipment. High stress during patient care in high income countries has resulted in HCWs experiencing fear, exhaustion and stress in the past. Aim: To investigate the relationship between work stress and mental health in HCWs working in public hospitals and CHCs during COVID-19 in Gauteng in 2020. Methods: The study was a cross-sectional study using secondary data from a longitudinal study that was conducted in Gauteng, South Africa in 2020. The primary study was conducted by sending a questionnaire to HCWs working in large hospitals and some clinics in Gauteng, South Africa in 2020. The questionnaire consisted of the General Health Questionnaire-12 (GHQ-12), Job-Related Tension Index (JRTI) and COVID-19 related questions. A sample size of 223 was required for the study and was analysed using STATA® 16 software. Regression analysis was conducted to analyse the different relationships and odds ratios were obtained at the end of the study. Results: A total of 336 HCWs participated from 6 facilities. Of the occupations that could be identified, Professional nurses made up the highest percentage of HCWs (19.11%). A majority 55.22% and 54.33% of HCWs experienced mental distress and work stress respectively. The prevalence of both mental health disorders and work stress in HCWs in Gauteng during the COVID-19 pandemic was 39.10%. The odds of developing mental health disorders among HCWs who were experiencing work-stress in Gauteng, 2020, were 7.51 times the odds of developing mental health disorders among HCWs not experiencing workstress in Gauteng, 2020 (p <.001, CI: 2.99, 18.85). The study also showed that a unit increase in the JRTI score was associated with a 19% increase in the GHQ-12 score (p < .001, CI: 0.14, 0.25). Discussion and conclusion: Work-stress significantly affected mental health among HCWs working in public hospitals and community health centres (CHCs) in Gauteng during the early COVID-19 pandemic. The study also shows that pandemics such as the COVID-19 pandemic can lead to a high proportion of work-stress as well as mental health disorders in HCWs. Negative perceptions of risk during COVID-19 also played a significant role in the work stress and the mental wellbeing of HCWs. Recommendations: Decision makers at the district and provincial level should aim to provide constant counselling services even during periods of less work-stress. Sufficient outbreak response training should be provided as part of HCWs Continual Professional Development (CPD) courses so that there is better readiness for future pandemics. There should permanent policy changes that reduce the number of hours worked by HCWs, and more effort staff retention in the public sector as this is what majority of the country uses for seeking healthcare services. Smaller healthcare facilities should also be better equipped with not just only professional HCWs but equipment, including training and storage of such equipment, and regularly checked as preparation for future outbreaks.
Risk factors for breast cancer among women in Ekurhuleni Metropolitan Municipality, Gauteng Province of South Africa, 2017–2020: a case-control study
(2024) Mashele, Sizeka Aubrey
Background: Breast cancer (BC) is the most common cancer among women in South Africa (SA). In 2020, the age-standardized incidence rate (ASIR) and the age-standardized mortality rate (ASMR) were 52.6 and 16.0 per 100 000, respectively. There is a paucity of evidence on the risk factors for BC among women of all population groups in SA. The goal of this study was to determine the risk factors for BC, calculate the ASIR as well as explore epidemiological changes in BC among women in Ekurhuleni Metropolitan Municipality, Gauteng Province, SA. Methods: An unmatched case-control study was conducted from 1 January 2017 to 31 December 2020 using secondary data extracted from the Ekurhuleni Population-Based Cancer Registry (EPBCR). Unconditional multivariable logistic regression analysis was carried out using the adjusted odds ratio (aOR). The variables race, employment, HIV, smoking and alcohol statuses were included in the multivariable logistic regression model while the model was adjusted for age. In addition to risk factor analyses, we calculated the ASIR for BC in women using the Statistics South Africa population estimates as a denominator and the Segi-World Standard Population (WSP) for standardization. The joinpoint regression program was used to estimate the average annual per cent change (AAPC) for the four years (2017–2020). Results: A total of 3068 (2217 cases and 851 controls) participants were enrolled in the study. The mean age (±SD) in years of the participants was 55.2 (±15.2). The White population group, being self-employed and Human Immunodeficiency Virus (HIV) -positive status was significantly associated with reduced odds of BC development among women. Women who were HIV-positive were 61% less likely to have BC than women who were HIV-negative (aOR 0.39; 95%CI: 0.27‒ 0.57). White women were 75% less likely to have BC than women of other races (aOR 0.35; 95%CI: 0.29‒0.43). Self-employed women were 59% less likely to have BC than women who v were formally employed (aOR 0.41; 95%CI: 0.18‒0.97). The ASIR for BC among all women in 2017 was 42.33 (95%CI: 39.25–45.59) and 23.39 (95%CI: 21.10–25.86) per 100 000 in 2020. White women had the highest incidence rate of BC throughout the study period (55.47 (95%CI: 47.57–65.08) in 2017, 69.70 (95%CI: 60.77–79.74) in 2018, 35.51 (95%CI: 29.29–42.85) in 2019 and 37.12 (95%CI: 30.74–44.62) in 2020) compared to other population groups. No significant reduction in BC incidence rate was observed among all women throughout the study period with an exception of Black women, whereby a significant reduction in BC incidence rate was observed between 2017 and 2020 with an AAPC of -23.5% (p=0.017) Conclusion: In this study, the White population group, being self-employed and HIV-positive had lower odds of BC and thus necessitate more in-depth studies using primary data to effectively explore the risk factors of BC among women in SA settings. There was no significant change in AAPC except for Black women, this indicates disparities in screening uptake among population groups, and as such, there is a need to strengthen BC preventive strategies. There is a need for public health awareness to scale up BC screening uptake as well as the promotion of early detection through targeted awareness campaigns.
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.
Percentage positivity and determinants of cytomegalovirus infection and immunity in the public sector of south africa, 2007–2021: a time series analysis
(2024) Mhlabane, Nelisiwe Lynneth
Cytomegalovirus (CMV) infection is common in all age groups but is more prevalent in women of childbearing age and neonates. If left untreated, CMV can cause birth defects, recurrent infections, and death. Understanding the burden of CMV disease and its risk factors is important to instigate preventive measures. Despite global research conducted on CMV, there is still a paucity of studies conducted in South Africa that focus on CMV current infection and its determinants as well as immunity to CMV. The goal of this study was to determine the prevalence of CMV infection and immunity and the factors that influence them in South Africa’s public sector between 2007 and 2021. Methods: An analytical cross-sectional study was conducted using the results of CMV tests carried out on patient samples. The included test results were obtained from the National Health Laboratory Services and included results from all South African provinces from 2007 to 2021. The data were extracted from the National Health Laboratory Services Corporate Data Warehouse. Records of participants of all age groups whose data were available at the National Health Laboratory Services Corporate Data Warehouse were obtained. Patient demographic details and laboratory results were extracted into data collection tables. Data was cleaned and analysed using Stata 17. The CMV results considered in the analysis were serological (immunoglobulin M [IgM] and Immunoglobulin G [IgG] and molecular polymerase chain reaction tests carried out for routine CMV diagnosis. Immunoglobulin M, 2 polymerase chain reaction, and IgG seroconversion are markers of current CMV infection. A positive IgG antibody result is a marker of immunity (previous infection). A current CMV infection was defined as a positive CMV immunoglobulin M result, a CMV IgG seroconversion from negative to positive within three months of testing, or a positive CMV polymerase chain reaction result. Descriptive statistical analysis along with multivariable logistic regression analyses was used using age, sex, province, year and HIV. Results: A total of 432,170 records were analysed for CMV infection from 2007 to 2021. Among those with available CMV IgG test results, 97.84% (190,933/197,157) tested positive. For those with available CMV immunoglobulin M test results, 5.85% (16,850/288,267) tested positive. Overall, 4.40% (19,006/432,170) of records had evidence of a current CMV infection. Stratified analysis by sex showed similar proportions of current CMV infection for men (4.48%; 7,534/155,515) and women (4.08%; 10,649/261,310). Individuals aged 0–1 year had the highest proportion of current CMV infection at 7.35% (7,682/104,510), while those aged 2–15 years had the lowest proportion at 2.74% (979/35,686). Limpopo had the highest proportion of current CMV infections with 5.23%, (1,586/30,340), and the Western Cape had the lowest CMV current infection with 2.24% (788/35,114). In adjusted analysis, age and province were significantly associated with current CMV infection. Using individuals 0–1 year as the reference, all other age groups were less likely to test positive for CMV; the age group 2–15 years had the lowest CMV current infection (AOR = 0.34; 95% CI = 0.32–0.36). Limpopo (AOR = 1.91; 95%CI = 1.76–2.0; p = <0.0018) had the highest odds of current CMV infection while Western Cape had the lowest odds (AOR = 0.66; 95%CI = 0.60–0.73; p = <0.001). HIV infection, sex, and season were not associated with current CMV infection in the adjusted analysis. Regarding CMV immunity, the age group 26–35 years had the highest number of individuals who were IgG positive (99.18%; 45,845/46,223). The Northern Cape province had the highest concentration of IgG-positive individuals (98.81%; 407/4,460), and the year 2012 had the largest percentage of IgG-positive individuals (98.29%; 11,607/11,809). Conclusion: Age and place of residence (province) were associated with current CMV infection. Cytomegalovirus seroprevalence did not differ by gender. We found that a significant proportion of children are not susceptible to CMV infection. More recent 3 data would be useful to evaluate CMV infection in the South African populace and to give a clearer idea of the epidemiology of CMV infection. Meantime, without an effective CMV vaccine, the major preventive measure is educating people about CMV risk mitigation measures. Cytomegalovirus infection vaccines are still in the early phases of development, and our study contributes to identifying a potential target age for vaccination.
Revalence and factors associated with virological nonsuppression amongst HIV positive pregnant and lactating adult women in the Kingdom of Eswatini in 2016-2017
(2024) Ndlangamandla, Mpumelelo
Antiretroviral treatment (ART) is the primary intervention for preventing mother to child transmission of HIV service package. The likelihood of vertical transmission of HIV can be drastically reduced by using ART. The World Health Organization (WHO) recommends ART initiation in pregnant and lactating women living with HIV regardless of WHO clinical staging and thereafter to continue combination Antiretroviral Therapy (cART) for life. There are some challenges in implementing the WHO recommendations in settings where many women cannot attend antenatal care services due to social or economic barriers or structural barriers and even fewer women attend postnatal care services. The objectives of this study are to determine the prevalence of virological non-suppression among pregnant and lactating women living with HIV, to quantify the association between self-reported ART use and virological non-suppression and determine socio-demographic, clinical and behavioural characteristics associated with virological non-suppression among pregnant and lactating women living with HIV. This is a cross-sectional study using secondary data from the Swaziland HIV Incidence Survey. The primary study was a population-based survey which was nationally representative, using a cross-sectional study design conducted in 2016-2017 in the Kingdom of Eswatini employing a two-stage stratified cluster sample design. This study sample included adult women living with HIV who were either pregnant or lactating at the time of the survey. Data analysis was conducted using Stata 17. The data analysis made use of sampling weights and clustering of individuals within each enumeration area using weighted clustered logistic regression survey analysis commands in Stata. A total of 195 adult women living with HIV were included in the survey with a median age of 28 years old. Among the women, 104 (54.4%) were either married or cohabiting with someone, and 151 (71.9%) were living in a rural setting. Only 77 (38.8%) had attained primary education as their highest level of education while 122 (63.8%) were lactating. A total of 120 (62%) reported being on ARVs and 158 (81.8%) being virally suppressed. The overall virological non-suppression prevalence of 36.8% was higher than the UNAIDS target of 10% by 2020 to speed up HIV elimination. In a multivariable analysis, two risk factors remained statistically significant. Women who were aged 17 to 24 years old were almost five times more likely to be virologically non-suppressed (aOR=4.7, 95% CI 1.8 - 11.8, p=0.001) while women who did not report ARV use during pregnancy were eight times more likely to have virological non- RESEARCH REPORT (COMH7060) 320775 IV suppression (aOR=8.1, 95% CI 3.0 - 21.8, p<0.001). Maternal age was dichotomised with the younger group compared to the older group (17-24 years, vs 25+ years). An additional analysis excluding self-reported ARV use at pregnancy found that virological non-suppression was associated with maternal age (OR=5.5, 95% CI 2.3 – 13.7, p<0.001) and number of sexual partners in the previous 12 months (OR=7.9, 95% CI 1.6 – 40.5, p=0.013). Maternal age was dichotomised with the younger group compared to the older group (17-24 years, vs 25+ years) The study found that virological non-suppression was associated with maternal age and ARV use at pregnancy. The additional analysis also found a strong association with maternal age and number of sexual partners the women reported having in the previoustwelve months. However, the primary study was not powered to detect differences in virological non-suppression among our population of interest. The sample size was also small, which limited the ability to investigate other possible risk factors. To help the country address the identified gaps, I would recommend the scale up of the DREAMS program and strict following of HIV guidelines to actively monitor viral load and ART uptake during pregnancy and lactation. In addition, messaging around avoidance of multiple sexual partners should be strengthened
Predictors of resilience among adolescents living in rural Mpumalanga in 2018: a cross sectional study
(2024) Snijder, Michelle
Literature suggests that resilience can be reached by practicing behaviours, thoughts and attitudes that promote resilience. To understand which behaviours, thoughts and attitudes foster resilience, predictors of resilience should be studied. This study aimed to examine predictors of resilience among adolescents living in the rural Mpumalanga Province, South Africa. Data were collected using a questionnaire from a sample of 245 adolescents between 13.1 and 15.2 years (median age 14.1 (13.1- 15.2); sex 52.7% female and 47.4% male). The questionnaire included questions from depression, stress and resilience scales as well as additional questions relating to communication with parents, and socio-demographic characteristics. The 20 question Centre for Epidemiological Studies Depression Scale (CES-D) measured depression, the 10-item Perceived Stress Scale (PPS-10) measured stress while the 25-item Connor Davidson Resilience Scale (CD-RISC-25) measured resilience. The prevalence of resilience was estimated at 46.1%. The findings suggest that perceptions of stress did not significantly predict resilience. Experiencing depressive symptoms and healthy interpersonal relationships significantly predicted high resilience. Although healthy relationships with parents predicted high resilience, adolescents relied more on relationships with friends to build resilience. However, regularly meeting with friends predicted low resilience, while always meeting with friends decreased the chances of low resilience. Thus, the study suggests that healthy relationships with both parents and friends may predict high resilience. However, when relationships with friends replaces that of parents, low resilience results. Finally, this study supports the need for further studies on the validity and acceptability of the PPS-10 and CES-D scales in the South African context.
The use of machine learning techniques in identifying gender differentials in COVID-19 hospitalizations, probabilities of hospitalization outcomes and hidden correlations with demographic and clinical factors
(2024) Malaatjie, Meghan Abigail
Background: Sex-differentiated data on hospitalisation frequency, case severity, pre-existing medical conditions, and mortality outcomes amongst Covid-19 hospitalised patients is needed but limited in Gauteng province, the epicentre of the Covid-19 pandemic in South Africa. This study aims to investigate whether Machine Learning techniques can provide insight into gender differentials in COVID-19 hospitalizations throughout the four waves of the pandemic, in the Gauteng province of South Africa. Method: A weak supervision learning algorithm was used to perform binary classification. The training of a DNN was performed on 14 features of patient characteristics (Demographic variables, presence of comorbidity, care received upon admission and setting of care), to separate the two classes of data sets: a) severe disease class (a proxy measure of higher severity, which included those who died during admission or were admitted into an intensive care (ICU) or high care unit (HCU)), and b) less severe disease class. Results: The number of Covid-19 hospitalisations was highest in wave 3 for both males and females, and higher in females than males across all 4 waves. The observed difference in COVID-19 hospitalization frequency between men and women was the highest in the 20 - 40-year age group with a ratio of 1:3. There was a higher frequency of COVID-19 hospitalization for hypertension, diabetes, and HIV frequencies across all age groups. Conclusion: This study demonstrated the utility of machine learning for analysing multidimensional sexdisaggregated data to provide accurate, real-time information for public health monitoring of sexdifferences in the Gauteng province.
Knowledge, attitudes, and referral practices regarding animal bites and prevention of human rabies among traditional health practitioners in Ethekwini district in Kwazulu-Natal province, South Africa, 2022
(2024) Mabona, Maxwell Musa
Background: Despite the availability of effective post-exposure prophylaxis (PEP), South Africa records about 10 human rabies deaths each year. Many animal bite victims initially seek help from Traditional Health Practitioners (THPs) before considering conventional healthcare facilities. Prompt referral of animal bite victims for PEP initiation by THPs can be lifesaving. Our study aimed to assess the knowledge, attitudes, and referral practices regarding human rabies and the associated factors among THPs in eThekwini District, KwaZulu-Natal. Methods: We conducted a cross-sectional study among registered THPs consulting patients in the eThekwini District. We used a structured standardized questionnaire to collect data. The questionnaire was administered through physical and telephonic interviews. We described socio-demographic characteristics using summary statistics. Multivariable logistic regression was used to analyze factors associated with knowledge, attitudes, and referral practices of human rabies. Odds ratios (OR) were used with a 95% confidence interval, and a probability (p)-value of ≤0.05 was considered statistically significant. Results: We interviewed 204 THPs, and 74% (150/204) were female. The median age was 43 years (inter-quartile range: 22-75 years) and 31% (64/204) had over 10 years of experience. The majority of THPs had inadequate knowledge (80%, 163/204), and poor referral practices (73%, 149/204). However, 91% (186/204) had positive attitudes toward human rabies prevention. Having more experience was associated with adequate knowledge (p<0.01), and positive attitudes (p=0.02). THPs who had adequate knowledge (aOR:2.30 95% CI: 1.12-4.75) and positive attitudes (aOR:1.21 95% CI: 0.37-3.89), had higher odds of having good referral practices. Conclusion: Despite THPs in eThekwini District having positive attitudes towards rabies prevention, gaps exist in their knowledge and referral practices. The study highlights that improving their knowledge and attitudes might lead to better referral practices of animal bite victims for PEP initiation. A multidisciplinary approach that includes THPs is recommended to decrease human rabies deaths in eThekwini District.
The spatial distribution of health facility viral suppression rates in the City of Matlosana Local Municipality, South Africa, 2011-2015
(2024) Ndlovu, Kudzayi
Objective: The highly mobile population and a large immigrant population within City of Matlosana Local Municipality contributes to the high tuberculosis and HIV burden. This study seeks to use routine HIV laboratory data to compare facilities’ viral suppression rates using geospatial techniques. Geospatial techniques give a visual presentation of the data including trends over time and patterns across facilities. Design: This was a longitudinal study design based on secondary data obtained from the NHLS laboratory in Klerksdorp for 19 health facilities in City of Matlosana Local Municipality between 2011 and 2015. Method: Program data extracted from the NHLS CDW database was used for the study. Data were collected each time a client comes for routine laboratory tests. The database contained data for all patients from the City of Matlosana Local Municipality who had their HIV care follow up tests done in the public sector between 2011 and 2015. Facility geocodes were used for mapping out suppression rates by facility and to present the data on a descriptive map. The choropleth map was computed using the functionality on QGIS that shows the dependent variable using color codes based on the corresponding percentage. This was done at baseline and over the follow up period to 2015 (spatiotemporal trends). STATA version 15 was used for the examination of the presence of clustering, where the Moran’s Index was computed at 5% level of significance. The Simultaneous Autoregressive model was used to examine factors associated with suppression while adjusting for geocodes. Akaike Information Criterion was used for determining the best model fit. Results: Of the total number of facilities assessed, 47% had the viral suppression rates between 60% and 70% while 21% of the facilities had their viral suppression ranging from 70 – 80%. The overall viral suppression rates were lowest in Klerksdorp hospital with 43.7% and the highest at Stilfontein municipal clinic with 78.2%. The viral suppression rates at Klerksdorp Hospital were the lowest throughout the entire study period. These rates started at 29.3% in 2011 and gradually rose over time, reaching a peak of 59.7% in 2015. The viral suppression rates across health facilities increased over time with Orkney and Stilfontein reporting highest performing. The yearly viral suppression rates showed a general increase in the viral suppression rates ranging from 69.4% in 2011 to a peak of 73.1% in 2012 and dipping in 2015 with a final rate of 72.1%. The local and global measure (Moran’s I and Getis – Ordi) test for spatial autocorrelation was insignificant (p=0.611>0.05) and therefore spatial autoregressive models could not be used. However, results from general linear regression showed that viral suppression increased by 0.64 for every unit increase in age of clients tested (95%CI: 0.25 – 1.02; p<0.01). Furthermore, viral suppression decreased by 0.41 for every unit increase in white cell count (95%CI: -0.80 – -0.02; p<0.05). Conclusion: Geospatial techniques can be employed to present a visual presentation of viral suppression rates, to identify trends over time and patterns across facilities. Results from the study showed that viral suppression rates ranged from 60% to 80% among the majority of facilities in the City of Matlosana Local Municipality. The lowest and highest viral suppression rates were at Klerksdorp hospital and Stilfontein municipal clinic respectively. Viral suppression rates across facilities were declining from 2012 to 2014, however there were sharp increases from 2011 to 2012 and from 2014 to 2015. White cell count and age for clients tested were significantly associated with viral suppression. In addition, there was no clustering of viral suppression rates in the City of Matlosana Local Municipality, implying that HIV viral loads varied across the health facilities
Factors associated with pre-exposure prophylaxis (PrEP) uptake and continuation among adolescent girls and young women in the uMhlathuze Municipality, KwaZuluNatal South Africa
(2024) Methazia, Jewelle Joanna Sardis
Background Despite the notable advancements in preventing human immunodeficiency-virus (HIV) globally, South Africa (SA) continues to report the largest epidemic of HIV in the world. Furthermore, adolescent girls and young women AGYW) in SA carry the unequal burden of infection in SA. Studies have reported that AGYWs find it difficult to negotiate condom use placing them at a direct risk of contracting HIV. Pre-exposure prophylaxis (PrEP) was identified as a novel preventative intervention with uptake and continued use offering the potential to decrease HIV incidence. In SA, guidelines, and strategies to provide of PrEP to high-risk groups, which include AGYW have been developed. This study aimed to describe the characteristics of the AGYW initiating PrEP services and determine the factors associated with PrEP uptake and continued use among AGYW enrolled in an HIV prevention combination program in the uMhlathuze Municipality in KwaZulu-Natal South Africa. Methods This is a retrospective cohort study involving secondary data analysis of programmatic data from an HIV combination prevention program for AGYW in 5 Department of Health community primary health clinics the uMhlathuze Municipality in KwaZulu-Natal. We sampled participants from a population of HIV uninfected AGYW between the ages 15 -24 that initiated the program between the 1st of June 2020 and the 31st of June 2021. Our primary outcome of interest was PrEP initiation at baseline defined as the number of AGYW who were offered PrEP and initiate its use during at their first visit. Our secondary outcome of interest was PrEP continuation at follow-up visit defined as having at least 1 record of follow up after PrEP initiation. Categorical variables were expressed as frequencies and proportions. Bivariable analysis was carried out to determine associations between PrEP initiation and the categorical variables using the Chi-squared (χ2) test. Log-binomial regression was utilised to evaluate risk factors associated with our primary outcome (PrEP initiation) and our secondary outcome (PrEP continuation). Risk ratios (RRs) and their 95% CI were used as the measure of effect. Variables with p<0.1 were included in the multivariable analysis for both PrEP initiation and PrEP continuation to ascertain factors associated with each outcome. A cut off p<0.05 was used in the multivariable model to identify factors associated with both the primary (PrEP initiation) and secondary outcome (PrEP continuation). All statistical analyses were performed using Stata (V.15) statistical software and RStudio. Results Between the 1st of June 2020 and the 31st of June 2021, 3324 AGYW were enrolled in the HIV prevention combination program and were offered PrEP services. Overall, 1609 (48%) initiated PrEP services. Majority (71%) were aged 19 - 24 and 6.5% of PrEP initiates reported having an STI in the 6 months prior to initiating PrEP pills. Among those that initiated PrEP only 8% (N=125) had at least 1 record of follow-up post initiation. Factors that remained significantly associated with PrEP initiation in the multivariable analysis were had STI in the last 6 months (RR:2, CI: 1.5-2.8, p<0.001); currently on STI treatment (RR:1.6, CI: 1.2-2.3, p=0.004); used condom at last sexual encounter (RR:1.8, CI: 1.2-2.8, p=0.007). For our secondary outcome of interest PrEP continuation, factors associated with continued use of PrEP in our univariable analysis were age category 19-24 (RR:0.7, CI:0.5-1.0, p=0.036); used condom at last sex (RR: 1.7, CI:0.9-3.2, p=0.092). However, none of these factors remained statistically significant predictors of PrEP continuation in the multivariable model. Conclusion This study had moderate uptake of PrEP and poorer continuation than other studies. It is possible that lockdown restrictions implemented to curb the transmission of COVID-19 at the time of the study may have hampered the success of the PrEP intervention for AGYW enrolled in the HIV combination prevention program. This finding calls for more innovative PrEP service delivery models for programs and interventions in real clinic settings to ensure AGYW have uninterrupted access to PrEP when access to clinics is restricted. Our findings demonstrate important differences between PrEP uptake and key sexual and HIV risk behaviours. Our unadjusted analysis showed positive associations between PrEP uptake and the use of condoms at last sexual encounter, current STI diagnosis and STI diagnosis in the last 6 months, pregnancy, HIV discordant relationships, and having heterosexual anal sex. We continued to observe positive associations between the PrEP uptake and the use of condoms at last sexual encounter, current STI diagnosis and STI diagnosis in the last 6 months in our adjusted analysis. Condom use at last sexual encounter was common among PrEP initiates, and many AGYW currently taking STI treatment and those who had an STI in the last 6 months also elected to use PrEP pills. Our findings indicate programs offering PrEP should also integrate STI services with appropriate testing approaches and targeted vaccination for AGYW.
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.
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.
Nurses’ experiences in implementing Nurse Initiated Management of Anti-Retroviral Therapy (NIMART) in primary health care facilities in Dr Ruth Segomotsi Mompati District, North West Province
(2024) Sibisi, Nthabiseng
Aim of study- This study aimed to explore the nurses’ experiences in the implementation of NIMART in Dr Ruth Segomotsi Mompati District since its inception in 2010 to 2017. Methods This study employed an exploratory qualitative research design. The study setting included nine PHC facilities in three sub-districts. The study included only those nurses who had been trained to implement the NIMART in the district PHC facilities from 2010-2017. The final sample included Sixteen (16) nurses, comprising of three males and thirteen females from the three eight-hour operational clinics and six 24-hour Community Health Centres (CHCs). Data were therefore collected using in-depth interviews lasting thirty-five minutes (minimum) one and half hours 1h30 minutes (maximum). These interviews were guided by a semistructured interview guide. Data were later transcribed verbatim using an electronic software O’ Transcribe, and then analysed using MAXQDA 2018v, where inductive coding was applied. Thematic analysis was employed to interpret and represent data, which was finally presented as themes based on participants’ dominant narratives. Results- There were five key themes that emerged from this study. These included: perceptions about the NIMART programme mostly related to it being a task-shifting strategy when managing HIV and Aids and the programme benefits; contextual elements affecting access and adherence to NIMART, and challenges such as socio-cultural factors, social norms, socio-political and governance factors; facilitators of NIMART implementation in terms of functional health information management system and clinical guidelines, multidisciplinary team and skilled personnel, impactful counselling services, and intrinsic nurse motivators. Challenges of NIMART implementation included insufficient human resources for health, services integration, poor management and health-service support systems, lack of capacity building, ART unavailability and poor patient compliance to ART, and nurse demotivation. The proposed interventions by the nurses included provision of training, increasing staff to curb workload, management support, and debriefing, health service support resources and patient support improvement. Conclusion Task-shifting and successful NIMART implementation are complex notions, which can be successful if accompanied by training, reorganisation of services, mentoring, supervision, and ongoing support from existing health-service system structures. The rural health context must be considered as unique, and policies should be tailored to suit the needs of rural healthcare workers and patients. Dr RSM case-study has shows the plight of farm labourers and the need for a multisectoral approach to address patient related issues in this context. The challenges to successful NIMART implementation suggest a need for reorientation of health-services to fit rural contexts.
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.
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.

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