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

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Subject: search.filters.subject.SDG-3: Good health and well-beingSubject: search.filters.subject.COVID-19Has files: Yes

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    The Experiences of Black Female Postgraduate Students With Mental Health During The Covid-19 Pandemic, 2019-2021, The Case of Witwatersrand University
    (University of the Witwatersrand, Johannesburg, 2024) Mashiane, Sphiwe; Bala, Samkelo
    The COVID-19 global pandemic has compelled institutions of higher education to transition to emergency remote learning, leading many postgraduate students, both nationally and internationally, to begin their studies online. Research has shown the need for universities to support the transition from undergraduate to postgraduate as this is a major transition into academia. Research has also revealed that the struggle with mental health has increased with this transition and additionally with the COVID-19 pandemic, however, there is a lack of research investigating the experiences of Black females in the academic space and their experiences with mental health. Thus, this study aims to understand the experiences of Black female postgraduate students with mental health during the spread of COVID-19, 2019-2021. The research approach used for this study was the qualitative approach as it was the most appropriate in seeking to understand the experiences of a unique group such as a Black female postgraduate. A case study design was employed, and the experiences shared were explored through the lens of the intersectionality theory and the research was grounded by the interpretivist paradigm. The sample was drawn from the population of students from Witwatersrand University and the sample consisted of eight (8) participants. The method of data collection was computer-mediated interviews which were interpreted using a five-phase thematic analysis. The participants' responses revealed that although all eight participants experienced challenges with their mental health sharing symptoms associated with anxiety, stress, depression, and loneliness, only two participants used the psychosocial services offered by the university. The reasons for not seeking help from the university psychosocial services included fear of the unknown, services feeling unreachable, stigma and fear of not being assisted immediately. The most shared reason for not seeking help however was participants not perceiving the need to seek help. Participants, therefore, opted for coping mechanisms such as sleeping, partying, and using substances and most participants turned to their spirituality. The study, therefore, made recommendations for campus psychosocial services to employ more mental health practitioners such that there is education about mental health and the services offered.
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    The Psychosocial Impacts of COVID-19 on Children: A Parents’ Perspective
    (University of the Witwatersrand, Johannesburg, 2024) Macingwane, Nontokozo; Mathebula, Mpho
    The 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 crisis
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    Primary caregivers’ perceptions of the effect of COVID-19 on the mental well-being of learners at a secondary school in Soweto
    (University of the Witwatersrand, Johannesburg, 2024) Maseko, Nokuthula; Watermeyer, Jennifer
    During the COVID-19 pandemic in March 2020 lockdown restrictions were introduced in South Africa and around world. This led to school closures as well. During this period learners around the world experienced mental-health challenges due to the restrictions on gatherings, school attendance as well as social distancing. Some of the mental-health challenges that affected the learners include depression, anxiety, sleeping disorders as well as weight gain. This study explored the perceptions of the primary caregivers of secondary school learners in Soweto on the mental well-being of learners during the COVID-19 lockdown. The study was conducted using an ecological theoretical framework which looked at the relationship of the learner in relation to different systems that they interact with. The researcher used a qualitative research approach and a phenomenographic research design. Purposive sampling was utilised to select the sample of 8 primary caregivers of grade 11 learners at a Secondary School in Soweto. Semi-structured interviews were the method of data collection and a semi-structured interview schedule was used as the research instrument. Data collected was coded, themed, and analysed using reflective thematic analysis. The results from this study showed how COVID-19 had a negative effect on the academic performance of learners. The learners still could not achieve pre-COVID-19 results even after efforts were made for after-school programs and catch-up sessions. The learners' attitudes towards the virus included fear of death or losing loved ones due to COVID-19 as well as confusion and fear of contracting the virus. The learners shared that coughing, sneezing, or the mere sight of a tissue triggers them to date as they associate such symptoms with COVID-19. The learners in this study experienced psycho-social effects such as anxiety and stress as well as physical challenges such as weight gain, migraines, sleeping challenges as well as communication issues with the family members. Social media and technology acted as a buffer for learners as it offered them information, knowledge as well as social connections with teachers, peers, friends, and extended family members. The importance of working in a multi-disciplinary team to support and foster resiliency for the learners is highlighted. The learners in Soweto had their own experiences, but they were similar to those from around the world and therefore one can conclude that pandemic experiences were generic to some extent.
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    The requirements of ethical journalism: An analysis of COVID-19 related news coverage by South African print and online media
    (University of the Witwatersrand, Johannesburg, 2024) Goba, Lindi Mpumelelo; Sithole, Enock
    The media provides people with medical scienYfic informaYon during a health crisis. This funcYon of the media is even more crucial when there are lockdown restricYons as seen during the COVID-19 pandemic. Previous studies of media coverage of pandemics show that reporYng was generally negaYve in that the stories were of an alarmist nature and there were high levels of sensaYonalism. The compromised standards of reporYng could be a`ributed to the need for print and online news media outlets to a`ract audiences and increase profits given the bad state of the economy, parYcularly during the COVID-19 pandemic. This study aimed to analyse the extent to which the South African print and online media met the requirements of ethical journalism, as set out in the South African Press Code, in their reporYng on COVID-19. The researcher uYlised a mixed methods approach as the study includes both qualitaYve and quanYtaYve aspects. The data was collected through the Press Council’s website and was sampled using the keyword COVID-19. In total, there were 105 complaints submi`ed to the Press Council of South Africa during March 2020 and March 2022. Out of the 105, the researcher analysed 13 complaints that were related to COVID-19 reportage made during the same period. This period includes the outbreak of the pandemic, the second wave, and concludes with the third wave which is when the pandemic began to wind down. The results and findings of this study show that the number of complaints submi`ed during the pandemic was significantly low and that the publicaYons that breached the Press Code were mainly sancYoned for serious breaches. This suggests that print and online publicaYons that subscribe to the Press Council pracYced ethical journalism and adhered to the requirements of the Press Code to a moderate extent.
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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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    Epidemiology of laboratory-confirmed SARS-CoV-2 hospitalized cases in a tertiary hospital, Gauteng Province, South Africa, 1 April 2020 to 31 March 2021
    (University of the Witwatersrand, Johannesburg, 2021-12) Sikhosana, Mpho Lerato; Makatini, Zinhle
    Gauteng Province (GP) was the most affected province in South Africa during the first year of the COVID-19 pandemic. We aimed to describe the epidemiology of COVID-19 cases admitted in one of the largest quaternary hospitals in the province during the two pandemic waves. We used data from the national hospital surveillance system, DATCOV, that recorded COVID-19 admissions at Charlotte Maxeke Johannesburg Academic Hospital in (GP) from 5 March 2020 to 27 March 2021. We used multivariable logistic regression to determine a) factors associated with hospitalization in the second compared to the first pandemic wave, and b) factors associated with in-hospital mortality. There were 1861 cases admitted during the study period. The mean age of the cases was 50 (IQR 37-61), 51.80% were females, and 58.68% were black. Of the total number of admissions, 2.10% were healthcare worker, 53.85% of whom were nurses. On admission, 91.99% of cases were admitted at a general ward while 5.86% were admitted at an intensive care unit. Overall, 10.59% of the cases required intensive care during their hospital stay. The case fatality ratio was the highest (28.54%) during wave 2 and lowest during pre-wave (11.49%). Compared to the first wave, factors associated with hospitalization during the second wave included age >80 years (adjusted odds ratio [aOR] 3.43, 95% CI 1.07-10.98) compared to ages 0-19 years, as well as being of other race (aOR 5.63, 95%CI 1.84-17.20) compared with White race. Regarding in-hospital mortality, associated factors included age groups 60-79 (aOR 4.53, 95%CI 1.03-19.86) and >80 (aOR 9.63, 95%CI 1.93-48.01) compared to ages 0-19 years; male sex (aOR 1.55, 95%CI 1.16-2.08); presence of an underlying comorbidity (aOR 1.99, 95%CI 1.45-2.71) 106 as well as being admitted during the second wave (aOR 1.54, 95%CI 1.12-2.10). Our study found that there was a higher risk of mortality during the second compared to the first wave, and other factors associated with mortality included older age, being male as well as having an existing comorbidity. These findings will help inform prevention strategies required to prevent high mortality rates during future waves of infection.
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    Validation of Roche immunoassay for severe acute respiratory virus 2/SARS-COV-2 in South Africa
    (University of the Witwatersrand, Johannesburg, 2023-01) Grove, Jurette Simone; George, Jaya; Mayne, Elizabeth
    Background: Serology testing is an important ancillary diagnostic to the reverse transcriptase polymerase chain reaction (RT-PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to evaluate the performance of the Roche Elecsys™ chemiluminescent immunoassay (Rotkreuz, Switzerland), that detects antibodies against the SARS-CoV-2 nucleocapsid antigen, at an academic laboratory in South Africa. Methods: Serum samples were collected from 312 donors with confirmed positive SARS CoV-2 RT-PCR tests, with approval from a large university’s human research ethics committee. Negative controls included samples stored prior to December 2019 and from patients who tested negative for SARS-CoV-2 on RT-PCR and were confirmed negative using multiple serology methods (n = 124). Samples were stored at –80 °C and analysed on a Roche cobas™ 602 autoanalyser. Results: Compared with RT-PCR, our evaluation revealed a specificity of 100% and overall sensitivity of 65.1%. The sensitivity in individuals > 14 days’ post-diagnosis was 72.6%, with the highest sensitivity 31–50 days’ post-diagnosis at 88.6%. Results were also compared with in-house serology tests that showed high agreement in majority of categories. Conclusions: The sensitivity at all-time points post-diagnosis was lower than reported in other studies, but sensitivity in appropriate cohorts approached 90% with a high specificity. The lower sensitivity at earlier time points or in individuals without symptomatology may indicate failure to produce antibodies, which was further supported by the comparison against in-house serology tests.
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    Clinical Characteristics and Outcomes of Patients with COVID Admitted to a Tertiary Care Centre: A Retrospective Study at Tshepong Hospital
    (University of the Witwatersrand, Johannesburg, 2023-11) Dullabh, Dixit Anil; Zachariah, Don
    Introduction: In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in China. It has since then rapidly spread across the globe causing millions to die. In March 2020, the WHO declared coronavirus disease 2019 (COVID-19) a pandemic. It’s clinical presentation and outcomes have been variable across the world. Thus, an analysis of the clinical characteristic and outcomes of patients with COVID-19 at a local setting, namely Tshepong Hospital. Objective: To determine the clinical presentation and outcomes, and correlate clinical and biochemical parameters to outcomes of patients admitted with COVID-19 at Tshepong Hospital. Method: This is a single centre retrospective review of all patients with COVID-19 admitted at Tshepong Hospital during the period 1 June – 31 July 2020. The study contains both inferential and descriptive elements. Results: A total of 200 patients were admitted with COVID-19 during this study period, of which 135 were female and 65 males. The mean age was 53 years with no significant gender differences. 63% of patients had hypertension as a coexisting condition while 35% had diabetes mellitus. Presence of co-morbid conditions were associated with severe disease. Dyspnoea (73%) and cough (94%) were the predominant symptoms. Laboratory parameters including elevated white cell count, C-reactive protein, urea, and creatinine were associated with severe disease. Of the 200 patients, 36 were deemed as severe. 34 of these patients required ICU admissions. 17 demised showing a case fatality rate of 8%. Treatment options given were in keeping with guidelines. Conclusion: COVID-19 has proven to be a clinical and therapeutic challenge. Its main factors being its novelty and variable presentation across the globe. This study has shown that a local setting, not all data is congruent with national or global trends. This speaks to the need of more centres and countries looking at their own variation of COVID-19 presentations, thus challenging the clinical and therapeutic decisions around the disease.
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    Practices and outcomes of resuscitation in cardiac arrest at a South African Emergency Department
    (University of the Witwatersrand, Johannesburg, 2022-12) Martin, Cathryn Sarah; Lewis, Carolyn; Saffy, Patricia
    Objectives: This study aimed to investigate the patient and resuscitation factors affecting outcome after cardiac arrest in the low-middle income setting. Methods: We retrospectively reviewed the data of patient’s aged ≥18 who experienced in-hospital cardiac arrest in the Emergency Department between January 2020 and December 2020 at a tertiary hospital. The data collection period included the first wave of the COVID-19 pandemic in South Africa. Return of spontaneous circulation (ROSC) was the outcome of interest. The registry from which data was collected was audited. Results: 98 patients were included. The ROSC rate was 43%. Asystole was associated with poor outcomes (likelihood 7.73, p ≤0.01). Cardiac standstill on ultrasound was associated with poor outcome (likelihood ratio 6.559, p ≤0.01). There was a significant improvement in ROSC after the first wave of the COVID-19 pandemic and a transition from airway management with bag-valve-mask to endotracheal intubation intra-arrest (p=0.04). Demographic factors, defibrillation and drug-use were found to have no significant impact. Conclusions: The resuscitation practices and outcomes in the low-middle income setting are similar to high-income settings. Further research on the impact of the COVID-19 pandemic on resuscitation outcomes in this setting is necessary.
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    Final-year medical students' experiences and perceptions of integrated primary care learning at decentralised training sites during the COVID-19 pandemic: A mixed-methods study
    (University of the Witwatersrand, Johannesburg, 2023-09) Ruch, Aviva; George, Ann; Francis, Joel
    Background: There is limited data on the effectiveness of online learning to augment theory and clinical knowledge and skills across decentralised training (DCT) sites. This study explored the 2021 cohort of final-year medical students’ experiences and perceptions of the integrated primary care (IPC) online teaching and learning across five DCT sites affiliated with the University of the Witwatersrand in South Africa. This information is essential to determine what online IPC teaching and learning should be retained and what adjustments are needed to enhance and standardise IPC online learning across our DCT sites. IPC is a final-year Bachelor of Medicine and Bachelor of Surgery (MBBCH) subject at Wits University. The subject focuses on primary health care, integrating Internal Medicine, Surgery, Psychiatry, Obstetrics and Gynaecology, Family Medicine, Community Paediatrics and Public Health. Training across different sites poses challenges for standardising learning content and the nature and quality of patient engagement and interaction. The Covid-19 pandemic not only exacerbated the difficulties associated with decentralised teaching and learning, but also decreased student-patient interaction. The rapid shift to emergency remote teaching left teachers with limited time to prepare for online and blended teaching and highlighted shortcomings in some health-professions educators’ ability to create meaningful, authentic learning interactions. The study design was underpinned by the Technology Acceptance Model, the Community of Inquiry Model and the Theory of Self-Regulated Learning. Methods: This explanatory sequential mixed-methods design consisted of a cross-sectional online survey conducted in November 2021, followed by two focus-group discussions in December 2021. The 316 final-year medical students who had completed their IPC block were purposively sampled to participate in this study. Medical students who had not yet completed the IPC block were excluded from the study. Twenty-one closed and four open-ended questions explored the students’ perceptions of how the online materials supported their learning and augmented their clinical skills and management of patients, their challenges with learning online, and ways to improve the online-learning experience. The closed and open-ended survey answers were analysed using descriptive and inferential statistics and content analysis, respectively. The results of the content analysis are presented graphically. The survey findings informed the questions asked in the focus-group discussions (n = 2 and n = 3). The discussions were audio-recorded and transcribed verbatim. The transcripts were analysed inductively in MAXQDA. The findings are presented as thematic maps. Results: The survey response rate was 52% (164/316). The respondents were representative of the study population. Most respondents easily accessed the online content, with more than 70% accessing the online content several times a week. More than 80% found the online content logically organised; the content analysis highlighted three categories of reasons why the online content and interactions influenced their learning. The content analysis also identified three categories of reasons why the online content influenced patient management, but more than a third of respondents remained neutral when asked if the online content introduced them to new clinical skills. Quizzes and tests were the preferred learning method. The features that best supported the respondents’ online learning were grouped into five categories: ‘Range of activities’ (n = 73), ‘Content selection’ (n = 56), ‘Flexible access to content’ (n = 8), ‘Organisation of content’ (n = 4) and ‘Other’ features (n = 7). Respondents highlighted several categories that presented challenges to online learning: ‘Pedagogical issues’ (n = 30), ‘Excessive workload’ (n = 27), ‘Operational issues’ (n = 20), ‘Learning issues’ (n = 17), ‘Technical issues’ (n = 11) and ‘Unclear course expectations’ (n = 50). Participants in the focus-group discussions (FGD) concurred with many of the perceptions and experiences of the questionnaire respondents. Three themes were identified in the thematic analysis of the FGD: ‘Features supporting learning’, ‘Challenges of learning online’, and ‘Ways to improve learning’. Conclusions: The respondents and focus-group participants displayed a positive attitude to the IPC online content and interactions offered to them during the Covid-19 pandemic. Their experiences and perceptions offered insights to better support learning through practical suggestions for students and faculty, especially around faculty competency to design meaningful learning interactions, both online and blended. While this study focused on IPC, the student recommendations may apply to other subjects nationally and internationally, suggesting the need for further research into using online teaching to support clinical teaching.