3. Electronic Theses and Dissertations (ETDs) - All submissions
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/45
Browse
12 results
Search Results
Item Factors associated with mortality in very low birth weight neonates treated with invasive mechanical ventilation at a tertiary hospital in South Africa(2024) Goldstein, Rowan CliveIntroduction: Respiratory support with invasive mechanical ventilation (IMV) is a critical intervention available to neonates, especially amongst very low birthweight (VLBW) neonates. Since its introduction in the 1960s it has been associated with an increased survival amongst VLBW neonates. Objectives: To describe the characteristics and outcomes of VLBW neonates who received IMV in the neonatal intensive care unit (NICU) at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methods: This was a retrospective, descriptive study of neonates who required IMV admitted to the NICU at CMJAH, between 1 January 2013 and 31 December 2019. The characteristics and outcomes of these neonates were described using univariate analysis. The NICU is combined with the paediatric ICU and comprises of 15 beds. Results: There were 3 484 VLBW neonates admitted during the study period of which 849 required IMV (24.4%). Of the 849, 445 survived (52.4%). 44 infants required high frequency oscillatory ventilation, 16 of whom survived (16/44, 36.4%) making the need for HFOV one of the factors strongly associated with a poor outcome (p<0.001). Other significant associations with poor outcomes were lower birth weight (p<0.001), lower gestational age (p=0.003), the presence of metabolic acidosis (p<0.001), the diagnosis of NEC (p<0.001), pathological cranial sonar findings (p<0.001), and longer length of hospital admission (p<0.001) Conclusion: One quarter of VLBW neonates admitted at CMJAH required IMV during their hospital admission. We demonstrated a survival rate of 52% for ventilated VLBW infants. The only predictive factor for mortality was the presence of metabolic acidosis, likely a surrogate for severity of illnessItem Rate of neonatal birth HIV positive tests and description of related risk factors in Johannesburg: can point of care testing be targeted effectively?(2024) Wannenburg, ElzetteBackground Prompt diagnosis of Human Immunodeficiency Virus (HIV) in South Africa and early initiation of antiretroviral therapy in infected newborns remains a challenge in South Africa. Point of Care Testing could expedite this process. This study describes the rate of, and risk factors associated with birth detectable HIV infection in a South African setting. Methods A secondary data analysis of infant HIV polymerase chain (PCR) reaction results was done at Rahima Moosa Mother and Child Hospital in Johannesburg between June 2014 to June 2019. Annual positivity rates were calculated and association tested against characteristics (maternal, delivery and infant) using descriptive statistical methods. Results 12466 infants had a final HIV result. The yearly positivity rate did not show significant fluctuation, ranging from 1.2-1.7%. Maternal risk factors for infant infection included adolescent age (3.6% vs 1.8% for mothers aged 20-30) (p1000 (8.9% vs 1.3% if 50-1000) (p<0.001); CD4 count <200 (3.3% vs 0.75% at CD4 200- 300) (p<0.001); antiretroviral therapy for less than a month (5.1% vs 2.3% after 1 month) (p<0.001); HIV diagnosis within a month of delivery (10.1% vs 1% preconception) (p<0.001) and those with viral loads >1000 (8.9% vs 1.3% if 50-1000) (p<0.001). Infant risk factors for infection were prematurity (2.3% vs 1.4%) (p=0.012); low birth weight (2.2% vs 1.4%) (p=0.009); ill infants warranting admission (3% vs 1.5%) (p<0.001) and infants born in cold seasons (1.8 vs 1.3%) (p=0.016). Conclusion Various maternal and infant factors were associated with HIV infection at birth while the birth positivity rate remained relatively constant across the study period. While universal birth point of care testing is ideal, high risk infant groups could be identified and targeted in resource constrained settings to expedite HIV diagnosis and treatmentItem Adult intracranial neoplasms: radiologic and histopathological correlation(2024) Mojapelo, BesleyBackground: Imaging plays an important part in the management and prognosis of an intracranial neoplasm. MRI and its advancement with the addition of DWI/ ADC, PWI and MRS have greatly enhanced the diagnostic accuracy of MRI in that there is better characterisation and differentiation of intracranial neoplasms. Aim: To document and evaluate the histopathological diagnoses and the MRI imaging findings of intracranial neoplasms in adult patients at CHBAH. Method: A retrospective study was conducted using MRI and histopathology reports from January 2017 to September 2019. Statistical significance was met when p-value <0.05. Results: The study included 53 (N=53) adult patients with confirmed intracranial neoplasms. There were 26 (49%) males and 27 (51%) females with an age range of 18 to 71 years. The most frequent anatomical sites were the sellar/suprasellar region 22 (42%) and the frontal lobe 8 (15%). Pituitary adenoma 18 (34%) was the most common neoplasm followed by meningioma 14 (26%) and glioblastoma 7 (13%). Low-grade (WHO I/II) neoplasms were more frequent 37 (70%) than the high-grade neoplasms (WHO III/IV) [16 (30 %)]. The overall concordance between the MRI and the histopathology diagnoses and grading demonstrated a good agreement with Kappa values of 0.63 and 0.71, respectively. Conclusion: Conventional MRI constitutes the most utilised MRI technique in the characterisation of intracranial neoplasms. Due to limitations thereof, advanced MRI techniques may improve the diagnostic accuracy. Conventional MRI, advanced MR techniques and histopathology are complementary diagnostic modalities for the classification of intracranial neoplasms.Item Pathological complete response in early-stage HER-2 positive breast cancer patients, receiving neoadjuvant chemotherapy/trastuzumab, in a single breast unit in Johannesburg(2024) Bellomo, Alessandro NBackground HER-2 positive breast cancers receiving neoadjuvant therapy containing Trastuzumab show higher rates of pathological complete response, correlating to better clinical outcomes. Trastuzumab is not available in the neoadjuvant setting in the public healthcare system in South Africa. Methods This study evaluated factors affecting pCR in early-stage HER-2 positive breast cancers. We retrospectively analysed data of 102 patients with early-stage HER-2 positive breast cancer who completed neoadjuvant trastuzumab/chemotherapy. The cohort was analysed for total pCR and looked at factors that may affect pCR (tumor size, menopausal status, hormone receptor status, Ki-67 levels, and nodal status). Results The pCR rate for the entire cohort was 58.82%. Factors associated with a higher pCR were ER receptor status (ER negative= 82.05%, ER positive 44.4%, P<0.00018), PR receptor status (PR negative=75.41% vs PR positive 34.15%, P< 0.00003). The Ki67 <14% was 46.15%, Ki67 14-30% was 51.11% and Ki67> 30% was 70.45% (P<0.037). Univariate analysis showed a significant difference in pCR relating to ER/PR/HER-2 grouping (ER/PR positive= 63.64%, Triple positive= 34.15%, Enriched= 82.05%; P<0.00007). Conclusions: This data highlights the importance of characterising the different subtypes of HER-2 positive early breast cancers and the association with pCR, in keeping with the international guidelines. Higher pCR rates were attained in HER-2 enriched subtypes. Currently, in South Africa, trastuzumab is not readily available in the public healthcare sector. This study emphasizes the need for trastuzumab to be made available to all patients with HER-2 positive breast cancers in the neoadjuvant setting in South Africa.Item Morphological evaluation of the heart, kidney and liver following simvastatin treatment of a mouse model of adolescent alcoholism(2024) Nchodu, MakgotsoIndividuals that begin drinking during adolescence are more likely to become alcohol addicts, resulting in the development of alcohol-related diseases such as alcoholic cardiomyopathy, renal tubulointerstitial fibrosis and steatohepatitis. This study investigated the protective capabilities of simvastatin against alcohol-induced damage on the heart, kidney, and liver of adolescent mice administered chronic alcohol. Fifty four–week old C57BL/6J mice (F = 5; M = 5) were assigned to each experimental group: (i) NT; no treatment; (ii) ALC; 2.5 g/Kg/day of 20% alcohol (iii) SIM; 5 mg/Kg/day (iv) ALC+SIM5; 5 mg/Kg/day of simvastatin followed by 2.5 g/Kg/day of 20% alcohol (v) ALC+SIM15; 15 mg/Kg/day of simvastatin followed by 2.5 g/Kg/day of 20% alcohol. Lower dosage of simvastatin was more effective against alcohol-induced myocardial hypertrophy in females while a higher dosage of simvastatin was more effective in males. Both simvastatin concentrations significantly reduced alcohol-induced myocardial fibrosis in the females but only the low simvastatin dosage was effective in the males. ALC+SIM5 improved inflammation only in the females. Alcohol increased the area of the renal corpuscles and glomeruli, the collagen and TNF-α distributions. 5 mg simvastatin was more effective against renal hypertrophy in both males and females. Both doses of SIM were effective against renal inflammation. Both concentrations of simvastatin were not beneficial in stimulating hepatocyte regeneration except for 15 mg simvastatin in males. Only a higher dose of simvastatin prevented alcohol effect on hepatic collagen distribution. Both concentrations of simvastatin following a chronic alcohol were not beneficial against alcohol-induced inflammation in the liver.Item Moral justification of continued exceptionalism of HIV care in South Africa(2024) Maserumule, Letjie CharmainSouth Africa has the largest population of people living with HIV (PLWHIV) in the world, and specialized HIV clinics to treat them are unsustainable. Decentralisation of care to primary health care (PHC) facilities reduces the burden on HIV clinics, but the PHC facilities are already overburdened with limited human and infrastructure resources. My aim is to defend that it is morally and legally justified to temporarily continue exceptionalism of HIV care in South Africa while strengthening health systems. My arguments are based on patients’ right to healthcare, the bioethical principles of beneficence and non-maleficence, and deontological moral theory. I contend that the complete abandonment of HIV clinics would burden PHC facilities even more, thus affect rendered care negatively, and violate patients’ intrinsic dignity. The complete decentralization of HIV care will be morally and legally justified when PHC facilities are improved for the progressive realisation of access to quality healthcare for all.Item Investigating knowledge, attitudes and perceptions of COVID-19 vaccines among young people in Soweto, South africa(2024) Muthoni, JeliothVaccination against SARS-CoV-2 is the most prominent strategy in the global fight against COVID-19. Studies continue to show that vaccines are one of the most dependable and cost-effective public health interventions available as they save life every year. However, World Health Organization (WHO) has identified vaccine hesitation as one of the primary threats to global health. Little is known, however, about the causes and nature of vaccine hesitancy in Africa. Moreover, in South Africa a significant drop of COVID-19 vaccine when it was rolled out the youth. The age group is of critical importance as they are becoming productive people who would be essential in the development of any country hence the need to protect them. Furthermore, understanding why youth are hesitant to get vaccinated is critical if we are to increase and sustain public demand for vaccination and preserve the tremendous achievements of vaccination programs on the continent. Unfortunately, there are limited studies that have investigated vaccine hesitancy among the youth populations and precisely looking at their knowledge, attitudes, and perceptions of the COVID-19 vaccine. Hence, the study aims to investigate knowledge, attitudes and perceptions of COVID-19 vaccine among young people in Soweto. The study employed a quantitative method, whereby closed ended questionnaires were administered using Redcap a very power tool for collecting data. Quantitative method was the best fit for the study for it accommodates a large sample size. SowetoThembelihle Health Demographic Surveillance System database was in the identification of the samples. STATA version 13.0 was used for statistical analysis. Out of a sample size of 380, the study recorded a 79.2% (301/380) hesitancy levels. The study population recorded to be knowledgeable on COVID-19 disease and vaccine. However, negative attitudes and perceptions based on the study participants responses in some important elements. The elements included ‘COVID-19 is a hoax’ (p=0.011), ‘I prefer to gain immunity by being sick rather than by having a vaccine ‘(p=0.000) and ‘COVID-19 vaccine has serious side effects’ (p=0.000) The study found out that infordemic has played a significant on the knowledge levels precisely among the youth. The study participants were well- informed, but they had poor attitudes and perception towards COVID-19 vaccine. These insights could help to reinforce national efforts to contain the pandemic across South Africa in particular Soweto and lessen other important consequences of the pandemic well-being.Item Ethical management of Gold mine workers with early and mild silicosis in South Africa(2024) Mojakwana, AngelineThe South African Gold Mining industry is an inherently risky working environment, with frequent accidents and crystalline silica dust exposure that causes silicosis and other cardiorespiratory and autoimmune complications. These diseases can considerably impact the gold mining industry and potentially lead to public health disasters by exacerbating existing tuberculosis (TB) burden in communities and the public health sector. It is of utmost importance to control silica dust exposure and to protect mineworkers from the impact of silicosis. In this study, I interrogate the morality of issuing certificates of fitness to already affected mineworkers to continue risk work underground where they are further exposed to silica dust, which leads to accelerated progression of their illness and its complications. Specifically, the study defends the thesis statement that mineworkers with early and mild silicosis ought not to be certified to continue risk work underground in the gold mining environment where they are further exposed to silica dust. A normative principle derived from the combination of key principles in welfarism and Afro -communitarian solidarity was used to defend the claim. This mostly evaluative study – that draws on desktop-based research – outlines many recommendations, including a revision of Occupational Diseases of Mines and Works Act ODMWA (given that the Act is insufficient and not adequately inclusive), continuous evaluation, monitoring and improvement of control processes to mitigate the impact of silica dust exposure and silicosis and alternative reasonable accommodation of mineworkers with silicosis to protect them from further exposure to silica dust.Item Socioeconomic determinants of early health care utilisation and association with malaria hospitalisation among under five years children in Manhiça, Mozambique(2024) Chauque, Alberto AnicetoIntroduction Malaria is one of the significant health problems in the world, and the greatest burden of the disease is concentrated in Africa, which accounts for about 95% of cases. The WHO (World Health Organization) indicates that early seeking for treatment is crucial to avoid worsening the disease and, consequently, death. This work, was evaluated the factors that influence early health care seeking in children under five years old and the effect of early health care seeking on hospitalisations. Methods It was conducted a health facility-based observational longitudinal study where malaria cases were identified in an ongoing surveillance database. Using the first visit for all children that visited a Health Facility with fever and malaria and defined early health care seeking as a visit to a health centre within 48h after the onset of fever. Multilevel logistic regression was used to identify the factors related to early health care seeking and the association between early health care seeking and hospitalisation. Results A total of 66 620 children aged 0 to 15 years were screened. Excluding all children who did not meet the study criteria, ending up with 2 299 children with malaria and fever, but only 1 603 children had demographic information. A kilometre increase in the distance to a health facility reduces the odds of early health care seeking (aOR = 0.89; CI: [0.83-0.95]; p=0.001). Early health care seeking reduces the odds of hospitalization (aOR = 0.56; 95% CI: [0.34 -0.93]; 0.024) and year increase in the year of the visit also increases the odds of hospitalization (aOR = 1.66; 95% CI: [1.41-1.93]; p<0.001). Conclusions Increasing the distance to health facilities reduces the likelihood of early health seeking, whereas early health care reduces the risk of hospitalisation. Maluane and calanga lead the hospitalisation cases in the study area in children with malaria and cases of delay in health-seekingItem From the onset: impact of nutrition and lifestyle during the preconception period in urban South African young adults(2024) Mukoma, Gudani G.Background- In South Africa, 22% of adolescents are overweight or obese, the onset of tobacco smoking is shown to peak between the ages of 15 and 22, 1 in 3 adolescents watch more than 3 hours of television per day, and nearly half of all adults are insufficiently active. Physical inactivity, poor diet, risky alcohol use, illicit drug use are among the behavioural risk factors associated with obesity and mental health problems, all of which have morbidity and mortality implications for adult health. Risks in later life include premature death, long-term disability, childbirth complications, gestational diabetes, diabetes and cardiovascular diseases. However, there is data paucity showing the personal, social, and environmental factors that are determinants of health, especially diet, physical activity (PA), obesity, and associated NCDs in South African adolescents and young adults. Aim- To investigate the individual, household, and environmental factors that influence adolescents' dietary and physical activity habits and to identify ways in which these factors can be leveraged for interventions to better ensure the health of future generations, especially during the crucial preconception years. Methods- This thesis was purposely designed to use a sequential mixed-methods approach that integrates quantitative (Chapter 3 paper 1: cross-sectional and Chapter 6 paper 4: longitudinal) and qualitative (Chapter 4 paper 2: longitudinal and Chapter 5 paper 3: crosssectional) analyses in order to meet the four specific objectives of my research. The methods selected for this series of investigations were primarily influenced by the substantive research questions that arose, as opposed to methodological and epistemological concerns alone. I utilized three pre-existing data sources, including the "Birth-to-Twenty Cohort," the "Determinants of Type 2 Diabetes Mellitus (T2D)" study, and the "Soweto household enumeration survey." I have gathered new prospective data that is quantitatively and qualitatively longitudinal and cross-sectional. Results- The findings of this thesis in the context of Soweto show that the relationship between dietary patterns and nutritional status (BMI) is independent of socioeconomic status (SES). Adolescents and young adults face a variety of intersecting barriers resulting from personal preferences and their living conditions, which influence their dietary and physical activity habits while occurring at the time; this is important to consider when designing interventions to promote healthy behaviour change. Unexpected stressors, such as the outbreak of the COVID-19 pandemic, contributed to exacerbating adolescents' and young adults' poor health conditions, and as a result, the prevalence of poor nutrition intake, a lack of physical activity, and mental health issues increased. Although the nutrient patterns of adolescents and adults were comparable over time, their associations with BMI were not. The associations with BMI of the "plant-driven nutrient pattern," "fat-driven nutrient pattern," and "animal-driven nutrient pattern" revealed sex differences. Conclusion- Adolescent diet and lifestyle continue to be important research areas in the intent to enhance preconception health and reducing maternal and infant mortality