3. Electronic Theses and Dissertations (ETDs)

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Determining the risk profile for chronic kidney disease (CKD) in rural South Africans using genetic risk scores and protein markers
(University of the Witwatersrand, Johannesburg, 2024) Govender, Melanie Ann; Ramsay, Michèle
Chronic kidney disease (CKD) is a global public health concern, with disproportionate morbidity and mortality in low- and middle-income regions, including Sub-Saharan Africa. Recent advancements in multi-omics approaches have explored disease risk indicators and contributed to the understanding of the pathophysiology of CKD in high-income populations. The overall aim of this research was to assess and understand CKD in a Sub- Saharan population using genetic risk models for kidney disease and to evaluate the proteomic profile of individuals with hypertension-associated albuminuria, with a view to detecting indicators of CKD and disease progression in a Sub-Saharan cohort. The first objective was a scoping review that was undertaken to evaluate existing literature for potential biomarkers for CKD and to identify gaps in literature. Key literature gaps identified included the lack of studies that focus on HT in the context of kidney disease and only one study on African individuals residing in Africa. In this work, two research studies were developed based on existing data from the African Research Kidney Disease (ARK) study, a well characterised population-based cohort study of black individuals from Agincourt in the rural Mpumalanga Province, South Africa. The second objective was a genomics study which aimed to examine the potential of using summary statistics from three discovery datasets to assess the predictive accuracy of polygenic scores (PGSs) for CKD and kidney function markers. Limited transferability was observed, explaining <1% of the variability in kidney disease markers in this African cohort. A PGS model derived from the transethnic cohort for estimated glomerular filtration rate (eGFR) explained the highest variability (0.8%) in African individuals and was significantly associated with HT (P<0.001), diabetes (P=0.007), and HIV (P=0.001). The third objective was a proteomics study which aimed to compare proteomic profiles of cases with both HT and albuminuria to controls (neither condition) to identify proteins and pathways involved in hypertension- associated albuminuria. Pathways including immune system (q=1.4x10-45) and innate immune system (q=1.1x10-32) were linked with hypertension-associated albuminuria. Proteins including angiotensinogen, apolipoprotein L1, and uromodulin had the highest disease scores (76–100% confidence). A machine learning approach was able to identify a set of 20 proteins that contributed to classifying disease status (ie, hypertension-associated albuminuria). Page | VI The assessment of PGSs for kidney function markers contribute to understanding of CKD genetic risk prediction in Africa, while the proteomics research added new knowledge to understanding the role of proteins and pathways involved in hypertension-associated albuminuria in Africa. This research addresses the gap of a lack of ‘omics research in resident African populations. It also contributes to the understanding of risk prediction for CKD and identifies potential proteomic markers for hypertension-associated albuminuria that may inform the development of personalised treatment strategies in Africa.
The assessment of patient-centred care among diabetic patients in southern Malawi
(University of the Witwatersrand, Johannesburg, 2024) Makwero, Martha; Muula , A; Igumbor, Jude
Introduction: Patient centred care (PCC) is gaining recognition in various quality care reforms, especially in the growing era of chronic care where its effects are palpable yet its functional elements are unknown and hardly measurable. PCC has been shown to improve care processes and patient reported outcomes among chronic care patients such as Diabetes Mellitus (DM). While the Malawi Quality management Directorate (QMD) and the Non-communicable disease and injury (NCDI) policies mention PCC as a strategic quality reform, its functional elements are hardly known and, if it matters, in mediating patient experiences and outcomes. It is clear that the vagueness is thwarting PCC’s implementation, assessment, and advocacy. Thus, as the burden of chronic diseases, including DM grows, there is a need to optimize PCC through the elicitation of its functional elements, its objective assessment, and its recommended implementation strategies. Aim: This study aims to assess the functional elements of PCC and its relationship to outcomes in diabetic patients. Methodology: I conducted a cross-sectional, exploratory mixed methods study in southern Malawi. Sequentially, I employed qualitative and quantitative methods in order to enrich the contextual understanding of the complex PCC construct and its correlates. Therefore, we initially explored the common elements of PCC in LMIC through a scoping review. Building on the findings, in the next phase, I explored PCC conceptualization among three stakeholders (patients, health care providers and policy makers) further, breaking down the PCC construct to its functional elements through a qualitative inquiry. The qualitative themes identified were used to build a tool on important elements of PCC from the same population. A psychometric analysis was done in order to confirm the structure and consistency of the tool to improve the validity of results obtained. Thereafter, I quantitatively measured the current PCC practice ix among patients with DM and its association with baseline adherence to DM care plans, self- efficacy, glycaemic control, and some complications. The study used Covidence to manage the scoping review and Nvivo version 11 for the qualitative data, which was analyzed through the thematic analysis. The quantitative data was analyzed using STATA version 18 and R-studio version 4.2.3. The psychometric analysis employed exploratory and confirmatory factor analysis. Dichotomization of study participants into those who perceived low and high PCC scores was done through K-means clustering was done in R studio. Similarly, correlational studies and Path analysis were conducted to determine the nature and direction of relationships between the perception of PCC during the encounter and adherence, self-efficacy and glycaemic control. Results: The study confirmed the paucity and fragmentation of literature on PCC in LMIC especially in Africa and therefore, the need to situate the elements in our context. The themes identified were interrelated, and differences in expression and emphasis of some of the elements compared to the Eurocentric ones were highlighted. The recurring themes included the facilitating ambience, sharing of information, and patient involvement, the wider organization of care and the macroenvironment in which care takes place. Although they are similar to the Eurocentric themes, our qualitative inquiry identified eight themes and proposed a working definition. Thus, in the Malawian context, PCC was conceptualized as an expected care process that incorporates warm patient reception, where the healthcare provider consciously aims to reduce the patient-HCP power gap to harness a good long-term relationship. This creates a conducive atmosphere that allows the gathering of information that holistically identifies the individual specific problems and all possible interacting factors, ensuring timely access to care and medication. While patients highlighted the value of PCC encounters, particularly shared decision-making, the study documented the x challenges and vulnerabilities faced in an attempt to engage their providers in shared decision making. The psychometric analysis identified three latent themes underlying the PCC elements namely 1) relational aspects of care, 2) individualization and shared decision making and, 3) organizational aspects of care highlighting what is important and the hierarchical nature of the PCC construct. While acknowledging the need for further refinement, the tool exhibited acceptable reliability and validity properties to be used as a measurement framework in the study. The study showed significant deficiencies in the delivery of PCC with 55.8% of patients perceiving low levels, particularly, in the area of individualization and shared decision-making. Higher PCC scores did not have a significant relationship with self-efficacy. Both the perception of PCC and self-efficacy were positive predictors of adherence independently. Having perceived higher PCC scores was associated with a marginal 0.03-point increase in one’s adherence scores (β = 0.03; 95% CI: 0.01 to 0.04, p-value <0.001). Self-efficacy and adherence were both positive predictors of blood sugar control independently. Better self- efficacy was associated with a 0.03 unit decrease in the level of HbA1c (β =-0.03; 95% CI: - 0.04 to -0.022, p-value <0.001). Additionally, as adherence scores went higher, there was a 0.15 unit decrease in HbA1c (β = -0.15; 95% CI: -0.25 to -0.02, p-value <0.05). The results highlight that PCC can affect glycaemic control only indirectly through adherence. Conclusion The study has confirmed the complexity of the PCC construct and the paucity of literature in LMIC. It has highlighted that above and beyond creating a conducive ambiance, medical encounters ought to evoke support and capacitation for patients to undertake self-care behaviors confidently to be able to produce patient outcomes. Even though this study is cross- xi sectional, the initial patterns are promising for the value of PCC in mediating patient-reported experiences and outcomes among DM patients.
Physical Activity Intervention Plan for Hypertensive Patients of Umlazi Township, KwaZulu-Natal
(University of the Witwatersrand, Johannesburg, 2024) Simamane, Mandisa Jewel; Constantinou, Demitri; Watson, Estelle
Background The global increase in hypertension, fueled by aging populations, sedentary lifestyles, and obesity, presents serious health challenges, including elevated risks of cardiovascular diseases and early mortality. Addressing this issue effectively necessitates a holistic healthcare approach that combines medication with lifestyle changes like physical activity, while also incorporating family support and exercise professionals into primary care for personalised treatment plans and improved adherence. Aim The principal aim of this study was to ascertain whether the implementation of a physical activity intervention plan, coupled with family member involvement within the primary healthcare sector, would contribute to the effective management of hypertension among hypertensive patients residing in the community of Umlazi Township, KwaZulu-Natal. Methods This study adopted a multifaceted methodology to enhance evidence-based hypertension management practices through physical activity. Initiating with a scoping review, it identified and organised relevant literature to establish a solid evidence foundation for a randomised controlled trial. The research included 12 weeks randomised controlled trial into intervention, and the control group assessing the impact of physical activity on hypertension management and secondary outcomes, thus providing a thorough evaluation of the intervention's effectiveness. Moreover, a qualitative inquiry further explored the comprehension and involvement of family members in managing hypertension. Results The review identified nine effective physical activity-based interventions out of 31 studies, indicating their success in reducing blood pressure and strengthening cardiovascular health. Notably, aerobic and interval training emerged as especially beneficial. The trial demonstrated significant progress in the Intervention Group (n = 36) compared to the IX Control Group (n = 37), particularly in 6-minute walk test results, without major changes in cardiovascular and anthropometric metrics over 12 weeks, underscoring the benefits on physical performance and potential heart health advantages. The qualitative analysis (n = 9) exposed a general lack of hypertension awareness among family members and a gap in their support levels. Discussion and Conclusion Conclusively, the study underscored the critical role of augmenting physical activity in managing hypertension, evidenced by its 12-week investigation at the Umlazi Township AA clinic. Though, it reaffirmed the synergy of pharmacological and lifestyle interventions, affirmed by physical activity and familial engagement, in enhancing hypertension care. Despite certain constraints like small sample size and brief intervention span, the findings advocate for an expanded clinical utilisation of physical activity in hypertension treatment, promoting prolonged and consistent exercise routines as integral to a comprehensive management strategy.
Effects of dietary supplementation with β-sitosterol on Cobb 500 broiler chicken productivity, health and product quality
(University of the Witwatersrand, Johannesburg, 2024) Bopape, Malebogo Audrey; Chivandi, Eliton
Antibiotic use as growth promoters in chicken feeds results in antibiotic resistance and environmental pollution. To mitigate these challenges alternatives natural growth promoters are required. Beta-sitosterol is one of several phytosterols with chemical structures similar to that of cholesterol. β-sitosterol has antimicrobial, antioxidant, anti-inflammatory and hypocholesterolaemic activities, thus might replace synthetic antibiotics as a feed supplement in chicken feeds. The current study evaluated β-sitosterol’s potential to replace oxytetracycline in Cobb 500 broiler chicken feeds by determining its effects on growth performance, meat yield and quality and bird health. β-sitosterol replaced oxytetracycline at 0 (control: 50 mg/kg oxytetracycline), 500, 1000 and 1500 mg/kg feed for diet 1 to 4, respectively with doses similar in starter, grower, and finisher diets. Chickens were fed from day 1 to 42 days of age. Body mass and feed intake were measured. Body mass gain, average daily gain and feed conversion ratio were computed. Terminally, broiler chickens were fasted, weighed, humanely slaughtered and dressed. The carcass yield, viscera morphometry and plasma surrogate markers of health were also determined. Meat pH, colour, thawing and cooking loss (TL; CL), water holding capacity (WHC), tenderness and myofibrillar fragmentation length (MFL) and nutrient content were determined. Femora and tibiae mass, length, breaking strength and liver fat content and histology were determined. Dietary β- sitosterol had similar (P > 0.05) effects as oxytetracycline on the chickens’ growth performance and feed intake utilization efficiency, gastrointestinal tract (GIT) and GIT accessory viscera macromorphometry, meat yield, meat colour, pH, TL, CL, WHC, tenderness and MFL. However, breast meat crude protein content of chicken fed diet 4 was higher (P < 0.0001) compared to that of counterparts fed diets 2 and 3. Breast meat fat content of chicken fed diet 2 and diet 4 was higher (P < 0.0001) compared to that of counterparts fed diets 1 and 3. Dietary β-sitosterol had similar (P > 0.05) broiler chickens’ breast meat total saturated fatty acids (TSFAs), monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs), palmitic, oleic and linoleic content as oxytetracycline. Dietary treatments had no effect on chickens’ tibiae masses and breaking strength (P > 0.05) albeit tibiae from chickens fed diet 4 were shorter (P < 0.01) than those of counterparts fed diet 2. Dietary β-sitosterol at 1000 and 1500 mg/kg feed increased (P < 0.05) liver lipid content but had no effect on hepatic microarchitecture. However, at 1500 mg/kg feed it caused micro- and macro hepatic steatosis and lobular inflammation and higher (P < 0.05) non-alcoholic fatty liver disease activity scores (NAS). Compared to control, dietary β- vii sitosterol decreased (P < 0.0001) the chickens’ malondialdehyde (MDA) concentration but increased superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) activities and glutathione S-transferase (GST) and glutathione (GSH) concentration (P < 0.05). Diet 4 increased (P < 0.01) plasma AST and GGT activities compared to diet 1 (control). At 1000 and 1500 mg/kg feed it increased plasma cholesterol concentration compared to control and β-sitosterol at 500 mg/kg feed. β-sitosterol can replace oxytetracycline as growth promoter in Cobb 500 broiler chicken diets without negatively affecting growth performance, meat yield and quality and potentially mitigates oxidative stress by upregulating systemic antioxidant enzymes activities. However, at 1500 mg/kg feed, it can increase the risk of fatty liver disease development and hypercholesterolaemia.
Myrmecophagous mammals in a changing world: the ecology of aardvarks and temminck’s pangolins in the kalahari
(University of the Witwatersrand, Johannesburg, 2024) Phakoago, Makabudi valery; Fuller, A.
Little is known about the distribution and ecology of the aardvark (Orycteropus afer) and Temminck’s pangolin (Smutsia temminckii) in southern Africa as they are rarely seen and difficult to study. Both species are myrmecophagous (feed on ants and termites), primarily nocturnal, 2and they tend to be solitary. Climate change, which is resulting in hotter and drier environments in most parts of southern Africa, may affect the aardvark and Temminck’s pangolin through direct impacts on the animals and through impacts on their prey resources. Understanding how climate change may impact these two myrmecophagous mammals requires us to gather further insights on how their environment and food sources are changing, how their diets overlap, how they use the environment and alter their activity to source food and buffer themselves from heat and cold, and how they are distributed across southern Africa. Previous research conducted in the semi-arid Kalahari of southern Africa showed that a decline in ant and termite populations (as indicated by counts in pitfall traps) associated with drought resulted in starvation of aardvarks and pangolins and decreased reproductive output of pangolins. Individuals of both species starved, despite previous work indicating that the diets do not overlap, with aardvark preying predominantly on harvester termites (Hodotermes mossambicus) and pangolins preying predominantly on ants (mainly Crematogaster ants). However, the research on each species was conducted at different times, so the dietary differences may have arisen from various factors that differed between the study periods. As part of a long-term project aimed at assessing the potential impacts of climate change on myrmecophagous mammals in the Kalahari ecosystem, the present study collected faecal samples from aardvark and Temminck’s pangolin at the same time in the Kalahari for one year to compare their diets and assess dietary overlap (Chapter 3). In addition to dietary analysis, the study added to our long-term data (since September 2014) of grass cover and counts of ants and termites in pitfall traps, from September 2019 to August 2022 (Chapter 2). These long-term data revealed substantial fluctuations in grass and insect availability over time, with termite populations apparently less likely to recover after drought years compared to ants (Chapter 2). The study also assessed the abundance xiii and orientation of burrows that are available to the aardvark and Temminck’s pangolin in the duneveld in the Kalahari during winter of 2021 (Chapter 4). Lastly, the study assessed the distribution and ecology of the aardvark and Temminck’s pangolin in southern Africa using freely available images and videos from Facebook and Instagram over 10 years (2010 – 2019) (Chapter 5). During the study, the study site, Tswalu Kalahari Reserve, experienced higher than average rainfall (2020 and 2021), resulting in high grass cover and an increase in the number of ants in pitfall traps, following a very hot and dry period in 2019. In contrast, termite numbers remained low. Despite the apparent low number of termites, as reflected in the pitfall traps, aardvark preferred termites over ants in their diet, and consumed predominantly termites of the genus Trinervitermes (45% of their diet) over the study period. Temminck’s pangolin preferred ants over termites and consumed mainly ants of the genus Crematogaster (42%). Although aardvarks and Temminck’s pangolin had preferences for their specific prey items, it was shown for the first time that there was dietary overlap between the two mammal species, with higher overlap when prey resources were readily available during autumn, and lower dietary overlap when prey resources were scarce during spring. The present study, however, was conducted during an unusually wet period characterized by above-average rainfall, so it is important to determine how competition for dietary items will change in hotter and drier years, when insect populations will likely be lower. Ants and termites rely on grasses for their survival; therefore, one would predict that the abundance of burrows, dug primarily by aardvark, is likely to be related to grass cover. The present study site comprised two distinct areas, differing in grass cover as a result of differences in historical grazing pressure. I therefore investigated the availability and use of burrows in the area with low grass cover and the area with high grass cover, during winter. Burrows serve as a beneficial buffer against climatic conditions for burrowing species, offering heat avoidance during the day and warmth during the night. It was found that burrow numbers were positively associated with grass cover. More burrows also were found on the western side of the dunes than on the eastern side, most likely because the xiv western side receives more direct sunlight in the afternoon, providing a warmer microclimate overnight during the cold winter. Finally, the study explored whether social media could provide supplementary information on the distribution and ecology of the aardvark and Temminck’s pangolin in southern Africa. The data, which were collected through examining photos and videos on Facebook and Instagram, confirmed that the aardvark is found throughout South Africa while Temminck’s pangolin is restricted to the northern regions of South Africa. The images also confirmed recent research that poor body condition is associated with greater diurnal activity for the aardvark, likely a response to high energetic demands of being active on cold nights. Little is known about drinking behaviour by the aardvark and Temminck’s pangolin, with only 7 records previously published for the aardvark. It was found a further 32 records for the aardvark, and 7 for the pangolin, showing that both species do occasionally drink opportunistically. The records also provided information on the predation of both myrmecophagous mammals. Predation was observed at almost all times of the year for both species, with leopard (Panthera pardus) the most common predator for the aardvark, and lion (Panthera leo) the most common predator for Temminck’s pangolin. Even though there were far fewer records of images in other southern African countries, social media appears to be a useful tool for collecting data on the distribution and ecology of the aardvark and Temminck’s pangolin. Understanding the ecology and distribution of the aardvark and Temminck’s pangolin in the Kalahari and other regions in relation to available prey resources and local climate is crucial for improving our conservation efforts of the species through informed management practices.
The Utility of Clinical Exome Sequencing as a First-Tier Diagnostic Tool in Critically Ill Infants in South Africa
(University of the Witwatersrand, Johannesburg, 2024) Campell, Lisa; Carstens , Nadia; Krause, Amanda
Genetic disorders are significant contributors to infant mortality, morbidity, hospitalisation, and the need for intensive care globally. The identification and diagnosis of genetic disorders in ill infants is challenging due to their indistinct, and often atypical disease presentations. Diagnosis is traditionally driven by a differential clinical diagnosis; however, broad genotype-first approaches are now the recommended strategy in ill infants. The use of NGS-based testing, including gene panels, whole exome sequencing and whole genome sequencing, has successfully been utilised to diagnose genetic disorders in ill infants and has begun to be implemented in global settings; however, representation of low- and middle-income countries is lacking. Local infrastructure, capacity and expertise significantly affect successful implementation in these contexts. We therefore aimed to investigate the utility and implementation of singleton virtual exome sequencing panels in a cohort of 32 ill infants in the South African State healthcare system, providing the first investigations into the use of NGS in a neonatal intensive care unit setting in Africa. Three virtual panels were used to analyse exome sequencing data: a curated panel of genes implicated in neonatal-onset conditions and enriched for variants in South African populations; a ClinVar panel; and the Developmental Disorders Genotype-to- Phenotype (DDG2P) panel. A diagnostic yield of 22% was achieved across the three virtual panels, providing a definitive molecular diagnosis in seven ill infants. These infants experienced changes in their clinical management as a result of this diagnosis, including the initiation of palliative care, familial screening and prenatal testing for future pregnancies. The adaptation of recommended implementation strategies was necessary in the South African context to address shortages in resources, infrastructure and bioinformatics capacity through the use of gene panels instead of whole exome sequencing and the use of locally available technologies; shortages in the trained genetics workforce through the reliance on primary care clinicians for referrals; and through the singleton sequencing approach to address the unavailability of parents for trio-sequencing and the additional cost factors. This pilot study demonstrated the utility of NGS for the diagnosis and management of ill infants in the South African State healthcare system and explored the challenges in implementing NGS technologies in resource-limited settings. The implementation strategy explored through this research provides a baseline from which advanced NGS diagnostic v strategies can be developed and from which scaled up investigations of utility in the South African State setting can commence.
Prosecutorial Attrition: Its Implications for South Africa’s Domestic and International Obligations to Uphold Women’s Human Rights
(2021) Lebitse, Palesa; Meyersfeld, Bonita
John Dugard states that a general rule of international law dictates that the conduct of a person with authority is an act of a state; however, the conduct of a private person is not considered to be an act of a state. An example is the state prosecutor. This research is concerned with the attrition of rape cases, with the purpose of determining whether rape prosecution failure is an international wrong of the state. To answer this, this study aims to broadly assess whether rape case attrition in South Africa is due to prosecutorial discretion being exercised in a deficient manner inconsistent with international human rights law, which leads to a violation of women's human rights and impunity for rape. This research will analyse evidence (i.e., the MRC report) that shows that prosecutors do not factually comply with international and constitutional standards. It is against the backdrop that this research argues that South Africa must ensure effective investigation and prosecution of rape cases to achieve compliance with international standards and the Constitution.
Work-based Learning for Occupational Competence
(University of the Witwatersrand, Johannesburg, 2024-10) Mazhinye, Rudo; Wedekind, Volker; Ramsarup, Presha
Policies in skills development in most countries consider work-based learning (WBL) crucial to Technical and Vocational Education and Training (TVET) because it integrates theory learned in the classroom and workplace practice to achieve occupational competence. Several authors argue that theoretical and practical knowledge integration is key to raising the occupational competence levels of students. It is, therefore, argued that strengthening this theory-practice relationship through WBL might lead to the kind of en-skilling required in the 21st-century economy. There are vast scientific reports on the benefits of WBL and workplace experience to students. However, only a few contemporary local empirical studies have advanced our understanding of the specific contributions of WBL towards building occupational competence in hospitality students. What students learn and how they learn to develop such competence remains unclear, indicating an existing gap in the literature. This necessitated an exploration of the learning experiences, modalities, and practices available to students to develop occupational competence during WBL. A qualitative approach was employed to investigate the contribution of WBL towards developing occupational competence in hospitality students. Face-to-face, semi-structured interviews and workplace observations were conducted with a purposively selected sample comprising N6 Report 191 students in a hospitality programme and their mentors. For analysing the data, I used manual methods for coding and identifying themes, which allowed me to closely engage with the data, immerse myself in the context, and uncover delicate and interrelated patterns and themes. I was able to interpret the data in a holistic and nuanced manner, resulting in a more comprehensive and insightful exploration of the research topic. Lave and Wenger’s (1991) and Wenger’s (1998) theory of situated learning in communities of practice was used to explain how students learn in the workplace. This research shows that learning in the workplace took place through social participation, which occurred through active engagement and interaction with others, specifically through experts and the community of pastry chefs. Rather than being an isolated activity, learning in the workplace was found to be a social process where students gained skills, knowledge, and understanding by participating in shared activities, discussions, and experiences with others. This study draws attention to four guided learning strategies identified by Billett (1994b, p. 11), modelling, coaching, scaffolding, and fading; which formed a central focus of the research. Within these strategies, experts used learning modalities such as observations, demonstrations, replication, and explanations to help students build occupational competence. These modalities show that learning in the workplace is both implicit and explicit. It was implicit through observations, demonstrations and replication and was made explicit when verbal descriptions, explanations and feedback were made. These affordances to WBL built a clear picture of interactions and engagements between students and experts and among members of the community. This made the expert pastry chefs and the community of practice the most valuable learning resources for developing students’ occupational competence in the workplace. However, the study highlights significant shortcomings in the workplace environment as a space for effective learning. While skilled in their trades, experts lack the necessary pedagogical qualifications and struggle to explain concepts clearly to students. Their protective attitude towards their jobs creates barriers to knowledge and skills sharing, as they seem more concerned with job security than with the development of occupational competence in students. Furthermore, their behaviour exhibits disrespect toward students, relegating them to menial tasks rather than meaningful learning experiences. Besides, experts are frequently too busy with production targets to dedicate time to mentoring students, further diminishing the value of WBL. This thesis contributes to the literature on WBL by offering a contextually grounded understanding of occupational competence in hospitality education. It expands the concept beyond technical skills to include relational, situated, and artefact-mediated dimensions of learning. Using Lave and Wenger’s (1991) theory of situated learning, the study shows how occupational competence develops through social participation and engagement with tools and practices, while also being shaped by contextual factors such as limited mentorship, power dynamics, and institutional constraints. These findings refine the application of situated learning theory within the South African TVET context and offer practical insights for improving WBL pedagogy and policy.
Virtual Teaching and Online Learning Ecosystem: Harnessing the Power of Digital Education for Equitable Educational Experiences
(University of the Witwatersrand, Johannesburg, 2025-05) Makda, Fatima Mahomed; Dlamini, Reuben
Virtual teaching and online learning have gained momentum as a response to the pandemic, revealing its potential and piquing the attention of the higher education sector. Higher Education Institutions (HEIs) are now recognising the value of this mode of instructional delivery for its unique affordances beyond maintaining educational continuity, but also for its adoption during non-disruptive times. The use of virtual teaching and the advancement of technology have led HEIs to invest in virtual instructional delivery, extending learning opportunities beyond closed brick-and-mortar environments to open online education ecosystems. To provide students with ubiquitous and equitable access to education, there is a need to understand how we can harness the power of digital education in an online education ecosystem while addressing structural and systemic barriers for effective virtual teaching and online learning. This research study aims to gain this understanding and provide insights into the opportunities offered by virtual teaching and online learning in the context of digitalisation in South Africa, a developing country. Additionally, the research study presents a sustainable Virtual Teaching and Online Learning Ecosystem Framework (VTOLE-Framework) for HEI’s, specifically tailored to South Africa’s unique needs and challenges, with a focus on transforming digital education contributing to Sustainable Development Goals (SDGs) 4 (quality education) and 10 (reduced inequalities). Grounded in pragmatism, this mixed methods study uses purposive sampling to gather data from 165 academic educators through an online questionnaire (containing both open-ended and closed-ended questions), supplemented by in-depth interviews with six academic educators across three HEIs (one urban, one rural, and one ODeL). Given its multifaceted nature, the research study draws on Socio-Technical Theory, Ecological Systems Theory, Transactional Distance Theory and the Community of Inquiry Framework to inform its analysis, which includes a thematic analysis of qualitative data and simple descriptive statistics and data visualisations for quantitative data. In responding to the research questions, the research study reveals six crucial aspects for facilitating equitable educational experiences in virtual teaching and online learning ecosystems (1) Harnessing the Power of Digital Education to Facilitate Virtual Teaching and Online Learning, (2) Core Elements Facilitating Virtual Teaching and Online Learning, (3) Optimising Virtual Teaching and Online Learning Environments Through Pedagogical and Student-Centred Design, (4) Higher Education Institutions Facilitating Support for Virtual Teaching and Online Learning, (5) Addressing External Macro Factors to Enhance Virtual Teaching and Online Learning Environments, and (6) Learning from the Past and Continuous Advancements to Build the Future of Virtual Teaching and Online Learning. Furthermore, in the development of the VTOLE-Framework, the key findings identified seven themes (1) Pedagogical and Student-Centred Course Design, Structure and Technology Integration, (2) Dialogue, Social Presence and Collaborative-Cognitive Learning Environment, (3) Academic Educator Professional Development and Teaching Competencies, (4) Student Efficacy, Agency and Support Cultivation, (5) Institutional Structure, Resource Availability and Education Equity, (6) Contextual Realities of National Infrastructure Readiness and Political Climate, (7) Socio-economic and Socio-cultural Context. The research study adds to the existing knowledge in the field by offering perspectives into harnessing the power of digital education while tackling structural and systemic barriers for virtual teaching and online learning in South Africa. It offers a practical solution of a VTOLE-Framework, outlining equitable access and digital inclusion for the successful implementation of virtual teaching and online learning in higher education.
The Development of a Competency-Based Programme for Management of Disease Outbreaks
(University of the Witwatersrand, Johannesburg, 2024) Engelbrecht, Linette; Schmollgrube, Shelley; Crous, Lizelle
Purpose: 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 health care 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 programme, consisting of ten modules was developed using the Backward design. In phase three the programme 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 health care 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 programme matrix consisting of ten modules, which was validated by three experts. Conclusion: A competency-based programme 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 nurses.

3. Electronic Theses and Dissertations (ETDs)

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