3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item The association between manganese exposure, parkinsonism, and quality of life in South African manganese mine workers(2018) Dlamini, Wendy WandileBackground Manganese is an essential micronutrient for humans, but excessive levels are harmful. Manganese neurotoxicity is associated with parkinsonism and the associated motor deficits can affect an individual’s daily activities and quality of life (QoL) in manganese–exposed persons. Objectives In this study, we sought to investigate the associations between manganese, parkinsonism and QoL in South African manganese mine workers, in the period 2010–2014. Methods This was a secondary analysis of data from 418 South African manganese mine workers already recruited into a prospective study of the association between Mn mining exposure and parkinsonism. Parkinsonism, the primary outcome, was defined as a Unified Parkinson’s Disease Rating Scale motor subsection part 3 score (UPDRS-3) ≥15. The 39–item Parkinson’s Disease Questionnaire (PDQ-39) was used to assess miners’ health status or QoL, the secondary outcome. Cumulative manganese exposure in mg/m3-year (measured as inhalable dust) was estimated using an exposure matrix from participants’ job histories. We used Mann-Whitney and Pearson’s Chi-Square tests to compare participants’ parkinsonism status with regard to baseline continuous and categorical characteristics. Multiple linear and logistic regression modeling was used to quantify associations. Results The mean age of the manganese mine workers was 41.5 years (SD=11.9); 97.6% were male. Average manganese exposure was estimated as 3.7 mg/m3-years (SD=5.8) at baseline with mean duration of 13.5 years (SD=11.7). The prevalence of parkinsonism was 29.4%. Participants’ characteristics, stratified by parkinsonism status, differed significantly by age, education, and comorbid disease. Parkinsonism prevalence decreased significantly with increasing miners’ education status, p=0.029 and was higher (36.4% vs 25.9%, p=0.042) in those with comorbidities. Parkinsonism participants were generally older (mean age 45.3 vs 39.6, p<0.0001). QoL sub-scores and total scaled PDQ-39 score means were higher in mine workers with parkinsonism compared to those without. We found no evidence of a monotonic dose-response relationship between cumulative manganese exposure and parkinsonism. Similarly, there was no statistically significant association between QoL and cumulative manganese exposure. Being aged 40 years or older was an independent risk factor for having parkinsonism (OR=2.11, 95% CI: 1.18, 3.78). Parkinsonism (β=0.63, p=0.004) and age (β= -0.48, p=0.031) were strong predictors of QoL. Conclusion We found a strong association between parkinsonism and QoL in manganese mine workers, confirming previous reports in manganese–exposed welders. There was no evidence of an association between parkinsonism and manganese exposure. The lack of a monotonic dose–response relationship between parkinsonism and manganese exposure may be due to the healthy worker survivor effect, a non-linear relationship, or exposure misclassification.Item Impact of caregiver burden in paediatric epilepsy at Charlotte Maxeke Johannesburg Academic Hospital, South Africa(2018) Sabo, Umar AbbaBackground: Chronic health conditions such as epilepsy may impose a high level of stress on the caregivers. The burden of epilepsy can cause significant dysfunction in the affected families resulting in a negative impact on the child’s adaptation to the disease. This study seeks to evaluate the effects of caregiver burden on the health-related quality of life (HRQOL) of the caregivers and their family functioning as well as factors associated with high impact of the caregiver burden. Methods: The participants consisted of primary caregivers who were involved in childcare for at least six months before study onset. Informed consent was obtained. One hundred and nine eligible caregivers recruited over a three months’ period completed questionnaires providing information on their socio-demographic and epilepsy-related variables as well as paediatric quality of life (PedsQL) family impact module. High impact on HRQOL/ Family functioning was defined by Score below the inter-quartile range. Results: The median HRQOL score of the caregivers was 46.3 (IQR = 31.3, 67.5) while the median family functioning score was 46.9 (IQR = 31.3, 71.9). In participants categorized with high impact, raw scores ≤ 31.3 were obtained for both caregiver burden and family functioning. The family functioning score correlated strongly with the HRQOL score of the caretakers, ρ = 0.78 and p<0.001. Multivariate analysis identified lower caregiver education level and a high seizure frequency as independent predictor of high impact of caregiver burden after adjusting for age of the caregivers and the number of anti-epileptic drugs taken. Conclusion: The burden of caregiving for children with epilepsy in Johannesburg impacts negatively on family functioning. The burden of care was associated with high seizure frequency and lower level of caregiver education.Item Physical activity and sedentary behaviour patterns in patients with knee osteoarthritis(2017) Kaoje, Yusuf SuleimanObjective: Physical activity (PA) is recommended in the management of osteoarthritis (OA) to reduce pain and improve function. Total volumes of PA and sedentary behaviour (SB) have been described in people with knee OA, but detailed information about the patterns of accumulation of PA and SB in knee OA populations is lacking. The purpose of this study was to objectively assess the patterns of accumulation of PA and SB and to explore associations with subjectively measured functional outcomes and quality of life in patients with knee OA. Methods: End-stage knee OA patients (n = 87, 65 ± 8.8 (mean ± SD) years, body mass index 34.4 ± 7.8 kg/m2) with Kellgren-Lawrence-defined grade 3-4 radiographic OA, wore an Actigraph and an activPAL accelerometer for 24 hours a day for 7 consecutive days. Total volumes of SB, light physical activity (LPA), moderate to vigorous physical activity (MVPA), and different bouts of SB, LPA, and MVPA were assessed. Self-report questionnaires were used to assess patient-experienced pain, function, quality of life and activities of daily living were the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and the Knee Injury Osteoarthritis Outcome Score (KOOS). Results: Of the 87 knee OA patients only 76 and 65 had complete Actigraph and activPAL data respectively. The participants had a mean (SD) age of 65.0 (8.8) years, were mostly women and most were classified as being obese with an average BMI of 34.4 (7.8) kg/m2. The Actigraph mean (95% CI) of awake wear time was 15.6 (15.1-16) hours/day, SB 10.9 (10.5-11.4) hours/day, LPA 4.5 (4.1-5) hours/day and MVPA 8.2 (3.3-13) min/day. Approximately 7% of patients met the current recommended PA guidelines. The activPAL mean (95% CI) of sitting time, standing time, stepping time and number of steps were 9.3 (8.5 – 10.1) hours per day, 5.0 (4.4 – 5.6) hour per day, 76.5 (66.6 – 86.3) minutes per day and 2489 (2130 – 2848) minutes per day respectively. There were variations in the hourly patterns of movement behaviours. Participants were significantly less sedentary between 6 am and 9 am compared to the grand mean of sedentary time per hour over the day (p<0.01) and were significantly more sedentary per hour from 3 pm to 7 pm (p<0.05). Significant correlations were found between WOMAC pain scores and Actigraph measured SB (r=0.277, p=0.031), LPA (r=-0.240, p=0.043), MVPA (r=-0.242. p=0.042), number of steps (r=-0.282, p=0.020), number of breaks in bouts of SB greater than 20 minutes (r=-0.292, x p=0.016), average duration of breaks in SB (r=-0.277, p=0.024), average duration of MVPA bouts (r=-0.326, p=0.012). Significant correlations were also found between WOMAC activity of daily living scores and Actigraph measured LPA (r=-0.206, p=0.048), MVPA (r=-0.246, p=0.029), number of steps (r=-0.286, p=0.010) and average duration of MVPA bouts (r=-0.383, p=0.002). Significant correlations were found between WOMAC pain scores and activPAL sitting time (r=0.029, p=0.02), and stepping time (r=-0.029, p=0.01), between self-reported WOMAC activity of daily living score and stepping time (r=-0.309, p=0.02), between KOOS activity of daily living score and stepping time (r=-0.276, p=0.004), and between KOOS quality of life score and stepping time (r=-0.263, p=0.008). Conclusion: This study describes novel detail of the patterns of activity and sedentary behaviour in patients with knee OA. The use of two accelerometers gives a detailed account of daily activity and the variation throughout the day, highlighting when interventions to improve activity might be most effective. Therefore, interventions should target the long bouts of inactivity in this population. Since even healthy populations of older adults struggle to meet current recommended PA guidelines, it may be important to shift attention from meeting recommendations of MVPA to creating feasible suggestions of doing more light activity and breaking more sedentary time in knee OA patients.Item A disability profile of Impala Platinum Mine workers presenting with nonspecific lower back pain(2017) Tsheole, Rorisang PrimroseBACKGROUND: Lower back pain (LBP) due to ergonomic exposure in a work environment is wide spread in most countries and is the leading cause of disability affecting quality of life and work performance of an individual suffering from it. LBP is the most common reason for repeated medical consultation and subsequent absenteeism. It is reported that LBP is responsible for a third of work related disability disorders and it is estimated to cause 21.7 million disability adjusted life years (DALY‘s). In addition to the physical impact, lower back pain can influence psychological issues such as anxiety, depression and fear of job loss. Mining is an ancient occupation characterised by intense physical labour such as lifting, carrying, pulling and pushing heavy materials, operating heavy machinery and working in constricted environment. Despite the fact that ergonomics plays a major role in mining, the element of proper ergonomics is currently ignored or applied in a minimal scale in South African mining.LBP continues to have a high prevalence in mining industries. AIM: To profile the disability level of Impala Mine workers presenting with nonspecific lower back pain. METHODS: A cross-sectional quantitative study using a consecutive sampling method was conducted on mine workers employed at Impala platinum mine as rock drill operators (RDOs) and scraper winch operators (SWOs) aged between 20 and 60 years who had been employed in the current occupation for at least a period of one year. Interviews were conducted using the questionnaires based on Oswestry Disability Index (ODI) assessing disability levels, Who Disability Assessment Schedule II (WHODAS II) for activity limitation and participation restriction and Who Quality of life-Bref (WHOQOL-BREF) to measure quality of life. The study received ethical approval from the University of the Witwatersrand Human Research Ethics Committee: (Medical) (Ethical clearance no.M140813). Consent was sort from participants and Impala hospitals granted permission for the study. Data was analysed using Statistica version12.5. Descriptive data was presented as frequencies expressed in percentages. The Spearman correlation test was applied to establish the association among variables. Further analysis was done by fitting bivariate and multivariate linear regression models to quantify the magnitude of relationship between age, job category, disability, activity limitation, participation restriction and quality of life. Finally data was illustrated by means of tables and a scatter graph.RESULTS: From the study sample, 44% (n=151) of the SWOs reported moderate disability while 36% (n=132) of the RDOs reported moderate disability. Results revealed that disability level was significantly associated with job category (p-value 0.04). Activity limitation level was adversely affected and showed a positive correlation with disability(r=0.831). Only a small proportion of participants reported severe participation restrictions RDOs (0. 76%) and SWOs (1. 99%). Majority of participants reported moderate to good Quality of life (QoL) with only a small proportion reporting poor QoL RDOs (4.55%) and SWOs(3.31%).The findings of the study showed no statistical difference between the two job categories in terms of activity limitation (p=0.20), participation restriction (p=0.31) and QoL (p=0.56). There was a negative correlation between QoL and disability (r=-0.536).The result of the bi-variate linear regression showed a statistical significance between age and years of service with disability (P=0.001). DISCUSSIONS: Disability due to nonspecific lower back pain (NSLBP) was significantly associated with job category, suggesting that SWOs were the category mostly affected than the RDOs. The results revealed no statistical difference between two job categories in relation to activity limitation, participation restrictions and QoL. Furthermore, the results showed a strong positive correlation between disability and activity limitation and a moderate positive correlation between disability and participation restriction while a moderate negative correlation between disability and QoL was noted. The results of the linear regression highlighted that increased age and long years of service predisposes the miners to higher levels of disability and activity limitation, resulting in difficulties with participation in work related or societal activities which subsequently leads to poor QoL. CONCLUSION: Results of the current study revealed that the majority of RDOs and SWOs presented with moderate disability due to NSLBP. This study identified that age, job category and length of service were significantly associated with the severity and functional disability of LBP among RDO‘s and SWO‘s.Activity limitation level was adversely affected among RDO‘s and SWO‘s whereas participation restriction levels and QoL levels were less affected.Item Neurodevelopment, quality of life and burden of care of young children who have undergone cardiac interventions in central South Africa: three-month and six-month post cardiac intervention outcomes(2017) Smith, RobynOver recent decades medical and surgical advances have significantly lowered the mortality rate for children born with congenital heart defects. Congenital heart disease (CHD) survivors are at high-risk of growth retardation and developmental morbidity that negatively affect their health-related quality of life (HRQOL). In addition, caring for a child with a chronic health condition such as CHD places a considerable financial and emotional burden on parents, putting them at risk of ongoing stress and psychological morbidity including anxiety and depression. The outcomes of children living with CHD and their families in South Africa (SA) are unknown. Outcomes for children with CHD in SA are likely to be further complicated by social disadvantage and Human Immunodeficiency Virus (HIV) co-infection. The aim of this observational descriptive study (Phase I and II) was to determine the pre-cardiac intervention, and three-month and six-month post-cardiac intervention development, growth, HRQOL and parenting stress outcomes of young children with CHD in central SA. Outcomes were compared over time, and variables associated with development, HRQOL and parenting stress outcomes determined. In addition, the developmental needs of young children living with CHD in central SA were to be identified. In order to meet the Phase I and II objectives, forty-eight consecutive children, 30 months and younger, and their parents were recruited into this study at the Universitas Academic Hospital in Bloemfontein. Children who had previous or emergency cardiac surgery were excluded. Development was assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), HRQOL using the Paediatric Quality of Life Inventory (PedsQLTM) and levels of parenting stress using the Parenting Stress Index Short-Form (PSI-SF). Growth outcomes were determined by z-scores calculated for growth parameters. Medical severity of the cardiac disease was rated by a paediatric cardiologist using the Cardiologists Perception of Medical Severity Scale. Baseline data was collected for 40 children. The majority of children (n=26) underwent open-heart surgery in infancy with cardiopulmonary bypass. Most children (n=30) had moderate disease severity, with twenty percent (n=8) having cyanotic heart defects. A quarter of the children (n=10) had Down syndrome (DS). Surgical outcomes were comparable to those reported in developed countries, with a mortality rate of 15%. There was a high attrition rate during Phase II of this study, with 47.5% of children and their families missing one or more follow-up visit. Mothers fulfilled the role of primary caregiver, and carried most of the burden of care. The majority of families were from a low socioeconomic backgrounds (87.5%) and mothers had low levels of education, with only 40% having graduated high school. The majority (68%) of children had suboptimal growth prior to cardiac intervention. There was significant growth catch-up for both weight (p=0.04) and head circumference (p= 0.02) by the six-month post-cardiac intervention. Complete catchup growth had not yet taken place by the six-month post-cardiac intervention, with 40.9% of the children still presenting with malnutrition. The growth trends of children with CHD with DS were found to be similar to those of children with CHD without DS. Growth in children with cyanotic heart defects tended to be poorer both before and after cardiac intervention. There was a high prevalence of moderate developmental delay across all development domains. Motor delays (27.5%) were most prevalent prior to cardiac intervention. Motor performance improved with age and post cardiac intervention, but language and cognitive performance declined with age and increasing skill complexity. There was not a significant change in the developmental outcome of the children over the timespan of this study. The developmental outcome for children with cyanotic heart defects tended to be similar to those with acyanotic heart defects. The presence of DS was significantly (p<0.001) associated with developmental outcome across all developmental domains at all time-points of assessment. Children with CHD with DS tended to have considerably poorer developmental outcomes compared to children with CHD without DS. Disease severity (p=0.02) and maternal age (p=0.01) were significantly associated with cognitive development. Age at first cardiac surgery was found to be significantly associated with language development both before cardiac intervention (p<0.01) and at three-month post-cardiac intervention (p=0.04). Suboptimal growth prior to cardiac intervention (p=0.04) and maternal age (p<0.001) were significantly associated with motor development. Developmental performance was well below the test mean on all subscales of the BSID-III at all the time points of assessment. Although the patterns of development and the prevalence of developmental delays in the current study were similar to those reported in developed countries, children living with CHD in central SA performed below the expected developmental levels for children with CHD when assessed on the BSID-III. Hypotonia was the most significant abnormal neurological finding, with 45% of the children presenting with hypotonia prior to cardiac intervention. The hypotonia tended to resolve in the children without DS by the six-month post-cardiac intervention. Overall parents’ perceived their children’s HRQOL as being relatively good, and similar to that of their healthy same-aged peers and other children with CHD in developed countries. Parents’ perception of their children’s HRQOL improved significantly after cardiac intervention (p= 0.04). Perceived HRQOL tended to be similar for children with cyanotic and acyanotic heart defects. Parents of children with CHD with DS tended to perceive their children’s HRQOL as poorer when compared with parents of children with CHD without DS. Motor development (p=0.01) and levels of parenting stress (p=0.02) were significantly associated with parents’ perceptions of their children’s HRQOL prior to cardiac intervention. The majority of parents’ (60%) experienced clinically significant levels of stress prior to their children undergoing cardiac intervention. Parenting stress decreased significantly from pre-cardiac intervention levels at both three-month (p<0.001) and six-month (p<0.001) post-cardiac intervention as the child’s cardiac symptoms resolved or decreased, and their health status improved. Parents of children with cyanotic and acyanotic heart defects tended to experience similar levels of stress. Parents of children with CHD with DS tended to experience higher levels of ongoing stress when compared with parents of children with CHD without DS. Parenting stress prior to cardiac intervention was significantly associated with parents’ perception of their child’s HRQOL (p=0.02) and language development (p=0.04). Parenting stress at threemonth post-cardiac intervention was significantly associated with age at first cardiac surgery (p=0.03), language development (p=0.03) and level of maternal education (p=0.04). HRQOL and parenting stress outcomes were closely linked before cardiac intervention. Parents perceiving their child as having a poor ability to function in everyday situations experienced increased stress levels. Based on developmental performance on the BSID-III 59% of the children in the current study would qualify for referral to early intervention (EI) services including physiotherapy, occupational therapy and speech therapy, with many children requiring access to more than one service. A home-based parent-driven developmental activity programme would likely be best suited to meet the developmental needs of children with CHD living in central SA taking into account the geography of the area and service delivery challenges in the public healthcare sector. Phase III of the study resulted in the development of a home-based developmental activity programme to meet the identified developmental needs of children with CHD in central SA. Qualitative methods, including an expert panel of rehabilitation professionals and a focus group of parents, were used to gain consensus on the content of the developmental activity programme. In conclusion, it is encouraging that the longer-term outcomes of children with CHD in central SA were not vastly different from those of children in developed countries. The greater extent of the growth retardation and developmental delay of the children in the current study is however of concern. The findings in this study strongly support the implementation of a cardiac neurodevelopmental programme as part standard cardiac care in SA. Early developmental intervention and psychosocial support services are indicated to optimise the outcome for both children living with CHD and their families. A home-based parent-driven developmental stimulation programme provides an innovative approach to meeting the developmental needs of young children living with CHD. Keywords Congenital heart disease, neurodevelopment, growth, parenting stress, health-related quality of life, home-based developmental activity programme, Bayley Scales of Infant and Toddler Development, Third Edition, Paediatric Quality of Life Inventory, Parenting Stress Index-Short Form.Item Functional status and health-related quality of life of the Institutionalised elderly in selected Johannesburg areas(2017) Uwumagbe, Iyare BrainBACKGROUND: Global life expectancy is on the rise and it is contributing to the growth of the population proportion of the elderly. More and more elderly are getting institutionalised. Functional status decline has been found to influence institutionalisation in the elderly while health-related quality of life seems to be better among the community dwelling elderly compared to the institutionalised elderly. As a result, there is increased interest on the functional status and health-related quality of life (QoL) of the institutionalised elderly. OBJECTIVES: The objectives of the study were: to determine the demographic profile of the institutionalised elderly in Alexandra, Orange Grove and Yeoville areas of Johannesburg. to determine the health-related quality of life and functional status of the institutionalised elderly in Alexandra, Orange Grove and Yeoville areas of Johannesburg. to determine the relationship between functional status and health-related QoL of the institutionalised elderly in selected Johannesburg areas. to determine the predictors of functional status and health-related QoL of the institutionalised elderly in selected Johannesburg areas. METHOD: The study utilised a cross-sectional, quantitative descriptive design. Functional status was assessed using the Physical Self Maintenance Scale (PSMS) and the Instrumental Activities of Daily Living (IADL) scale while health-related QoL was assessed using the EQ-5D-5L. The functional status and health-related QoL of the participants were assessed as a onetime event over 11 weeks. The calculated sample size was 137 participants but only 116 residents met the inclusion criteria. Questionnaires were administered individually on participants who met the study inclusion criteria after obtaining consent to get activities of daily living (ADL), IADL and health-related QoL scores. Stata version 13 was used for data analysis. RESULTS: There were 105 participants, 66 (62.86%) female and 39 (37.14%) male. The mean age was 75.2 (±8.56) years and age range being 61-98 years. The median ADL score was 5. The median IADL score for female participants was 2 while the mean IADL score for male participants was 1.95±1.70. The median EQ-5D-5L index value was 0.69. Activities of daily living (r=0.685, p<0.001) and IADL (r=0.434, p<0.006 (male); r=0.369, p<0.003 (female)) were positively correlated with health-related QoL. The correlation between health-related QoL and ADL and that between QoL and IADL were strong and moderate respectively. Independent predictors of health-related QoL were race and religion. Religion was the only independent predictor of functional status (basic ADL) for both male and all participants. There was no independent predictor of functional status (IADL) for female participants. CONCLUSION: The age range of participants was a span of four decades of life beginning from the sixth decade. Females outnumbered male participants in the ratio 1.69:1. The functional status of participants was poor (IADL) to moderate (ADL). The health-related quality of life of participants was moderate. Functional status and health-related quality of life were positively associated with strong strength. Religion and race independently predicted functional status and health-related QoL. Although the data gotten from participants’ responses were sufficient for analyses, the findings from this study cannot be generalised to all the institutionalised elderly in the selected areas in Johannesburg because the number of residents who met the study inclusion criteria and participated in the study fell short of the calculated sample size. In essence, there is the need for more studies on the functional status and health-related quality of life of the institutionalised elderly.Item Validation of self reported measures of adherence to ART and factors associated with adherence in Jinja, Uganda(2016) Made, FelixBackground: Good adherence to ART prolongs survival and improves quality of life in people living with HIV/AIDS. Adherence is commonly assessed using self-reported measures, but these tend to over-estimate adherence. Viral load testing is the gold standard for measuring ART adherence but it is unaffordable in resource limited settings. Therefore, the aims of this small sub-study were to validate self-reported measures of adherence and to find factors associated with adherence to ART in Jinja, Uganda. Methods: This study was a secondary analysis of data collected from a cluster randomized equivalence trial which was carried out to compare facility based ART care versus home based care. In the main study, 1453 participants aged 18 and above were enrolled. A total of 1276 men and women qualified for this sub-study. Receiver operating characteristic (ROC) was computed to see how well two self-reported measures of adherence predicted virological failure. The two self-reported measures were firstly a visual analogue score (VAS) where participants rated the number of doses that they had taken in the past month on a scale from 0 (meaning no ART taken) to 100 (meaning that all required doses had been taken) and secondly an adherence score based on the number of pills missed in the three days before the visit. Logistic regression models were fitted with survey estimator to find factors associated with virological failure. Tobit models were fitted to find factors associated with self-reported adherence measures, since these were restricted to the range of 0-100% and censored. We then compared associated factors among the three different outcome measures. Results: There were 914 women and 362 men in this study. Home based care had larger number of patients (754) than facility based care (522). The median age of the patients was 38 years (IQR 32.0-44.0). Most of the participants were either married (518) or single (456). The majority of the trial participants had primary school education (n=713) and very few achieved tertiary education. A large number of participants had CD4 cell counts of less than 50 cells/mm3 (n=351), and very few of the patients in the trial had CD4 counts greater than 200 cells/mm3. The median CD4 count of the study participants was 116 cells / mm3 (IQR 43.0-167.0). A very large number of the patients were either in WHO clinical stage II or III (Stage II: n= 595; Stage III: n=577). A total of n=1079 (84.56%) and n=197 (13.44%) participants had no virological failure and failure respectively. The ROC methods showed that the iv self-reported adherence measures estimated virological failure with a sensitivity that ranged between 35-65%. Female patients had lower odds of experiencing virological failure (odds ratio: 0.7; 95% CI: 0.485, 0.968; p=0.033). The odds of virological failure decreased with each one year increase in age (OR: 0.95; 95% CI: 0.928, 0.979; p=0.001). Participants who found adherence reminders very useful were less likely to experience virological failure (P=0.001). Conclusion: This study show that self-reported measures are not good predictors of ART adherence since approximately only a half of the Jinja participants with virological failure were predicted by such measures. None of the factors associated with virological failure was also associated with both of the self-reported adherence measures. Viral load testing should be encouraged in place of self-reported adherence measures to ART. In addition, alternative methods of measuring adherence such as electronic medication monitoring, pharmacy refills and drug level detection should be investigated.Item Factors affecting health-care seeking behaviour, and assessment of the population's perception of the major health problems in Gauteng province, South Africa 2013(2016) Abaerei, Admas AberaBackground: More than a billion people, mainly in low- and middle-income countries (LMICs), are unable to access needed health care services for a variety of reasons. Possible factors influencing health-care seeking behaviour are socio-demographic and economic factors such as age, sex, ethnicity, religion, education and employment; and income and expenditure levels, and other cultural or political factors. There are limited studies on health-care seeking behaviour especially of vulnerable populations such as immigrants in South Africa. Aim of the study: To assess factors associated with health care seeking behaviour, and to assess the population’s perception of major health problems and its determinants in Gauteng Province, South Africa in 2013. Methods: We conducted secondary data analysis of data from a Quality of Life (QoL) survey carried out by Gauteng City-Region Observatory (GCRO) to determine factors associated with health care seeking behaviour and perception of major health problems among adults living in Gauteng province. We used Coarsened Exact matching (CEM) to improve estimation of causal effects. A multiple logistic regression model was used to identify factors associated with health care seeking behaviour and multinomial logistic regression was employed to determine factors associated with perception of major health problems. Results: From a total of 27 490 participants interviewed, a total of 26 318 (95.7%) participants reported usually utilizing health care services while the remaining 4.3% reported not having sought health care services of any type, when they needed. In addition 141 (0.5%) reported having visited traditional healers when they are ill. Higher odds of reported health care seeking was associated with being white compared to being African (Odds Ratio (OR) =2.28 95% CI: 1.84 - 2.74; p<0.001); with having medical insurance compared to not having any (OR=5.41 95% CI: 4.06 - 7.23; p<0.001). In contrast, lower odds of seeking health care was associated with being an immigrant compared to being a citizen of Republic of South Africa (OR=0.61 95% CI: 0.53 - 0.70; p<0.001) and being employed compared to being unemployed (OR=0.84 95% CI: 0.72 - 0.97; p=0.02). the perception of major health problems was significantly associated with age, sex, population group and educational status. Conclusion: Age and sex of participants, population group, immigration status and presence/absence of health insurance were associated with health care seeking behaviour. There is a need to improve the quality of public health care services and perception towards them as improved IV health care quality increases the choice of health care provider relative to either going to traditional healers or self-treatment. Furthermore, health education and health promotion campaigns should focus on creating continuous awareness especially about chronic diseases and their risk factors.Item The development and validation of a quality of life assessment instrument for cancer patients in South Africa(2016-11-04) Van Rensburg, Jacoba Johanna Maria JansenBackground: Quality of life (QoL) of cancer patients has been well researched, but not necessarily from the perspective of the patient and not in third world countries. Total care of cancer patients should encompass all aspects of the person, such as physical-, psychological- and social aspects, existential wellbeing and spirituality, in order to ensure optimal QoL. The purpose of the study was to explore QoL from the perspective of the cancer patient who accesses public health care services in South Africa for treatment and to develop and validate an appropriate patient-directed assessment instrument. Method: The study was conducted in two phases. In Phase 1 assessment of QoL was done by means of in-depth qualitative interviews. Open coding and template analysis was conducted \during data analysis and the applicable domains of QoL were identified. In Phase 2 an appropriate QoL assessment instrument was developed for cancer patients in South Africa. The Rasch Measurement Model was utilized for the validation of the instrument. Results: The domains of QoL identified by the cancer patients were: physical, psychosocial, financial, spiritual, existential and emotional. When compared with the domains included in available QoL assessment instruments such as the World Health Organization Quality of Life Instrument (shortened version) (WHOQOL-BREF), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Functional Assessment of Cancer Therapy General (FACT-G), the domains identified by cancer patients in South Africa were not fully addressed by these instruments. Significance of results: Culture, psychosocial status, financial aspects and spirituality play a major role in QoL of South African patients, as indicated by this study as well as a previous study on QoL of palliative patients from a resource-poor community in South Africa. These aspects of QoL are not addressed by the most commonly used assessment instruments. The importance of the utilization of an instrument which addresses all the appropriate domains of QoL is highlighted by the study.