4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
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Item The Psychosocial Impacts of COVID-19 on Children: A Parents’ Perspective(University of the Witwatersrand, Johannesburg, 2024) Macingwane, Nontokozo; Mathebula, MphoThe societal and psychological repercussions of the COVID-19 pandemic on children have become a crucial focus, necessitating thorough examination. Given the pandemic's disruptions in various aspects of children's lives, ranging from education to social interactions, a comprehensive investigation is vital to unravel the intricate impacts on their well-being and development. This Qualitative research delves into the psychological and social consequences of COVID-19 on children aged 6-17 in Gauteng, South Africa. Through semi-structured interviews with seven participants, including parents and guardians, the study aimed to discern the psychological and social effects of the pandemic on their children. Employing thematic analysis, six major themes were identified: Psychological and Emotional Impact, Fear and Anxiety, Adjustment to Changes in Routine and Social Contact, Changes in Everyday Functioning, Impact on Learning and Education, and Changes in Behaviour and Emotions Post-Lockdown. The thematic analysis uncovered a range of emotional responses among children during the COVID-19 pandemic, including loneliness due to extended indoor confinement and diverse expressions of fear and anxiety. Furthermore, the findings emphasized the challenges in adapting to changes in social contact and routine, disruptions in everyday functioning, and notable consequences on children's learning and education. The COVID-19 pandemic significantly impacted the psychological well-being and social functioning of children, underscoring the need for focused support to enhance their resilience and overall well- being. The findings highlight the importance of prioritizing social connections, adaptive coping mechanisms, effective reintegration into educational settings, and collaborative efforts among stakeholders to support children's psychological resilience and overall well-being during and after the crisisItem Children placed in alternative care: experiences of primary caregivers pending finalisation of the Children’s Court Inquiry(University of the Witwatersrand, Johannesburg, 2024) Mdluli, BusisiweThe goal of the child welfare system in South Africa is to create preventative and early intervention programmes. However, statutory intervention becomes necessary when a child needs emergency protection. The removal of a child from their primary caregiver and placing the child in alternative care can be traumatic for both child and primary caregiver. However, most research studies have focused on children’s experiences of removal to alternative care pending finalisation of the Children’s Court Inquiry. The purpose of this study was to explore the experiences of primary caregivers whose child had been removed from their care and placed in temporary safe care. To explore their experiences a qualitative approach, specifically a case study research design. The theoretical framework underpinning the study was ecosystems perspective related to the person-in- environment social work concept, and Kübler-Ross model of grief. The study was undertaken in Johannesburg and the sample consisted of 12 purposively selected adult primary caregivers. To gather data, face-to-face interviews were conducted. An interview guide comprising of open-ended questions, was utilised as a research tool. Thematic analysis was used to analyse the data. The main findings of the study were that regardless of socio-economic status, age and reasons for the removal, most primary caregiver usually feel devastated when their child is removed. The sometimes develop a lack of trust in the justice system and the social work profession. Recommendations are made, based on research findings, of how social workers can improve the quality of services rendered to primary caregivers when statutory intervention is necessary and the child is placed in temporary safe care pending finalisation of the Children’s Court InquiryItem Virological response in children and adolescents switching to dolutegravir based regimens in Johannesburg, South Africa – A Longitudinal Cohort Study(University of the Witwatersrand, Johannesburg, 2023) Mafora, Tshiamo; Technau, KarlIntroduction: Dolutegravir (DTG) was introduced into South African HIV management guidelines in November 2019, and has since been the mainstay of both adult and paediatric first line antiretroviral treatment (ART) regimens. Following its rapid and widespread introduction we assessed the rate of virological suppression over two years in paediatric patients switching to DTG as part of first line treatment. Methods: We performed a retrospective cohort study at Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa. Children and adolescents already on first line ART who switched to DTG (between November 2019 and November 2021) were included. Baseline characteristics (at DTG switch) included age, weight, gender, viral load (VL), CD4, and pre-switch regimen. Past ART exposure and past viraemic periods (years VL >1000 copies/ml) were assessed and VL suppression rates (< 50 copies/ml) were calculated at 6, 12 and 24 months post-switch. Associations with non-suppression were assessed using uni- and multivariate analysis. Results: Of the 747 participants that were switched to DTG, 724 (97%) qualified for a VL and 697 (96%) of those had at least one VL done after switch. Overall, 83% (450/543) were suppressed at 6 months, 86% (434/504) at 12, 91% (487/534) at 24 months. Overall, at a median of 637 days after switch, 90% (624/697) were suppressed at their last VL. Factors associated with not being suppressed at the last VL included: missing a follow-up visit by more than 90 days post-switch to DTG (OR: 3.2 [CI:1.5-6.8], p=0.003), switching to DTG with a VL of 50-1000 rather than <50 copies/ml (OR 2.0 [CI:1.1-3.9], p=0.042), having the blood test done during July December (OR 2.0 [CI:1.2-3.4], p=0.011), and having had exposure to viraemia ≥1000 copies/ml for more than two years between first ART start and DTG switch (OR: 1.9 [CI: 0.9-3.7], p=0.071). Conclusion: In our population, similar to other studies, VL suppression was effectively maintained in the majority of patients after switching to DTG. The switch did however result in a loss of suppression in some patients and caution is needed in children and adolescents with missed visits and extensive prior viraemiaItem Parental Perception of the Impact of COVID-19 on Children’s Psychosocial and Cognitive Development(University of the Witwatersrand, Johannesburg, 2023-05) Chopdat, Habeebah; Schutte, EnidCOVID-19 caused a myriad of global problems. This study aimed to establish whether the COVID-19 pandemic and the preventative measures that occurred as a result thereof had an impact on the cognitive and psychosocial development of 6–13-year-old learners in South Africa as per parental perception (N=31). A mixed methods research design was used, and the data collection occurred through an electronic survey consisting of specifically designed Likert scale items to collect numerical data, along with open-ended questions which were posed to collect qualitative data. The data was analysed by means of t-tests and a one-way ANOVA for the quantitative data analysis, whilst a thematic analysis was used to analyse the qualitative data. The t-tests and one-way ANOVA showed that there were no statistically significant differences in the cognitive and psychosocial abilities of children across gender (p>0.05), school type (p> 0.05), and the amount of school missed (p> 0.05). Certain themes emerged through the qualitative analysis including both positive and negative themes relating to the learning situation during the lockdown; behavioural changes were also evident in some of the sample; however, others did not report any differences compared to pre-COVID-19. Additionally, children were reported to have worries and concerns over the pandemic as well as the effects thereof. This study contributes to understanding the long-term effects that the measures associated with a global pandemic have on children. As per this study, it appeared that children’s development amidst a pandemic was not impacted by their socioeconomic status however, due to certain limitations of this study, including the sample recruited not being an accurate representation of the socioeconomic divide in South Africa, further studies are required.Item The psychological impact on adult children who moved back home due to the financial consequences of COVID-19(2023-08) dos Reis, Danielle; Marchetti-Mercer, Maria ChiaraThe COVID-19 pandemic has had a significant impact on most countries across the globe. It also resulted in severe losses in various aspects of life such as work, school, and the family. Family life was particularly strongly affected by the lockdowns that were implemented to curb the spread of the virus. Many young adults returned to the parental home, experiencing a disruption in the family life cycle, because the decision to make this move delayed their transition to adulthood and parenthood. The purpose of this research study was to explore the psychological impact on such young adults of returning to their parents’ home because of the financial consequences of the COVID-19 pandemic in Gauteng, South Africa. The study drew on Family Systems theories and the Family Life Cycle model to understand this phenomenon and its impact on South African families. The participants of the study included young South African adults between the ages of 23 and 30 years. The data gathered from semi-structured interviews were analysed using thematic analysis. The findings show that many young people moved back to their parents because of economic challenges experienced as a result of difficulties related to finding or retaining employment. Moreover, the study found that the return home had negative implications for participants’ sense of independence, privacy, and mental health, despite increased emotional and financial support from parents. This influenced changes in their perceptions of adulthood, as well as a concurrent sense of stagnation and failure. The study also found that the return home of adult children led to an increase in interpersonal connectedness on the one hand, and to conflict between adult children and parents or guardians on the other, and it created a change in the parent-adult-child dynamic. The study adds to the emerging body of work on the impact of the COVID-19 pandemic on family life and functioning.Item Investigating levels of cybersecurity risk awareness by South African Parents(University of the Witswatersrand, Johannesburg, 2022) Masutha, HangwelaniThe rapid development in technology and easy accessibility to the internet has resulted to an increase in cybersecurity challenges on a daily basis. Children get introduced to the internet at an early age when they still have very low levels of perception. As a result, children get exposed to cybersecurity risks such as cyberbullying, cyberstalking, stranger danger, identity theft and phishing scams. These necessitates parents’ awareness of such risks as parents play a vital role in ensuring safety and teaching safe practices in order to protect children while they navigate the internet. This research examined the levels of South African parents’ cybersecurity risks awareness and knowledge which children face when interacting on the Internet. It also examined the role parents play in educating their children on such risks and examined whether parents applied appropriate security measures in order to protect their children while accessing the internet. The research used quantitative methods to collect data. A survey of parents with children between the ages of 3 and 12 years who live with their children in the households, was undertaken. The results showed that that although majority of the parents were aware and knowledgeable of the cybersecurity risks, lower levels were evident on parents educating their children of those risks and lower levels were also reported on the application of security measures. Therefore, children were still compromised and exposed to such risks while they access the internet which necessitates parents further improving on educating children and also applying necessary security measures in order to protect them while accessing the internet.Item Correlation of maternal age to their children born with orofacial cleft treated at Wits Oral Health Centre(2024) Ravat, NaseebaObjectives: Orofacial Clefts (OFC) are the most common congenital malformations of the craniofacial complex. OFC affects 1/700 live births globally with extensive variability across geographic origin, racial and ethnic populations. In South Africa the prevalence of OFC is 0.3 per 1000 live births. Advanced maternal age has been associated with cell division errors, that can predispose to the occurrence of OFC. This study evaluated the correlation of advanced maternal age with the occurrence of OFC and the types of OFC. Methods: A retrospective cross-sectional study was conducted to review records of 105 children with OFC from 1 January 2013 to 31 December 2019. The clinical information reviewed included the child’s sex, race and type and laterality of OFC. The mother’s demographic information including the age at birth to the child with OFC, race, marital status, education level, number of children that the mother gave birth to as well as the familial history of OFC was documented. Stata version 17.0 was used to analyse the data and statistical tests were conducted at a 5% significance level. Results: The mean maternal age at the birth of a child with OFC was 26 years, with a range of 17-46 years. The majority of the mothers were Black (64.76%) followed by White (14.29%), Indian (11.43%) and Coloured (9.52%). There were more female children with OFC (51.43%) compared to male children (48.57%). Most of the children were Black (63.81%) followed by White (12.38%), Indian (11.43%) and Coloured (10.48%). The predominant type of OFC was the unilateral cleft lip and palate (CLP) occurring on the left side of the face (39.05%) compared to the right side (23.81%). Bilateral CLP was observed in 28.67% of children, and 0.57% of children had a cleft palate only. Mothers who gave birth to children with right CLP were older (over 30 years old) compared to those who gave birth to children with left CLP (under 25 years old). No statistical significance was found between maternal age and OFC. Conclusions- The clinical appearance of OFC highlighted the maternal age differences to type of OFC in our study sample. Children with right CLP were born to older mothers whilst the youngest mothers had children with CP. The majority of the mothers were unemployed, single parents with low level of education. This signified the burden of care these single parents have in caring for their children with OFC.Item Surveillance of gastrointestinal infections in individuals over the age of 5 years in South Africa(2024) Johnstone, Siobhan LindsayGastrointestinal infections cause significant mortality and morbidity, especially in Africa. While children ≤5 years of age bear the brunt of diarrhoeal disease, there is a significant burden in older age groups. Limited data on aetiology in these older age groups limits appropriate interventions. Diarrhoeal surveillance is important for monitoring disease trends in a population and should inform testing and treatment guidelines, and interventions. This body of work evaluated the epidemiology of diarrhoea at each level of the surveillance pyramid to assist in interpretation of routine health data and identify gaps in surveillance. A household survey was conducted in Soweto to estimate community diarrhoeal prevalence, associated risk factors and healthcare seeking behaviors. An analysis of diagnostic testing practices for diarrhoeal diseases was done, using a doctors’ survey, at three public hospitals in South Africa. Routine diagnostic data and enhanced surveillance data were compared to evaluate patient-related factors associated with requests for diagnostic investigation, type of diagnostic testing offered and the efficiency of available tests. A hospital surveillance study investigated the infectious causes of diarrhoea in hospitalised patients >5 years. Results indicated a high diarrhoeal burden across all age groups in South Africa (5.3% of respondents reported an episode in the preceding 2 weeks). While the majority of infections were mild, 40% required healthcare. Many of those requiring healthcare (34%), specifically adults, were unable to access the required care. Those that did access healthcare were treated empirically and seldom had stool samples collected for diagnostic investigations (approximately 10% of admitted cases). Available diagnostics in public health laboratories detected pathogens in only 13.7% of these submitted stools due to pre-analytical and analytical issues including not testing for all relevant pathogens. Diarrhoeal prevalence was particularly high among HIV-infected patients (67.5% of patients >5 years admitted for diarrhoea were HIV-infected) and these patients presented with a unique aetiology. This research highlights the need for diarrhoeal testing and treatment guidelines based on local epidemiological data with a focus on HIV-infected patients. Current diagnostics require optimisation including specimen collection, standardisation, pathogens included in routine testing panels, turnaround time and methods of detection. This will guide decisions on future public health interventions including vaccines.Item Long-term outcomes of HIV infected, and uninfected children aged 1-59 months following inpatient management of severe acute malnutrition(2024) Bwakura-Dangarembizi, MutsawasheChildren with complicated severe acute malnutrition (SAM) are at a high risk for mortality and morbidity in the time after hospital discharge, and those with HIV are particularly vulnerable. What is not known is whether this higher risk for poor outcomes in children with HIV has improved in the era of treating all who are infected. The thesis' main aim was to characterize the 52-week outcomes of children aged 1 to 59 months who were hospitalized for complicated SAM and to identify the characteristics present at hospital discharge that were most predictive of these outcomes. The thesis utilised the HOPE SAM study, an observational cohort established in Zimbabwe and Zambia that enrolled children hospitalised for complicated SAM and followed them up for one year after discharge from hospital. The study outcomes were death, morbidity, nutritional recovery and body composition assessed using skinfold thickness and bioelectrical impedance analysis. There were 3 main findings from the thesis; nearly 1 in 10 children treated for SAM died and the risk of dying continued throughout the one year following discharge. Children living with HIV had an almost 4-fold higher mortality compared to those without HIV regardless of whether they were receiving antiretroviral therapy or not; wasted children and those with ongoing SAM had a 2-fold higher mortality compared to those who had oedema on admission; and cerebral palsy was associated with a nearly 6-fold higher mortality risk. Similar risk factors, with the exception of HIV infection and addition of stunting were associated with impaired anthropometric recovery and increased hospital readmission. In this cohort, the time to hospital readmission was correlated with low peripheral fat mass and low lean mass. Overall, this thesis emphasizes the vulnerability of children treated for SAM even after they are released from the hospital and identifies high-risk populations that require focused interventions to enhance outcomes