4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
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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 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, JoelBackground: 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.Item An exploration of the Lived Mental Health Experiences of psychologists working in the public sector during the COVID-19 pandemic in South Africa(University of the Witwatersrand, Johannesburg, 2023) Harvey, Zena; Laher, SumayaThe COVID-19 pandemic severely impacted mental health in South Africa, exacerbating the existing mental healthcare treatment gap. Psychologists working at public institutions have been at the forefront of providing mental health care to the public during the crisis. However, psychologists themselves may be considered a vulnerable group at risk of developing adverse mental health outcomes, such as depression, anxiety, burnout and vicarious traumatisation due to the nature of their profession. This vulnerability may have been further amplified during the COVID-19 pandemic. The well-being of psychologists is integral to ensuring high quality patient care and to the overall management of pandemic and other disease outbreaks. There remains a significant dearth in the available literature examining the lived mental health experiences of psychologists, especially those working in the public sector. This study aims to address this pertinent gap by investigating the lived mental health experiences of ten psychologists employed in South African public institutions, amidst COVID-19 pandemic. Semi-structured interviews comprising sixteen questions were conducted with each psychologist. The following five overarching themes emerged from an Interpretive Phenomenological Analysis (IPA): ‘The personal effects of COVID-19 on psychologists’, ‘Changes to therapy During COVID-19’, ‘Experiences of COVID-19 exposure in public hospitals’, ‘Coping Mechanisms’ and ‘Survivor Guilt: Privilege during the pandemic’. A discussion of the abovementioned findings highlighted the importance of addressing, prioritising and monitoring the psychological wellbeing of these public sector-psychologists, during pandemic and other disease outbreaks to increase their support structures.Item Factors associated with Social Grant uptake In South Africa: A Closer Look at the Special Covid-19 Social Relief of Distress Grant among the Youth Aged 18 – 35 Years(University of the Witwatersrand, Johannesburg, 2023-08) Mabala, Moyahabo Thomas; De Wet-Billings, Nicole; Godongwana, MotlatsoBackground: Globally nearly 900 million people benefited from social assistance in 2017, most of them in the form of cash transfers, which accounts for 44% of the social assistance budget. During the same period, Sub-Saharan Africa was found to be far behind in terms of social assistance coverage, of those living in extreme poverty it is estimated that only 15% of them are receiving social assistance. In South Africa, with a population of 60 million people, it is estimated that 11.4 million of them received some sort of grant at the end of March 2021. When the Special COVID-19 Social Relief of Distress Grant (SCSRDG) was introduced, it received over 9.5 million applications of which only 6.5 million were approved with the youth aged 18 – 34 accounting for 70% of the applicants. As a result of the high number of applicants for the SCSRDG, this study wanted to gain an understanding of the profiles of the applicants. Objective: To explore the demographic, socio-economic, and household factors associated with the uptake of the Special COVID-19 Social Relief of Distress Grant (SCSRDG) among the youth aged 18 – 35 years in South Africa. Methodology: This study is a quantitative analysis of secondary data obtained from the National Income Dynamics Study – Coronavirus Rapid Mobile Survey 2020 wave 5. The survey interviewed 7074 youth aged between 18 – 35 years. The outcome variable of this study is the Special COVID-19 Social Relief of Distress Grant (SCSRDG) receipt status. To assess the uptake of the grant, descriptive statistics including tables and graphs were used. The predictor variables consist of demographic, socioeconomic and household characteristics, with age as the main predictor variable. To check for the association between the outcome and predictor variables, binary logistic regression was utilised. Where the odd ratio < 1.00, meant that the outcome was less likely in the index group when compared to the reference. Results: Using the weighted data, a total of 3 438 046 applicants who applied for the grants received it while 3 003 320 of them did not receive the grant. Among those who received the grant, the majority 1 223 192 of them are aged between 21- 25 years. Most of the applicants were male representing 63.58%. African/Black is the highest population group that applied for the grant accounting for 90.66% of the applicants while whites account for the least proportion of the applicants at 0.88%. For both that received and did not receive the grant, the African/black population group is the highest when compared to other population groups at 92.93% and 88.07% respectively, while whites are the lowest at 1.31% and 0.40% respectively. Most of the applicants 91.47% were unemployed. A total of 4 994 322 (77.54%) of the applicants reported their dwelling type as formal and 4 891 137 (75.93) reported that they had access to both water and electricity in their household. Most applicants 39.98% come from a household with between 4 – 6 family members. Out of the 14 independent variables included in this study only two variables, marital status, and multiple grants recipients, were statistically significant. Females have a lower likelihood of receiving the grant when compared to males with an odd ratio of 0.6431 and 0.55637 using the unadjusted and adjusted binary regression model, respectively. Conclusion: This study has found that marital status and multiple grants recipients are the two characteristics that are associated with the uptake of the Special COVID-19 Social Relief of Distress Grant among youth aged 18 – 35 years in South Africa. It found that males as compared to females are more likely to receive the SRD grant, this is because of the initial qualifying criteria that excluded a high number of females that were already receiving the Child Support Grant. This criterion was later changed to say that an applicant of the SCSRDG must not be entitled to a social grant for himself or herself.Item Trends in reporting on climate change, water and COVID-19 by JSE listed companies(University of the Witwatersrand, Johannesburg, 2022) Seedat, Zakiyyah; Lange, Yvette; Maroun, WarrenEnvironmental, social and governance (ESG) information is increasingly demanded by stakeholders as companies face risks and opportunities due to ESG issues, such as climate change, water and COVID-19. ESG disclosure helps reduce information asymmetry for users of company reports and helps companies maintain their social licence to operate. Disclosure is voluntary and this introduces differences in the information disclosed by companies. This study analysed the annual, integrated and ESG reports of the top 40 Johannesburg Securities Exchange (JSE) listed companies. These reports were analysed following an interpretive approach to determine the extent of disclosure on climate change, water and COVID-19 in 2018, 2019 and 2020. This study also considered the change in disclosure on climate change and water over these three years. A disclosure checklist has been developed using professional literature. Content analysis has been used to codify the disclosed information with disclosures being scored using an ordinal scale. Descriptive statistics have been used to analyse and graphically present the data. Exploratory factor analysis has been used for the identification of major disclosure themes. This study contributes to existing research by considering the current state of ESG disclosure at a time when notable developments in the reporting environment have occurred. The findings indicate that companies have focused on quantitative and strategy-related disclosure, indicating the adoption of similar reporting practices by companies. The study also found that there was no significant change in climate change and water disclosure from 2018 to 2020Item E-learning as an innovative platform for medical doctors in South Africa(2021) Pillay, TerenceE-learning could be an innovative continued medical education platform for medical doctors in South Africa, especially now with the COVID-19 pandemic and its effects on physical contact between pharmaceutical companies’ representatives and doctors. This study aimed to determine and develop a more effective way to reach and provide accurate, credible education for all doctors using an e-learning platform as an alternative to representative visits. This research involved a quantitative study, deploying a survey to a sample of 456 doctors in South Africa via an online platform. The results arising from the analyses to prove the three hypotheses were statistically significant, and all were accepted. In summary doctors in South Africa valued their relationships with medical representatives, but simultaneously questioned the credibility of the education received from the representatives. Many doctors accessed the internet for their own education as one of their channels of education. In view of the research findings, an innovative e-learning platform is proposed to deliver continued medical education to all doctors and to allow for best practices sharing across the medical fraternity in South Africa