Faculty of Health Sciences (ETDs)

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    Risk factors for caries and periodontal diseases: a comparative4 study among HIV-positive and HIV-negative adults in nyarugenge5 district, Rwanda
    (University of the Witwatersrand, Johannesburg, 2024) Murererehe, Julienne
    Dental caries and periodontal diseases are among HIV-positive persons' most frequent oral conditions. These common oral diseases contribute to the impairment of general health and well- being. Dental and periodontal problems among HIV-positive individuals are more severe and difficult to manage than dental and periodontal problems among HIV-negative people. Thus, risk factors for caries and periodontal diseases must be controlled for comprehensive oral health and the general well-being of HIV-positive patients. The burden of oral diseases is reported to be high in Rwanda. Nearly 65% of the oral health survey participants had experienced dental caries and above 54% had untreated cavities. In addition, dental calculus was found among 60% of participants. More than 34% had oral debris. Surprisingly, more than 70% of this population has never visited dentists or dental facilities. This evidence gives impetus to undertake more focused investigations on oral diseases in Rwanda, particularly among HIV-positive people. Therefore, this study sought to assess the risk factors for caries and periodontal diseases among HIV-positive and negative adults in Nyarugenge District, Rwanda Methods This research used a mixed-method approach (qualitative embedded design). For the quantitative part, a comparative cross-sectional study was conducted among 200 HIV-positive and 200 HIV- negative adults aged ≥18 years. Consecutive and purposive sampling method was used to select participants for quantitative and qualitative parts of the study respectively. Caries was assessed using the Decayed (D), Missing (M), and Filled Teeth (F) index (DMFT). Periodontal disease was assessed using the Plaque Index (PI), Community Periodontal Index of Treatment Need (CPITN), and Clinical Attachment Loss (CAL). Oral health Related Quality of Life (OHRQoL) was assessed using the oral health impact profile short version (OHIP-14). Descriptive statistics, Chi-square test, t-test, Cronbach alpha, and multiple logistic regression were applied to analyse quantitative data using Stata version 15. For the qualitative data collection, in-depth interviews (IDIs) were conducted among 10 HIV-positive and 11 HIV-negative adults with caries and periodontal diseases using a semi-structured interview guide. Thematic content analysis using an inductive approach was applied for data analysis of IDIs. NVivo software version 11 was used to code and organize the data. Results A higher proportion (50.5%) of HIV-positive adults had experienced caries (DMFT>0) compared to HIV-negative counterparts (40.5%) and the difference was statisticaly significant (p=0.045). The prevalence of D was higher (23.5%) among HIV-positive compared to HIV-negative adults (13.6%) (p=0.011). The Mean (SD) DMFT score among HIV-positive and HIV-negative participants were 2.28 (3.68) and 1.29 (2.21) respectively (p=0.001). The predictors of caries in HIV-positive persons were being female (OR= 2.33; 95%CI= 1.14-4.75), frequent dental visits (OR= 4.50; 95% CI=1.46-13.86) and detectable RNA viral load (OR= 4.50; 95% CI=1.46-13.86). Among HIV-negative participants, the middle age range (36-45 years) [OR= 6.61; 95%CI=2.14- 20.37], and frequent dental visits were significantly associated with caries (OR=3.42; 95%CI: 1.337-8.760). For periodontal status, having dental calculus was the most prevalent item of the CPITN found among HIV-positive 168 (84%) and 182 (92%) HIV-negative individuals. The mean (SD) score for CAL was higher in HIV-positive persons 1.23 (0.95) compared to HIV-negative counterparties 0.99 (0.75). The difference was statistically significant (p=0.003). Being a male was a predictor of having dental plaque and a need for periodontal treatment for both HIV-positive (PI OR: 2.90 (95%CI=1.26-6.66)); (CPITN OR: 3.33 (95%CI=1.14-9.70)) and HIV-negative respondents (PI OR:3.28 (95%CI=1.48-7.28)); (CPITN: OR: 7.78 (95%CI=1.04-58.07)). A higher percentage of HIV-positive individuals had poorer OHRQL than HIV-negative counterparties in all items of OHIP-14 except for OHIP3 (found it uncomfortable to eat any foods because of problems with teeth or mouth) and OHIP-14 items (being totally unable to function because of problems with teeth or mouth). The findings revealed significant results regarding OHIP1 “trouble pronouncing any word” with a prevalence of 11(2.5%) and 9(2.25%) in HIV-positive and HIV-negative participants, respectively. Also, HIV-positive persons had higher percentage 11(2.75%) for the OHIP 13 item “life not satisfying due to teeth and mouth problems” than HIV-negative counterparties 8(2%) and the difference was statistically significant p≤0.05. Moreover, dental caries was significantly associated with poor OHRQoL among HIV-positive and HIV-negative participants for all 14 items of OHIP-14 tool. There was no association between periodontal disease and OHRQoL in both HIV-positive and HIV-negative adults. Two broad domains and five themes emerged from the interviews. The first broad domain was “perceptions on causes of oral diseases” with 2 themes (individuals and external themes). The second broad domain was “perceptions on oral diseases effect” with 3 themes (physical or functional effect, psychological effect and social effect themes). Conclusion and recommendations This research showed a higher prevalence of caries and CAL among HIV-positive adults than HIV- negative counterparts. Also, the mean (SD) PI value was significantly higher in HIV-positive adults compared to the mean PI value in HIV-negative individuals. The reported higher prevalence of caries in HIV-positive persons was associated with being female, detectable viral load, and frequent dental visits. Periodontal disease was associated with older age, being male in HIV-positive and HIV-negative participants. Moreover, HIV-positive adults reported poorer OHRQoL than HIV-negative counterparties. Furthermore, qualitative results revealed individual and external levels factors of oral disease and emphasized the physical/ functional, psychological and social effects of oral diseases on quality of life. Therefore, there is a need for effective oral health interventions specific to HIV-positive persons in Rwanda. The interventions should also raise awareness of the risk of common oral diseases (such as dental caries, and periodontal disease) and provide preventive oral health services among the Rwandan population, especially HIV-positive individuals. There is a need for a collaborative effort to establish programmes for regular and timely screening and management of periodontal disease and dental caries among the general population and specifically, HIV-positive individuals in Rwanda. To ensure timely oral health care among HIV- positive Rwandans, this study provides baseline data to aid policymakers and stakeholders to integrate oral health care services within HIV treatment programmes in R
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    Factors contributing to uncontrolled high blood pressure in Ekurhuleni, Johannesburg: the community health workers’ perspectives
    (University of the Witwatersrand, Johannesburg, 2024) Dawood, Zaheerah; Sekome, Kganetso
    Background: Uncontrolled high blood pressure has become a concern in underserved communities of South Africa due to its consequence resulting in rising cardiovascular and cerebrovascular diseases. Community health workers at a primary care level offer door to door services for patients with chronic diseases and are often key in health education, health promotion, and disease monitoring. Understanding the voice of the community health workers regarding factors that contributes to uncontrolled high blood pressure for their patients can provide insight on strategies for future intervention programme from a systems, patient, and community perspectives. Aim: To explore community health workers' perceptions on factors that contribute to uncontrolled high blood pressure in adults living in Ekurhuleni South sub-district, Johannesburg. Methods: A descriptive, qualitative study design was used for this study. In-depth face-to- face interviews were conducted with 22 community health workers from four communities within the South sub-district in Ekurhuleni, Gauteng. The interviews focused on: the community health workers knowledge on measures used to control high blood pressure, the community health workers opinions on barriers and facilitators contributing to uncontrolled high blood pressure for their patients, and lastly their perceptions on strategies which can be used to improve the control of high blood pressure. Data analysis following thematic analysis was used in this study. An inductive approach was used to generate codes, themes, categories and to analyse the data. Results: Analysis of the qualitative data revealed six themes. Community health workers possessed knowledge regarding the symptoms, causes and complications of uncontrolled high blood pressure however, they didn’t fully comprehend the physiological concept of blood pressure and uncontrolled high blood pressure. It can be noted that the type of advises and education which community health workers provided their patients with are generally very contextualized and simple. Multiple barriers included financial, personal, social, system, medication and cultural and traditional issues. Facilitators included government and health workforce assistance, improvement of clinic accessibility, inter and intra collaboration from multiple sources such as media, other health professionals as well as patient centred approaches. Strategies to improve control of high blood pressure included improved team work, awareness creation, holistic healthcare, improved access to clinic facilities, system related improvements and patient initiatives. Conclusion: Community health workers in this study have knowledge regarding the causes, symptoms and complications of uncontrolled HBP. Multiple barriers to controlling high blood pressure included financial, social system, personal, cultural and patient barriers. The facilitators which were identified required a multidisciplinary approach. Interventions which the community health workers provide to patients are reported to be easy to follow and usually contextualized to the patient needs. Strategies required to improve the control of high blood pressure in this community are easy to implement with less assistance required from the health care system
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    A survey of the perceptions and knowledge of anaesthesia and anaesthetists possessed by Grade 12 learners in four Johannesburg districts
    (University of the Witwatersrand, Johannesburg, 2022) Talane, Pulane Adelice
    Background William J.G Morton (1816-1868) introduced the world to modern anaesthesia when he successfully anaesthetised a patient using Ether at Massachusetts General Hospital in Boston in October 1846. (1) Since then, advances in pharmacology have resulted in the safer use of anaesthetic drugs and technological advances have improved monitoring of patients under anaesthesia. Anaesthetists around the world are now involved in the fields of critical care, trauma and pain management. (2)This has brought a sense professional esprit de corps to the anaesthetic fraternity. Despite this radical growth and development of the speciality, there is still a lack of public knowledge regarding the discipline of anaesthesia, anaesthetists’ expertise, or the role played by the anaesthetist in the chain of health care delivery. (3) Methods A cross sectional study was carried out between June and September 2021 on Grade 12 learners in four Johannesburg districts. A questionnaire consisting of three sections and 26 questions was handed out at pre-selected schools. The first part of the questionnaire acquired demographic data, the second contained questions pertaining to anaesthetists and anaesthesia as a speciality, and the third part pertained to interest in the field of anaesthesia. Results Of the 595 learners that participated in this study, 335 (56.3%) were aware that an anaesthetist administers anaesthesia in the operating room. A considerable number of learners n=344 (57,8%) believed that a nurse monitored and recorded the patient’s vital signs during surgery. Only 95 learners (16%) correctly identified all the duties of the anaesthetist outside of the theatre environment. Overall, learners fared poorly, achieving an average score of 14% for the questionnaire. However, there was a statistically significant correlation between being from a high socioeconomic background and awareness that the anaesthetist administers anaesthesia. A high socioeconomic background was defined as having a suburban residence, a household income comprising a salary instead of social grants and care givers that possessed a university degree. Knowledge regarding the intraoperative duties of the anaesthetist was still poor, regardless of the socioeconomic background of the learner. Previous exposure to anaesthesia did not improve awareness about anaesthesia among the learners. Conclusion This study has shown that awareness regarding anaesthesia and anaesthetists is still lacking despite the radical growth in the field. This lack of awareness cannot be ignored; education of the general public should be intensified in order to empower people to ask the right questions as well as make informed decisions about their perioperative care in the future. More than half of the learners in the study (58.5%) believed that good medical education can reduce the burden of health care costs and medicolegal consequences; and 70% of them would request an anaesthetist to provide them with detailed information about their anaesthetic before the start of surgery. Therefore, despite lack of awareness, the majority of the learners displayed interest and willingness to know more about anaesthesia, and grade 12 learners would be a formidable target group to direct anaesthetic education campaigns