4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
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Item Could Not Sing in the Dead Heat: Liner Notes Under the Sun(University of the Witwatersrand, Johannesburg, 2022) Ramphalile, Molemo Karabo; Schuhmann, AntjeOn the one hand we place blackness as a historical if inconsistent category inextricable with morbidity, disfavour, depravity, mystery, wretchedness, penumbra, opacity or absence of light, and the abyssal – in both secular and religious metaphysical symbolism. On the other hand we place space as a historical and physical category denoting area, range, clearance, scope, volume, expanse, lacunae, aperture, margin, and in its instance as verb – opening, arranging, ordering, placing, separating, and locating; which in cosmography, geography and cartography finds its varied imaginative and applied interpretation. We coalesce what is in both hands in order to envisage how blackness persistently becomes and comes to be the extractable property of sub-Saharan Africans. Through various ontological-cosmographic- geographic designations such as Torrid Zone, ‘land of the blacks’ or even terra nullius, we encounter visualisations of a territory and expanse that is always either completely devoid of people or inadequately peopled, that is, the territory whence blackness as inextricably embodied (or fleshened) exists and is cultivated. Blackness: not only does it determine our modes of being, or non-being, in this world, but for us in this study, it is also an experiential, experimental and analytical lens permitting the suggestion and scribing of historical narratives and discourses that centre the inveterate decentring of blacks. In the tradition of liner notes, this study is written in a performative relation to the subject or object at hand; there under the sun, in the dead heat.Item Voiding cystourethrography in the renal pre-transplantation workup: an essential investigation?(University of the Witwatersrand, Johannesburg, 2022-10) Sofianos, Zelia; Rajkumar, Leisha; Lucas, SusanINTRODUCTION: Due to resource constraints in the South African public healthcare sector, patients with End-Stage Renal Disease (ESRD) are eligible for renal replacement therapy only if they are also found to be eligible for renal transplant. AIM: The aim of this study is to document Voiding Cystourethrogram (VCUG) findings in potential renal transplant candidates to assess the contribution of the VCUG as a standard investigation in the renal transplant workup. METHODS: Of the patients who underwent VCUG in Klerksdorp/Tshepong Hospital Complex (North West province, South Africa) from 1 January 2019 to 31 March 2020, 85 patients were included in the study and their VCUG findings retrospectively analysed. RESULTS: The mean age was 40.0 years (range 21-62 years), with males constituting 57.7% of patients and females 42.3%. Lower urinary tract abnormalities were identified in 24.7% of patients, some of whom had more than one abnormality. Of the total abnormalities, VUR (vesicoureteral reflux) accounted for 15.3%, bladder diverticula for 5.9%, urethral strictures for 3.5% and a significant post-void residual volume for 4.7%. No comorbidities were found to have a statistically significant association with the presence of VCUG abnormalities. CONCLUSIONS: To ensure that patients with End-Stage Renal Disease are adequately prepared for renal dialysis and potential renal transplant, and that their comorbidities and lower urinary tract are optimised should abnormalities be identified on VCUG, the VCUG remains an essential investigation in the renal transplant workup.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 Adherence to the Standard Treatment Guidelines in managing patients with hypertension at Chiawelo Community Health Centre, Gauteng, South Africa(University of the Witwatersrand, Johannesburg, 2022-04) Dawduth, Nikkeeta; Torlutter, MicheleBackground: Hypertension is a highly prevalent chronic disease, causing significant morbidity and mortality and is poorly managed and controlled in primary care, with only 24.5 to 56% of patients being controlled. Aim: The aim of the study was to determine health care worker adherence to the Standard Treatment Guidelines in managing hypertensive patients in primary care. Methods: The study was conducted at Chiawelo Community Practice Johannesburg. A retrospective file review was done on 261 hypertensive patients and information extracted to determine whether health care workers performed correct baseline tests at diagnosis; correct investigations were done on ongoing basis; lifestyle modification was addressed; and correct pharmacological therapy was prescribed and titrated. Data analysis included descriptive statistics and bivariate analysis. Results: A total of 77% of participants were female and 23% were male of which 80.5% participants had co-morbidities. Patients were treated by a doctor in 97% of cases; 84.3% by clinical associate, and 0.6% by a nurse only over time. Baseline findings recorded in the file at diagnosis were: weight 65.9%, height 73.2%, potassium 32.2%, BMI 50.2%, abdominal circumference 51.7%, and urine dipsticks 47.9%. Vitals and investigations recorded in the file: BP 99.6%, weight 19.5%, blood glucose 86.6%, creatinine 95.4%, eGFR 94.3% and urine protein 3.4%. Lifestyle modification was recorded for 23.7% and medication adherence was checked and recorded for 36.4% of patients. The correct antihypertensive medications were prescribed in 96.5% of patients but titrated correctly in only 73.5% of patients. 52.8% of patients were controlled on treatment. Conclusion: Adherence to guidelines by health care workers was suboptimal and several aspects of care warrants quality improvement processes.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 Financial inclusion through WhatsApp banking in Johannesburg(University of the Witwatersrand, Johannesburg, 2022) Miller, Jade Rowan; Balabanoff,GarthApproximately three billion people will use mobile banking by 2024. Mobile devices and widespread Internet access are helping to boost mobile banking's popularity. Retail banks can now offer their customers even more convenience with mobile banking applications like WhatsApp. Consumers and financial institutions have embraced advanced technologies, including mobile banking, in recent years. Social media, mobile banking and new ideas like WhatsApp banking have made it easier for people to do business. Mobile banking is now possible thanks to high smartphone penetration and technological advancements. The fourth industrial revolution will continue to exponentially transform the modern economy. Globalisation has forced banks to open new channels to remain competitive in today's market. Banks have had to cut costs and improve their financial position by introducing new products and services. Mobile banking has grown rapidly globally due to the rapid development of information technology. Due to multi-channel distribution, most banks now have a global presence with cross-border customers. A quantitative approach was taken to examine factors that may influence behavioural intention to use WhatsApp banking in the context of financial inclusion. A questionnaire was used as the primary data collection instrument. The survey was conducted using an online questionnaire distributed to people living in Johannesburg, South Africa. The study adds to the body of knowledge by identifying factors that influence WhatsApp banking adoption, particularly in developing countries. The Technology Acceptance Model by Davis (1985) was used to investigate behavioural intention to use WhatsApp banking. My findings show that perceived trust, banking inclusion, perceived usefulness and awareness all play a significant role in WhatsApp banking adoption. Managers in financial institutions should focus on increasing consumer trust across all age groups to increase customer comfort with non-traditional banking platforms in general and thus increase financial inclusion. This is crucial because ix WhatsApp banking has the potential to bank the unbanked and underbanked while also increasing financial inclusion.Item The nexus between the World Governance Indicators’ scores on corruption and the financial performance of SOEs in South Africa(University of the Witwatersrand, Johannesburg, 2022) Mdluli, Mthokozisi XolaniSouth Africa, according to Crompton et al. (2017), is dealing with a triple threat of poverty, inequality, and unemployment. As a result, the government is faced with the task of meeting all of these urgent demands while being hampered by a tight budget and weak economic growth. Procurement is a critical component of the government's service delivery system, and it has been utilised as a policy tool to achieve the government's socioeconomic goals (Badenhorst-Weiss, 2012). Government spending is required to be thoroughly thought out on this basis before any public funds are spent. As a result, government expenditure should be monitored and evaluated as part of the architecture of all government-led projects (Crompton et al., 2017). SOEs (State-owned entities), also known as public entities, are tasked with specific responsibilities by the country's constitution in order to assist the state in fulfilling its mandate (Ovens, 2013). In line with international trends, South Africa has implemented corporatisation, or the transfer of state assets or agencies into state-owned corporations, in a number of areas to encourage more effective and efficient service delivery. Increased public procurement is the result of this. Public procurement involves a large amount of money, which has attracted corruption because of the scale at which it is carried out (Crompton et al., 2017). According to the South African Department of Commerce and Industries, government purchasing power contributed between 15% and 25% of GDP in 2016 (Makube, 2016). Makube (2016) estimates that, between 2013 and 2016, public infrastructure investment in healthcare facilities, schools, water, sanitation, housing, and electrification totalled R827 billion. As a result, the SOEs have been subjected to outside intervention, as well 2 as possible wrongdoing and corruption. According to recent media reports, the country has unacceptably high levels of corruption (Mantzaris, 2016). Understanding how this corruption affects the workings of SOEs is important if the country wants to attempt to start addressing this scourge. Therefore, this study seeks to investigate the relationship that exists between a known measure of governance in a country, namely the World Governance Indicators and the financial performance of SOEs in South AfricaItem The adoption of efficient technology in emerging markets within State Owned Bank in South Africa(University of the Witwatersrand, Johannesburg, 2022) Malatji , Jaftha Sechube; Dladla, PholileThis study aims to explore the adoption of efficient technologies in a South African state-owned enterprise (SOE) or state-owned bank (SOB), specifically investigating the factors that affect how efficient technologies are adopted, the challenges that come during the adoption phase, and the advantages that result from successfully adopting efficient technologies. The research study applied a qualitative research design and used interviews with open-ended questions to collect data. The findings reveal a complex landscape influenced by various elements such as communication, leadership, organisational culture, and operational efficiency. The study highlights the importance of technology adoption within an SOE or SOB. Based on the findings, recommendations were formulated that can be used to enhance how the South African State-Owned Bank can manage the adoption of new technologies efficiently while reducing the risks connected with technology adoption. Despite certain limitations, the study provides valuable insights into the intricate dynamics of new technology adoption in a traditionally oriented country like South Africa.