4. Electronic Theses and Dissertations (ETDs) - Faculties submissions

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    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, Michele
    Background: 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.
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    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, Merika
    Background: 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.
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    Exploring the influence of COVID-19 on the utilisation of the Employee assistance programme within a private medical laboratory in South Africa
    (University of the Witwatersrand, Johannesburg, 2023) Mavuso, Grisselda Sithembile; Umanah, Tebogo
    Employee assistance programmes (EAPs) are programmes designed to support employees to handle challenges that may affect their work performance. The programmes assist them to adopt behaviors that promote health, improve quality of life, support their personal growth and effectiveness, and ultimately contribute to the organization's bottom line. Despite the availability of EAP services, the prevalence of mental health disorders remains high both in South Africa, and the rest of the world. The COVID-19 pandemic presented a novel form of stressor in many lives globally and it negatively impacted employees worldwide. Health care workers, including medical laboratory workers, were hit the most by the effects of COVID-19 as they faced infected patients or infected patient samples on a daily basis. The aim of the study was to assess the impact of COVID-19 on the EAP usage in one of the largest private medical laboratories in South Africa. The study assessed if there were any notable changes in the use of the programme in year 2020 compared to the pre- COVID-19 period years 2018 to 2022. The study also aimed to understand the perceptions of the employees towards the programme and to find out if there are any benefits that the EAP offers to them. Many of the study’s interviewed respondents reported that COVID-19 presented immense psychological pressure in their lives. However, despite the severe negative impact of COVID-19, fewer respondents utilised the EAP in that COVID-19 period. Discrepant findings were however noted between the interviews and the secondary EAP data. Secondary data showed that there was an increase in the EAP usage rates between year 2020 - 2021, up to 20.4% from 15.37 % in year 2019. The respondents who have used the EAP reported that they derived great benefits from it
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    The relationship between mental health and work stress in healthcare workers during COVID-19 in Gauteng, South Africa (2020)
    (2024) Butao, Themba Archiford
    Background: Research into the 2003 severe acute respiratory syndrome (SARS) outbreak in Toronto, by Maunder et al (2006), revealed that health care workers (HCWs) experienced high “levels of burnout (p=0.019), psychological distress (p<0.001) and posttraumatic stress (p<0.001)” compared to HCWs that were working in Hamilton at hospitals that were not treating SARS infected patients. In June 2012, the Middle East Respiratory syndrome (MERS) had high nosocomial transmissions, and this led to increased distress among HCWs. Coronavirus Disease 2019 (COVID-19) is the most recent global pandemic, and it is has led to a negative impact on the healthcare sector and its employees. The impact of pandemics such as COVID-19 on the mental health of HCWs in low-middle income countries like South Africa is not fully known. Previous studies have shown that low-middle income countries, such as South Africa experience higher stress and burnout levels due to their limited resources such as access to personal protective equipment. High stress during patient care in high income countries has resulted in HCWs experiencing fear, exhaustion and stress in the past. Aim: To investigate the relationship between work stress and mental health in HCWs working in public hospitals and CHCs during COVID-19 in Gauteng in 2020. Methods: The study was a cross-sectional study using secondary data from a longitudinal study that was conducted in Gauteng, South Africa in 2020. The primary study was conducted by sending a questionnaire to HCWs working in large hospitals and some clinics in Gauteng, South Africa in 2020. The questionnaire consisted of the General Health Questionnaire-12 (GHQ-12), Job-Related Tension Index (JRTI) and COVID-19 related questions. A sample size of 223 was required for the study and was analysed using STATA® 16 software. Regression analysis was conducted to analyse the different relationships and odds ratios were obtained at the end of the study. Results: A total of 336 HCWs participated from 6 facilities. Of the occupations that could be identified, Professional nurses made up the highest percentage of HCWs (19.11%). A majority 55.22% and 54.33% of HCWs experienced mental distress and work stress respectively. The prevalence of both mental health disorders and work stress in HCWs in Gauteng during the COVID-19 pandemic was 39.10%. The odds of developing mental health disorders among HCWs who were experiencing work-stress in Gauteng, 2020, were 7.51 times the odds of developing mental health disorders among HCWs not experiencing workstress in Gauteng, 2020 (p <.001, CI: 2.99, 18.85). The study also showed that a unit increase in the JRTI score was associated with a 19% increase in the GHQ-12 score (p < .001, CI: 0.14, 0.25). Discussion and conclusion: Work-stress significantly affected mental health among HCWs working in public hospitals and community health centres (CHCs) in Gauteng during the early COVID-19 pandemic. The study also shows that pandemics such as the COVID-19 pandemic can lead to a high proportion of work-stress as well as mental health disorders in HCWs. Negative perceptions of risk during COVID-19 also played a significant role in the work stress and the mental wellbeing of HCWs. Recommendations: Decision makers at the district and provincial level should aim to provide constant counselling services even during periods of less work-stress. Sufficient outbreak response training should be provided as part of HCWs Continual Professional Development (CPD) courses so that there is better readiness for future pandemics. There should permanent policy changes that reduce the number of hours worked by HCWs, and more effort staff retention in the public sector as this is what majority of the country uses for seeking healthcare services. Smaller healthcare facilities should also be better equipped with not just only professional HCWs but equipment, including training and storage of such equipment, and regularly checked as preparation for future outbreaks.