3. Electronic Theses and Dissertations (ETDs) - All submissions

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    Radioiron absorption studies in idiopathic haemochromatosis, malnutritional cytosiderosis, and transfusional haemosiderosis
    (1953-05) Bothwell, T. H.
    The quantity of iron in the body is regulated largely by the amount absorbed from the gut as the body's capacity to excrete it seems to be very limited. However three conditions have been described in which enormous amounts of iron may accumulate. Such a finding is characteristic of idiopathic haemochromatosis, it is present in a proportion of malnourished South African and is seen also in cases of refractory anaemia treated over long periods with blood transfusions.
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    The influence of slaughter on blood composition in cattle
    (University of the Witwatersrand, 1986-04-01) Riekert, Sydney Peter
    In this study the effects of blood sampling, transportation and slaughter on certain blood variables (sodium, potasium, chloride, glucose, lactates, lipids, proteins, colloidal osmotic pressure, cortisol, ACTH, T3, TSH, osmolality etc.) of cattle were investigated. The experimental animals, crossbreed (Brahman, Afrikander and Hereford) heifers and oxen obtained from Kanhym Estates, Middelburg, were unaccustomed to handling. One group of animals was subjected to the stress of sampling with restraint, a second group was sampled with restraint after transportation and a third group had blood taken after slaughter at the Kanhym abattoir at Balfour. Control blood samples were obtained from Friesland dairy cows accustomed to handling and blood sampling and from crossbreed oxen unaware of the sampling procedure. Both control and experiment groups were studied in the same season. (April and May, 1984). Results were analysed and compared statistically. The blood cortisol, ACTH, lactates and glucose were significantly higher in the experimental groups than in the control group. Cortisol and ACTH values were significantly higher, and the lactate and glucose values significantly lower in the group subjected to the stress of sampling with restraint than in the other two experimental groups. Therefore, if the variables measured are an assessment of stress and change because of stress, then the animals investigated experienced stress. In addition, cattle unaccustomed to handling perceive the slaughtering process as less stressful than blood sampling in a crush (based on cortisol and ACTH results).
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    Occupational exposure to blood in selected oral health facilities in Botswana: experiences and practices of oral health staff
    (2012) Ndlovu, Siphiwo
    Introduction: Sub-Saharan Africa has a high burden of HIV and other blood borne pathogens. Botswana’s estimated prevalence of HIV and HBV are between 17-40%, and 14 % respectively. Ninety percent of the three million health care workers exposed annually to blood borne pathogens through injury are in developing countries. Previous studies in Botswana indicate 24%-26% health workers sustain needle stick and other sharps injuries annually, posing a threat to them. Dentistry requires work with sharp objects in a confined space; thus oral health workers (OHWs) are at high risk of infection from occupational blood exposures (OBEs). Universal (Standard) Precautions were first recommended by the Center for Disease Control in the United States of America and were adopted in several countries, including Botswana, to minimize the risk of exposure to, and infection from, blood. However, studies in different health care settings, mainly in developed countries, have shown that these guidelines are not always adhered to. Few studies have been done to evaluate their utilization in developing countries. Aim: To quantify the occupational blood exposure experience of OHWs in Botswana’s public service and determine the infection control practices through self reporting and observation. The Objectives were: 1) To determine the demographic profile of the OHWs in Botswana, 2) To determine self reported blood exposure experience of oral health workers within the 12 months prior to the study, 3) To determine self reported infection control practice of oral health workers within the 12 months prior to the study, 4) To determine the knowledge of risks associated with blood borne pathogens amongst oral health workers at the time of the study, 5) To determine, by observation, which v precautions were practiced by oral health workers to prevent exposure at the time of the study, 6) To assess whether there was a written policy available in the dental facility on the prevention and management of occupational blood exposures. Methodology: A cross sectional descriptive survey was carried out using a combination of self reporting and observation. A total of 85 OHWs in 5 of the 6 main oral health facilities were invited to participate. Knowledge of risks pertaining to blood borne pathogens, frequency of blood exposures and practice of universal precautions were assessed. Documents and posters were also reviewed. Results: Sixty eight (80%) OHWs returned the questionnaires and 51 (60%) observations were carried out. At least 80% of respondents had correct knowledge of occurrences that can contribute to the spread of blood borne pathogens in the dental environment. Over 60% were aware of universal precautions and 75% knew that post exposure prophylaxis (PEP) was available at their facilities. Almost 43% of the respondents had experienced blood splashes in the last year and 35.3% experienced needlestick injuries. Half of these reported the injury and 16.2% took PEP. Predictors of needlestick injuries during the previous year were perception of risk, knowledge of and compliance with, Universal Precautions Personal protective equipment was poorly utilised; only 17.6% were observed to use protective eye wear. Two thirds of the respondents were observed to use double-handed recapping. None of the facilities visited had a written protocol displayed. Conclusion and recommendations: The prevalence and reporting of OBEs amongst vi OHWs were comparable with findings of other studies. Self protection through compliance with universal precautions, immunization and post exposure prophylaxis was not fully utilised. The high burden of disease in the country warrants that further efforts be made to protect oral health workers. Appropriate guidelines should be made available at all dental facilities and staff needs to be retrained regarding standard precautions. Monitoring of exposures and vaccination status should be carried out. Further research should be undertaken regarding the poor uptake of prophylaxis.
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    Factors associated with elevated blood lead levels in first grade school children in Cape Town, South Africa
    (2013-01-25) Aliraki, Lisbon
    Introduction: Lead metal toxicity in children is a major public concern internationally. In South Africa, January 2006 was the date set for the complete phase-out of leaded petrol, a well known major source of environmental lead contamination. Analysis was conducted to describe the distribution of blood in children, to establish proportions of children with elevated blood lead levels (unacceptable blood lead levels of ≥ 10 μg/dl) and to establish factors associated with elevated blood lead levels using data collected in 2007, one year after the phase-out of leaded petrol. Methods and Materials: An analytical cross-sectional secondary data analysis was conducted on a survey dataset from the Environment and Health Research Unit of the Medical Research Council, South Africa. The primary sampling unit (cluster) was defined as primary schools. Data on first grade children from 13 schools from three suburbs of Cape Town – Woodstock (eight schools), Hout Bay (three schools) and Mitchell’s Plain (two schools) – were analyzed using a survey method, calculating design-based robust standard errors. Different weights were applied to schools in the suburbs which formed the stratification variable. The outcome variable was defined as blood lead levels < 10 μg/dl or ≥ 10 μg/dl. A number of background characteristics – health and diet, housing and social aspects – were investigated; odds ratio measurement was calculated and reported. Results: A total of 532 children were included in the analysis, representing a weighted total of 1 744 children. The children’s weighted mean age was 7.40 years (95% CI 7.39 to 7.41). The geometric weighted mean blood lead level was 5.27 μg/dl (95% CI 5.08 to 5.46). The weighted proportion of children with BLLs ≥ 10 μg/dl was 11.81% (95% CI 8.78 to 15.72); in Woodstock it was (21.0%). In the multivariable logistic regression, several factors were independently associated with higher odds of having BLLs ≥ 10 μg/dl, including use of gas for cooking OR 3.24 (95% CI 2.34 to 4.48) p <0.0001; houses in need of major repairs OR 7.81 (95% CI 1.59 to 38.33) p = 0.017; attending a crèche/preschool OR 15.23 95% CI (3.40 to 68.29) p = 0.003; Others included use of buses or taxis, which increased the odds of a child having a BLLs ≥ 10 μg/dl compared to walking to school by 5.20 times (95% CI 3.00 to 8.99) p < 0.0001 and children who were living in flats (OR 5.55, 95% CI 3.76 to 8.18, p < 0.0001) or in informal/shack dwellings (OR 2.09, 95% CI 1.06 to 4.12, p = 0.037) were at greater odds of having a blood lead ≥ 10 μg/dl than if they lived in free-standing houses. The following factors offered protection against elevated BLLs: Using private cars to transport children to school offered 0.83 lower odds of a child having elevated lead levels (OR 0.17, 95% CI 0.09 to 0.31, p < 0.0001) compared to walking to school, use of plastic water pipes OR 0.60 (95% CI 0.44 to 0.82) p = 0.005 and, domestic cleaning practices, such as cleaning floors with a wet mop (rather than a dry broom) reduced the odds of having blood lead levels ≥ 10 μg/dl by 0.88 (OR 0.12, 95% CI 0.10 to 0.15, p < 0.0001). Conclusion and Discussion: This analysis indicated that the distribution of blood lead appears similar that determined in the leaded petrol era. The proportion of children with elevated blood lead levels in a Cape Town study was still high. Multiple factors were associated with BLLs ≥ 10 μg/dl. Some factors were protective. The implementation of the phasing out of the leaded petrol should be critically monitored to determine the time period before observing a reductive effect. Preventive measures targeting removal of non petrol sources of lead from the school and home environments should be considered as important.
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    The use of blood and blood products in the maternity ward of Boitumelo Regional Hospital
    (2013-01-23) Modiko, Serahome Obed
    BACKGROUND: Recently, South African health system has been experiencing shortage of blood and blood products due to increase in demand for conditions (such as road accident injuries, assaults, surgery and complications of labour) and decrease in supply due to conditions such as Human Immunodeficiency Virus and Hepatitis B. This resulted in difficulty in managing conditions such as obstetric haemorrhages which is one of the commonest causes of maternal mortality and morbidity in South Africa. It was therefore important to monitor the use of these products in South African hospitals to avoid inappropriate use as well as to contain expenditure. However, no formal study has been done in recent past to systematically study the use of blood and blood products in the maternity units in these hospitals. The researcher believed that this study that was conducted in the Boitumelo Regional Hospital based in the Free State would provide evidence to provincial as well as institutional managers regarding the use of blood and blood products and to quantify financial resources spent on these items. This particular Hospital was chosen because of its significant expenditure on the blood and blood products mainly for maternity patients. AIM: To determine the extent of the use of blood and blood products in the Maternity ward of the Boitumelo Regional Hospital and the factors that influenced their uses. METHODOLOGY: The study design was a cross-sectional study based on retrospective review of routinely collected hospital data from hospital records of patients for the period of 1 April 2009 to 31 March 2010. The setting of the study was the maternity ward of Boitumelo Regional Hospital. Data was collected on the following variables: types of blood and blood products transfused, profile of patients transfused with blood and blood products, turn-around time and cost of these products. Data from the hospital records was captured in the data collection tools designed for the study and descriptive statistics was used to report the findings. RESULT: This is probably the first study done at a regional hospital setting in South Africa which looked at broad issues pertaining to the use of blood and blood products in the Maternity ward of the Boitumelo Regional Hospital, and the factors associated with these specified blood and blood products during one study period. The study found 99 (4.2%) among these 2304 patients delivered during this one year period received blood and blood products transfusion (13 units of whole blood, 250 units of red blood cells, 33 units of fresh frozen plasma and 1 unit of platelet). Primiparity (32, 32.6%), pre-term labour (49, 49.5%), booking status (unbooked 20, 20.4%) were found to be common among these patients. A significant number of them (36, 36.4%) were anaemic based on their booking haemoglobin but only a few of them were diagnosed and treated for anaemia. Among the other antenatal diseases, Pregnancy Induced Hypertension was commonest (27.3%) followed by Human Immunodeficiency Virus (15.2%). The majority of the subjects who received transfusion had Normal Vaginal Delivery signifying the need for active management of third stage. Only 5% (36/776) of Caesarean Section patients received transfusion, which is much lower than other studies. The median blood loss during delivery was 400 ml. Seventeen (17.5%) patients were transfused before delivery and one (1%) was transfused during delivery and 81 patients (81.5%) were transfused after delivery. Eighteen of them (18.4%) were transfused for Antepartum Haemorrhage and 81 (81.6%) of them were transfused for Postpartum Haemorrhage. The median time interval between prescription and administration was 160 min which is quite long and could be improved by reducing the interval between prescription and ordering blood and interval between receipt and administration. The total cost of transfusion during one year study period was R 329,579.27 (Whole blood: R7, 433.37, Red Blood Cell: R282, 192.50, Fresh Frozen Plasma: R33, 411.37 and Platelet: R6, 542.03) and the average cost of transfusion per patient was R3329.01. CONCLUSION: The findings of this study will be reported to the Hospital management for improving management of obstetrics patients. The researcher also proposed further study among all the patients who received transfusion at all the regional hospitals in the Free State Province to compare the use of blood and blood products in these institutions.
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