Faculty of Engineering and the Built Environment (ETDs)

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The Enhancement of the SDLC Methodology utilised in the Delivery of Digital Healthcare Products
(University of the Witwatersrand, Johannesburg, 2024) Asamoah-Bekoe, Michael; Sunjka, Bernadette
The digital healthcare industry has experienced significant growth in recent years, resulting in increased competition among companies operating in this market. Company X, a competitor in this industry, utilises a mixed set of methodologies across their teams, where some methodologies may be outdated. With the emergence of new software development lifecycle methodologies (SDLC), it is crucial for Company X to adapt their current approach to remain competitive. As part of a research study, 24 participants from various teams in Company X were interviewed to gain insights into the industry, the current methodology being used, and how management could ensure a smooth transition to a new SDLC methodology. According to the study results, 21% of participants from Team A-D were unwilling to change their current methodology, while 37% were willing to make a switch. The remaining 42% were indifferent, with their decision depending on the reason for the transition. Based on the literature review and the findings from the study, a conceptual framework was developed to guide the process of transitioning to a new SDLC methodology.
Using a hybrid adsorption-membrane filtration system to produce biologically stable drinking water
(University of the Witwatersrand, Johannesburg, 2024) Omalanga, Landry Sendango; Biyela , Precious; Simate, Geoffrey S.
The purpose of water treatment is to produce clean and safe drinking water, for consumers. Water quality, both during treatment and distribution, is greatly affected by the presence of natural organic matter (NOM). The presence of NOM affects the effectiveness of water treatment processes and sometimes increases the cost of water treatment and leads to operational problems. Furthermore, the presence of biodegradable organic matter (BOM), which is a fraction of NOM, can degrade water quality during distribution resulting in the loss of biological stability. The excessive presence of BOM can be addressed using advanced water treatment processes or by relying on systems which combine multiple water treatment processes to increase treatment efficiency. The main aim of this study was to evaluate the effectiveness of a hybrid adsorption- membrane filtration system in lowering the bacterial regrowth potential in water. Ready-made multi-walled carbon nanotubes (MWCNTs) were used as adsorbents in this study. MWCNTs were chosen because they exhibit high adsorption properties mainly because of their fibrous shape and external surface accessibility. MWCNTs have hydrophobic characteristics and a propensity to aggregate due to the presence of electrostatic interactions among them, therefore, functionalization of MWCNTs was required to improve their dispersion in the organic and inorganic solvents. A non-covalent functionalization process was employed using cetyltrimethylammonium bromide (CTAB) as a cationic surfactant to ameliorate the stability and dispersibility of MWCNTs in aqueous solution. The non-covalent functionalization was preferred to sustain the functionalities needed for BOM capture enhancement and environmental safety. Polysulfone (PSF) membranes were produced by phase inversion method using N, N- dimethylformamide as solvent for the removal of BOM from water. The phase inversion method was chosen in this study due to its simple processing, flexible production scales, and low cost. The MWCNTs and PSF membranes were characterized using microscopy techniques such as transmission electron microscopy (TEM), scanning electron microscopy (SEM), X ray diffraction (XRD), Raman spectroscopy, tensile strength test, and the hydrophilicity (contact angle) test. These techniques were selected because they enable the evaluation of the morphology, composition, physical characteristics, and dynamic behavior of nanostructured materials. iv Batch adsorption experiments were employed to investigate the adsorption properties of functionalized MWCNTs for BOM removal. Four different concentrations of functionalized MWCNTs were tested to determine the ideal conditions for the adsorption of two forms of BOM; assimilable organic carbon (AOC) and biodegradable dissolved organic carbon (BDOC), from water. The concentrations of functionalized MWCNTs used were 4, 8, 12, and 16 mg in 100 mL of BOM solution. Furthermore, the cross-flow filtration mode, also known as tangential flow filtration, was used to separate the remaining BOM in water by passing water along the surface of the NF membrane using pressure difference. Cross-flow filtration was chosen because it removes the buildup from the surface of the membrane and provides the benefit of an improved membrane lifespan by helping to prevent irreversible fouling. A mathematical model of membrane filtration process in continuous system was also developed to better understand the correlations between the different variables of the membrane filtration process such as the inlet (feed) concentration (Cin) and flow rate (Qin), and the outlet (retentate) concentration (Cout) and flow rate (Qout), and the permeate concentration Cp. Results obtained after the functionalization process of MWCNTs showed an improvement in their stability and dispersibility in aqueous solution. The characterization of both MWCNTs and PSF membranes showed some interesting features. For example, morphological and structural studies show that MWCNTs possess fibrous shapes with a high aspect ratio, and a hollow structure with an inner diameter. The finger-like structures found on the surfaces of PSF membranes play a crucial role in their adsorption capabilities. These structures, which vary in pore size, contribute to the overall capacity of the membranes to absorb BOM from water. During adsorption experiments, it was observed that the removal of BOM from water increased with an increase in the adsorbent (functionalized MWCNTs) concentration. This is likely due to high concentration gradient which acts as a driving force to overcome resistances to mass transfer of dye ions between the aqueous phase and the solid phase. However, the maximum removal of both AOC and BDOC was recorded at a concentration of functionalized MWCNTs of 12 mg, at a contact time of 4 hours and at an agitation speed of 180 rpm. The PSF membrane produced by phase inversion method demonstrated the highest flux of 0.0091 ml/cm2.min at room temperature (25°C) and after a filtration time of 90 minutes. The selectivity and permeate flux were increased with forward flushing and backwashing processes of the PSF membranes because it flushes out accumulated debris and particles on the surface and inside the pores of the membranes. After using the hybrid adsorption-membrane v filtration system, BDOC concentrations dropped to an average of 65% of the initial raw water BDOC and the AOC concentrations dropped to approximately 80% of the initial raw water AOC. Outputs from the mathematical model demonstrated that the change in initial conditions (Cin and Qin) is responsible for the transient response (changes from one steady state to another) in these membranes. The adsorption and membrane nanofiltration hybrid system adopted in this study, effectively removed both AOC and BDOC from water, and can therefore be used to produce biologically stable drinking water. The outcome of this study could be the application of the combination of BOM targeting strategies and residual disinfection to better control bacterial regrowth in drinking water distribution systems (DWDSs). This in turn could help water utilities with meeting distribution systems, water quality guidelines, and protect public health
Spirit of place: demystifying the significance of sangoma practices in our communities, education, and well-being, while looking at how they can exist in modern spaces
(University of the Witwatersrand, Johannesburg, 2024) Pitse, Dikeledi
With the evolution of technology and the modern man, sacred spiritual practice and African tradition has become lost amongst our people. Ancient communities took pride in preserving ancestral teachings and rituals that kept us connected and grounded before the rise of modern medicine as we know it. The role of the sangoma/traditional healer in these communities was seem as extremely significant, in that they can communicate with our forefathers. These modes of communication provide clarity on where we come from, as well as where we should go. Therefore, I will be looking at ways in which this sacred practice can be preserved and have a legacy in the modern environment. Additionally, I will show that indigenous knowledge can form part of higher education. Lastly, through research and interviews, I will show the types of spaces that are required in urban the environment for traditional spiritual practices to remain part of everyday life.
Healing from the Past, into the Future: Socio-Cultural & Health Remediation for a Holistic Wellness Facility in Riverlea Township (Extension)
(University of the Witwatersrand, Johannesburg, 2024) McCulloch, Claude Martin; Jivan, Sundeep
The Witwatersrand Mining Basin has been in existence since 1852, which is astonishingly more than a century old. It is the world’s largest gold and uranium basin and has created extraction from over 120 mines stretching from the East to the West of Johannesburg. It is an integral part and the backbone of Johannesburg’s economy. However, regardless of how much mining has boosted the economy, it has not played a sustainable role with the health of the citizens of Johannesburg. This is largely because of radioactive chemicals within the pyrite basin, holding 600 000 tons of uranium, amongst other chemicals as well (Liefferink, 2022). These radioactive chemicals are spread from the mining basin into the surrounding environment via windblown dust (Coetzee et al., 2008). Monitoring of these occurrences have shown that this dust is inhalable due to its structure and particle size, that being either PM 2,5 or PM 10. These happen at residential settings and have exceeded the levels of occupational health standards. A link is suggested from (Nkosi et al., 2015) between the respiratory issues amongst residents that live in communities next to mine tailings & waste facilities. These communities are exposed and have an increased prevalence of ‘chronic respiratory symptoms’ compared to other communities (Van Wyk, 2013). There are currently 585600 people living in communities next to mine tailings according to the 2011 census. (Kneen et al., 2015). The community I will be conducting my research will be in the Township of Riverlea, located in the South-West of Johannesburg. Riverlea is in close proximity to industrial areas and mine dumps. Research has shown that harmful pollutants can from these areas can have negative effects such on the respiratory system, as the particles are airbourne (Makene, 2007). Built in 1963 during Apartheid, ‘coloured’ residents were forcibly removed from other parts of the city and given new homes by the government. The township is conveniently located 500m away from the mine dumps, thus making it a high exposure zone to airborne dust pollution (Kneen et al., 2015). The respiratory diseases in Riverlea are caused from environmental problems. To relate this Architecturally, I research that social and cultural problems may be a symptom towards the residents being unhappy about their environment. This unhappiness and deals with the ‘Sense of Place’ for the resident’s and I believe, alters their social and cultural behaviour, hence many of these communities suffer from poverty, drugs, and crime (Najafi et al., 2011). This can be done using the design methods of Salutogenic design, which promotes healthy living and creates better places that can reduce stress, encourage physical activity, and afford opportunities for socializing, enhancing the general daily health and wellbeing of people (Cushing et al., 2020). I aim to design a holistic wellness facility that remediates the social, cultural and environmental problems which contests the current narrative of the context - that being poverty and respiratory disease.
Factors influencing innovation in public healthcare in South Africa: A critical analysis
(University of the Witwatersrand, Johannesburg, 2024) Nkosi, Mbali Rosemary; Siriram, Rajenlall
Healthcare innovation has proven to reduce morbidity and mortality rates by enhancing healthcare delivery. Most of the South African population depends on the public healthcare system for health needs. The morbidity and mortality rates in South Africa are much higher compared to other middle-income countries in the world. To enhance healthcare delivery in South Africa, understanding the factors that influence innovation in public healthcare is important. Therefore, this research aims to provide a comprehensive understanding of the factors influencing innovation in public healthcare in South Africa and the potential impact of innovation on the country's healthcare system. The main objectives of this study are to determine the level of successfully implemented innovation in public healthcare and the factors influencing it. Existing literature identifies several factors that influence innovation in public healthcare, including design empathy, technological infrastructure, decision-makers, human capital, and organisational culture. This study also investigates the readiness of the public health sector to embrace innovation and the strategies in place for implementing innovation in public healthcare. A gap was identified in the existing literature. There is evidence in literature is that healthcare innovation centres in South Africa and their impact on the adoption of innovation in public healthcare were only covered marginally by existing literature. To bridge this gap, this study provides results on the status of suitable research and development hubs for testing healthcare innovation prototypes in South Africa and their impact on the adoption of innovation in public healthcare. Currently, there are limited health innovation centres in South Africa. This study posits that an increase in the number of healthcare innovation centres would increase evidence-based innovation which would increase the uptake of innovation in public healthcare. A qualitative research approach was used to acquire descriptive information on the factors that influence innovation in healthcare through interviewing participants. Semi-structured interviews were used as the primary instruments of data collection. The interviews were then subjected to a thematic analysis. One of the significant findings of this research is that the lack of funding in public healthcare hinders innovation in the public healthcare system. Also, the rigorous regulatory requirements pertaining to healthcare innovation tend to cause uncertainty and delays, which in turn reduces the funding available for innovative proje
Birth Freedom: Healing Architecture’s Impact on the Experience of Childbirth and Healthcare Through a Community Maternity Centre in Alberton
(University of the Witwatersrand, Johannesburg, 2024) Grobler, Leonie; Szentesi, Anita
This research explores the topic of childbirth and maternal health care in a community context where such facilities are lacking in focus and accessibility. The study explores the narratives of pregnancy, childbirth, and the postnatal period through the lenses of phenomenological experience, feminist theory, and healing. Its focus lies in how these concepts can shape the design of maternal healthcare architecture. The aim is to research and design a community health care centre that focusses primarily on aspects surrounding childbirth, and secondarily, aspects of female reproductive healthcare and family planning. The intervention aims to challenge the clinical nature of healthcare, improve accessibility to quality and affordable healthcare, and give women freedom over their reproductive healthcare choices. The site of the study is within the town of Alberton, located South of Johannesburg, in the Ekurhuleni Metropolitan Municipality. The goal of the research study is the development of a birthing centre model that serves as an alternative option to existing clinical birth settings which are part of larger hospitals. Research will be conducted through site analysis, contextual analysis, data analysis, theoretical and architectural research and precedent studies. This information will be used to guide the design process and develop a resolved building. This research project consists of two parts, a research report, and a set of design drawings, which will be combined into a single thesis document.
Rituximab therapy in connective tissue disease associated interstitial lung disease - a retrospective single centre observational study
(University of the Witwatersrand, Johannesburg, 2023-11) Seedat, Ubaid Feroze; Schleicher, G.K.; Christian, Berenice
Introduction: Connective tissue disease associated interstitial lung disease (CTD-ILD) is a challenging clinical entity. Rituximab (RTX) is a chimeric monoclonal antibody targeted to CD20+ B-cells, resulting in B-cell depletion and has been suggested as a potential therapeutic modality in progressive disease. Objectives: To investigate the therapeutic effects and safety of rituximab in patients with progressive CTD-ILD. Methods: A retrospective observational analysis was performed at WDGMC between January 2010 and December 2020. A total of 19 patients with CTD-ILD were treated with RTX and various combinations of immunomodulatory therapy. The effects of RTX were investigated with serial pulmonary function testing (PFT), high resolution computed tomography (HRCT) of the chest, and the WHO functional class assessment (FC). Results: At an average of 24-month follow up from baseline, the mean change in forced vital capacity (FVC) was not significantly different from baseline (0.01L, 95% CI -0.13 to 0.14L) (p=0.91). At an average of 24-month follow up, 17 follow up HRCTs were available of which 13 showed disease stability, 3 indicated progression and 1 indicated improvement. At an average of 24-months follow up, FC remained stable compared to baseline (p=0.083). No serious adverse drug reactions or mortalities occurred. Conclusion: Rituximab is a potential therapeutic option in patients with progressive CTD-ILD and appears to result in stability in FVC, HRCT findings and FC over a 24 month period.
An investigation of factors contributing to long waiting of patients collecting repeat medication in a tertiary hospital pharmacy
(University of the Witwatersrand, Johannesburg, 2022) Oladipupo, Rekgopetse Victoria; Sunjka, B.
According to the World Health Organization (WHO) patient waiting time is identified as a key measurement to a responsive healthcare service and is an important indicator of quality of services offered by hospitals (NDoH, 2011) as it affects the patient’s responsiveness to the services received (NDoH, 2011; SA FAM PRACTICE, 2008; Tegabu, 2008; Pandit et, al. 2016). Long waiting times at healthcare facilities undermines the services rendered resulting in compromised or unfulfilled patient care (Afolabi & Erhun, 2003). This research studies the processes associated with the collection of repeat medication in a tertiary hospital pharmacy in order to identify value adding activities and non-value adding activities that could be impacting patient waiting time using the Lean thinking concept of driving out waste. A qualitative observational method was therefore employed to observe all the steps involved during the journey of the patient collecting repeat medication from the registration point until medication was issued at the pharmacy. Value stream mapping (one of Lean Thinking principle) was employed to analyze the processes that took place. Patient waiting time was also measured from the registration point to the pharmacy. On average patients had to wait a total 159 minutes before they could access services both at the registration point (67 minutes) and at pharmacy (92 minutes). The service time was 29 minutes at both registration point (11 minutes) and pharmacy (18 minutes). Of the 18 minutes pharmacy service time; eight minutes were found to be value-adding while 10 minutes were non-value-adding mainly due to prescriptions waiting on queue to be picked, waiting to be signed by the pharmacist and waiting to be issued out to the patient. Lack of a dedicated pharmacy service points exclusively for chronic repeat patients, manual dispensing, illegible doctor’s prescriptions, were found to prolong the time it takes the Pharmacist to complete a prescription. Post Basic Pharmacist Assistants performing duties that could be performed by a less qualified staff (e.g., Learner Basic Pharmacist Assistants) during peak hours was not value adding and thus decreasing productivity. The level of staff commitment in addressing issues of quality such as long waiting time was questionable. The demand / workload and capacity during the early hours of business at the registration point did not seem to match, thus resulting in bottlenecks at the patient registration point and throughout the system.
An Investigation of Factors Contributing to Long Waiting of Patients Collecting Repeat Medication in a Tertiary Hospital Pharmacy
(University of the Witwatersrand, Johannesburg, 2023-02) Oladipupo, Rekgopetse Victoria; Hattingh, Teresa; Sunjka, Bernadette
According to the World Health Organization (WHO) patient waiting time is identified as a key measurement to a responsive healthcare service and is an important indicator of quality of services offered by hospitals (NDoH, 2011) as it affects the patient’s responsiveness to the services received (NDoH, 2011; SA FAM PRACTICE, 2008; Tegabu, 2008; Pandit et, al. 2016). Long waiting times at healthcare facilities undermines the services rendered resulting in compromised or unfulfilled patient care (Afolabi & Erhun, 2003). This research studies the processes associated with the collection of repeat medication in a tertiary hospital pharmacy in order to identify value adding activities and non-value adding activities that could be impacting patient waiting time using the Lean thinking concept of driving out waste. A qualitative observational method was therefore employed to observe all the steps involved during the journey of the patient collecting repeat medication from the registration point until medication was issued at the pharmacy. Value stream mapping (one of Lean Thinking principle) was employed to analyze the processes that took place. Patient waiting time was also measured from the registration point to the pharmacy. On average patients had to wait a total 159 minutes before they could access services both at the registration point (67 minutes) and at pharmacy (92 minutes). The service time was 29 minutes at both registration point (11 minutes) and pharmacy (18 minutes). Of the 18 minutes pharmacy service time; eight minutes were found to be value-adding while 10 minutes were non-value-adding mainly due to prescriptions waiting on queue to be picked, waiting to be signed by the pharmacist and waiting to be issued out to the patient. Lack of a dedicated pharmacy service points exclusively for chronic repeat patients, manual dispensing, illegible doctor’s prescriptions, were found to prolong the time it takes the Pharmacist to complete a prescription. Post Basic Pharmacist Assistants performing duties that could be performed by a less qualified staff (e.g., Learner Basic Pharmacist Assistants) during peak hours was not value adding and thus decreasing productivity. The level of staff commitment in addressing issues of quality such as long waiting time was questionable. The demand / workload and capacity during the early hours of business at the registration point did not seem to match, thus resulting in bottlenecks at the patient registration point and throughout the system.

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