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Start date: 2010Subject: search.filters.subject.SDG-4: Quality education

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    Comparing health inequalities in maternal health: An analysis of the South African Demographic and Health Surveys (SADHS) 1998 and 2016
    (University of the Witwatersrand, Johannesburg, 2023-09) Holden, Celeste Claire; Blaauw, Duane
    Background: Inadequate access to maternal health services (MHS) is directly linked to maternal and neonatal mortality and morbidity. South Africa (SA) is known to be an unequal society. Researching and documenting the utilisation and access to MHS can assist in the appropriate redirection of services to ensure equitable service delivery. The study identifies differences in MHS access between ethnicity groups, residence, province, maternal education level and household wealth quintile. The study quantifies the inequalities in access to MHS in SA in 1998 and 2016, and then evaluates the change in inequalities between the two periods. Methods: Data was analysed from the 1998 and 2016 South African Demographic and Health Surveys. First. the study identifies differences in MHS access between ethnic groups, residence, province, maternal education level and household wealth quintile using regression analyses. Then, the inequalities related to access of MHS in 1998 and 2016 are calculated using the relative (RII) and slope (SII) index of inequality and the concentration index (CI). Lastly, the inequalities between 1998 and 2016 were compared using generalised linear models, indicating whether inequalities increased, decreased, or remained the same. All analyses were done in Stata and adjusted for the multistage-stratified sampling of the surveys. Results: Utilisation of MHS in SA varies between different groups based on ethnicity, residence, province, mothers’ education level, and wealth quintile. In 1998 and 2016, Black/African women have the least utilisation of all MHS. A clear pattern is seen where women with higher education and high wealth quintile, have increased MHS utilisation. In most cases, the inequalities narrowed between 1998 and 2016 for all MHS. However, inequalities are still present in 2016 for many MHS. For example, using simple inequality measures, the largest inequalities in 2016 are seen between women of different ethnicities accessing four or more antenatal visits (ANC4), where there is a 11.1 percentage point difference between the highest group (White & Indian/Asian) and the lowest group (Black/African). For complex inequality measures, there are still significant relative and absolute inequalities in antenatal visits in 2016 for maternal education (RII: 1.25; SII: 1.14) and household wealth quintile (RII: 1.23; SII: 1.11). Conclusions: Between 1998 and 2016, population-level utilisation to MHS increased in all MHS and the majority of within group inequalities narrowed over time. However, inequalities still exist in all maternal health outcomes. SA has implemented multiple programmes and policies to address inequalities in MHS and decrease maternal mortality and morbidity. However, these need to be continuously monitored and evaluated based on the latest data to ensure that efforts are going towards addressing the specific groups where inequalities are still present.
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    Experiences of healthcare workers using the AwezaMed translation application in antenatal settings
    (University of the Witwatersrand, Johannesburg, 2023-06) Cason, Caroline Marian; Slemming, Wiedaad; Wilken, Ilana
    Introduction: Language barriers impede quality health care service in South Africa. Trained interpreters could alleviate this problem, but they are not employed in public or private health settings. Health care workers rely on informal interpreters, who do not necessarily provide an adequate service, and may be resentful of this extra task. AwezaMed is a smart application developed by the Council for Scientific and Industrial Research (CSIR) with content developed for maternal health settings. The aim of this study was to assess usability and user experience relating to AwezaMed. Methods: A user experience study was conducted using mixed methods. The systems usability scale (SUS) was employed, surveying 12 users, to generate a quantitative score, representing the overall usability of the system. Interviews were conducted with 14 users and analysed thematically to identify themes of usability and user experience, and recognise factors which contribute to use of the application. Results: The application (app) achieved a total score of 66.25, rating it between ‘OK/Fair’ and ‘Good’. Understandability, operability, attractiveness, and trust were important usability themes. Users also reported using the app as an aid to language learning. Factors which influenced the use of the app included previous experience with mHealth, experiencing a language barrier in health settings, and unavailability of, or problems with interpreters. Discussion: While the app was received positively, it did not meet users’ expectations, as two-way communication could not be achieved. Due to the often-strained relationship between healthcare workers and informal interpreters, there remains a demand for a usable, trustworthy mHealth solution. A framework is proposed, based on these findings, to evaluate mHealth translation applications in South Africa in the future.
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    Reporting Silica Dust Exposure Measurements in South African Gold and Coal Mines: 2005 to 2016
    (University of the Witwatersrand, Johannesburg, 2023-10) Mongoma, Brian Tshepo; Nelson, Gill; Brouwer, Derk
    Background: Arising from the Mine Health and Safety Act 29 of 1996 (MHSA), one of the measures to protect mine workers is monitoring exposure to airborne pollutants. Mines are statutorily required to report airborne pollutant concentrations to the Department of Mineral Resources and Energy (DMRE) on a regular basis. Based on the DMRE's 2013 report, it was determined that 76% of workers were exposed to airborne pollutants at concentrations less than 10% of their respective occupational exposure limits (OELs). Using the same exposure data from the DMRE, the Chamber of Mines of South Africa reported a 14% improvement in the exposure to the airborne pollutants from 2005 to 2013. However, these reported reduced exposures to airborne pollutants are based on the summation of all airborne pollutant exposures by the DMRE. The annual reports refer to the percentage of employees exposed to the combined airborne pollutants, rather than to specific pollutants, such as silica dust – a hazard that is high on the occupational health agenda of the mining industry. From these reports, broad (and perhaps incorrect) conclusions are reached with regard to trends in silica dust and other exposures. The limitations of the SAMI include inaccurate data, self-regulation, incomplete employment and exposure records, and historical biases, which hinder its ability to effectively handle occupational health risks. This emphasizes the immediate need for clear and consistent regulations, accurate data collection, and impartial research approaches to protect the health of mine workers. Objectives: The objectives of this study were to describe trends in combined airborne pollutant and silica dust concentrations from 2005 to 2016, and to evaluate the DMRE Mandatory Code of Practice (MCoP) and the EN 689 methods (for testing exposure levels in the workplace against the OEL of 0.1 mg/m3) as published by the European Committee for Standardization (CEN), using reported silica dust concentrations from 2015 and 2016. Methods: This was a cross-sectional study in which secondary airborne pollutants exposure data, reported to the DMRE by coal and gold mining members of the Minerals Council, were analysed. The 282 870 data points were pooled together to describe trends in airborne pollutant exposures as they comprised 69 airborne pollutants reported by different mines with various mining methods, activities, and occupations. The exposure data was categorized into coal and gold mines, and further into four three-yearly periods (i.e. period 1: 2005-2007, period 2: 2008-2010, period 3: 2011-2013, and period 4: 2014-2016). This was conducted in order to have a consistent metric to allow for uniform assessment across different pollutants with varying OELs. Dividing the exposure concentration by its OEL provided a ratio, similarly to the way that an Air Quality Index is calculated. As a result, the data was normalized by dividing each pollutant exposure concentration by its occupational exposure limit (OEL) to obtain a ratio, termed Q. The arithmetic mean, standard deviation, geometric mean, and geometric standard deviation of the Qs were calculated for each of the three groups i.e. coal and gold mines combined, b) coal mines, and c) gold mines, for each period. Jeffreys’s Amazing Statistics Program was used to analyse the Qs and silica dust concentrations. The Kruskal–Wallis test was used to identify statistically significant differences among the four time periods for each commodity group. Additionally, Scheffe’s post-hoc test in JASP was conducted for further analysis and comparison of differences across all observed periods. Two methods, namely the EN 689 and the method required by the DMRE MCoP, were used to assess compliance. EXPOSTATS Tool 1 was used to calculate the arithmetic mean (AM), median, standard deviation (SD), geometric mean (GM), geometric standard deviation (GSD), and 90th and 95th percentiles of the exposure data derived from EN 689. Microsoft Excel was used to calculate the 90th and 95th percentiles of the exposure data based on MCoP method. A total of 127 014 silica dust data points from 2005 to 2016 out of the 282 870 were utilized to describe silica dust exposure trends, and 44 990 data points from the 127 014 were used to assess compliance for the years 2015 and 2016. Results: A total of 282 870 personal airborne pollutant concentrations from 2005 to 2016, obtained from DMRE, were included the analysis. Analysis of the pooled airborne pollutant exposure concentrations indicated that there was a high variability (data points were far apart and also far from the GM) as the GSDs ranged from 6.37 to 7.53, 7.8 to 8.43, and 5.7 to 6.16 for the coal and gold mines combined, coal mines alone, and gold mines alone, respectively. The variabilities of the silica dust concentrations were less than that of the pooled airborne pollutant data. The GSDs of the silica dust concentrations were < 3.5 for all three groups compared to the GSDs calculated from the pooled airborne pollutants concentrations, where the lowest GSD was 5.7. The trends in the pooled airborne pollutant exposure concentrations over the 12-year period, for all three groups, showed that there was a reduction in reported exposures to combined airborne pollutants. The AMs of the ratios (Q) indicated that the reduction in exposures for coal and gold mines combined, gold mining alone and coal mining alone, were 57%, 55% and 26%, respectively. The corresponding GMs of the ratios (Q) for gold mining alone, coal and gold mines combined, and coal mining alone, reduced by 64%, 45% and 15%, respectively, from 2005 to 2016. The distribution of the airborne pollutant data was skewed, which affected AM more than GM, and resulted in differences between the two measures. This was evident in the gold mining data, where the AM decreased by 55% but the GM decreased by 64%. Data for the period 2005-2007 had the highest AM (1.54) and standard deviation (2.75), suggesting that there were outliers. In this period, ratios (Q) ranged from 0.003 to 7.7, impacting the AM and creating a gap between median and AM values. From 2008 to 2010, the AM (1.26) and SD (2.04) decreased, showing reduced variability. A similar trend was observed from 2011 to 2013, with increased numbers of observations and further reduced variability. In 2014-2016, the AM decreased to 0.67 and SD to 1, indicating stability. The GMs for the coal and gold mines combined, coal mines alone and gold mines alone ranged from 0.17 to 0.31, from 0.22 to 0.28, and from 0.16 to 0.45, respectively. The trends in reported silica dust concentrations in all three groups showed a reduction over the 12-year period. The AMs indicated that the reductions for coal and gold mines combined, gold mining alone and coal mining alone, were 61%, 38% and 34%, respectively. The GMs of the silica dust concentrations indicated that the reductions in exposures for coal and gold mines combined, coal mining alone, and gold mining alone, were 54%, 35% and 31%, respectively. The AMs of the silica dust concentrations for coal and gold mines combined ranged from 0.17 to 0.44 mg/m3, while the coal mines ranged from 0.67 to 1.02 mg/m3 from 2005 to 2016. For gold mines, the AMs ranged from 0.13 to 0.23 mg/m3. Similarly, the GMs of the silica dust concentrations for the coal and gold mines combined ranged from 0.11 to 0.24 mg/m3, whereas coal mines ranged from 0.41 to 0.63 mg/m3, and gold mines ranged from 0.09 to 0.13 mg/m3. The 90th percentiles for the silica dust concentrations almost correlated with the AMs as they reduced by 67%, 40% and 34% for coal and gold mining combined, gold mining alone, and coal mining alone, respectively. The 90th percentiles for silica dust concentrations for the coal and gold mines ranged from 1.64 to 2.48 mg/m3, and 0.29 to 0.51 mg/m3, respectively. Although the trends indicated a reduction in exposure to silica dust concentrations, the AM, GM, 90th and 95th percentiles exceeded the OEL of 0.1 mg/m3 for the entire study period for the three groups, except for the gold mines alone in 2016. In that year, the GM was 0.09 mg/m3 (rounded to 0.1 mg/m3). For coal mining only, the 90th percentiles ranged from 1.64 to 2.48 mg/m3, whereas the 95th percentiles ranged from 2.16 to 3.16 mg/m3. For gold mining only, the 90th percentiles ranged from 0.29 to 0.51 mg/m3, and the 95th percentiles ranged from 0.35 - 0.63 mg/m3. A total of 44 990 silica dust concentrations were used from 2015 to 2016 to compare the 95th percentiles according to EN 689, and the 90th percentiles according to the MCoP. The DMRE MCoP method was shown to underestimate the exceedance of the occupational exposure limit by 5-26%, when compared with the EN 689 method. Conclusion: Despite the variabilities and challenges associated with pooling the airborne pollutants concentrations in the coal and gold mining industries, exposures to the airborne pollutants in the three commodity groups decreased from 2005 to 2016. However, reporting employee exposure as pooled airborne pollutants concentrations is flawed and obscures exposures to individual pollutants such as silica dust. The three commodity groups showed a decrease in silica dust exposure measurements from 2005 to 2016. However, there was still overexposure to silica dust in the three groups (greater than the OEL of 0.1 mg/m3). Inhalation of particles containing silica was higher in the coal than the gold mines, which is contradictory to what is known about the silica content of the ores in which the two commodities are found. The DMRE MCoP approach to compliance with silica dust levels underestimated the exceedance of the OEL in comparison to the EN 689’s approach. The current DMRE reporting methodology, i.e. the pooling of all data, does not allow accurate reporting of silica dust exposures and as a result, it does not provide direction or support for carrying out measures to decrease exposure to silica dust. The MCoP method for compliance testing revealed higher 90th-percentiles for coal mining compared to the 90th-percentile estimated for the population (EN 689). For gold mining it was the opposite. The EN 689 method is a more precise means of estimating OEL compliance, which is crucial for managing silica dust and specific pollutant health hazards and should be used in favour of the method in the MCoP.
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    Indoor/outdoor PM4 (respirable dust) and respirable crystalline silica source tracking in households located in close proximity to gold mine tailing dumps
    (University of the Witwatersrand, Johannesburg, 2023-10) Makhubele, Nkateko Rawendar; Mizan, Gabriel; Manganyi, Jeanneth; Masekameni, Masilu Daniel
    Background: Particulate matter (PM) is a major contributor to air pollution in indoor and outdoor environmental spaces. Exposure to respirable dust (PM4) and respirable crystalline silica (RCS) indoor and outdoor in communities located in close proximity to gold mine tailings dumps in South Africa has not yet been determined. Aim: The aim of this study was to investigate the concentration of RCS and PM4 mass in samples measured indoor and outdoor of the nine (9) selected households located in close proximity to a gold mine tailings dumps. Methodology: Sampling locations were separated according to grids, based on the distance from the mine tailings dumps. Three different grids were determined as follows: A (<500m from the dump), B (>500m<1km) and C (1km – 3 km). Three households were selected from each grid zone to measure indoor and outdoor PM4 samples continuously over a 24-hour period using GilAir constant sampling pumps calibrated at the flowrate of 2.2 L/min in both the dry and wet seasons. PM4 samples were collected on a 37mm polyvinyl chloride (PVC) filter with a pore size of 0.8, which was assembled on the Higgin Dewell cyclones fitted with a filter pad of the same pore size. PM4 sample filters were gravimetrically weighed before and after sampling to determine the mass concentration of PM4. The respirable crystalline silica in PM4 samples were analysed by an X-ray diffraction method by South African National Accreditation System (SANAS) accredited laboratory of the National Institute for Occupational Health (NIOH). Samples were collected during the dry and wet seasons in the Riverlea community, Johannesburg. Results: During the wet and dry seasons, the mean indoor and outdoor PM4 mass concentration ranged from 0.02±0.01 µg/m3 to 2.26±0.02 µg/m3, respectively. The dry season mean PM4 mass concentrations were higher than the wet season PM4 mass concentrations in all zones. The pairwise comparison of PM4 mass concentration for dry and wet season revealed no statistically significance difference (p<0.05) at 95% confidence interval. Results presented in Figure 5 depicts the mean indoor PM4 mass concentration distribution for the dry season. The zone with the highest mean indoor PM4 mass concentration was zone A, followed by zone B. Since the mean outdoor PM4 concentration in zone C was the lowest, this suggests that the mine tailings dumps were the primary source of PM. The dry season mean indoor/outdoor ratio was greater than one across all zones; indicating that indoor activities were the primary source of PM. In both seasons, the mean indoor and outdoor percentages of crystalline silica ranged from 0.08±0.01% to 0.08±0.01%. The mean indoor and outdoor 24hr RCS concentrations in both seasons were below the California Office of Environmental Health Hazard Assessment (OEHHA) defined 24hr ambient exposure threshold of 3µg/m3. Recommendations: The results of this study suggest that nearby mine tailings dumps may be the primary source of PM in the indoor and outdoor environments; however the strength of this source in comparison to other sources remains unknown. Therefore, it is recommended that further studies focusing on source apportionment be carried out to determine the relative contribution of the mine tailings dust to the overall PM load in the environment. Although the difference was not statistically significant, indoor and outdoor PM4 concentrations were greater in Zones A&B, with the lowest PM4 concentrations in Zone C. The I/O ratio indicated that there was contribution of PM from outdoor. It is also recommended that further studies be conducted, with focus on monitoring PM4 over a 30 days period, to determine the level of free crystalline silica that may be present in PM4 mass concentrations. Conclusion: In the South African context, studies that focus on the investigation of indoor and outdoor PM4 concentrations in households located in close proximity to gold mine tailings are limited. The findings of this study can be used to provide valuable information on the indoor and outdoor PM4 concentrations, which can be used in modelling exposure and conducting probabilistic health risk assessment. High dust levels are related with dry season weather conditions due to strong wind conditions. Therefore, the PM4 mass concentrations in all zones were higher during the dry season than during wet season. Since the mean outdoor PM4 concentration in zone C was the lowest, this suggests that the mine tailings dumps were the primary source of PM.
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    A Cost Comparison study of the electronic tick register with a paper based tick register in clinics within the Ekurhuleni District
    (University of the Witwatersrand, Johannesburg, 2023-08) Khoza, Courage Macduff; Thomas, Leena Susan
    Introduction & Background: A paper-based register is used to capture routine health information from Primary Health Care (PHC) clinics into the District Health Information System (DHIS) in South Africa. However, DHIS data was reportedly unreliable and inaccurate, as the paper-based system was error-prone. To address this, the Ekurhuleni Health District in the Gauteng Department of Health (GDOH) developed and piloted an electronic (E-tick) PHC register in three of its facilities. Upon completing the pilot in 2019, the implementation of this system was halted as it was not incorporated into the GDOH budget, partly due to inadequate information on its costs compared to the paper-based system. Aim: This study aims to cost and compare the expenditure of the electronic tick register and the paper-based tick register systems and determine provider views on their use in the Ekurhuleni Health District. Methods: Two methods were used: a) a descriptive cost-comparison study of the paper-based tick and the E-tick registers from November 2017 to December 2019 and b) a descriptive cross-sectional study using interviewer-administered questionnaires about health worker experiences using both registers during the stated period. Results: The study found that the E-tick register was less costly than the paper-based register. The year 2018/19, which was the only complete financial year in the study period is used for comparison. The paper-based register cost the district R42.4 per patient, while the E-tick cost R29.9 (29.5% cheaper). Of ten study theme areas explored in the interviews, the E-tick was advantageous in eight, these were: Convenience, easy accesses, quick recording time, safe information storage, immediate data capturing, ability to add more elements, fewer errors and good font size and legibility. The paper-based register was found to be advantageous in just four study themes which were: Convenience, easy accesses, independence from electricity supply and sufficient writing space. Conclusions: The E-tick register was found to be preferred over the paper-based register as it was quicker, cheaper, and acceptable to most of the health workers who used it. These are important findings for the health district as the study generates local evidence that the Ekurhuleni Health District and the Gauteng Department of Health can use to justify investments in scaling up and sustaining locally developed innovative digital solutions such as the E-tick register. This further enables the health district to improve recording times and compliance with record management legislation.
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    Educational programmes used in teaching nurses mechanical ventilation in adult intensive care units: a scoping review
    (2024) Davis, Daniele Ruth
    Introduction Mechanical ventilation is a common form of life support intervention and nurses are the key personnel in providing safe and specialized care to these patients. Their education determines whether patients receive optimal quality care and attain the best possible outcomes. Purpose: To identify the available evidence on invasive mechanical ventilation educational programmes developed for teaching all nurses working in adult intensive care units; regardless of their level of qualification or years of experience. It includes the content taught and the method of instruction used. Methods: Due to the breadth of the review topic, a scoping review methodology was considered appropriate and guided by The Joanna Briggs Institute (JBI) Scoping Review methodology. Eligibility criteria using the PCC framework, and relevant keywords and phrases originating from these criteria were used to search five databases in July and August 2022 (PubMed, EBSCO CINAHL, Wiley Online, Scopus and ProQuest). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were used to report the results. Results: Nine studies fulfilled the inclusion criteria for full review. Four studies were relevant to invasive mechanical ventilation; two studies were specifically related to ventilator associated pneumonia and one each on weaning, endotracheal tube cuff pressure management and the development of a programme for nurses transitioning into the intensive care unit. Conclusion: There is limited evidence of comprehensive educational programmes on invasive mechanical ventilation for all nurses working in the intensive care unit.
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    Nurses’ experiences in implementing Nurse Initiated Management of Anti-Retroviral Therapy (NIMART) in primary health care facilities in Dr Ruth Segomotsi Mompati District, North West Province
    (2024) Sibisi, Nthabiseng
    Aim of study- This study aimed to explore the nurses’ experiences in the implementation of NIMART in Dr Ruth Segomotsi Mompati District since its inception in 2010 to 2017. Methods This study employed an exploratory qualitative research design. The study setting included nine PHC facilities in three sub-districts. The study included only those nurses who had been trained to implement the NIMART in the district PHC facilities from 2010-2017. The final sample included Sixteen (16) nurses, comprising of three males and thirteen females from the three eight-hour operational clinics and six 24-hour Community Health Centres (CHCs). Data were therefore collected using in-depth interviews lasting thirty-five minutes (minimum) one and half hours 1h30 minutes (maximum). These interviews were guided by a semistructured interview guide. Data were later transcribed verbatim using an electronic software O’ Transcribe, and then analysed using MAXQDA 2018v, where inductive coding was applied. Thematic analysis was employed to interpret and represent data, which was finally presented as themes based on participants’ dominant narratives. Results- There were five key themes that emerged from this study. These included: perceptions about the NIMART programme mostly related to it being a task-shifting strategy when managing HIV and Aids and the programme benefits; contextual elements affecting access and adherence to NIMART, and challenges such as socio-cultural factors, social norms, socio-political and governance factors; facilitators of NIMART implementation in terms of functional health information management system and clinical guidelines, multidisciplinary team and skilled personnel, impactful counselling services, and intrinsic nurse motivators. Challenges of NIMART implementation included insufficient human resources for health, services integration, poor management and health-service support systems, lack of capacity building, ART unavailability and poor patient compliance to ART, and nurse demotivation. The proposed interventions by the nurses included provision of training, increasing staff to curb workload, management support, and debriefing, health service support resources and patient support improvement. Conclusion Task-shifting and successful NIMART implementation are complex notions, which can be successful if accompanied by training, reorganisation of services, mentoring, supervision, and ongoing support from existing health-service system structures. The rural health context must be considered as unique, and policies should be tailored to suit the needs of rural healthcare workers and patients. Dr RSM case-study has shows the plight of farm labourers and the need for a multisectoral approach to address patient related issues in this context. The challenges to successful NIMART implementation suggest a need for reorientation of health-services to fit rural contexts.