4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
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Item Exploring the challenges to drone-aided inspections in construction site management(University of the Witwatersrand, Johannesburg, 2024-09) Khorombi, Shadrack; Terblanche, RolienThe construction industry, marked by its complexity and evolving standards, demands attention and commitment to quality. To guarantee that works are going according to plan, standards and regulations, in terms of quality and compliance, routine inspection strategies are implemented as an intrinsic part of the project management plan. Construction inspections are generally performed as a contractual obligation to enable an independent view of construction works and their progress for key stakeholders and the client. However, traditional inspection techniques are generally laborious and risky. Inspectors are often exposed to exterior elements; unfavourable conditions; intrinsic risks. Despite all of this, inspectors are still unable to obtain in-depth information on some of the surfaces due the inability to access surfaces or structures to optimal proximity. Drone technology has been proposed as an alternative method to traditional inspection for safer and more efficient inspections. This study endeavoured to explore key challenges to the implementation of drone technology for construction inspections. The methodological approach that the researcher adopted to achieve the research aim encompassed a qualitative method with document analysis, case study and interviews selected as data collection strategies. Techniques to gather empirical information required included observations and semi-structured interview questions. To present findings that are valid, reliable and generalisable, NVivo software was used as a data analysis tool where content analysis and thematic analysis were employed as data analysis strategies. The utilisation of qualitative, inductive case studies within an interpretivist paradigm was considered necessary to contextualise and deepen the understanding of the nature and occurrence of the challenges impeding key role players from full adoption of drone technology for construction site inspection processes. Key findings entail the lack of capital and resource allocation, concerns about transparency and contractual accountability, and the need for clear evidence of return on investment. Technical complexity, disruption to site activities, lack of interest from key stakeholders, capacity issues, and connectivity issues were also uncovered as challenges in the adoption of drone-aided inspections. Additionally, the findings encompassed strategies to overcome challenges impeding the optimal use of drones in construction projects. This study evaluates the current state and potential for drone technology adoption within the South African construction industry, highlighting practical challenges encountered during actual deployments. By proposing solutions such as streamlining regulatory processes and enhancing stakeholder collaboration, the research offers valuable pathways to optimise drone technology implementation during construction documentation and management.Item An assessment of the necessity of implementing a blockchain based land registry in South Africa(University of the Witwatersrand, Johannesburg, 2024-08) Jeram, Deelan; Saghatforoush, Ehsan; Azasu, SamuelBackground statement: Several nations have recently implemented blockchain-based land management systems, focusing on land registration, titling, recordation, and information management, to enhance transparency, trust, data security, data quality, and immutability through consensus mechanisms. This technology streamlines access and tracking of land records, reducing fraud, corruption, record manipulation, and property resale while lowering transaction costs. These advantages aim to address issues of inefficient and untrustworthy land records in less developed countries. Problem: South Africa faces challenges, ranking 108 out of 190 in property registration according to the World Bank, with lengthy procedures (7), extended transaction times (23 days), and high costs (8% of property value). In contrast, blockchain-adopting countries like Sweden and Georgia are ranked at 9 and 5, respectively. Despite these inefficiencies blockchain technology has not yet made an inroad into the land registration or transaction process. Aim – The aim of this study is to investigate the potential use of blockchain technology to digitize land registration in South Africa. Methods: This paper investigates a blockchain property registry pilot project in Khayelitsha, South Africa, using Peled's theoretical framework and employs qualitative research methodologies, including case study analysis and expert interviews, supplemented by a systematic literature review. Outcomes: The study reveals significant challenges in South Africa's land registration, including unreliable land records, informal land tenure systems, limited access for marginalized communities, corruption, weak legal frameworks, post-colonial property rights legacy, and inefficient real estate transactions. Despite the promise of blockchain, these issues persist, hindering progress. Eight key factors obstruct blockchain adoption in South Africa's land registry, including legal barriers, organizational resistance, technological hurdles, resource constraints, political and social factors, and trust-related issues. The case study identifies additional obstacles, such as misalignment of interests, lack of formal agreements, data quality issues, and further legal barriers. Nonetheless, the pilot project managed to create a "pseudo title deed" with potential benefits for the city. This study suggests the application of blockchain in state-subsidized housing developments to enhance data security and enable electronic land transactions. It emphasizes the need for a combination of expertise, infrastructure readiness, and procedural changes to facilitate innovation in the public sector. Despite the potential, the study concludes that South Africa's land registry is not yet prepared for widespread blockchain implementation, citing legal, technological, and organizational challenges. Significance: This research is the first to explore the limited adoption of blockchain technology for land registration in South Africa, contributing valuable insights to the field. This paper identifies critical factors for successful blockchain-based property registry implementation, offering insights for legislation, policy development, and land registration system design to address inequalities and improve land tenure in developing countries. It outlines a potential path for South Africa's Deeds Registry to implement blockchain technology in state-subsidized housing developments.Item In-hospital Mortality Outcomes of ST-segment Elevation Myocardial Infarction(University of the Witwatersrand, Johannesburg, 2023-04) Ndaba, Lindokuhle; Mutyaba, Arthur; Tsabedze, NqobaBACKGROUND: ST-segment elevation myocardial infarction (STEMI) is a common malignant complication of ischaemic heart disease. Despite optimal treatment, STEMI is often associated with significant morbidity and mortality. In high-income countries (HICs), STEMI-related morbidity and mortality incidence have decreased. However, in sub-Saharan Africa (SSA), there is an increasing burden of non-communicable diseases driven by atherosclerotic cardiovascular disease. Similarly, the incidence of STEMI is increasing. However, despite the growing burden of STEMI in SSA, there is still a paucity of data reporting on the regional morbidity and mortality associated with this disease. AIM: Hence, this study aims to provide a comprehensive description of the clinical profiles, determine the in-hospital all-cause mortality rate, and identify predictors of mortality for STEMI patients treated at the Division of Cardiology in Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa. METHODS: We conducted a retrospective review of the medical records of 815 consecutive patients diagnosed with ST-elevation myocardial infarction (STEMI), with confirmatory angiography findings, between January 1, 2015, and December 31, 2019. All participants underwent diagnostic coronary angiography, with or without percutaneous coronary intervention (PCI). As our institution is a PCI-capable centre, all patients underwent angiography either during the index admission or at a later date, and this removed ambiguity regarding the diagnosis of STEMI. The study included patients who met the third and fourth universal definitions of myocardial infarction. Data on demographics, clinical presentation, electrocardiogram (ECG) changes, biochemical parameters, coronary angiographic findings, coronary interventions, STEMI-related complications, and ongoing medical management were extracted from these sources. We compared socio-demographic characteristics, comorbidities, clinical parameters, biochemistry investigation findings, treatment, and complications between the patients who survived in-hospital and those who died. To identify predictors of in-hospital all-cause mortality in patients with STEMI, we developed a multivariable logistic regression model. RESULTS: Among 677 participants with a mean age of 55.5 ± 11.3 years, 533 (78.7%) were males. The in-hospital all-cause mortality rate was 6.2%. Co-morbidities in STEMI patients included smoking (56.1%), hypertension (52.8%), dyslipidaemia (40.0%), a family history of coronary artery disease (32.7%), and diabetes mellitus (28.3%). The median duration from the onset of chest pain to arrival at the catheterisation laboratory was two days [interquartile range (IQR): 1-3] for survivors and one day (IQR: 0-2) for non-survivors (p=0.010). Pharmaco-invasive treatment was the pre-dominant management strategy, with 61.4% of patients receiving thrombolysis and 53.9% undergoing PCI. On the age and sex-adjusted multivariable logistic regression model, the use of inotropes (OR: 4.04; CI: 1.14-14.34, p=0.031) and an increase in heart rate (OR: 1.02; CI: 1.01-1.04, p=0.010) independently predicted in-hospital all-cause mortality, while thrombolytic therapy (OR: 0.27; CI: 0.10-0.75, p=0.012), and PCI to the right coronary artery (OR: 0.03; CI: 0.00-0.46, p=0.011) reduced the risk of all-cause mortality. CONCLUSION: Our study's all-cause mortality rate among STEMI patients is comparable to rates reported in other countries globally.Item The experiences and impact of workplace violence on doctors and nurses working in Emergency Departments in the Gauteng Province, South Africa(University of the Witwatersrand, Johannesburg, 2023-10) Kobe, Lerato; Saffy, Patricia; Bentley, AlisonObjectives: Workplace violence (WPV) remains grossly under-reported preventing a true appreciation of the problem. With South Africa currently rated in the top three in the world for crime, it is likely that such crime correlates with WPV experienced by health care workers. This study investigates the range of WPV experienced in the Emergency Department (ED), the demographics of the perpetrator, the impact of WPV on ED staff, and reporting behaviour. Study design: prospective, quantitative, observational, cross-sectional study of five public hospitals in Gauteng. Methods: During the period October 2020-March 2021 data was collected through the completion of a self-administered questionnaire. Nursing staff and doctors, with the exclusion of those in training, were enrolled. The questionnaire included questions on demographics, experience of physical and non-physical WPV over the last 12 months as well as responses and effects of those events. Results: There were 211 respondents. Seventy percent of respondents had experienced at least one physical WPV event and 84% had experienced at least one non-physical WPV event. In both types of violence most did not require treatment. The incidents, mainly perpetrated by patients or their relatives/visitors, left 42% of victims very worried about violence in their workplace and some with symptoms of post-traumatic stress disorder however reporting of events was severely lacking. Respondents indicated that there were no clear reporting procedures available to them. Conclusions: Workplace violence is a problem in the ED and more needs to be done in encouraging reporting of incidents but most importantly methods of preventing violence need to be prioritized.Item An audit of anaesthetic charts at Chris Hani Baragwanath Academic Hospital(University of the Witwatersrand, Johannesburg, 2022-04) Nkadimeng, Lebohang Matau; Gilliland, Lizil; Nel, Dorinka; Mashinini, MduduziBackground: The anaesthetic chart is an important component of a patient’s health record in the perioperative period. Studies have shown that anaesthetic charts are often incomplete. The adequacy of chart completion in the anaesthetic department at Chris Hani Baragwanath Academic Hospital (CHBAH) has never been quantified. An audit was done, and the charts were assessed for adequacy of completion. Methods: A retrospective audit of anaesthetic charts was done for the year 2019. Using a peer reviewed checklist adapted from the Australian and New Zealand College of Anaesthetists (ANZCA) and the South African Society of Anaesthesiologists (SASA) guidelines, a sample of 333 charts was audited to assess adequacy of completion. To eliminate sampling bias, a stratified sampling method was used. Results: Completeness was defined as a chart scoring 100%. None of the charts scored 100%. The overall median score of the charts was 77%. Charts were subdivided into three groups. Charts scoring between 75-99% (n=212), 50-74% (n=121) and charts less than 50% complete (n=0). Patient category (adult versus paediatrics), time of shift (day versus night) and type of anaesthetic were audited and compared as factors that could affect chart completeness. The only factor that had a statistically significant difference in chart completeness was the patient category, where adult chart completion scored higher compared to paediatric charts with a p-value <0.0074. Conclusion: In conclusion the charts audited scored higher than previous audits done both locally and internationally. Some important aspects of the charts were poorly documented. Ongoing audits and training on chart completion can potentially improve the adequacy of completion and should be part of the academic program. Better documentation has the potential to improve perioperative patient care and mitigate medicolegal risks.Item Non-tuberculous mycobacteria (NTM) at Charlotte Maxeke Academic Hospital, 2010-2017(University of the Witwatersrand, Johannesburg, 2023-11) Nqwata, Lamla; Feldman, Charles; Black, MarianneRationale: Diseases due to non-tuberculous mycobacteria (NTM) are difficult to diagnose and are not reportable in South Africa (SA), resulting in the disease burden and trends being under-appreciated. Objectives: To characterize NTM disease occurrence and trends in Johannesburg and to estimate end-of-treatment outcomes. Methods: A retrospective review of all clinical isolates that were positive for NTMs between 1 January 2010 and 30 June 2017 and the corresponding medical records of the patients at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) were analysed. A data collection form was designed, and data was collected based on information listed on the form. This was analysed using Graphpad Instat (Graphpad Inc, 3.1 version, San Diego, California, US) and STATA version 11, College Station, Texas, software. In descriptive analyses, two-tailed Fisher’s exact tests were used to compare categorical variables, while Kruskal-Wallis tests and Student’s T-test were used to compare continuous variables, as needed. Kaplan-Meier curves and log-rank tests were used to compare time-to-death, while Cox regression analyses were used in multivariate analyses of the same. Results: A total of 123 patients with positive NTM isolates were enrolled in this study. In this cohort, positive NTM isolates were found mostly in males (71; 57,7%), with a median age of 39 [Interquartile range 31.5-49.5] years. Mycobacteria avium complex (MAC) was the most common, isolated in 90 (75%) cases. Human immunodeficiency virus (HIV) infection, found in 96(80%) patients, and prior pulmonary tuberculosis (TB), found in 38(30%), were the common comorbidities. Overall, 27(22%) were successfully treated and 28(23%) died. In multivariate Cox regression analysis the adjusted hazard rates were 2.79 (95%CI 1.20 – 6.50) in those with low CD4 cell counts and 4.01 (95%CI 1.17 – 13.77) in those with unknown HIV test results. Receipt of antimicrobials did not significantly improve survival. Conclusion: Non-tuberculous mycobacteria (NTM) appear to be common in our setting and is associated with poor outcomes.Item Prevalence and risk factors of intraventricular hemorrhage in Very low birth weight infants at Chris Hani Baragwanath academic hospital(University of the Witwatersrand, Johannesburg, 2023-11) Mabasa, Kulani; Nakwa, Firdose L.; Ntuli, NandiBackground: Intraventricular hemorrhage (IVH) is the commonest form of bleeding in the central nervous system (CNS) of premature neonates. Pathogenesis is attributed to germinal matrix fragility. Risk factors are multifactorial and related to various events that may happen in utero, peri-partum and postnatally. Methods: This was a retrospective descriptive study in the neonatal unit of CHBAH. 529 VLBW infants of <1500g admitted between January 2017 to December 2018 were studied. Those with IVH were cases and those without IVH were controls. Results: Of the 529 infants studied, 33%(n=176) had IVH, 56% (n=99) were mild IVH (grade 1 and 2) and 44% (n=77) were severe IVH (grade 3 and 4). Median gestational age (28 vs 30, p<0.001) and birthweight (1059g vs 1220g, p<0.001) were lower in those with IVH. More neonates with no IVH received steroids (40.5% vs 30.1%, p=0.020) and magnesium sulphate (11.9% vs 2.8%, p<0.001). Neonates with an Apgar score < 6 at 5 minutes (OR 8.17, 95%CI: 2.54-26.3), intubated (OR 8.822, 95%CI: 1.34-56.41) and had meningitis (OR 104.92, 95%CI: 40.10 -274.5) were more likely to have IVH. Those with IVH had a 20-fold chance of having PHHC (OR 20.25, 95%CI: 1.21 -338.84) and a higher likelihood of dying (3.70 95% CI 1.50-9.15). PHHC was observed in neonates who had severe IVH (grade 3 and 4). Of the neonates who died IPPV (2.20, 95% CI 1.117-4.34), hypotension (10.46, 95% 2.32-47.11) and meningitis (1.13, 95% 1.016-1.26) were associated with death. Conclusion: Incidence of IVH is consistent with those of LMIC. The significant risk factors for IVH were low Apgar score at 5 minutes, those who were intubated, and had meningitis. Steroids and magnesium sulphate were protective against developing IVH. More studies are needed to analyze risk factors associated with severe IVH (grade 3 and 4). Identifying pharmacological neuroprotective agents may be beneficial in future.Item A Retrospective Observational Study of The Impact of HIV Status on The Outcome of Paediatric Intensive Care Unit Admissions(University of the Witwatersrand, Johannesburg, 2022-12) Whitehead, Kim; Ballot, DayniaBACKGROUND: Previously it was thought futile to offer HIV infected children ICU care, however this has changed with the availability of Antiretroviral Therapy (ART). Improved Prevention of Mother to Child Transmission (PMTCT) has led to a larger population of HIV exposed uninfected (HEU) children with unique health risks. Our study looked at how HIV exposure and infection impact presentation and outcomes in PICU in an era of improved access to ART and PMTCT. METHODS: A retrospective analysis of children admitted to PICU at a tertiary/quaternary hospital between 2015 and 2019 was conducted. De-identified data was obtained from an existing database and analysed using SPSS software. Medians and interquartile ranges were used to analyse continuous variables and frequencies and percentages to analyse categorical variables. The sample was then divided into three groups (HIV negative, HEU and HIV infected) and their presentation and outcomes compared using Chi-Squared and Kruskall-Wallis tests with a significance level set at p < 0.05. RESULTS: Our study showed that 16% (109/678) of children admitted to PICU were HEU and 5.2% (35/678) HIV infected. HIV infected children were admitted at a younger age (median two months) and had an increased incidence of lower respiratory tract infections than HIV negative children (p < 0.001). HIV infected children required longer ventilation and admission than HIV negative and HEU children (p < 0.001). HIV infected children had a higher mortality (40%) (p = 0.02) than HIV negative children (mortality 22.7%); when comparing children admitted with a medical diagnosis however the difference in mortality was not statistically significant (p = 0.273). HEU children were admitted at a younger age (median three months) with a higher incidence of lower respiratory tract conditions than HIV negative children (p < 0.001). HEU children had similar outcomes to HIV negative children with no statistically significant difference in duration of ICU stay (p =0.163); ventilation (p = 0.443) or mortality (p=0.292). CONCLUSION: HIV infected children presented with more severe disease requiring longer ventilation and admission. HEU had similar outcomes to HIV negative children.Item Diagnostic Coronary Angiography Access In Johannesburg(University of the Witwatersrand, Johannesburg, 2023-10) Ntaka, Khulasande Liso Sifiso; Tsabedze, Nqoba; Kalk, Thomas; Mpanya, DineoBackground: Contemporary interventional cardiology guidelines prefer radial over femoral artery access when performing diagnostic coronary angiograms (DCA). There is a paucity of data on the safety and efficacy of radial and femoral DCA in low-and-middle-income countries. Methods: We retrospectively reviewed inpatient medical records and DCA reports of patients referred for DCA and evaluated the safety and efficacy of the femoral versus radial artery access route. Results: There were 653 patients with a mean age of 58.2 ±12.6 years. Radial access was used in 318 (48.7%) patients. The median duration of the DCA was slightly longer with radial access and was 50 minutes (Interquartile range (IQR): 40–60), while the median procedural duration for femoral artery access was 45 minutes (IQR: 35–60) (P = 0.010). The median total radiation dose in the femoral artery access group was 3511 µGym2 (IQR: 2154–5821), and patients in the radial artery access group were exposed to a median radiation dose of 4011 µGym2 (IQR: 2298–6411) (P = 0.0661). A total of 639 (97.9%) DCA were performed without crossover, and 99.0% (95% CI: 97.2 – 99.8) of DCA performed via the radial artery did not require crossover to transfemoral access, and 96.1% (95% CI: 93.4 – 97.9) of the DCA done via the femoral artery did not require crossover to transradial access (P = 0.009). Conclusion: Almost half of all diagnostic angiograms were performed via the radial artery. Both radial and femoral artery access were equally safe and efficacious in patients with coronary artery disease.Item (Il)legitimacy of Freelance Artists: Exploring Current Government Legislation and Policies that Influence Economic Exclusion and Inclusion of South African Freelance Artists(University of the Witwatersrand, Johannesburg, 2024-03) Mmeti, Lehlohonolo Tebalelo Rudy Matome; Chatikobo, MunyaradziThe prevailing descriptors—such as "illegitimate," "non-compliant," "unprofessional," and "informal"—resonate globally, attributing a lack of structure to freelance artistry. This characterization places these artists in precarious legal and economic positions, hindering access to fundamental employment benefits, credit, loans, and housing. Therefore, it is imperative to answer the central questions, Which legislative measures and policies currently influence the economic integration, compliance and legitimacy of freelance profession within Cultural Creative Industry and Economy in South Africa? The scarcity of literature on the subject prompts an exploration into the legislative landscape, framed by the notion that policy acts as a guiding roadmap. The central argument is that existing policies failure to adequately address the unique challenges faced by South African freelance artists, leaving a critical void in understanding their economic participation. Focused on a qualitative methodology, the research examines documents and policies to unravel the impact on freelance artists' economic standing, employing lenses that navigate the intersections of formality and informality within the Cultural Creative Industries. The research underscores the imperative to bridge this knowledge gap, arguing for targeted interventions to rectify the economic disparities and (il)legitimacy associated with freelance artists in South Africa. It is through the aims and objectives of this research that I was be able to come with a concrete understating of the landscape so appropriate intervention measures can be suggested.