Electronic Theses and Dissertations (Masters)
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Item Indoor/outdoor PM4 (respirable dust) and respirable crystalline silica source tracking in households located in close proximity to gold mine tailing dumps(University of the Witwatersrand, Johannesburg, 2023-10) Makhubele, Nkateko Rawendar; Mizan, Gabriel; Manganyi, Jeanneth; Masekameni, Masilu DanielBackground: Particulate matter (PM) is a major contributor to air pollution in indoor and outdoor environmental spaces. Exposure to respirable dust (PM4) and respirable crystalline silica (RCS) indoor and outdoor in communities located in close proximity to gold mine tailings dumps in South Africa has not yet been determined. Aim: The aim of this study was to investigate the concentration of RCS and PM4 mass in samples measured indoor and outdoor of the nine (9) selected households located in close proximity to a gold mine tailings dumps. Methodology: Sampling locations were separated according to grids, based on the distance from the mine tailings dumps. Three different grids were determined as follows: A (<500m from the dump), B (>500m<1km) and C (1km – 3 km). Three households were selected from each grid zone to measure indoor and outdoor PM4 samples continuously over a 24-hour period using GilAir constant sampling pumps calibrated at the flowrate of 2.2 L/min in both the dry and wet seasons. PM4 samples were collected on a 37mm polyvinyl chloride (PVC) filter with a pore size of 0.8, which was assembled on the Higgin Dewell cyclones fitted with a filter pad of the same pore size. PM4 sample filters were gravimetrically weighed before and after sampling to determine the mass concentration of PM4. The respirable crystalline silica in PM4 samples were analysed by an X-ray diffraction method by South African National Accreditation System (SANAS) accredited laboratory of the National Institute for Occupational Health (NIOH). Samples were collected during the dry and wet seasons in the Riverlea community, Johannesburg. Results: During the wet and dry seasons, the mean indoor and outdoor PM4 mass concentration ranged from 0.02±0.01 µg/m3 to 2.26±0.02 µg/m3, respectively. The dry season mean PM4 mass concentrations were higher than the wet season PM4 mass concentrations in all zones. The pairwise comparison of PM4 mass concentration for dry and wet season revealed no statistically significance difference (p<0.05) at 95% confidence interval. Results presented in Figure 5 depicts the mean indoor PM4 mass concentration distribution for the dry season. The zone with the highest mean indoor PM4 mass concentration was zone A, followed by zone B. Since the mean outdoor PM4 concentration in zone C was the lowest, this suggests that the mine tailings dumps were the primary source of PM. The dry season mean indoor/outdoor ratio was greater than one across all zones; indicating that indoor activities were the primary source of PM. In both seasons, the mean indoor and outdoor percentages of crystalline silica ranged from 0.08±0.01% to 0.08±0.01%. The mean indoor and outdoor 24hr RCS concentrations in both seasons were below the California Office of Environmental Health Hazard Assessment (OEHHA) defined 24hr ambient exposure threshold of 3µg/m3. Recommendations: The results of this study suggest that nearby mine tailings dumps may be the primary source of PM in the indoor and outdoor environments; however the strength of this source in comparison to other sources remains unknown. Therefore, it is recommended that further studies focusing on source apportionment be carried out to determine the relative contribution of the mine tailings dust to the overall PM load in the environment. Although the difference was not statistically significant, indoor and outdoor PM4 concentrations were greater in Zones A&B, with the lowest PM4 concentrations in Zone C. The I/O ratio indicated that there was contribution of PM from outdoor. It is also recommended that further studies be conducted, with focus on monitoring PM4 over a 30 days period, to determine the level of free crystalline silica that may be present in PM4 mass concentrations. Conclusion: In the South African context, studies that focus on the investigation of indoor and outdoor PM4 concentrations in households located in close proximity to gold mine tailings are limited. The findings of this study can be used to provide valuable information on the indoor and outdoor PM4 concentrations, which can be used in modelling exposure and conducting probabilistic health risk assessment. High dust levels are related with dry season weather conditions due to strong wind conditions. Therefore, the PM4 mass concentrations in all zones were higher during the dry season than during wet season. Since the mean outdoor PM4 concentration in zone C was the lowest, this suggests that the mine tailings dumps were the primary source of PM.Item A Cost Comparison study of the electronic tick register with a paper based tick register in clinics within the Ekurhuleni District(University of the Witwatersrand, Johannesburg, 2023-08) Khoza, Courage Macduff; Thomas, Leena SusanIntroduction & Background: A paper-based register is used to capture routine health information from Primary Health Care (PHC) clinics into the District Health Information System (DHIS) in South Africa. However, DHIS data was reportedly unreliable and inaccurate, as the paper-based system was error-prone. To address this, the Ekurhuleni Health District in the Gauteng Department of Health (GDOH) developed and piloted an electronic (E-tick) PHC register in three of its facilities. Upon completing the pilot in 2019, the implementation of this system was halted as it was not incorporated into the GDOH budget, partly due to inadequate information on its costs compared to the paper-based system. Aim: This study aims to cost and compare the expenditure of the electronic tick register and the paper-based tick register systems and determine provider views on their use in the Ekurhuleni Health District. Methods: Two methods were used: a) a descriptive cost-comparison study of the paper-based tick and the E-tick registers from November 2017 to December 2019 and b) a descriptive cross-sectional study using interviewer-administered questionnaires about health worker experiences using both registers during the stated period. Results: The study found that the E-tick register was less costly than the paper-based register. The year 2018/19, which was the only complete financial year in the study period is used for comparison. The paper-based register cost the district R42.4 per patient, while the E-tick cost R29.9 (29.5% cheaper). Of ten study theme areas explored in the interviews, the E-tick was advantageous in eight, these were: Convenience, easy accesses, quick recording time, safe information storage, immediate data capturing, ability to add more elements, fewer errors and good font size and legibility. The paper-based register was found to be advantageous in just four study themes which were: Convenience, easy accesses, independence from electricity supply and sufficient writing space. Conclusions: The E-tick register was found to be preferred over the paper-based register as it was quicker, cheaper, and acceptable to most of the health workers who used it. These are important findings for the health district as the study generates local evidence that the Ekurhuleni Health District and the Gauteng Department of Health can use to justify investments in scaling up and sustaining locally developed innovative digital solutions such as the E-tick register. This further enables the health district to improve recording times and compliance with record management legislation.Item The in vitro diffusion across exercised porcine skin of various formulations of compounds used topically in the treatment of skin afflictions(University of the Witwatersrand, Johannesburg, 2023) Elonga, Jessica; Eyk, VanIntroduction and Aim: Skin afflictions have been treated with topically applied active compounds since the ancient Greek era. Topical compounds mostly avoid first-pass metabolism and move directly into the local region of the skin or mucous membranes to exert their therapeutic effects. In this study, the aim was to investigate the in vitro diffusion characteristics of active compounds commonly used in topical formulations, such as caffeine, theophylline, retinol, L-carnitine, and Co-enzyme Q10 across porcine skin, used as a model for human skin. These compounds were tested alone and in combination within different topical formulations (liquid, gel, and cream) to investigate skin permeation, skin accumulation and effect on skin integrity. Methods: Method development and validation were performed to detect and quantitate all compounds tested by using a RP C18 HPLC system. Mobile phases included the following: caffeine and theophylline (Methanol:water [40:60], 20oC), retinol (Methanol:water [95:5], 20oC), L-carnitine (Sodium Phosphate buffer (pH 3.0):Methanol [99:1], 40oC) and Co-enzyme Q10 (Methanol:2-propanol [40:60], 25oC). All analyses were performed at 1 ml/min and injection volume of 20 μl. In vitro diffusion studies were performed using a PermeGear 7-in- line flow-through system. Either caffeine (2.5%), theophylline (2%), retinol (0.3%), L-carnitine (2%) or Coenzyme Q10 (0.5%) in various formulations alone, and in combinations were loaded into the donor compartments and PBS (pH 7.4) was pumped through the acceptor chambers at 1.5 ml/h (32°C, over 4 hours and 24 hours). The fluid collected (every 30 min or 2 hours) was analysed by RP HPLC. Skin accumulation for each compound was performed after completion of each experiment and skin integrity was established by measuring tissue resistance. Results: HPLC methods were found to be sensitive and valid for linearity, precision, accuracy and robustness. Retention times were as follows: caffeine 2.57±0.02 min, theophylline 2.18±0.03 min, retinol 2.91±0.02 min, L-carnitine 3.0±0.009 min and Co-enzyme Q10 3.15 ±0.003 min. From the in vitro diffusion studies of active compounds alone, caffeine within all formulations had the highest diffusion rate compared to theophylline and L-carnitine (caffeine>theophylline>L-carnitine). Retinol and Co-enzyme Q10 did not diffuse across the skin within a 24-hour time-period. In combination with Co-enzyme Q10, the diffusion of caffeine increased from both gel and cream formulations (p<0.05), while retinol increased the diffusion of theophylline from a liquid formulation (p<0.05). Theophylline increased the diffusion of L-carnitine from both liquid and gel formulations (p<0.05). Liquid and gel formulations without compounds, decreased the skin’s integrity after 24 hours and 2 hours, respectively. After 24 hours, the skin’s integrity decreased after exposure to all compounds tested (liquid and gel formulations), while the cream formulation mostly kept the integrity of the skin intact. Caffeine accumulated much more in the skin (>13%) compared to all the other compounds (<2.5%) for all three different formulations tested (caffeine>>L- carnitine>theophylline>retinol>Co-enzyme Q10). Combination studies mostly caused a decrease in accumulation of all compounds within the skin, except the following: retinol increased theophylline accumulation from a gel formulation and vice versa, Co-enzyme Q10 increased caffeine accumulation from all formulations and L-carnitine’s accumulation mostly increased when combined with other compounds. Conclusion: Caffeine was found to diffuse across and accumulate within the skin to a higher extent as compared to all the other compounds due to its ideal physicochemical characteristics. Very lipophilic compounds like retinol and Co-enzyme Q10 only accumulated to some degree in the skin. The findings indicated that the preferable combinations to increase efficacy, would be Co-enzyme Q10 in combination with caffeine, especially from a cream formulation, retinol in combination with theophylline (gel) and any of the compounds combined with L-carnitine (gel and cream). Cognisance must however be taken about possible systemic side effectsItem Assessing the potential interaction between CBD and TBR1 CBD and T-box domain(University of the Witwatersrand, Johannesburg, 2024) Blignaut, Chanel; Sylvia, Fanucchi; Adeyemi, SamsonIn 2020, Cannabidiol (CBD) emerged as the most commonly used recreational substance among pregnant women and was perceived as a natural and safer option for alleviating pregnancy- related symptoms, yet its potential effects on foetal neurodevelopment remain uncertain. With varied results from existing literature on the association between prenatal cannabis use and Autism Spectrum Disorder (ASD) development, this study focuses on filling these knowledge gaps. It investigates the potential interaction of CBD with the T-box domain of TBR1, a transcription factor implicated in ASD. CBD may cross the placenta and distribute throughout the developing foetal organs, including the brain, where it may interact with TBR1. This study's objective is to lay the groundwork for future research into the impact of CBD binding on TBR1 functionality, whose dysregulation is implicated in ASD. The study aims to use in vitro and in silico methods to identify and characterise the interaction between CBD and TBR1 T-box Domain. Initially, predictive models were utilised to determine the structure of the TBR1 T-box domain and its binding domains. Subsequently, the ADMET properties of CBD are assessed to determine its potential interaction with TBR1 T-box domain within the body. Through the optimisation of the TBR1 T-box domain and CBD structures, induced fit docking and molecular dynamics simulations, the study aims to predict the potential interaction sites, dynamics and stability of this interaction. The study confirms the computational results using in vitro methodologies. After expressing and purifying the TBR1 T-box domain, a pull-down assay (PDA), thermal shift assay (TSA) and Time-resolved Fourier-transformed infrared spectroscopy (TR-FTIR) are used to evaluate the potential binding, stability and physiochemical properties of the interaction. Computational analysis, using Maestro Schrödinger Induced Fit Protocol, predicts that CBD binds stably within a hydrophobic pocket of TBR1 T-box domain, away from its DNA-interacting residues. Pose 2 and 3 from molecular docking shows the highest binding affinity and molecular dynamics simulations, using Maestro Schrödinger Desmond Molecular Dynamics System, reveal that the TBR1 T-box domain stabilises upon interaction with CBD. Specifically, the interaction is facilitated by hydrophobic interactions and hydrogen bond formation with residues Ser238, Pro335, Thr360, Glu363 and Asn240. Experimental validation through PDA and TSA provided inconclusive results, but TR-FTIR confirmed the dynamic nature of the CBD-TBR1 interaction, characterised by time-dependent spectral changes. While the results do not directly indicate an impact of CBD on TBR1 functionality, further DNA binding studies are necessary for confirmation. This study suggests caution in using CBD during pregnancy due to its complex and largely unexplored interaction with TBR1, underscoring the need for more comprehensive research to conclusively understand its influence on neurodevelopmental disorders and its therapeutic potentialItem Efficacy of noise control measures at high noise zones from a copper mine in Zambia(University of the Witwatersrand, Johannesburg, 2024) Nchimunya, Bbautu; Hayumbu, Patrick; Masekameni, Masilu DanielNoise exposure is a global problem, it is estimated that about 30 million workers in the United States of America (USA) are exposed to high noise levels while across Europe, 28% of the workers are exposed to high noise levels. Hazardous noise exposure is associated with a wide range of health effects that include noise induced hearing loss (NIHL), stress, poor concentration, communication difficulties and fatigue due to lack of sleep. The mining industry worldwide is struggling with hearing loss due to noise overexposure and in a copper mining set-up, the concentrator section is assumed to be among high noise zones exposing workers to noise above the occupational exposure limit (OEL) of 85 dB(A). This study aimed at evaluating the efficacy of noise control measures at various sections at Konkola Copper Mine concentrator section in Zambia. This quantitative cross-sectional study was conducted at Konkola Copper Mines (KCM) Konkola Business Unit (KBU) in Chililabombwe District in the Copperbelt Province of Zambia. A walk through survey was conducted to collect information to describe the operations, identify noise sources, understand noise release mechanisms and describe noise control measures. Quality control was achieved by triplicate noise measurement per location using an instrument with a valid annual calibration certificate. Raw data was pre-processed by cleaning to make it ideal for use. An ethical waiver W-CBP-230428-01 was granted as this study did not involve animal or human subjects but only area noise samples using CR: 172B SLM. The study identified the noise sources, described noise release mechanisms, described the noise controls and assessed the efficacy of noise controls in four sections within the concentrator of a copper mine in Zambia. Seventeen noise generating equipment were identified with about 53% of the equipment operated at the crushing section, 18% operated at the Flotation and Filtration section respectively and 11% at Milling section. A substantial portion (65%) of the identified noise sources in the concentrator are not housed, and among these, 36% are mobile in nature. It was also found that none of the noise areas were demarcated There are three types of noise controls (enclosure, silencer & HPD) that are in use at the concentrator and they fall in two categories of the hierarchy of controls (engineering & PPE). Out of the nine noise sources at the Crushing section, 56% (5 of the 9) utilized enclosure as control, 33% (3 of the 9) had HPDs as control and 11% (1 of the 9) source was installed with a silencer as a control. Enclosure is utilized to control noise from the two sources found in the Milling section while HPDs and enclosure are the noise control measures in use at both Flotation and Filtration sections of the concentrator. Enclosure is the most available control in the concentrator at 53%, followed by HPDs at 41%, and the least available is silencer at 6 %. About 76.5% (13) of the noise controls at the concentrator had efficacy strong enough to reduce noise levels to below the OEL while 23.5% (4) of the controls had weak efficacy that failed to reduce noise levels to below the OEL. This has prompted the need to strengthen efficacy in areas where controls were found to be weak. There is need to sustain controls that were found to be strong to maintain their efficacy. About 75% (3 of the 4) of the controls with lower efficacy were from the Crushing section while 25% (1 of the 4) was from Filtration sectionItem The relationship between traumatic events and quality of sleep in older adults in rural South Africa(University of the Witwatersrand, Johannesburg, 2024) Dzimbanhete, Tsitsi Cherry; Mall, Sumaya; Redman, Kirsten N.Introduction: A number of factors are associated with the quality of sleep, a broad measure that includes sleep duration and disturbance. There are many factors associated with quality of sleep including communicable and non-communicable diseases and life course traumatic events (TE). Older adults who have experienced life course TE and the onset of comorbidities may be at risk of fluctuations in their quality of sleep. However, there are limited data on the African continent examining these relationships. Therefore, this study aimed to bridge the aforementioned gap and 1. examine the prevalence of traumatic events (TE), 2. examined the prevalence of poor quality of sleep in adults in the Health and Aging in Africa: a longitudinal study (HAALSI) cohort 3. examine the relationship between the TEs and quality of sleep in the HAALSI cohort in the Mpumalanga Province of South Africa. Methods: A cross sectional analysis using data from the second of four waves of the HAALSI cohort was undertaken. The second wave which recruited 4176 participants was conducted between 2018 and 2019. Measures include the English Longitudinal Study of Aging life history data to estimate prevalence of TE, brief version of Pittsburgh Sleep Quality Index (B-PSQI) to estimate the prevalence of poor sleep quality and the relationship between TE and poor sleep quality. Descriptive analysis, bivariate and multivariate analysis of the data was conducted in Stata 17. Results: The mean age of the participants was 65 years (SD=13). The majority of the sample were of South African origin (70%). With regard to education status, less than half (43%) had not completed a formal education (i.e., primary school). Poor quality of sleep was reported by 27% of the participants. With regards to TEs 66% of the sample reported caregiving trauma, 58% accident and disaster TEs, 30% childhood trauma, 15% war related TEs and 22% community violence. The multivariate analysis suggested that participants with history of exposure to childhood TEs and war related TEs had higher risk of poor sleep quality (OR 1.5 (CI1.2-1.8)) and (OR 1.5(CI 1.2-2.0)) respectively. The other variables associated with higher risk of poor sleep quality were being married (OR=1.2 (CI 1.0-1.4)) history of smoking (OR=1.6 (CI 1.2-3.1)), mild to moderate (OR=1.7 (CI 1.3-2.1)) and major depression symptoms (OR=2.1 (CI 1.8- 2.7)), being obese (OR =1.3 (CI 1.0-1.6)) and being HIV negative (OR= 1.4 (1.0-1.6)). Conclusion: Exposure to war related and childhood TEs were found to be associated with poor sleep quality in the older adults in rural South Africa. While a cross-sectional analysis is valuable, an examination of the full cohort of the trauma at baseline and quality of sleep would inform trauma focused interventions that seek to improve quality of sleep in older adultsItem Predictors of frailty and multimorbidity in adults aged 40 to 65 years in a rural population cohort in Burkina Faso(University of the Witwatersrand, Johannesburg, 2024) Georges, Some; Kandala, Ngianga-BakwinBackground: Frailty and multimorbidity are vulnerable geriatric syndromes that pose a disability problem among the elderly in Sub-Saharan Africa (SSA). Assessment of factors associated with frailty and multimorbidity in middle-aged adults has remained limited despite the prevalence established in previous studies. We determined factors associated with frailty and multimorbidity among middle-aged adults in rural areas from 2015 to 2022 in Burkina Faso. Methods: This study utilized data from the Africa Wits-INDEPTH Partnership for Genomic Research (AWI-Gen) sub-study, a retrospective cohort study of 1500 participants aged 40-65 residing in Nanoro and Yako in Burkina Faso between 2015-2022. Each participant was asked to complete a standardized and structured questionnaire on socio-demographic, lifestyle, and clinical information. In addition, measures of Fried's phenotypic frailty components, and twelve chronic diseases were assessed for derivation into frailty and multimorbidity score variants respectively. To determine the risk factors associated with frailty and multimorbidity, we performed an ordinal and multinomial logistic regression analysis respectively with a significance level of 5%. Results: The prevalence of pre-frailty and frailty was 59.3% and 8.5% respectively while that of multimorbidity was 38.3%, where the multimorbidity prevalence rate stratified by existing chronic diseases was 13.0%. Half of the participants who had multimorbidity were frail (47.2%) while 10.4% of frail participants had multimorbidity. Weight loss (23.9%) and self-reported exhaustion (23.1%) were the most frequent phenotypic components. Dyslipidemia (63.9%), hypertension (26.4%) and rheumatic arthritis (15.0%) were the most frequent chronic diseases. On the one hand, age (≥50 years, aOR 1.4[1.0-1.9]), being widowed (aOR 1.5[1.1-2.1]), being unemployed (aOR 2.5[1.1-5.8]), smokeless tobacco use (aOR 2.5[1.1-5.7]), being underweight (aOR 26.2[17.1-40.2]) and multimorbidity (aOR 1.4[1.0-2.1]) were independently associated with increased odds of frailty. However, fruits (aOR 0.9[0.8-1.0]) and vegetables consumption (aOR 0.9[0.8-1.0]), and being highly active in weekly activities (aOR 0.1[0.0-0.2]) significantly reduced the odds of frailty. On the other hand, age (≥60 years, RRR 1.8[1.1-2.8]), being a woman (RRR 2.6[1.7-3.9]), being widowed (RRR 1.6[1.0-2.7]), being unemployed (RRR 4.5[1.1-18.0]), overweight (RRR 5.0[2.8- 9.1]), obesity (RRR 3.4[1.1-11.0]), pre-frailty (RRR 1.8[1.2-2.6]) and frailty (RRR 2.1[1.0-4.2]) were strongly associated with an increased risk of multimorbidity. Nevertheless, the consumption of alcohol (RRR 0.4[0.3-0.6]) and fruit (RRR 0.9[0.8-1.0]) significantly reduced the risk of multimorbidity. There was no significant association with determinants such as gender, level of education, smoking status. Conclusion: These findings provide additional evidence on the determinants of frailty and multimorbidity in Burkina Faso. Community awareness initiatives should be strengthened to influence lifestyle on tobacco consumption, alcoholism, physical activity, and vitamin supplementation associated with the consumption of fruits and vegetablesItem The relationship between mental distress and somatization in hospital based health care workers in Gauteng during covid-19 pandemic in 2020(University of the Witwatersrand, Johannesburg, 2023) Ramuedi, Ntsako Khosa; Kerry Wilson, NiohBackground Mental distress among Health Care Workers (HCWs) is an urgent health concern, and somatization is a known outcome of mental distress. The Covid-19 pandemic increased stress for HCWs globally due to working with Covid-19 patients and resource limitations. Although there was already a lot of mental distress in HCWs in prior years, the coronavirus pandemic made matters worse, with 45% of people reporting that the pandemic had a significant negative impact on their lives. Somatization can lead to increased use of health services, sick leave and poor health. Service delivery is also impacted negatively if the service providers are not well or are suffering from the mental distress and are also showing symptoms. Aim To identify if a relationship exists between mental distress and somatization symptoms in Gauteng hospital-based health care workers in 2020. Objectives. To describe the prevalence of mental distress and somatization among health care workers by socio demographic status. To identify the somatization symptoms associated with high GHQ-12 scores in health care workers during Covid-19. To describe the association between mental distress and somatization among health care workers during covid-19 adjusting for demographic variables. Methods Health care workers can be described as anyone working in the health sector or at a health facility. All staff in the three selected hospital facilities in Johannesburg, were given the opportunity participate in the study. The PHQ-15 and GHQ-12 tools were used to collect information on HCWs somatization and mental distress after the first wave of the Covid-19 pandemic in South Africa. The anonymous questionnaire consisted of the two tools and demographic questions was used. The responses to each question on the tools were summed in order to determine severity of mental distress and somatization in HCWs, a higher score indicating more stress and or more somatization. Logistic regression was used to determine the adjusted relationship between somatization and mental distress. Results The study had a sample size of 295. A large proportion of participants (52%) reported suffering somatic symptoms. Males mean somatization score was significantly lower than the females. The majority (62%) of HCWs were troubled indicating a high burden of mental distress in the health care sector. The most commonly reported symptoms were back pain, headaches and being tired or low energy, all three were significantly associated with mental distress among others. There was a positive moderate correlation between PHQ-15 and GHQ-12 scores (0.30592) (p < 0.0001). Logistic regression indicated somatization was significantly associated with mental distress with a significant OR 2.14 (p = 0.0029) adjusted for demographic factors in these workers. Conclusions There was a statistically significant positive relationship between somatization and poor mental health. Health care workers with mental distress may be at risk of somatization, particularly specific symptoms such as back pain, headache and having low energy. Females were more bothered by most of the somatoform symptoms as compared to their male counterparts. Support for health care worker’s mental health is required as well as increased awareness of somatization linked to mental distress. Policies and services need to be developed to protect and support HCWs mental health during times of stress in the sectorItem The relationship between the combined effects of life-course trauma and HIV on cognition in rural South African adults: A secondary data analysis(University of the Witwatersrand, Johannesburg, 2024) Kupa, Nkgodi Obed; Matsena-zingoni, Zvifadzo; Mall, SumayaBackground: Lifecourse traumatic events (TE) refers to both childhood and adult trauma. Childhood TE refers to a spectrum and domains of adverse experiences occurring before the age of 18. Global and South African-based research suggests that life-course TE are associated with both physical and mental disorders including HIV and poor cognition (also referred to as neurocognitive impairment (NCI)). While data suggests that life-course TE, HIV and NCI are highly prevalent in South Africa and risk of NCI has been researched, little is known of the combined effect of life-course TE and HIV on NCI in adulthood. To fill the gap in the literature, I analysed data from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), from rural Bushbuckridge (Mpumalanga province). Study Aim To examine the combined (interaction) effect of TE and HIV infection on the cognition of older adults in South Africa. Methods: I analysed (secondary) data from the HAALSI study. The main exposures analysed were: life-course TE and HIV-positive status. A pre-analysis phase consisted of several exploratory steps to define the exposure and outcome: First TE data which had been measured by the English Longitudinal Study of Aging (ELSA) life history questionnaire were examined. The main exposure variable was coded 1 if one experiences a TE and 0 otherwise from seven potential TE. NCI, the main outcome variable was defined based on measuring cognitive domains: orientation and memory. A score≥1.5 standard deviations (SD) below the mean of the baseline cognitive function distribution on the cognitive assessment (managing to know the date, day, month and president) will mean no NCI while a score below the means some degree of NCI). The main outcome variable was cognition measured by the Oxford Cognitive Screener (OCS-plus). Based on the validation of Tablet-Based OCS-plus in HAALSI, OCS-Plus included nine brief tests measuring cognitive ability in nine different domains, including language, memory (intentional and incidental), and executive functioning (task switching-alternating jobs between tasks), attention (auditory), and praxis (doing things). A stand-alone application called OCS- Plus was developed using Matlab and Psychophysics Toolbox for Windows Surface Pro tablets. Further preparatory steps for the analysis included: the exposure variables (HIV status and composite trauma-defined as the presence of at least one trauma item-) were created as follows: 1. HIV status was categorized into HIV positive and negative and coded 1 and 0 respectively. 2. Composite trauma was coded 1 if ever experienced any of the seven trauma items and 0 if none were experienced. Four groups of participants were created by exposure status. These were: 1. HIV positive and also experienced TE. 2. HIV negative but experienced TE. 3. HIV positive but TE negative. 4. HIV negative and trauma negative. Descriptive statistics were calculated for both exposures and outcomes as well as relevant sociodemographic variables. Both unadjusted and adjusted logistic regression techniques were employed to examine the combined effect of life course TE and HIV on NCI in older adults. The adjusted logistic regression models were done: 1) handling HIV and composite trauma separately and 2) considering the interaction term of HIV and composite trauma. Variables such as education, employment status, age, nationality, gender, hypertension, stroke, HIV status, marital status and composite trauma were considered confounders and adjusted accordingly. Results: Of the 5,059 study participants recruited and residing in the Agincourt study area in Bushbuckridge, 65% of the study participants had experienced at least 1 TE, and the most common trauma experienced were “ever experiencing severe financial hardship which was experienced by 58.74% of the participants, 39.73% whom “ever experienced a natural disaster” and 23.30% “ever experienced a death of a relative or friend” and the prevalence of NCI was 7% ( n=352).. The median age of participants was 64 (IQR: 55-74) years; 53.07% of the study participants were females; 44.42% had no formal education, and 72.63% of the study participants were not working. In the multiple logistic regression model with the interaction term, the odds of having NCI decreased by 64% (AOR=0.36; 95%CI: 0.25-0.52) and 59% (AOR=0.41; 95%CI: 0.24-0.75) among those who had some primary school (1-7 years) and some secondary school (8+ years), respectively compared to those with no education. The odds of having NCI decreased by 98% (AOR=1.98; 95%CI: 1.05-3.72) among those who were not working compared to those employed. A one-year increase in age was associated with a 5% increase in the odds of having a cognitive impairment (OR=1.05; 95%CI: 1.04-1.07). Those who were married had 37% (OR=0.63, 95%CI: 0.47-0.84) reduced odds of having NCI compared to those who were married. Those without composite trauma had 90% (AOR=0.10; 95%CI: 0.07-0.15) reduced odds of having NCI compared to those who have composite trauma. Those who were HIV positive and had experienced composite trauma had an increased odds of 1.78 (95% CI: 1.04-3.04) of having NCI compared to those who are HIV negative and had not experienced composite trauma. In the interaction model, we found no association between HIV status, stroke, or hypertension and NCI. However, the results of the interactionmodel suggested a significant association between HIV and the composite trauma score on NCI. Conclusions: The results suggest that lifecourse TE and HIV infection influence NCI. The full HAALSI cohort could be employed to examine the effect of TE data collected at baseline and incident NCI at later wavesItem A visual analytics approach to characterising disease progression among adults with chronic diseases in rural Agincourt northeast South Africa(University of the Witwatersrand, Johannesburg, 2024) Nhlapho, Mapule Dorcus; Kabudula, ChodziwadziwaChronic diseases pose a significant challenge to the healthcare systems in South Africa, calling for innovative approaches for comprehensive understanding and management. This research study utilizes the Agincourt HDSS-Clinic dataset to design and implement a visual analytics system using the R Shiny web application framework. Focused on adults with chronic diseases, the tool employs dynamic visualizations to show patterns of healthcare utilization and disease progression. Through the R Shiny platform, the system provides a user-friendly interface for exploring and interpreting complex data, offering valuable insights into patient healthcare behaviours and the dynamics of chronic illnesses. The study used data from a total of 26 426 patients consisting of 19 265 (73%) females and 7 161 (27%) males. The study revealed previously unrecognized associations between specific chronic conditions including the existence of a substantial intersection between HIV, Hypertension, and Diabetes with 101 patients experiencing the coexistence of all the three conditions. Notably, the visual analytics system facilitated the identification of distinct healthcare utilization patterns across different demographic groups highlighting the most frequently visited health facility accounted for 5 912 patient visits overall while the least visited health facility accounted for 1 447 patient visits. The findings underscore the effectiveness of visual analytics in uncovering trends within complex datasets. The implications of these findings extend beyond the immediate research scope, influencing healthcare strategies and contributing to the ongoing discussions on innovative solutions for chronic disease management. This study contributes to the evolving field of visual analytics in healthcare, demonstrating the potential for such tools to inform decision-making and enhance patient outcomes