4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
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Item Maternal death at Leratong Regional Hospital: a six-year retrospective review, South Africa(University of the Witwatersrand, Johannesburg, 2021-11) Motau, Tumelo Ngaka; Chauke, LawrenceBackground: The aim of the study was to systematically examine the main causes of maternal deaths and contributing factors at Leratong Regional Hospital in order to recommend strategies that can assist in reducing maternal mortality at this level of healthcare. Objectives: The objectives of the study were to: determine the institutional maternal mortality rate at Leratong Regional Hospital between 2012 to 2017, compare the trend (year on year) in the iMMR over the study period, describe the profile of women who died during the period under study, describe the clinical and surgical management of the women who died, and to determine the leading causes of maternal deaths, contributing factors and avoidable factors. Methods: A hospital based retrospective study based on patient clinical records at Leratong hospital. It included all the maternal deaths that occurred at Leratong Regional Hospital during the six-year study period (2012-2017). Results: There was a total of 78 maternal deaths with 32441 live births giving the MMR of 240 per 100 000 live births. However only 74 files could be analysed. The results showed that there was a rise in the maternal mortality rate over a six years period. The majority (70, 94.5%) of the women who died were African, aged between 20-35 years (56, 76%), multigravida (54,73%) with a parity of three or more (23, 31%). Obstetric haemorrhage was the leading cause of maternal death particularly postpartum haemorrhage (11.14%) followed by non-pregnancy related infections, sepsis and eclampsia. Conclusion: Maternal mortality has decreased according to recent confidential enquiry into maternal death in South Africa (2017-2019) However our study did not demonstrate a decline but rather an increase in the maternal mortality rate at Leratong. It showed that most of the maternal deaths were avoidable and the need for urgent interventions in terms of education, improving access to health care facilities, intensifying health care worker skills training and better transport systems between health care facilities is important.Item Financial inclusion in South Africa: An analysis of the financial sector regulatory framework and proposals for reform(2018-09) Duma, Amanda; Kawadza, HerbertAbstract Not Available.Item COVID-19 and health care worker exposure at Chris Hani Baragwanath Academic Hospital(University of the Witwatersrand, Johannesburg, 2021-12-05) Glatt, Sara Chaya; Menezes, Colin; Winchow, Lai ling; Tsitsi, MerikaBackground: Health care workers (HCWs) are at an increased risk of acquiring coronavirus disease 2019 (COVID-19). Appropriate risk assessments and testing are essential to reduce transmission and avoid workforce depletion. Objective: Investigate the risk of COVID-19 infection among HCWs at Chris Hani Baragwanath Academic Hospital who fulfil the Person Under Investigation (PUI) case definition or had exposure to a confirmed COVID-19 contact. Methods: A retrospective review of HCW records was conducted over a two month period. Data collected included demographics, exposure type, risk level, and COVID-19 test result. Frequency distribution tables, bivariate analyses and univariate and multivariate analyses were conducted. Results: Among the 1111 HCWs reviewed, 643 were tested with 35.6% positive results. PUI’s accounted for 62.4% of positive cases. Symptomatic HCWs with no known contact were at a greater risk of infection than those with a patient exposure (p=0.000). Risk of testing positive was higher after a patient exposure (p=0.000) compared to a co-worker contact. Conclusion: There is a higher positivity rate among HCWs than the general population. The presence of symptoms warrants testing. Nosocomial transmission was derived from patient more than co-worker contacts.Item Surgical aortopulmonary shunts - a thirty-seven year experience in a South African tertiary institution(University of the Witwatersrand, Johannesburg, 2019-11) Dladla-Mukansi, Nontobeko Charity; Cilliers, Antoinette; Mammen, Vijay; Vanderdonk, KathyIntroduction: The surgical aortopulmonary shunt is a valuable palliative procedure in the management of congenital heart diseases. There is a paucity of data regarding aortopulmonary shunts in the developing world, including South Africa. Objectives: The primary objective was to describe the demographic, clinical and echocardiographic characteristics of children between ages 0 and 14 years that underwent surgical aortopulmonary shunts. The secondary objectives were to describe trends in aortopulmonary shunt designs, outcomes in terms of morbidity and mortality, progression to definitive surgery and to assess patency of shunts. Material and Methods: A retrospective clinical audit of patient files who underwent an aortopulmonary shunt between 01 January 1980 to 30 December 2016 was undertaken at Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto, Johannesburg. The study period was divided into 3 stages and for descriptive purposes as follows: 1980-1991 refers to period 1, 1992-2003 refers to period 2 and 2004-2016 refers to period 3. Results: A total of 177 aortopulmonary shunts were done over the 37-year study period. Of these 177 patients, 165 (93.2%) patient files were available. Fifty-six percent of the patients included in the study were male. The majority of patients were from the Gauteng Province (76.8%). The four most common diagnoses across the entire study period were tricuspid atresia (26.0%), pulmonary atresia with VSD (23.7%), tetralogy of Fallot (23.2%) and complex cardiac lesions (16.9%), with no particular trend in the proportion of these diagnoses presenting across this study period. There was no statistical difference between period 1 and 2 (p-value a=0,328) and between period 1 and 3 (p-value b=0,548). The total number of all surgeries done over the entire study period was 2145, of which 8.3% were aortopulmonary shunts. Period 1 had the highest percentage [35 (10.9%)] of aortopulmonary shunts compared to the total number of surgeries performed. There was a decline in the number of aortopulmonary shunts performed over the study periods 1-3. With no statistical difference across periods as shown in table 1 with p-value a and b. Of the different types of aortopulmonary shunts, most patients [157 (88.7%)] had a modified Blalock-Taussig shunt (BTS). The remainder of the shunts included 3 (1.7%) classic BTS, 12 (6.8%) central shunts and 5 (2.8%) unknown BTS. The percentage of modified BTS done increased from 80% in period 1 to 87.3% in period 2 and to 95.2% in period 3. Period 1 had the most complications (28.6%) compared to 11.4% in period 2 and 19.1% in period 3. Sepsis as a complication following surgery increased over the study period from 2.9% in period 1 to 3.8% and 7.9% in periods 2 and 3 respectively. Early mortality was 17.1%, 26.6% and 25.4% from periods 1-3 respectively. Late mortality declined from 17.0% in period 1 to 11.4% and 0% in periods 2 and 3 respectively. Only 37 (20.9%) patients were documented to have further surgery after the initial aortopulmonary shunt. Across all three study periods, no blocked shunts were documented. Conclusions: This study describes the characteristics and outcomes of aortopulmonary shunts over a 37-year period in a tertiary care resource limited low to middle income country setting. The commonest cardiac lesions for which aortopulmonary shunts are performed are tricuspid atresia, pulmonary atresia with VSD, tetralogy of Fallot and other complex cyanotic cardiac lesions. The frequency of aortopulmonary shunts compared to total surgeries has corrective surgery for these cardiac lesions. The modified BTS is the most frequently performed aortopulmonary shunt used for palliative surgery in our setting, which is a similar trend in developed countries. The morbidity and mortality in this study is higher than developed countries, with sepsis being the most common complication. Attention to infection control practises need to be emphasized peri- and post-operatively in our hospitals.Item Employer brand activities for effective responses to gig economies in South Africa(University of the Witwatersrand, Johannesburg, 2021) Makhafola, Kelebogile; Roselyne, KoechThis research paper aims to investigate employer brand activities that effectively respond to the engagement dynamics introduced into the working environment by gig economies. The focal points are elements which contribute to the sustenance of the organisations’ brand equity, brand reputation and competitive advantage. The paper uses two frameworks to guide the process of investigating the employer brand activities which influence employer brand attractiveness, employee value contribution, and the organisational culture amongst other research attributes and variables within this paper. The first framework used to approach the analysis is the employer brand experience framework and the second framework is the framework on Human Resource Management (HRM) and platform ecosystems in the gig economy. The study follows a qualita-tive research method, introducing the use of semi-structured interviews. Broadly, the findings communicate that effective employer branding that keeps the employees involved and valued will most likely enjoy a higher retention and productivity rate, further stimu- lating the organisational bottomline. Accessible research and material regarding employer brand effective in context to gig economies within South Africa is not popularly explored. Further- more, the investigation of employer brand activities and programmes are limited to the traditional organisational structures which exclude the attributes introduced by nuances in gig economies (roles, responsibilities, productivity, brand loyalty, the measurement of value contri- bution and innovation). The key findings further elaborate that the participating organisations (employer brands) and their employees aren’t confidently aware of the introduction of gig economies as a direct effect to their organisation. Through the findings, it further appears that they, the organisations, are not adequately prepared to embrace the new world of work in light of policies, Human Resource Management systems and work related structuresItem Small Medium Enterprise (SME)’s Competitiveness within a volatile regulatory environment in South Africa(University of the Witwatersrand, Johannesburg, 2021) Shai, Gift; Wotela, Kambidima; Ameyibor, LeefordSMEs have been established as the driving force for developing the South African economy and the main source of competitive advantage. They are recognized as agents of industrial change and innovation; they are also seen as an important vehicle for employment creation and economic development. On the other hand, we have a regulatory environment that is volatile and, as a result, poses challenges to the competitiveness of the SMEs in South Africa. This study is an attempt to determine the level of competitiveness of the SME within the emerging markets as well as how SMEs can monitor their external environment. In addition to that, this study establishes the coping mechanisms of the SMEs and suggests ways to enhance their competitiveness. A case study qualitative strategy was adopted for this study which allowed research to get in-depth understanding about the case. Semi-structured interviews were conducted in which 8 formal SMEs with more than 3 years in existence were targeted. The findings reveal that SMEs need to have research and development measures in place which will enable their organisation to know what is happening around them, which coupled with information technology, can enable them to plan for all anticipated changes. This, in consequence, will help them build their capabilities in a way that it will give them a competitive advantage. It is also of paramount importance for SME to have a Quality Management System consisting of policies and procedures in place that will guide the crafted strategies. Strategies coupled with information gathered from research and development and relevant training initiatives can be put in place. Adaptation to change mechanisms can also be forged that will make the SME sustainable and perform better even under volatile environmental conditions. Lastly, governance within the SME plays a vital role in enhancing competitiveness. Good governance creates an organizational culture that keeps employees motivated, reduces workforce fluctuations and increases value for all the stakeholders, both internal and external.Item The Use of Data Analytics in Strategic Decision-Making in a South African Pay-TV Company(University of the Witwatersrand, Johannesburg, 2021) Reddy, Prebashni; Chidzungu, ThandiweThe extent to which data and analytics inform decision-making in the Pay-TV industry in South Africa is not known. Netflix used data to achieve a competitive advantage and became a leading player in the streaming services arena. Blockbusters no longer exist because they did not change with the times and listen to what their customers wanted. Companies must use the data that they collect to make decisions and remain relevant in a continually evolving business environment. This research aims to evaluate the extent to which senior management use data and analytics to make decisions. The study measured the relationship of each of the following 3 constructs: data literacy, data accessibility, and data usage with data-driven decision making. The researcher carried out an exploratory study employing a quantitative and observational design approach. Adopting a cross- sectional methodology and drawing on a purposive nonprobability sample of senior managers from a South African Pay-TV company. An online structured interview survey was used to collect data from a population of 294 senior managers who were assumed to be decision-makers. The findings of the study were that data usage, data literacy, and data accessibility each have a positive relationship with data-driven decision-making. The research identified opportunities for the South African Pay-TV company to improve the use of data in decision-making for better- informed decisions and better business performance through a 3-step programme which was recommended should form part of their data strategy. To improve data literacy amongst senior management and other decision-makers a continuous programme of training in the skills to interpret and understand data and analytics is recommended as the first step and arguably most important step. Crafting and implementing an accessibility strategy is the next step and driving usage of that data and analytics is the last and crucial step in the programme. The findings of this study supported by previous research indicate that this company will improve performance and outperform its competitors with the use of data in decision making.Item An aftermarket parts framework for capital mining equipment in South Africa: An OEM Perspective(University of the Witwatersrand, Johannesburg, 2021) Ganasram, AmithThe purpose of this research study is to create an aftermarket framework for capital mining equipment in South Africa, which can be applied in organizations that currently are OEM Manufacturers for mining equipment. The background literature that was reviewed for this study focused on aspects of SPM, SCM, inventory management, parts pricing methodologies, processes, purchasing, CRM and maintenance management. These topics were reviewed in detail, the definitions of these concepts and their respective components were identified and acknowledged during the learning journey. Models were touched on in this research study followed by a theoretical framework which was defined making use of the sourced academic literature. To achieve the objectives set out in this study, there was a case study research conducted on an OEM, which was utilised for the full duration of the research. The case company used in the research is a Global OEM that manufactures mining equipment for the various stages of mining. It is projected that there will be a combination of 12 semi-structured and 10 structured interviews that will be conducted where the semi structured will focus on the customer and the structured will focus on the internal employees of the case company. All interviews will be conducted personally by the researcher to ensure that all information is treated in the strictest of confidence. The data collected from the interviews will be transcribed from their recordings and will be qualitatively analysed. Research aims and objectives of this research study is: To systematically review previous work on aftermarket parts supply and aftermarket support. To identify aftermarket parts issues that are not supported by sourced literature which relates to my research topic, and which my research will be able to reveal or provide additional insight from a a mining OEM perspective. To study aspects with respect to CRM, aftermarket strategy, pricing and aspects related logistics. To identify an appropriate aftermarket framework for aftermarket parts of aging and new capital mining equipment Key results or arguments - To be completed in the Empirical Research Conclusion – To be completed at the end of the researchItem International Fisher Effect and Purchasing Power Parity: The case of the South African Rand and US Dollar(University of the Witwatersrand, Johannesburg, 2021) De beer, Ricardo; Nattoh, Dina; Wotela, KambidimaThis study aims to investigate the presence of the International Fisher Effect (IFE) and Purchasing Power Parity (PPP) in the case of the South Africa Rand (ZAR) and the United States Dollar (USD) using monthly data that span from January 2014 to December 2019. The study adopted an ordinary least square (OLS) model and the Granger causality econometric technique to achieve the stated objectives. Based on the IFE and PPP assumptions, the OLS results indicate an insignificant positive relationship between the inflation differentials in South Africa and the United States of America. The model revealed that a 1% increase in the inflation differential between the two countries will trigger an increase in the South African interest rate which will furthermore cause an appreciation of the exchange rate in the long run. The model revealed the presence of the IFE and PPP between the ZAR and the USD. The pass-through effect of the IFE and PPP adjustment is incomplete in the analysis due to the peculiarities of the South African economy (reliance on community and its volatile effect on the country’s foreign earnings, corruption, civil unrest, concern around political instability, etc.). In light of the above, the study recommended policy measures that focus on diversifying the foreign earning source of the country and policies that enhance the level of political stability in the country to further increase the level of confidence foreign investors have in the stability and monetary policy of the countryItem An evaluation of the effectiveness of financial inclusion programs in the South African financial sector(University of the Witwatersrand, Johannesburg, 2021) Korte, Maude; Pamacheche, RukudzoEmpirical literature argues that FI has a positive bearing on socio-economic aspects for developing economies, evidence of this is found in Sarma and Paris (2011), Ramakrishna and Trivedi (2018) and World Bank (2020). Accepting the positive impact, the correlation between FI and expected social benefits one needs to understand in the context of the society in which it exists for benefit maximisation. Amidži et al.(2014) explain that understanding the correlation in its societal context is critically important, as these supply and demand-side factors have significant impacts on FI's efficacy. The SA FI tactics to date have resulted in 80% of the population having access to bank accounts, however, dormancy on these accounts are estimated to be as high as 30% - 40% (FinMark, 2019). The central thought around a bank account led theory is that once a consumer has access to a bank account, the consumer is likely to use additional products and services (called secondary products in this context). How much of these secondary products and services have been taken up under the current tactic is unclear, as results are not published regularly. What is clear is that the shape of the FI landscape for SA has changed from many consumers being involuntary excluded (National Treasury Report, 2015) to many consumers volunteering exclusion. This can be seen in the dormancy ratio, a definitive indication of voluntary exclusion. Despite the landscape changes and the reported mismatch in supply and demand, SA FI strategy has remained unchanged since 2002. This paper interrogates the viability of the current FI strategy and argues for a new perspective of FI; it finds that SA will need to pivot from a supply-led focussed plan to a demand-led focused plan achieve the last mile of FI.