Faculty of Health Sciences (ETDs)
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Item Validation of Roche immunoassay for severe acute respiratory virus 2/SARS-COV-2 in South Africa(University of the Witwatersrand, Johannesburg, 2023-01) Grove, Jurette Simone; George, Jaya; Mayne, ElizabethBackground: Serology testing is an important ancillary diagnostic to the reverse transcriptase polymerase chain reaction (RT-PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to evaluate the performance of the Roche Elecsys™ chemiluminescent immunoassay (Rotkreuz, Switzerland), that detects antibodies against the SARS-CoV-2 nucleocapsid antigen, at an academic laboratory in South Africa. Methods: Serum samples were collected from 312 donors with confirmed positive SARS CoV-2 RT-PCR tests, with approval from a large university’s human research ethics committee. Negative controls included samples stored prior to December 2019 and from patients who tested negative for SARS-CoV-2 on RT-PCR and were confirmed negative using multiple serology methods (n = 124). Samples were stored at –80 °C and analysed on a Roche cobas™ 602 autoanalyser. Results: Compared with RT-PCR, our evaluation revealed a specificity of 100% and overall sensitivity of 65.1%. The sensitivity in individuals > 14 days’ post-diagnosis was 72.6%, with the highest sensitivity 31–50 days’ post-diagnosis at 88.6%. Results were also compared with in-house serology tests that showed high agreement in majority of categories. Conclusions: The sensitivity at all-time points post-diagnosis was lower than reported in other studies, but sensitivity in appropriate cohorts approached 90% with a high specificity. The lower sensitivity at earlier time points or in individuals without symptomatology may indicate failure to produce antibodies, which was further supported by the comparison against in-house serology tests.Item Clinical Characteristics and Outcomes of Patients with COVID Admitted to a Tertiary Care Centre: A Retrospective Study at Tshepong Hospital(University of the Witwatersrand, Johannesburg, 2023-11) Dullabh, Dixit Anil; Zachariah, DonIntroduction: In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in China. It has since then rapidly spread across the globe causing millions to die. In March 2020, the WHO declared coronavirus disease 2019 (COVID-19) a pandemic. It’s clinical presentation and outcomes have been variable across the world. Thus, an analysis of the clinical characteristic and outcomes of patients with COVID-19 at a local setting, namely Tshepong Hospital. Objective: To determine the clinical presentation and outcomes, and correlate clinical and biochemical parameters to outcomes of patients admitted with COVID-19 at Tshepong Hospital. Method: This is a single centre retrospective review of all patients with COVID-19 admitted at Tshepong Hospital during the period 1 June – 31 July 2020. The study contains both inferential and descriptive elements. Results: A total of 200 patients were admitted with COVID-19 during this study period, of which 135 were female and 65 males. The mean age was 53 years with no significant gender differences. 63% of patients had hypertension as a coexisting condition while 35% had diabetes mellitus. Presence of co-morbid conditions were associated with severe disease. Dyspnoea (73%) and cough (94%) were the predominant symptoms. Laboratory parameters including elevated white cell count, C-reactive protein, urea, and creatinine were associated with severe disease. Of the 200 patients, 36 were deemed as severe. 34 of these patients required ICU admissions. 17 demised showing a case fatality rate of 8%. Treatment options given were in keeping with guidelines. Conclusion: COVID-19 has proven to be a clinical and therapeutic challenge. Its main factors being its novelty and variable presentation across the globe. This study has shown that a local setting, not all data is congruent with national or global trends. This speaks to the need of more centres and countries looking at their own variation of COVID-19 presentations, thus challenging the clinical and therapeutic decisions around the disease.Item Practices and outcomes of resuscitation in cardiac arrest at a South African Emergency Department(University of the Witwatersrand, Johannesburg, 2022-12) Martin, Cathryn Sarah; Lewis, Carolyn; Saffy, PatriciaObjectives: This study aimed to investigate the patient and resuscitation factors affecting outcome after cardiac arrest in the low-middle income setting. Methods: We retrospectively reviewed the data of patient’s aged ≥18 who experienced in-hospital cardiac arrest in the Emergency Department between January 2020 and December 2020 at a tertiary hospital. The data collection period included the first wave of the COVID-19 pandemic in South Africa. Return of spontaneous circulation (ROSC) was the outcome of interest. The registry from which data was collected was audited. Results: 98 patients were included. The ROSC rate was 43%. Asystole was associated with poor outcomes (likelihood 7.73, p ≤0.01). Cardiac standstill on ultrasound was associated with poor outcome (likelihood ratio 6.559, p ≤0.01). There was a significant improvement in ROSC after the first wave of the COVID-19 pandemic and a transition from airway management with bag-valve-mask to endotracheal intubation intra-arrest (p=0.04). Demographic factors, defibrillation and drug-use were found to have no significant impact. Conclusions: The resuscitation practices and outcomes in the low-middle income setting are similar to high-income settings. Further research on the impact of the COVID-19 pandemic on resuscitation outcomes in this setting is necessary.Item Final-year medical students' experiences and perceptions of integrated primary care learning at decentralised training sites during the COVID-19 pandemic: A mixed-methods study(University of the Witwatersrand, Johannesburg, 2023-09) Ruch, Aviva; George, Ann; Francis, JoelBackground: There is limited data on the effectiveness of online learning to augment theory and clinical knowledge and skills across decentralised training (DCT) sites. This study explored the 2021 cohort of final-year medical students’ experiences and perceptions of the integrated primary care (IPC) online teaching and learning across five DCT sites affiliated with the University of the Witwatersrand in South Africa. This information is essential to determine what online IPC teaching and learning should be retained and what adjustments are needed to enhance and standardise IPC online learning across our DCT sites. IPC is a final-year Bachelor of Medicine and Bachelor of Surgery (MBBCH) subject at Wits University. The subject focuses on primary health care, integrating Internal Medicine, Surgery, Psychiatry, Obstetrics and Gynaecology, Family Medicine, Community Paediatrics and Public Health. Training across different sites poses challenges for standardising learning content and the nature and quality of patient engagement and interaction. The Covid-19 pandemic not only exacerbated the difficulties associated with decentralised teaching and learning, but also decreased student-patient interaction. The rapid shift to emergency remote teaching left teachers with limited time to prepare for online and blended teaching and highlighted shortcomings in some health-professions educators’ ability to create meaningful, authentic learning interactions. The study design was underpinned by the Technology Acceptance Model, the Community of Inquiry Model and the Theory of Self-Regulated Learning. Methods: This explanatory sequential mixed-methods design consisted of a cross-sectional online survey conducted in November 2021, followed by two focus-group discussions in December 2021. The 316 final-year medical students who had completed their IPC block were purposively sampled to participate in this study. Medical students who had not yet completed the IPC block were excluded from the study. Twenty-one closed and four open-ended questions explored the students’ perceptions of how the online materials supported their learning and augmented their clinical skills and management of patients, their challenges with learning online, and ways to improve the online-learning experience. The closed and open-ended survey answers were analysed using descriptive and inferential statistics and content analysis, respectively. The results of the content analysis are presented graphically. The survey findings informed the questions asked in the focus-group discussions (n = 2 and n = 3). The discussions were audio-recorded and transcribed verbatim. The transcripts were analysed inductively in MAXQDA. The findings are presented as thematic maps. Results: The survey response rate was 52% (164/316). The respondents were representative of the study population. Most respondents easily accessed the online content, with more than 70% accessing the online content several times a week. More than 80% found the online content logically organised; the content analysis highlighted three categories of reasons why the online content and interactions influenced their learning. The content analysis also identified three categories of reasons why the online content influenced patient management, but more than a third of respondents remained neutral when asked if the online content introduced them to new clinical skills. Quizzes and tests were the preferred learning method. The features that best supported the respondents’ online learning were grouped into five categories: ‘Range of activities’ (n = 73), ‘Content selection’ (n = 56), ‘Flexible access to content’ (n = 8), ‘Organisation of content’ (n = 4) and ‘Other’ features (n = 7). Respondents highlighted several categories that presented challenges to online learning: ‘Pedagogical issues’ (n = 30), ‘Excessive workload’ (n = 27), ‘Operational issues’ (n = 20), ‘Learning issues’ (n = 17), ‘Technical issues’ (n = 11) and ‘Unclear course expectations’ (n = 50). Participants in the focus-group discussions (FGD) concurred with many of the perceptions and experiences of the questionnaire respondents. Three themes were identified in the thematic analysis of the FGD: ‘Features supporting learning’, ‘Challenges of learning online’, and ‘Ways to improve learning’. Conclusions: The respondents and focus-group participants displayed a positive attitude to the IPC online content and interactions offered to them during the Covid-19 pandemic. Their experiences and perceptions offered insights to better support learning through practical suggestions for students and faculty, especially around faculty competency to design meaningful learning interactions, both online and blended. While this study focused on IPC, the student recommendations may apply to other subjects nationally and internationally, suggesting the need for further research into using online teaching to support clinical teaching.Item The development of a competency-based programme for management of disease outbreaks(University of the Witwatersrand, Johannesburg, 2024) Engelbrecht, LinettePurpose: The purpose of this study was to develop, a competency-based programme for the management of disease outbreaks. Method: The study utilized an exploratory sequential mixed method approach, using both qualitative and quantitative methods to develop a competency-based program. This study was conducted in South Africa, Gauteng, whilst the country was experiencing the third COVID-19 wave (May 2021 – October 2021), the fourth COVID-19 wave (December 2021– April 2022), and the fifth (May 2022 – July 2022), as well as the post-pandemic phase. The study was conducted in three phases namely: Phase One: Exploratory phase, Phase Two- Development of the programme Phase Three- Validation of the programme. In phase one, a scoping review on the existing literature was conducted using the Joanna Briggs Institute methodological approach. Following this were individual in-depth interviews with purposively sampled healthcare professionals as well as professional nurses. Through reflexive thematic analysis themes were identified for inclusion in the Delphi-survey in the next phase. For the second phase, a Delphi-survey was developed based on the data from phase one. The Delphi-survey consisted of two rounds whereby categories were identified to be included in the competency-based curriculum. A curriculum, consisting of ten modules was developed using the Backward design. In phase three the curriculum matrix was validated by experts. Results: A total of 62 publications were included in this study. Three categories and eight sub-categories were identified as needs of nurses during disease outbreaks. In-depth interviews with healthcare professionals resulted in the development of eight themes and 21 sub themes (challenges) of nurses. The in-depth interviews with nurses resulted in the development of 11 themes (challenges) of nurses. The results of the scoping review and in- depth interviews were used to develop a Delphi-survey. Experts in this two-round Delphi survey validated the domains and statements. The results of the Delphi-survey was used to develop a curriculum matrix consisting of ten modules, which was validated by three experts. Conclusion: A competency- based curriculum was developed based on the challenges nurses experienced working through the COVID-19 pandemic. This program could contribute to the development of disease outbreak competent nursesItem Understanding SARS-CoV-2 vaccine hesitancy among pregnant women in Soweto, South Africa: A qualitative study(University of the Witwatersrand, Johannesburg, 2024) Zungu, Zwile; Myburgh, NellieThe study focused on understanding SARS-CoV-2 vaccine hesitancy among pregnant women in Soweto, South Africa. Pregnant women are at a greater risk of experiencing COVID-19 complications during pregnancy if infected with the SARS-CoV-2 virus. Vaccination uptake remains low in the population at large. This is a qualitative exploratory study approach using key-informant interviews. A total of sixteen key informant interviews with vaccinated pregnant women, unvaccinated pregnant women, healthcare workers and alternative healers were conducted. This study took place in Soweto townships, South Africa. Thematic qualitative analysis was used to construct themes in NVivo, where the gathered data was reviewed and analysed. The study found that pregnant women experience barriers and motivations that determine their decision to get vaccinated against COVID-19. Motivators to vaccinate health concerns, monetary benefit and structural motivators such as employment, travelling and education. Barriers included vaccine related fears were the main reason for poor vaccine uptake. The lack of knowledge, healthcare system barriers, misinformation, and lack of trust in the government were some reasons for vaccine hesitancy. The study's findings show that pregnant women's decisions to get vaccinated are significantly influenced by several barriers, perceptions and the motivators they haveItem Antibacterial stewardship practices in South Africa during the COVID-19 era: A retrospective review(University of the Witwatersrand, Johannesburg, 2024) Spinickum, Logan Jade; Leigh-de Rapper, StephanieBackground: Several mechanisms may facilitate and steer the development of antibiotic resistance patterns. The most prominent driver associated with antibiotic resistance has been indicated as inappropriate use or consumption of antibiotics. The sudden emergence of Coronavirus Disease 2019 (COVID-2019) changed the conventional practices related to drug utilisation through the repurposing of antibiotics. Despite the implementation of antibiotic stewardship programs, the pressure that COVID-19 placed on healthcare systems resulted in poor prescribing and antibiotic review practices, potentially exacerbating antibiotic resistance. Moreover, the public health sector faces various challenges that make it difficult to consistently assess and quantify antibiotic usage; while providing quality review, feedback, and intervention, especially in low- and-middle-income countries like South Africa. As a result, there is a paucity of information concerning antibiotic utilisation in the public healthcare sector, even following the emergence of the COVID-19 pandemic. It is essential to determine the extent of antibiotic use to improve antibiotic utilisation, patient outcomes and stimulate viable policies and initiatives to strengthen public healthcare drug surveillance amidst the challenges of increased infectious diseases, resistance, and health personnel shortages. Aim of study: The aims of the study were to determine, analyse and compare antibiotic consumption amongst intensive care unit (ICU) patients admitted in a Gauteng public hospital during the pre-COVID-19 era and commencement of the COVID-19 era. Methodology: A retrospective cross-sectional data analysis of 335 medical files of ICU patients hospitalised in a Gauteng Provincial Tertiary Hospital (GPTH) between January 2017 and December 2021. Descriptive statistics were used to examine patient characteristics and antibiotic prescribing variables. Results: The study found that the more frequently prescribed antibiotics were amoxicillin/clavulanate (pre-pandemic = 31.99%; COVID-19 = 38.43%), followed by ceftriaxone (pre-pandemic = 15.44%; COVID-19 = 14.55%), piperacillin/tazobactam (pre-pandemic = 11.40%; COVID- 19 = 8.58%) and azithromycin (pre-pandemic = 7.73%; COVID-19 = 19.78%). Common bacterial pathogens detected in both periods included Acinetobacter baumannii (pre-pandemic = 29.2%; COVID-19 = 20.9%), Enterobacter cloacae (pre-pandemic = 10.4%;COVID-19 = 14.0%), Escherichia coli (pre-pandemic = 22.9%; COVID-19 = 25.6%), and Klebsiella pneumoniae (pre-pandemic = 25.0%; COVID-19 = 18.6%). Resistance was predominantly observed in ciprofloxacin (pre-pandemic = 11.4%; COVID-19 = 12.9%), piperacillin/tazobactam (pre-pandemic = 12.7%; COVID-19 = 0.1%), cefotaxime (pre-pandemic = 13.2%; COVID-19 = 14.7%), and cefepime (pre-pandemic = 12.7%; COVID-19 = 11.2). Resistance to commonly prescribed antibiotics observed a decrease trend moving from the pre-pandemic period into the COVID-19 pandemic. Conclusion: The macrolide and penicillin (in combination with beta-lactamase inhibitor(s)), classes demonstrated an increase in prescribing and use across the pre-pandemic period transitioning into the COVID-19 pandemic. While overall resistance observed a decline moving into the COVID-19 pandemic. However, “Watch” category antibiotic resistance increased slightly. An increase in prescribing and use of macrolides coupled with an increase in “Watch” category antibiotic resistance, highlights the need for improved antibiotic stewardship programs in public healthcare and pathogen-directed prescribing, to combat inappropriate and unnecessary use of antibiotics.Item Registrars’ perspectives towards virtual teaching in an academic department during the COVID-19 pandemic(University of the Witwatersrand, Johannesburg, 2022) Mpemnyama, Lerato NomondeBackground The COVID-19 pandemic brought about unprecedented times that resulted in measures of social distancing that had to be put in place. The Department of Anaesthesiology at the University of Witwatersrand had to comply with these regulations and switched the teaching of registrars from in-person format to a virtual platform. The study aimed to look at the perceptions registrars had towards virtual teaching during the COVID-19 pandemic. Methods This cross-sectional quantitative study was conducted in the Department of Anaesthesiology at the University of Witwatersrand via an online self-administered questionnaire that was distributed to the registrars registered in the department. The validated questionnaire that was used was developed following a literature search and an adaptation from two validated questionnaires. The study was conducted from December 2021 to February 2022. Results The department has a total of 100 registrars, and the response rate was 90%. The study highlighted that virtual teaching did have a positive impact in teaching in the academic department, with 91% (n=81) finding virtual teaching to be effective and 63.9% (n=53) of respondents preferring virtual teaching over in-person teaching. Conclusion The COVID-19 pandemic brought about a disruption to the academic programme in the Department of Anaesthesiology at the University of Witwatersrand, resulting in virtual teaching being implemented. This move has been met with a positive response among the registrars in the department.Item Off-label evaluation of alternative specimen types: Cobas® plasma separation card for HIV viral load and dried blood spots for COVID-19 serology testing(2024) Mampa, Thabiso MmammitsiPlasma is the preferred specimen for HIV viral load (VL) monitoring and COVID-19 serology testing but poses a challenge in resource-limited settings due to the need for venous blood, skilled phlebotomy, and cold storage for specimen integrity. In this study dried blood spots and novel plasma separation devices (PSC, HSSE, and VLPlasma) versus plasma were investigated as alternative specimen types. The plasma separation devices (PSD) were compared to DBS to determine if eliminating cellassociated nucleic acids could improve HIV VL performance. Paired PSD (n=72), DBS (n=72) and plasma (n=72) were prepared from HIV positive residual whole blood. Similarly, paired PSC, DBS (n=91) and plasma (n=91) were prepared from HIV positive prospective whole blood to assess PSC as an alternative specimen for use on the Abbott m2000. The eluates were processed on the GeneXpert (residual blood), Abbott m2000 (residual and prospective blood) and Roche cobas® 68/8800 (prospective blood). Using plasma as reference, residual blood: DBS outperformed PSC, HSSE and VLPlasma in terms of accuracy 91.8%, compared to 87.8%, 79.1% and 75%. Prospective blood: PSC had improved performance over DBS in terms of sensitivity (92.2% and 87.1%), specificity (65% and 61.9%), and accuracy (86.9% and 80.7%). Additionally, the performance of DBS was evaluated for COVID-19 serology testing in 45 PCR-confirmed, COVID-19 positive individuals by preparing laboratory paired DBS-plasma samples. DBS were eluted using two diluents followed by manual ELISA and results compared to reference plasma testing. DBS-PBS and DBS-manufacturer’s diluent showed the same accuracy (93.6%). Kappa values (0.817 and 0.845) and sensitivity (100% and 91.4%) were similar, but DBS-PBS showed low specificity (75%) compared to DBS-diluent (100%). Off-Label use of the cobas® PSC for HIV VL and DBS for COVID-19 serology testing provides expanded options for testing in resource-limited settings. Further evaluation on capillary blood and automated laboratory workflow optimisation would still be required prior to scaled implementation.Item Understanding barriers and motivators of Covid-19 vaccine uptake among young people in Soweto, South Africa(2024) Nkhata, BernadetteThe SARS-CoV-2 novel human coronavirus is the cause of coronavirus disease (Covid-19) Covid19 is coupled with common symptoms such as fever or chills, dry cough, and tiredness. Less common symptoms include muscle or body aches, the new loss of taste or loss of infection. Vaccines are the most effective public health intervention that could protect individuals and the community from the severity of Covid-19. Several vaccine candidates have shown good safety and efficacy during recent randomized clinical trials, and seven of which have been rolled out to different African counties with over 1 million doses administered. In south Africa there has been a low uptake of the Covid-19 vaccine particularly among the youth, despite studies showing positive attitudes towards vaccination. The youth play an important role in the pandemic as they are a crucial source for the spread of the virus to more vulnerable populations. Understanding the barriers and motivations towards vaccine uptake in this population group will assist in implementing interventions targeted specifically for the youth. Aim The aim of this study is to understand the barriers and motivations towards vaccine uptake among the youth aged 18-35 in Soweto, South Africa. Methodology This is a qualitative exploratory study approach employing focus group discussions. Eight focus group discussions with both male and female participants between the ages of 18 and 35 took place in two study sites, Themb’Elihle and Meadowlands South Africa. A total of 62 participants were enrolled in the study. The Health Belief Model theoretical framework served as a guide for this investigation. Themes were developed through thematic qualitative analysis and the data collected was examined and interpreted with the use of qualitative software ATLAS.ti. Results The study found that young adults do experience barriers and motivations that determine their decision to get vaccinated against Covid-19 or not. Misinformation was among the strongest barriers to vaccination. The spread of rumors and conspiracies of the vaccines left participants feeling scared to be vaccinated. This led to the lack of trust in health care professionals, and the lack of trust in governmental authorities leading the vaccines rollout. Motivation to vaccinate came as a result of the need to protect themselves and loved ones. Participants were also willing to vaccinate as a means to reintegrate back into society and to access basic means that were previously restricted due to the Covid-19 pandemic. Conclusion The results of this study demonstrate that motivations and barriers that young adults in Soweto, South Africa encounter have a significant impact on their decision to get immunized. Policymakers are encouraged to look into the challenges faced by this group, with a focus on how social media can be used as a useful tool for reaching out to young adults and spreading correct information.