Faculty of Health Sciences (ETDs)
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Item Public attitudes to corneal tissue donation in an urban South African population(University of the Witwatersrand, Johannesburg, 2023-08) Hajee, Faheema; Hollhumer, RolandBackground: Corneal pathology is the second leading cause of preventable blindness in Sub-Saharan Africa. Corneal disease is the cause of visual loss in 11% of blind or severely visually impaired children and 4% of blind adults in South Africa. In majority of cases, a corneal transplant or keratoplasty can restore or significantly improve vision. South Africa has an immense shortage of donor corneas, causing the burden of corneal disease requiring transplantation to continually rise. Aim: The aim of this study was to determine the public attitude towards corneal tissue donation in an urban South African population. Setting: The study was conducted at St John’s Eye Hospital, Soweto, South Africa. Method and Design: This was an observational, cross-sectional quantitative study of the current attitude of an urban South African population towards corneal tissue donation. A self-designed questionnaire was developed. The participants were asked about reasons for both willingness and unwillingness to donate their corneas. The study population included patients or escorts attending the out-patients clinic at Saint John’s Eye Hospital. Results: A total of 100 participants (60 females and 40 males) completed the questionnaire. The mean age (±SD) of the study participants was 41.26 (±14.7) years. Seventy-six percent of participants did not know about corneal donation. Sixty four percent of participants were willing to donate their corneas, whereas 25% were not willing to do so. The main reason for unwillingness to donate their corneas was cultural reasons. In this study there was no statistically significant correlation between the willingness to donate corneal tissue and age, gender, level of education and employment status. There was a statistically significant difference between the willingness to donate one’s solid organs as compared to the willingness to donate one’s cornea (p-value 0.029). Participants were more willing to donate their solid organs than they were willing to donate their corneas. Conclusion: There is a decreased level of awareness of corneal tissue donation in this urban South African population. However, many of the participants had a positive attitude towards corneal donations. Increasing the awareness of donation and its benefits may help increase the supply of corneal tissue.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 Spontaneous Bladder Rupture: Demystifying the Condition – A Systematic Review(University of the Witwatersrand, Johannesburg, 2023-08) Reddy, Deshin; Laher, Abdullah; Adam, AhmedObjectives: To perform a systematic review of all cases of spontaneous rupture of the urinary bladder (SRUB) and to describe the demographic data, associated co-morbidities, clinical presentation, diagnosis, relevant laboratory findings, associated factors, management, morbidity, and mortality associated with the presentation of SRUB. Methods: The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). A search was carried out across the following electronic databases: PubMed, Web of Science, Scopus, Google Scholar, and the Cochrane Database of Systematic Reviews. Full texts of selected studies were analysed, and data extracted. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: A total of 278 articles comprising 240 case reports and 38 case series, with a total of 351 patients were included. The median (IQR) age of all included patients was 47.5 (33-65) years. The median (IQR) time to presentation was 48 (24-96) hours, with the major presenting symptom being abdominal pain (76%). In patients in whom the diagnosis was made prior to any intervention, the condition was misdiagnosed in 64% of cases. The diagnosis was confirmed during explorative open surgery in 42% of cases. Pelvic radiation (13%) and alcohol intoxication (11%) were the most common associated factors. Intraperitoneal rupture (89%) was much more common with the dome of the bladder being most frequently involved (55%). The overall mortality was 15%. Conclusion: This review identified a number of key factors that appear to be associated with an increased incidence of SRUB. It also emphasised the high rate of misdiagnosis and challenges in confirming the diagnosis. Overall, it highlighted the importance of the need for increased awareness and maintaining a high index of suspicion for this condition.Item The stability of C-peptide and insulin in plasma and serum samples under different storage conditions(University of the Witwatersrand, Johannesburg, 2023-10) Nkuna, Delhia Xikombiso; Maphayi, MphoObjectives: C-peptide and insulin are peptide hormones and their stability is affected by a number of pre-analytical factors. The study aimed to investigate the impact of sample type, storage temperature and time delays before centri-fugation and analysis on the stability of C-peptide and insulin. Methods: Ten healthy non-diabetic adults in fasting and non-fasting state were enrolled. 40 mL of blood was collected from each participant into SST and dipotassium EDTA tubes. Samples were centrifuged immediately or at timed intervals (8, 12, 48 and 72 h). After baseline measurements on the Roche Cobas e602 analyzer using electrochemiluminescence immunoassays, aliquots were stored at room temperature (RT), 2–8 and −20 °C for 4 h to 30 days. The percentage deviation (PD) from baseline was calculated and a change greater than desirable biological variation total error was considered clinically significant. Results: C-peptide was more stable in separated serum than plasma (PD of −5 vs. −13 %) samples stored at 2–8 °C for 7 days and was most unstable at RT when centrifugation was delayed (PD −46 % in plasma and −74 % in serum after 48 h). Insulin was more stable in plasma than in serum under the different storage conditions with a minimum PD of −1% when stored at −20 °C for 30 days. When samples were kept unspun at RT for 72 h, PD was −23 and −80 % in plasma and serum, respectively. Conclusions: C-peptide was more stable in serum provided the sample was centrifuged immediately and stored in the fridge or freezer while insulin was found to be more stable in EDTA plasma.Item Outcomes of diaphyseal femur fractures managed in children 10 years and younger at Charlotte Maxeke Johannesburg Academic Hospital(University of the Witwatersrand, Johannesburg, 2023-10) Hitge, Curran; Robertson, Anthony; Simmons, DinaIntroduction: Paediatric femur fractures have a bimodal age presentation. Children under the age of six are generally treated with non-operative management, while those older than ten have been shown to do better with surgical fixation. The management of the intermediate age group of six to ten years remains controversial, with recent opinions tending to favour surgical fixation. At Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) a clearly defined stepwise protocol has been established, in which patients that do not meet defined indications for surgery are managed in skin traction until clinical and radiological signs of union are present, at which point, patients are discharged to weight-bear as tolerated. Methods: This study was a retrospective review with a prospective recall of paediatric orthopaedic patients aged 10 years and younger treated in skin traction for femur fractures at CMJAH from January 2016 to December 2018. X-ray parameters were assessed on the Picture Archiving and Communication System for patients who met the inclusion criteria. Patients were then followed up at a minimum of 24 months to assess outcomes according to Flynn’s criteria. Other variables assessed included length of hospital stay and rotational profiles. Results: One hundred and seventy-nine patients were admitted to the paediatric orthopaedic ward at CMJAH with femur fractures over this period. Sixty-nine patients met the inclusion criteria set out in the study, of which 31 were available for follow-up. Seventy-seven percent of patients were aged 5 years and younger and 52% of injuries occurred due to low velocity falls. In terms of complications, 3 patients were found to have a limb length discrepancy, none of which exceeded 1cm. Three patients were found to have radiological malunion of >5 degrees. One patient sustained a pressure sore which healed uneventfully, and no patients had any joint stiffness, pain or refracture. Twenty-four of the patients achieved excellent outcomes, with 6 satisfactory and 1 poor outcome. No patients reported any subjective concerns or complaints with the outcome. Time in traction showed a median of 25 days per patient, with increased length of traction having a significant correlation to advancing age. There was a median time to full weight-bearing of 6 weeks and a median of 8 weeks of school missed per child. Conclusion: The majority of patients with femur fractures treated non-operatively at CMJAH went on to excellent outcomes with no patient subjective complaints. These findings were comparable to similar studies reviewing surgical management. The findings in this study suggest that there is a role for promoting our protocol of treatment to surrounding regional and peripheral hospitals that do not have access to orthopaedic expertise to offload specialist hospitals.Item 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 SusanIntroduction & 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.Item Critical incidents in gynaecology: audit at Charlotte Maxeke, Johannesburg Academic Hospital(University of the Witwatersrand, Johannesburg, 2023-07) Chikwiri, Christopher; Chauke, LawrenceBackground: Critical incidents are among the ten leading causes of death and disability worldwide. Improving patient safety has become a global priority and one way to reach this goal is to report and analyse critical incidents. Objectives: To describe the epidemiology, patient outcomes and avoidable factors associated with critical incidents in gynaecology department at Charlotte Maxeke Johannesburg Academic Hospital (CJMAH). Methods: This research was a retrospective descriptive analysis of critical incidents in patients admitted to gynaecology wards at CMJAH from 1st January 2019 to 31st December 2019. All medical records of patients identified to have experienced critical incidents were reviewed and demographic information, timing of admission, critical incident markers and avoidable factors were extracted for analysis. Results: In total there were 257 critical incidents (CI) in 2082 gynaecology admissions during the one-year study period, which gives a critical incidence of 12.3%. A total of 158 patients experienced at least one or more critical incidents. The mean age (SD) of patients was 41.1 (14.8) years. The median (IQR) duration of admission was 6 days (3-10). Reasons for admission were emergencies 60 (38.0%), elective 54 (34.2%), oncology 44 (27.8%). Majority of the critical incident events were omission of procedures (n=45, 17.5%), deaths (n=34, 13.2%), massive transfusion (n=30, 11.7%), repeat laparotomies (n=29,11.3%) and fistula/organ damage (n=19, 7.4%). Avoidable critical incidents were (n=87, 55.1%). Most critical incidents were associated with no harmful outcomes to the patients (50, 31.5%), death (34, 22.8%) (mainly as a result on oncology admissions), moderate disability (29,17.9%), minimal disability (26, 16,1%), permanent/severe disability (14, 8.6%) and in (5,3.1%) harm could not be specified. Critical incidents forms were only filled out in 39 patients, that is a reporting rate of 24.7%. Conclusions: Critical incidents are a major cause of unnecessary harm in gynaecology at CMJAH. Half of these critical incidents are avoidable and therefore corrective measures can be undertaken to eliminate them in order to improve patient safety. Underreporting of critical incidents is still a major problem. There is need for precise definitions of critical incidents terms and modification of critical incident reporting system (including electronic) to promote patient safety culture in gynaecology.Item Prevalence and correlates of alcohol use, mental disorders, and awareness and utilization of support services among healthcare professionals in West Rand District, Gauteng, South Africa(University of the Witwatersrand, Johannesburg, 2022-06) Mc Magh, Charlotte Stephanie; Francis, JoelBackground: Healthcare professionals (workers) are at an increased risk for developing mental and alcohol use disorders due to increased psychological distress, long working hours, medical litigation, role conflict and verbal/physical abuse from colleagues and patients. Psychological well-being in Healthcare workers is crucial to provide the best quality of care to patients. There is limited data on mental and alcohol use disorders among healthcare professionals in South Africa. Objectives: To determine the prevalence and correlates of alcohol use disorder, depression, anxiety, suicidality and covid anxiety during the covid pandemic among healthcare professionals in West Rand district, Johannesburg, South Africa. Methods: We conducted a cross-sectional study conducted on a sample of healthcare professionals including doctors, nurses, clinical associates and dentists working in the West Rand District of Gauteng, South Africa, during Covid-19 pandemic. Participants were invited to complete a paper-based questionnaire addressing socio-demographic questions, a set of measures for alcohol use disorder (AUDIT-C), depression (PHQ-2), anxiety (GAD-7), suicidality (PSS-3), covid anxiety (CAS) and awareness and utilization of support services. Results: A total of 330 Healthcare professionals (60.9% nurses, 33% doctors, 5.5% other) participated. Majority of the participants were females 78.8%, and 48.2% of the participants were in the age band 35-64 years. Overall, 20.9% of the healthcare professionals reported risky alcohol use. Females were 73% less likely to report risky alcohol use (AOR=0.27;95% CI 0.13-0.54). Prevalence of probable depression was 13.6% and female professionals were 5 times more likely to be classified as having probable depression (AOR=4.86;95% CI=1.08-21.90). The grouped prevalence of anxiety ranging from mild to severe was reported at 47.3%, female professionals were 3 times more likely to be classified as having anxiety symptoms (AOR=2.78;95%CI 1.39-5.57). Furthermore, races other than black were found to have higher rates of anxiety (AOR=2.54; 95%CI 1.00-6.42). The prevalence of suicide symptoms was 7.9% and that of covid dysfunctional anxiety 4.8%. Only 5% of participants were involved in an employee wellness program, with 60% expressing interest in joining one. Conclusion: Alcohol use and mental disorders were common among healthcare professionals in West Rand district, Johannesburg, South Africa. There is overall poor awareness and use of support structures highlighting the need to design and pilot targeted interventions to increase awareness and utilization of the existing services and delivery of alcohol use and mental disorder screening and referral to treatment.Item Incidence of incomplete excision of basal cell carcinoma and associated factors at two tertiary hospitals(University of the Witwatersrand, Johannesburg, 2023-10) Hoogendyk, Charles August; Sofianos, Chrysis; Kruger, DeirdréIntroduction: Basal Cell Carcinomas (BCC) account for the majority of skin cancers in South Africa. They have low mortality but can cause significant morbidity primarily through local destruction, therefore recurrence should be mitigated. Surgery is the preferred treatment for BCC. The excision margin is determined firstly by oncological safety and then preservation of normal tissues. Therefore, a wider or narrower margin increase the risk for aesthetic complications and recurrence, respectively. However, the optimal surgical excision margin size remains unclear and guidelines established based on lesion size and histological aggression are inconsistent. This may be because incomplete excision has a more complex relation with other associated factors. Aim: The aim of this study was to examine the rate of incomplete excision (involved margin) of BCC at tertiary Hospitals in South Africa, and to assess the influence from associated factors, such as age, sex, histological type, size, site, and lesion occurrence (primary; re-excision; recurrence). Method: This was a retrospective quantitative observational study with chart reviews, performed at the Plastic Surgery Department at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwanath Academic Hospital (CHBAH). Patients who underwent BCC excision from January 2016 to December 2020 were screened and biopsies were collected. The normality of continuous data (age and biopsy size) was tested with Shapiro-Wilks test. The standard descriptive statistics and interquartile ranges (IQR) were reported. Involved excisional margins associations with continuous and categorical variables were tested using the Mann-Whitney U test, and Chi-squared test, respectively. Results: he cohort consisted of 226 patients who underwent a total of 461 biopsies. The median age was 65.3 years, there were predominantly male (56.0%) patients, from CHBAH (81.0%). Baseline associated factors of largest biopsies (n=226) and smallest (n=91) biopsies of the cohort were examined overall. Margin was involved at excision on 16.8% (38/226) of largest samples and 23.1% (21/91) of smallest biopsies. The commonest site was the Head and Neck region, with 146 (64.6%) in the largest biopsies and 61 (67.0%) amongst smallest biopsies. The commonest subtype was nodular which was 38.9% (88/262) and 40.6% (37/91) amongst the largest and smallest, respectively. On assessment of the diameter and the involved excisional margin, there was a significant association for smallest biopsy (p<0.001). On cross-tabulation, involved excisional margin for larger biopsies was significantly associated with head and neck biopsies (p<0.001) and aggressive lesions (p=0.004). In smallest biopsies lesions, involved excisional margin was also associated with head and neck sites (p=0.009) and primary occurrence (p<0.001), and smallest biopsies in the head and neck region was associated with aggressive type lesions (p=0.003). In the latter group, indolent type lesions were associated with primary biopsies (p=0.001). Conclusion: In this population the associated factors for margin involvement on excision are head and neck site, aggressive type, and non-primary lesions. For best patient outcomes, and the prevention of BCC recurrence, we recommend that these factors are considered when deciding on excision margin size.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.