Electronic Theses and Dissertations (Masters)

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Levels and factors associated with homicide-related deaths in a rural South African population
(2011-03-25) Otieno, George Omondi
Background: World Health Organization (WHO) estimates that more than 1.6 million people die every year because of violence and out of these deaths, homicide accounts for almost one third. Ninety percent (90%) of homicide are thought to occur in low and middle income countries. South Africa has one of the most disturbing rates of homicide in the world. These high homicide rates besides resulting in reduced life expectancy also have serious health, social and economic consequences. Aim: The study aimed at quantifying the burden as well as and identifying factors associated with homicide deaths in rural KwaZulu-Natal in South Africa during the period of 2000 to 2008. Objectives: To estimate a 9 year period (2000-2008) homicide incidence rates as well as identify factors associated with homicide-related deaths. Further, the analysis described spatial distribution of homicide-related deaths in a rural South African population. Design: Analytical longitudinal study. Methods: Using data drawn from the Verbal Autopsies (VAs) conducted on all deaths recorded during annual demographic and health surveillance over a 9-year period (2000-2008), Kaplan-Meier (K-M) survival estimates of incidence rates were used to estimate the cumulative probability of death until the end of the period. Estimates were reported by sex and residency. Weibull regression methods were used to investigate factor associated with homicide deaths. Kulldorff spatial scan statistics was used to describe homicide clustering. Results: With 536 homicide-related deaths, and 814, 715 total Person Years of contribution, the study found an overall incidence rate of 66 (95% CI= (60, 72) per 100, 000 Person Years of v Observation (PYOs) for the period studied. Death due to firearm was reported the leading cause of mortality (65%). Most deaths occurred over the weekends (43%), followed by Friday (16.2%).The highest homicide incidence rates were recorded in 2001 (90; 95% CI= (71, 111) per 100,000 person years at risk and 2004 (86; 95% CI= (68, 108) per 100,000 person years at risk. Males had a rate that was about six times more than females 115 (95% CI=105,127) per 100,000 PYOs. Age-specific homicide rate were highest among males aged 25-29 years (209.90 per 100,000 PYOs) and females aged 50-54 years (78 per 100,000 PYOs). Resident, age, sex, education, socioeconomic status, and employment independently predicted homicide risk. The study identified two geographical clusters with significantly elevated homicide risk. Conclusion: A significant six fold difference in homicide rate existed between males and females. Sex differential increases with age, with males aged 15-54 years the most likely to be killed, and females aged 55 years and above having the highest homicide rate. Increase in wealth status and level of education increases one‘s risk of homicide. Employment per se was protective from homicide risk. Firearm was the leading cause of mortality. Most deaths occur over the weekend. Two geographical areas with elevated homicide risk were observed. These findings underscore the need to have timely information and strategies for effective violence prevention program to subgroups and areas at risk.
The relationship between awareness of violence against women prevention campaigns and gender attitudes and talking about violence among women in Gauteng
(2016-10-12) Mataba, Rumbidzayi B.
Introduction: Gender based violence (GBV) is a public health problem with as many as 35% of women having been subjected to either physical and or sexual violence globally. Gender attitudes and silence around gender based violence, are factors that exacerbate GBV. Global and local awareness campaigns are means for preventing violence against women. Campaigns have the potential to challenge women and men’s underlying gender beliefs and attitudes that contribute to unequal power relations between women and men. The overall objective of this study was to examine the association between awareness campaigns and gender attitudes or talking about domestic violence among women in Gauteng, South Africa. Materials and Methods: This study is a secondary analysis of data from a cross-sectional study conducted in Gauteng, South Africa from April to July 2010. The study aimed to describe the prevalence and patterns of experiences of GBV, HIV risk, gender attitude and awareness of GBV prevention campaigns in Gauteng. The main exposure variable in this study is having heard about 16 Days of Activism for No Violence Against Women and Children campaign and the 365 Days National Action Plan to End Gender Based Violence. The two primary outcomes are gender attitudes and discussing about domestic violence. Gender attitudes were measured using three scales: the Gender Equitable Women’s Scale, the Ideas about Gender Relations Scale and the Ideas about Rape Scale. Univariate analysis was conducted to describe the socio-demographic characteristics, awareness of campaigns, gender attitudes and talking about domestic violence among the participants. Multivariate analysis was conducted to examine the associations between awareness of campaigns and the outcomes while adjusting for age, education, employment, nationality, race and relationship status. Results: The results show that only a minority of the participants had heard of the 16 Days of Activism for No Violence Against Women and Children campaign (32.6%) and the 365 Days National Action Plan to End Gender Based Violence (9.2%) campaigns. Most of the participants had progressive gender attitudes; GEWS (71.7%), IGRS (82.1%) and the IRS (88.1%) while less than half (48.7%) had spoken about domestic violence to someone else. Women who were exposed to the 16 Days of Activism for No Violence Against Women and Children campaign were twice as likely to have progressive gender attitudes measured by the Gender Equitable Women’s Scale (aOR 2.2, 95% CI 1.2-3.8) compared to those who had not been exposed. Education, relationship status and nationality were found to be significantly associated with gender attitudes on the same scale. No association was found between awareness of 16 Days of Activism for No Violence Against Women and Children campaign and gender attitudes measured through the Ideas about Gender Relations Scale and the Ideas about Rape Scale. Awareness of 16 Days of Activism for No Violence Against Women and Children campaign was also associated with talking about domestic violence (aOR 1.9, 95% CI 1.2 - 3.0). Age and education were also significantly associated with talking about domestic violence. Gender attitudes were also significantly associated with talking about domestic violence (aOR 1.2 95% CI 1.1 – 3.6). No association was found between exposure to the 365 Days National Action Plan to End Gender Based Violence and gender attitudes or talking about domestic violence. Conclusions: From this study, the majority of the women interviewed had progressive gender attitudes. However, the majority of the women had never spoken about domestic violence to someone else. Women exposed to GBV campaigns had more progressive gender attitudes and spoke about domestic violence more than those who were not exposed. These findings are evidence to the need for wider coverage and different messaging approaches in the implementation of GBV campaigns in South Africa. Wider coverage of campaigns is only possible with more funding for national, provincial and local GBV programmes. Key messages in GBV campaigns need to include a priority focus on addressing the underlying social and cultural norms that contribute to the imbalances of power due to gender difference.
The psychosocial work environment of women construction workers: an integrative literature review
(2022) Williams, Thato Leslie-Ann
Background: There is an increase in the number of women in the construction industry, which was considered as a masculine trade for decades. This is prone to have a bearing on the psychosocial work environment of women employed in this male dominated field of work. Women face unique challenges as opposed to their male counterparts who are employed in the same trade. These challenges include discrimination, sexual harassment, overlooked for promotions and being office bound regardless of education. These challenges can impact the psychosocial work environment of women in the workplace, which can result in them opting to exit the industry. Aims and objectives: To gather and critically analyse scientific literature to describe the psychosocial work environment of women employees in the construction industry. Design: An integrative literature review using the Whittemore and Knafl (2005) framework’s stages was used. These stages included problem identification, literature search, data evaluation, data analysis and presentation of findings. Methods: A comprehensive literature search was performed using Asce Library, Emerald, Science Direct electronic databases and from reference list of included articles. The studies were in English, published between January 1993 to November 2018. A total of 3764 studies were retrieved from the search. The inclusion and exclusion criteria were applied, and 57 studies were eligible for abstract reading, which yielded 7 eligible studies that were used in the study. Results: Four themes that emerged include, less representation of women in the construction industry due to inability of retaining women. Discussion and conclusion: Discrimination due to the benevolent sexism that women face. Stressful work environment which is amplified for women as it affects work-life balance. Labour laws, they are implemented and hardly reviewed. Women are an un-tapped resource and by eradicating these challenges by interventions the industry can be inclusive.
Exposure and risk assessment of benzene, toluene, ethyl benzene and xylene (btex) in a petrochemical depot at Heidelberg, South Africa
(2022) Mdlalose, Richard John
Background: The International Labour Organization estimated 2.2 million workers are dying yearly from work-related accidents and occupational diseases, whilst about 270 million suffer serious injuries, and 160 million become ill due to their work. It is further estimated that work-related accidents and diseases cause 4% of annual Global Gross Domestic Product or US $1.25 trillion due to lost working time, workers’ compensation, the interruption of production, and medical expenses. In 2005, the ILO estimated that 440 000 people died throughout the world because of exposure to hazardous chemicals. In 2018 chemicals production was the second largest production sector in the world. Chemicals are indispensable and critical part of life. Their visible positive outcomes are quite palpable. They are well recognized for instance pesticides improve the quality of food production, pharmaceuticals cure illness, cleaning products help to establish hygienic living conditions. Chemicals are key development of final products that make life little easy for human beings, etc. Controlling employees ‘exposure to chemicals and preventing or minimizing emissions remains a significant challenge in workplaces throughout the world. The production, storage, and handling of petrochemical products particularly BTEX emissions are known and associated with potential harm to human and aquatic organisms. Some of the health effects associated with exposure to BTEX are the health effects on hematopoietic system, including pancytopenia. The benzene exposure leads to an acute myelogenous leukemia. The exposure to toluene, ethylbenzene, and xylene have been linked to the damaging the central nervous system and irritation of the respiratory system. Benzene and ethylbenzene are confirmed carcinogens (Benzene is classified as a Group 1 and ethylbenzene is a Group 2 B carcinogens). Purpose: To characterize, assess exposure and health risk assessment to benzene, toluene, ethylbenzene, and xylene (BTEX) at the petrochemical depot at Heidelberg in Gauteng, South Africa. Methods: Exposure sampling was done using a MiniRAE 3000 Photoionization detector (PID). The PID (equipment) was calibrated before the commencement of the monitoring program following the manufacturer’s operating manual. The PID equipment was used to collect the BTEX samples. The PID was mounted on a marked tripod stand at 1.5 m above ground and approximately 0.2 m to 0.5 m in the microenvironment (Exposure scenario) of the depot workers (Controllers and/or laboratory assistant) with the probe extended or placed within 30cm of the breathing zone of the depot workers. Sampling was conducted at three different exposure scenarios (workstations) i.e., density huts, laboratory, and during plant equipment cleaning in the plant (strainer removal) over three days period. The sampling started from 08h00 to 17h00. One workstation was sampled per day. The sampling of BTEX per workstation took 30 minutes per hour over ten hours, every hour BTEX was sampled for a duration of 30 minutes and in totality ten samples were collected per 12- hour shift, a total of 30 BTEX samples were collected over the 3 days period. Additionally, the measured BTEX concentrations were used to obtain dose estimates. Data from the equipment was exported to a Microsoft Excel spreadsheet. All outliners were removed from the data and a correction factor was applied to derive the final concentration. Thereafter, statistical tests using student F-test and Test were performed to evaluate for significant differences amongst paired comparisons. Results : The highest average BTEX concentrations were measured in the laboratory, followed by density huts and the least was measured during the removal of the strainer (plant equipment cleaning). The activity areas (exposure scenarios) served as direct sources for the BTEX vapours. The average benzene concentrations measured in three activity areas ranged from 469 ppm to 542 ppm. The highest benzene concentration was found to be 542 times higher than the current South African Occupational Exposure Limits of 1ppm. The average toluene concentrations measured ranged from 1335 pm to 1542 pm; the highest toluene concentration was found to be more than 30 times above the South African Occupational Exposure Limits of 50 ppm. The average ethylbenzene concentrations measured ranged from 433 ppm to 500 ppm; the highest concentration was found to be 5 times above the South African Occupational Exposure Limits of 100 ppm. The average xylene concentrations measured ranged from 1372 ppm to 1584 ppm, the highest concentration was found to be more than 15 times above the South African Occupational Exposure Limits of 100 ppm. All the measured BTEX compounds were found to be above their respective South African Occupational Exposure Limits. The cancer risk was determined to be 13 x 10-2 (male) and 10 x 10-2 (female), 14 x 10-2 (male) and 11x 10-2 (female), 16 x 10-2 (male) and 13 x 10-2 (female), 12 x 10-3 (male) and 10 x 10-3 (female) for the workers in the density huts, laboratory, strain remover (plant equipment cleaning), respectively. In all exposure scenarios (male and female) the cancer risk was found to be higher than the acceptable risk levels of 1E-4 . There were 13 males and 10 females in the population of 100 controllers who were likely to develop cancer when working density huts environment. In the laboratory work environment, 14 males and 11 females in a population of 100 controllers were likely to develop cancer, whereas 16 males and 13 female laboratory workers were likely to develop cancer in a population of 100 laboratory workers, and during plant equipment cleaning 12 males and 10 female controllers were likely to develop cancer in a population of 1000. Therefore, the potential of developing cancer was heightened by working in the laboratory and density huts. The risk of the number of employees who were likely to develop cancer was reduced when doing plant equipment cleaning. In all three activity areas, cancer risk for males was higher than for their female counterparts. This finding denotes that male were more vulnerable than females even though the exposure concentration is the same. The higher number of males who were likely to develop cancer in all the activity areas were influenced by two factors i.e., males have a shorter average life expectancy and higher average body weight versus their females’ counterparts. A hazard quotient was used to determine the non-carcinogenic health effects, a hazard quotient of greater than 1 was used as a reference value. A value greater than 1 denoted a higher possibility that depot workers will get health effects from exposure to the Toluene, ethylbenzene, and xylene (TEX). The hazard quotient for males ranged from 4.6 to 577.5, the highest hazard quotient was more than 577 times above the HQ reference value. The lowest was at density huts for xylene and the highest was at the laboratory for a chemist for xylene. The hazard quotient for females ranged from 3.15 to 399.00, the highest hazard quotient was more than 399 times above the HQ reference value. The lowest was at density for xylene and the highest was at the laboratory for laboratory assistant. From the results, both males and females had a hazard quotient far above 1 which means health effects arising from TEX exposure were anticipated. Conclusion: The results showed highest constant BTEX concentrations in the three exposure scenarios over the 12 hours shift. The BTEX emissions were generated by activities that were performed by the depot workers. Highest BTEX concentrations were measured at laboratory, followed by density huts and the least was measured during the removal of the strainer (plant equipment cleaning). The lack of effective vapour recovery system and natural ventilation in the laboratory and in density huts also contributed to the high BTEX concentrations measured in these areas. Individual BTEX component results measured in the three activity areas indicated concentrations that were far above the South African Occupational Exposure Limits for individual BTEX. The cancer risk score was found to be far above the reference USEPA cancer risk value and denoting that depot workers were likely to develop cancer. The hazard quotient for the three exposure scenarios was also found to be greater than the reference value of 1 which indicates the potential to develop non-carcinogenic health effects due to exposure in three exposure scenarios. Recommendations: The following recommendations are made to assist management of the depot to control employees’ exposure to BTEX emissions per activity area: Density huts: The practicality of introducing a vapour recovery system on workbenches to extract the VOCs generated during sample collection and from density measuring jugs should be investigated or alternatively, the introduction of an online fuels and density analysis should be investigated or the practicality of introducing sample bombs to collect fuel samples should be investigated. Keep the windows opened to promote an ingress of fresh air and allow BTEX emissions to escape. A practicality of introducing a controlled mechanical ventilation to blow vapours away from the breathing zone of the depot workers should be investigated. Laboratory: The practicality of automating or modifying the GC equipment in the laboratory to be able to conduct an online petrochemical analysis to control employees’ exposure should be investigated. The tasks that require rinsing of testing tubes with fuels, refilling of the testing tubes, and discarding of superfluous samples should be performed under controlled conditions, the practicality of introducing a vapour recovering system to control vapours emissions should be investigated. The current practice of keeping the decanting drum open should be discontinued to prevent the accumulation of vapours in the laboratory or alternatively, it should be kept under a vapour recovery system. The practicality of keeping the retained fuel samples under the vapour recovery system in the laboratory storage should also be investigated. The fume hood and two extraction units should be serviced on a regular basis. Cleaning of plant equipment (strainer removal): The practicality of automating the removal and lifting the strainer to be cleaned to increase the distance between the strainer and receptors (controllers) should be investigated. The practicality of putting the clogged-up strainer in degreaser bath to remove and clean the strainer with the view of automating the task to prevent employees ‘exposure to VOC emissions. Recommendations applicable to all activity areas: Employees exposed to BTEX including the other petrochemicals should undergo a risk-based medical surveillance program including biological monitoring to evaluate the efficacy of the existing controls and as part of a preventative medical surveillance program. Provide information, instruction, and training at regular interval about: - petrochemicals (BTEX) that employees are potentially exposed to at workplace and duties of persons who are likely to be exposed to VOCs vapour. The names and potential harmfulness of the BTEX at the workplace and the employees who are likely to be exposed. Significant findings of the BTEX exposure assessment (an occupational health risk assessment survey). Information on how to access the relevant safety data sheets and information that each part of an SDS provides. The work practices and procedures that must be followed for the use, handling, storage, transportation, spillage, and disposal of samples, in emergency situations, as well as for good housekeeping and personal hygiene. The necessity of personal exposure air sampling, biological monitoring, and medical surveillance; The need for engineering controls and how to use and maintain them. The need for personal protective equipment, including respiratory protective equipment, and its use and maintenance. The precautions that must be taken by an employee to protect themselves against health risks associated with exposure, including wearing and using protective clothing and respiratory protective equipment. The necessity, correct use equipment, maintenance and potential of safety facilities and engineering control measures provided. Supervisor/Line Manager must give written instructions of the procedures to be followed in the event of spillages, leakages, or any similar emergency situations to employees. Once the aforementioned information, instruction and training have been provided, enforce the wearing of the prescribed PPE including ABEK respirator and no employee should be allowed to enter and remain in respiratory zone without the prescribed PPE and respiratory protection equipment (ABEK respirator).
Evaluation of implementation fidelity to national guidelines on management of tuberculosis in paediatric patients in Homa-Bay County, Kenya
(2022) Kiptoon, Sharon Cherono
Background: Tuberculosis (TB) has been a major public health concern for a long time. Infection in children has not been given a lot of focus as in adults despite children being a vulnerable population with weaker immunity. Prognosis is worse when there is HIV/TB coinfection. The WHO rolled out guidelines for the management of TB in pediatric patients which were adopted by the Kenya Government. Health care workers then implement the guidelines. The Objectives of this study were to measure adherence to national guidelines on the management of Tuberculosis in Pediatric patients (up to 14 years) and to identify moderators affecting implementation fidelity. Methods: A convergent parallel mixed method design was used to collect information from TB treatment sites in Homa bay County. The study was conducted during the months of August, September and October 2018.Quantitative data collected focused on Pediatric patients between ages zero and 14. A checklist based on the guidelines was designed to review 442 records in the clinics for a four-year period (2014 to 2018). Qualitative data was collected through in-depth interviews with eight Sub-County TB coordinators. Interview moderators were based on Carrol et al Implementation Fidelity framework. Summation of "yes" and "No" responses were tallied to get an adherence score for the County as a whole and for the sub-counties individually. The qualitative analysis used the thematic method in excel spreadsheets. Results: Results showed high adherence for the County with a median of 80% (IQR 66.66-93.33%). Four of the sub-counties with normally distributed scored had a mean score of 79% and while the other four had a median score of 80% (66.66 – 93.33). Guidelines which had low implementation fidelity scores were those involving follow up tests i.e., sputum, gene X-pert and X-ray during duration of treatment. In the qualitative aspect good facilitation strategies were found to be in place from both the County and national TB programs. An attitude of fear, lack of knowledge on infection prevention, lack of skills to produce specimens for TB testing and staff shortages affected quality of treatment delivery. The health care workers reported ease in following the guidelines especially with the roll out of new guidelines which simplified diagnosis of TB in children, drugs which are dispersible and in fixed dose combination. Participant’s response to the intervention was poor with both health care workers and patients expressing difficulties with direct observed therapy schedule which required frequent visits and frequent follow up tests. Conclusion and recommendations: In conclusion, implementation fidelity to guidelines on management of tuberculosis is high. Good facilitation strategies is a positive moderator towards achieving high implementation fidelity. The national TB program in Kenya is doing well so far in monitoring the process of guideline implementation once rolled out, however, to be able to achieve the sustainable development goal eradicating TB, further follow up is needed in the facilities to improve the levels of adherence from 80% to 100%. Use of the conceptual framework by Carroll has proved to be a good guide in evaluating healthcare worker’s performance in implementing treatment guidelines It is recommended that health workers should undergo more sensitization on why certain guidelines have been put in place e.g., repeating sputum samples at different phases of treatment in order to improve quality of care. More training on vital procedures e.g., gastric aspirate should also be done to improve health workers' confidence and ease diagnosis of TB at younger age. Further research on implementation fidelity on other evidence based interventions would go a long way to improve service delivery and ensure other program goals are met.
The burden of severe Hepatitis A disease in South Africa’s public sector: A cross sectional study using routine laboratory data from 2016 to 2021
(University of the Witwatersrand, Johannesburg, 2023) Khoza, Mariana Makhanani; Mazanderani, Ahmad Haeri; Somaroo, Harsha
Background Hepatitis A virus (HAV) is a common cause of acute viral hepatitis in South Africa, however, there is limited data on the burden of severe HAV disease in the South African population. Objective To describe the burden of severe HAV disease in South Africa’s public sector by describing the prevalence of laboratory diagnosed acute liver failure (ALF) in patients with HAV infection, during the period January 2016 to December 2021. Methods This was a cross-sectional study using retrospective secondary data from the National Health Laboratory Service (NHLS), from January 2016 to December 2021. Laboratory patient records that were positive for HAV IgM were extracted and merged with International Normalised Ratio (INR) test records, using the NHLS Corporate Data Warehouse (CDW) record linking algorithm. All patients with a positive HAV IgM result linked to an INR result >1.5 were reported as having laboratory diagnosed ALF. Descriptive statistics and regression analyses were conducted using STATA 17 SE. Results A total of 15 261 laboratory patient records were positive for HAV infection. Of the patients with HAV infection a total of 7 824 (51.27%) were linked with an INR test result, and of those a total of 1 420 (18.15%) patients had ALF. The average annual burden of patients with ALF was 237 patients per year (range: 136–333). Children <10 years had the highest number of HAV infections (n= 6 227, 40.80%) and ALF (n=576, 40.56%) for the study period. Patients 50-59 years with HAV infection were most likely to have ALF compared to children <10 years (OR 2.95, 95% CI 2.207 - 3.935, p<0.000). Conclusion Whereas adults with acute HAV infection are more likely to develop ALF, severe HAV disease is predominantly a childhood disease in South Africa. This study emphasises the need to strengthen HAV prevention strategies to limit the incidence and burden of severe HAV disease
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, Van
Introduction 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 effects
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, Nioh
Background 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 sector
Determinants of sub-optimal glycaemic control among patients enrolled in a medicine dispensing programme in Kwazulu-Natal: A cohort study, 2018 – 2021
(University of the Witwatersrand, Johannesburg, 2023) Johnston, Leigh Clare
Background: In South Africa, type 2 diabetes mellitus (T2DM) is a growing public health problem, thus, by 2030, 50% of T2DM patients, receiving treatment, must achieve optimal glycaemic control (haemoglobin A1c (HbA1c) ≤7%). The CCMDD (Central Chronic Medicines Dispensing and Distribution) programme allows glycaemically-stable patients to collect their medication from community-based pick-up points. While the CCMDD is a large public health programme, there is a paucity in stakeholder’s knowledge of T2DM patients glycaemic control over time. We determined glycaemic control for CCMDD-enrolled T2DM patients in eThekwini, South Africa from 2018-2021, as well as the rate and predictors of becoming sub-optimally controlled. Methods: We performed a cohort study, linking HbA1c data from the National Health Laboratory Service to CCMDD-enrolled patients in eThekwini, South Africa from 2018–2021. We included patients optimally controlled at their baseline HbA1c, and having ≥1 repeat test available. We used Kaplan Meier analysis to assess survival rates and Cox regression to determine associations between time to sub-optimal control (HbA1c > 7%) and several factors. Adjusted hazard ratios (aHR), 95% confidence interval (95% CI), and p-values are reported. Results: Of 41145 T2DM patients enrolled in the CCMDD, 7960 (19%) had an available HbA1c result over the study period. A quarter of patients (2147/7960; 27%) were optimally controlled at their baseline HbA1c. Of those controlled at baseline, 695 (32%) patients had a repeat test available, with 35% (242/695) changing their status to sub-optimal control. Patients prescribed dual-therapy had a higher risk of sub-optimal glycaemic control (aHR: 1.503; 95% CI: 1.16–1.95; p-value=0.002) compared to those on monotherapy. HbA1c testing frequency per national guidelines (aHR: 0.46; 95% CI: 0.24–0.91; p-value=0.024) was associated with a lower hazard of sub-optimal glycaemic control. Conclusions: HbA1c monitoring, in line with testing frequency guidelines, is needed to flag sub- optimally controlled patients who become ineligible for CCMDD enrolment. Patients receiving dual-therapy may require special consideration. Addressing these shortfalls can assist planning and implementation to achieve 2030 targets.
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 Susan
Introduction & 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.
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 Daniel
Background: 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.
Early life factors associated with childhood trajectories of violence among the birth to twenty- plus cohort in Soweto, South Africa
(University of the Witwatersrand, Johannesburg, 2024) Muchai, Lilian Njeri; Kagura, Juliana; Naicker, Sara
Introduction Violence against children has devastating and long-term negative consequences on individuals' and society's health, social and economic well-being. There is limited research on the life course experience of violence especially in Africa. This study aimed to identify sub-groups of physical & sexual violence victimization patterns separately in childhood, and evaluate early life factors predicting these violence trajectories. Methods This study used data from age 5 to 18 years from the ongoing prospective Birth to Twenty Plus cohort (Bt20+). Children within the Bt20+ cohort with data on physical and sexual violence in at least 2-time points between 5 and 18 years were included in the analyses. Group-based trajectory modelling was employed to identify groups of children with similar patterns of violence over time. Descriptive statistics was used to summarize study variables by violence trajectory group membership, while multivariable logistic regression was used to identify early life factors measured between birth and 5 years, associated with violence trajectory group membership. Results Two trajectory groups were identified for both physical and sexual violence victimization. For physical violence victimization, the majority of participants fell into the adolescent limited group (65.1%) and just over a third (34.9%) of the children were in the chronic increasing group. For sexual violence victimization, most participants fell into the adolescent limited group (74.1%, with a quarter in the late increasing (25.9%) group. Early life factors associated with a higher risk of chronic increasing physical violence victimization trajectory group membership, after adjusting for covariates, were being male (aOR 1.67, 95% CI 1.31; 2.10) and having a mother with at least secondary education compared to higher education (aOR 1.73, 95% CI 1.08; 2.76). In addition, residing in middle, compared to low, socioeconomic households (aOR 0.68, 95% CI 0.50; 0.92) was protective against membership in this group. Residing in high compared to low socioeconomic households, was the only early life factor with marginally significant (aOR 0.63, 95% CI 0.42; 0.95) association with membership in the late-increasing sexual violence victimization trajectory group, with those in better-off households less likely to experience sexual violence victimization with this pattern. Conclusion Children within the same community can follow different patterns of both physical and sexual violence victimization across childhood. Identification of early factors that predict membership to sub-groups of violence trajectories provides key violence prevention intervention points that can preempt or mitigate children’s exposure or experience of violence. Future research should explore a larger variety of early life factors proximal to the child as well as those more distal at the community and school levels
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.
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
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.
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.
Exploring inter-professional collaboration between community health workers and health care providers in two clinics in the City of Johannesburg district
(University of the Witwatersrand, Johannesburg, 2024) Bokaba, Dorah Dorothea; Nxumalo, Nonhlanhla
Background: Large-scale community health worker (CHW) programmes gained renewed interest over time. This was more pronounced during the emergence of the Coronavirus disease 2019 (COVID-19) pandemic, with CHWs exemplifying the role of task-shifting to alleviate already fragile and resource-scarce health systems. Many low- to middle-income countries (LMICs), including South Africa, implemented CHW programmes to complement health workforce. Thus, health care providers (HCPs) including professional nurses, health promoters, allied health workers, operational manager clinic, social workers, and CHWs are expected to collaborate with CHWs to provide health care service. Aim: The aim of the study was to explore inter-professional collaborations (IPC) between CHWs and HCPs in two primary health care (PHC) facilities in the City of Johannesburg, Gauteng Province. Methodology: This study used an exploratory qualitative design. In-depth semi-structured interviews were conducted with purposively sampled CHWs (n=12) and HCPs (n=10) in two PHC facilities from two sub-districts. All interviews were transcribed verbatim. Thematic content analysis was used to analyse the data. Results: Team structures were reported to be centred around the CHWs and Outreach team leader (OTLs), however other HCPs like nurses, health promoters, and social workers also played a role. Reporting procedures were hierarchical, with CHWs reporting to OTLs, who reported to operational managers (OPMs). CHWs were at the bottom of the hierarchy with the reporting structures being described as challenging as they were related to power dynamics. Communication was poor and with unplanned meetings. Participants suggested the need for improved support and communication to strengthen IPCs. Conclusion: IPC between the HCPs and CHW is critical in ensuring patient care continuity. Some dimensions of IPC, such as shared responsibility and mutual understanding of roles by team members, were evident. The communication processes showed some weaknesses, including the consequences in power relations. In order to enhance the contribution of CHWs in PHC and universal health coverage (UHC), it is necessary to explore ways to strengthen IPC between HCPs and CHWs
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.
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.