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

Permanent URI for this communityhttps://hdl.handle.net/10539/37773

For queries relating to content and technical issues, please contact IR specialists via this email address : openscholarship.library@wits.ac.za, Tel: 011 717 4652 or 011 717 1954

Browse

Search Results

Now showing 1 - 10 of 12

Voiding cystourethrography in the renal pre-transplantation workup: an essential investigation?
(University of the Witwatersrand, Johannesburg, 2022-10) Sofianos, Zelia; Rajkumar, Leisha; Lucas, Susan
INTRODUCTION: Due to resource constraints in the South African public healthcare sector, patients with End-Stage Renal Disease (ESRD) are eligible for renal replacement therapy only if they are also found to be eligible for renal transplant. AIM: The aim of this study is to document Voiding Cystourethrogram (VCUG) findings in potential renal transplant candidates to assess the contribution of the VCUG as a standard investigation in the renal transplant workup. METHODS: Of the patients who underwent VCUG in Klerksdorp/Tshepong Hospital Complex (North West province, South Africa) from 1 January 2019 to 31 March 2020, 85 patients were included in the study and their VCUG findings retrospectively analysed. RESULTS: The mean age was 40.0 years (range 21-62 years), with males constituting 57.7% of patients and females 42.3%. Lower urinary tract abnormalities were identified in 24.7% of patients, some of whom had more than one abnormality. Of the total abnormalities, VUR (vesicoureteral reflux) accounted for 15.3%, bladder diverticula for 5.9%, urethral strictures for 3.5% and a significant post-void residual volume for 4.7%. No comorbidities were found to have a statistically significant association with the presence of VCUG abnormalities. CONCLUSIONS: To ensure that patients with End-Stage Renal Disease are adequately prepared for renal dialysis and potential renal transplant, and that their comorbidities and lower urinary tract are optimised should abnormalities be identified on VCUG, the VCUG remains an essential investigation in the renal transplant workup.
Maternal death at Leratong Regional Hospital: a six-year retrospective review, South Africa
(University of the Witwatersrand, Johannesburg, 2021-11) Motau, Tumelo Ngaka; Chauke, Lawrence
Background: The aim of the study was to systematically examine the main causes of maternal deaths and contributing factors at Leratong Regional Hospital in order to recommend strategies that can assist in reducing maternal mortality at this level of healthcare. Objectives: The objectives of the study were to: determine the institutional maternal mortality rate at Leratong Regional Hospital between 2012 to 2017, compare the trend (year on year) in the iMMR over the study period, describe the profile of women who died during the period under study, describe the clinical and surgical management of the women who died, and to determine the leading causes of maternal deaths, contributing factors and avoidable factors. Methods: A hospital based retrospective study based on patient clinical records at Leratong hospital. It included all the maternal deaths that occurred at Leratong Regional Hospital during the six-year study period (2012-2017). Results: There was a total of 78 maternal deaths with 32441 live births giving the MMR of 240 per 100 000 live births. However only 74 files could be analysed. The results showed that there was a rise in the maternal mortality rate over a six years period. The majority (70, 94.5%) of the women who died were African, aged between 20-35 years (56, 76%), multigravida (54,73%) with a parity of three or more (23, 31%). Obstetric haemorrhage was the leading cause of maternal death particularly postpartum haemorrhage (11.14%) followed by non-pregnancy related infections, sepsis and eclampsia. Conclusion: Maternal mortality has decreased according to recent confidential enquiry into maternal death in South Africa (2017-2019) However our study did not demonstrate a decline but rather an increase in the maternal mortality rate at Leratong. It showed that most of the maternal deaths were avoidable and the need for urgent interventions in terms of education, improving access to health care facilities, intensifying health care worker skills training and better transport systems between health care facilities is important.
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.
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.
Surgical aortopulmonary shunts - a thirty-seven year experience in a South African tertiary institution
(University of the Witwatersrand, Johannesburg, 2019-11) Dladla-Mukansi, Nontobeko Charity; Cilliers, Antoinette; Mammen, Vijay; Vanderdonk, Kathy
Introduction: The surgical aortopulmonary shunt is a valuable palliative procedure in the management of congenital heart diseases. There is a paucity of data regarding aortopulmonary shunts in the developing world, including South Africa. Objectives: The primary objective was to describe the demographic, clinical and echocardiographic characteristics of children between ages 0 and 14 years that underwent surgical aortopulmonary shunts. The secondary objectives were to describe trends in aortopulmonary shunt designs, outcomes in terms of morbidity and mortality, progression to definitive surgery and to assess patency of shunts. Material and Methods: A retrospective clinical audit of patient files who underwent an aortopulmonary shunt between 01 January 1980 to 30 December 2016 was undertaken at Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto, Johannesburg. The study period was divided into 3 stages and for descriptive purposes as follows: 1980-1991 refers to period 1, 1992-2003 refers to period 2 and 2004-2016 refers to period 3. Results: A total of 177 aortopulmonary shunts were done over the 37-year study period. Of these 177 patients, 165 (93.2%) patient files were available. Fifty-six percent of the patients included in the study were male. The majority of patients were from the Gauteng Province (76.8%). The four most common diagnoses across the entire study period were tricuspid atresia (26.0%), pulmonary atresia with VSD (23.7%), tetralogy of Fallot (23.2%) and complex cardiac lesions (16.9%), with no particular trend in the proportion of these diagnoses presenting across this study period. There was no statistical difference between period 1 and 2 (p-value a=0,328) and between period 1 and 3 (p-value b=0,548). The total number of all surgeries done over the entire study period was 2145, of which 8.3% were aortopulmonary shunts. Period 1 had the highest percentage [35 (10.9%)] of aortopulmonary shunts compared to the total number of surgeries performed. There was a decline in the number of aortopulmonary shunts performed over the study periods 1-3. With no statistical difference across periods as shown in table 1 with p-value a and b. Of the different types of aortopulmonary shunts, most patients [157 (88.7%)] had a modified Blalock-Taussig shunt (BTS). The remainder of the shunts included 3 (1.7%) classic BTS, 12 (6.8%) central shunts and 5 (2.8%) unknown BTS. The percentage of modified BTS done increased from 80% in period 1 to 87.3% in period 2 and to 95.2% in period 3. Period 1 had the most complications (28.6%) compared to 11.4% in period 2 and 19.1% in period 3. Sepsis as a complication following surgery increased over the study period from 2.9% in period 1 to 3.8% and 7.9% in periods 2 and 3 respectively. Early mortality was 17.1%, 26.6% and 25.4% from periods 1-3 respectively. Late mortality declined from 17.0% in period 1 to 11.4% and 0% in periods 2 and 3 respectively. Only 37 (20.9%) patients were documented to have further surgery after the initial aortopulmonary shunt. Across all three study periods, no blocked shunts were documented. Conclusions: This study describes the characteristics and outcomes of aortopulmonary shunts over a 37-year period in a tertiary care resource limited low to middle income country setting. The commonest cardiac lesions for which aortopulmonary shunts are performed are tricuspid atresia, pulmonary atresia with VSD, tetralogy of Fallot and other complex cyanotic cardiac lesions. The frequency of aortopulmonary shunts compared to total surgeries has corrective surgery for these cardiac lesions. The modified BTS is the most frequently performed aortopulmonary shunt used for palliative surgery in our setting, which is a similar trend in developed countries. The morbidity and mortality in this study is higher than developed countries, with sepsis being the most common complication. Attention to infection control practises need to be emphasized peri- and post-operatively in our hospitals.
The feasibility of telemedicine based consultation in the primary healthcare sector in Johannesburg
(University of the Witwatersrand, Johannesburg, 2021) Mistry, Karishma Jivan; Wotela, Kambidima; Zhuwao, Patrick
Healthcare system in South Africa is overburdened and telemedicine is considered a useful tool to make quality healthcare more accessible. In South Africa, regulations imposed by Health Professional Council of South Africa (HPCSA) and restricted access to technological, educational, economic and sociocultural factors has limited the ease of accessing and using telemedicine. In order for telemedicine to gain prominence, it needs to be integrated into everyday practice and be seen as an alternative to face-to-face consultation. Hence, the purpose of this study was to evaluate a combination of factors, in the context of Covid-19 pandemic, namely telemedicine as an engaging platform, seeking written or verbal informed consent for clinical procedures and using information and communication technology (ICT) and availability and knowledge of electronic resources to conduct virtual consultation. In addition, the method used to store patient information was examined to understand the prominence it has in the context of telemedicine. A quantitative, cross-sectional research strategy was used to collect data from 80 family physicians practicing in either private, state or both sectors. This study reported that a large number of participants have used some form of telemedicine, although only one third use it daily. On average the study population reported to agree that telemedicine is an engaging platform, but half the respondents found that the explanation concerning the disease or treatment is not better. Verbal consent is used more than written consent for activities relating to clinical examination or when using ICT. While, majority of the respondents indicated that they do have an electronic device to implement telemedicine consultation, only half the respondents had access to quality broadband network. The study also reported that about two-thirds of the respondents reported to stored patient information manually. Overall, more attention is required to make the functionality of telemedicine more noticeable. Telemedicine may not be valued so much when there is good health infrastructure, however, when health infrastructure is poor, telemedicine is unable to stand on its own. Hence, associated economic, education and socio cultural factors needs to be evaluated further so that behavioural barriers are reduced and telemedicine is used more frequently
Effects of Covid-19 on the psychological well-being of employees in South Africa
(University of the Witwatersrand, Johannesburg, 2022) Ashruf, Ahmed; Conradie, Bruce
On January 30, 2020, the World Health Organization (WHO) declared the Covid-19 virus to be a pandemic (Zanke et al., 2020, p.49). The virus first spread in South Africa when a traveller returned to the country after visiting Italy. To stop the infection from spreading South Africa implemented a national lockdown as per the Disaster Management Act, Regulations: Alert level 5 on the 26th of March 2020. South Africans were only permitted to leave their homes for medical crises, food, and medication (Villani et al., 2021, p.2). Furthermore, universities and schools were shut down whereby some functioned online, intern-regional, and international travel was suspended. During this time, all kinds of meetings were prohibited. Inter-regional travel became feasible six month later, and five months later it was conceivable for those living in various regions to be able to return to their homes (Villani et al., 2021, p.2). However, front line workers were only permitted at the time to attend work while other companies transitioned to remote work
Menstrual Hygiene and Management in Zamimpilo Riverlea Informal Settlement
(University of the Witwatersrand, Johannesburg, 2021-08) Khofi, Lucy; Manderson, Lenore
Managing menstrual hygiene in low- and middle-income countries is difficult, due to lack of proper facilities. With inadequate WASH (water, sanitation, and hygiene) services and infrastructure, such as proper working toilets and lack of access to sanitary materials, some women end up using unhygienic sanitary materials, such as rags, leaves, sand, tissues and so forth to manage menstruation. In this study, I used an anthropological approach to describe and analyse women’s understandings of menstrual health and hygiene in the informal settlement of Zamimpilo, Johannesburg. Firstly, I looked at how women understood menstruation and how this was influenced by community attitudes and social norms. Secondly, I identified what material, structural and normative factors hindered or enabled women to manage their menstruation and hygiene: shame, embarrassment, level of education, access to information, gender inequality, affordability of pads and soap, access to water, and access to sanitation and hygiene facilities. Thirdly, I explored women’s experiences of their bodies, and how menstruation influenced their decisions to go out, go to school, have sex, bathe with others, manage pain, and sleep. I looked also at the practices that women used to manage menstrual waste. As I illustrate, these practices are shaped by cultural, social, and religious factors. I have explored women’s creative ways to manage menstruation, menstrual waste, and hygiene under different conditions, and explored the extent to which they have internalised or resisted negative attitudes towards their bodies and bodily products. I emphasise women’s narratives. In theorising these questions, I have adapted ideas from Purity and Danger (1984) by Mary Douglas, and following her, I have analysed menstruation as something polluting and dirty that contributes to menstrual shame. I have also drawn on Emily Martin’s book The Woman in the Body (2001) and examined how social and cultural factors shape women’s understanding of themselves. The data on which this thesis was based is drawn from research using qualitative methods. Due to constraints in movement and social interactions associated with COVID-19, primary data were collected through telephonic semi-structured interviews. Twelve women – six young women between 18 and 25 years and six women between 25 and 40 years of age – were each interviewed twice, bringing the total number of in-depth interviews to 24. Participants were recruited through a key informant, using purposeful sampling for maximum variability to ensure diversity of age, ethnicity, religion, education background, among participants. This was significant given that the population of Zamimpilo was diverse and includes people from different provinces and communities: Xhosa, Zulu, Pedi and other South Africans all live in Zamimpilo, as well as people from other African countries including Mozambique, Zimbabwe, Zambia, and Nigeria. My findings suggest that women’s MHM (Menstrual Hygiene Management) in Zamimpilo is still a huge challenge. The environment is deeply compromised, and no residents have access to adequate housing, water and sanitation. These basic challenges, along with the lack of sanitary products, hinder women from managing their menstrual hygiene. However, I found that these women used alternatives to manage their MH (Menstrual Hygiene), including various herbs for menstrual hygiene purposes and to prevent urinary tract and reproductive tract infections. Women expressed various understandings of their bodies, menstrual blood and menstruation as a process. I describe how the South African Department of Women, Youth and Persons with Disabilities has tried to address ‘period poverty’ in the country with the collaboration of non-government, non-profit organisations, the private sector, and menstrual activists. However, the need is greater than available resources. In places like Zamimpilo, women still do not receive any assistance from community organisations or from the state, and so they must improvise to manage this most private, routine, mundane event.
Investigation of Middle Ear Function Through Wideband Absorbance Measure in Adults Living with Human Immunodeficiency Virus in Gauteng Province, South Africa
(University of the Witwatersrand, Johannesburg, 2022-06) Sebothoma, Ben; Khoza-Shangase, Katjah
Background: The association between the human immunodeficiency virus (HIV) and auditory pathologies, including middle ear pathologies, has been extensively researched. However, most of this research has documented the middle ear pathologies of people living with HIV using conventional tympanometry with single probe tone, which has been shown to have poor sensitivity and specificity. Consequently, middle ear function and pathologies of people living with HIV may not have been accurately represented. While wideband acoustic immittance (WAI) such as wideband reflectance or/and absorbance measures emerged as a potential measure that can accurately identify early signs of middle ear pathologies and provide an accurate picture of the middle ear function, little is known about middle ear function and pathologies of adults living with HIV using wideband acoustic immittance. The value of preventive audiology in this population that comprises a big component of South Africa’s quadruple burden of disease cannot be overemphasized. Purpose: The primary purpose of this study was to investigate middle ear function through WAI in adults living with HIV. Specific objectives included to: review evidence on trends of middle ear pathologies in adults living with HIV; determine current practices employed by South African audiologists in identifying middle ear pathologies; determine the usefulness of using tele-practice to identify middle ear pathologies in adults living with HIV; determine the usefulness of wideband absorbance measures in identifying middle ear pathologies in adults living with HIV; determine the sensitivity, specificity, and characteristics of wideband absorbance measures in adults with and without HIV; determine the combined effects of HIV and comorbidities on hearing function; and explore risk factors that influence the development of middle ear pathologies in adults living with HIV. Participants: A non-probability purposive sampling was used to recruit and select participants. South African adults aged 18 years and above who were diagnosed and living with HIV in the Gauteng Province and attending an HIV clinic, as well as adults who are HIV negative as a control group were recruited and included in the study. Design: While the general methodology for this research comprised of a quantitative, cross-sectional design, each research article that forms part of this study has its own specific research design and methodology, and this is presented in each article. Data analysis: Data were analysed using the STATA version 1.5. For each paper (presented as chapters in this thesis), specific statistical analysis procedures were adopted, and are reflected in each of the chapters. Results: Findings in this study revealed that middle ear pathologies are common and highly prevalent in adults living with HIV, reaching approximately 60% in the current sample. These pathologies vary according to type and severity, and this is influenced by the middle ear measure used for assessment. The common middle ear pathologies in this study were otitis media with effusion, chronic suppurative otitis media, with conductive hearing loss. Despite the existence and occurrence of middle ear pathologies, some audiologists do not regularly incorporate tympanometry into their clinical practice. Asynchronous tele practice, through video-otoscopy, was found to be useful and feasible in the identification of middle ear pathologies in adults living with HIV, with substantial agreement (K=0.5801 to 0.6047) between otorhinolaryngologists. The wideband absorbance measure was found to be more accurate in identifying middle ear pathologies than the tympanometry with 226Hz probe tone and pure tone audiometry using air/bone gap. The sensitivity of wideband absorbance reached 88%, while that for tympanometry with 226Hz probe and pure tone audiometry was below 20%. In addition, the wideband absorbance patterns, measured at ambient pressure and tympanometric peak pressure, were also established for participants with normal middle ear function and middle ear pathology. While there was a difference between the wideband absorbance pattern of participants with normal middle ear function and middle ear pathologies, with middle ear pathologies being lower in the low to mid frequencies (226Hz to approximately 3000) for both ambient pressure and tympanometry peak pressure, this difference was not statistically significant between and within groups. Finally, findings of this study indicated that adults living with HIV, with comorbidities such as hypertension and hypercholesterolemia, and risk factors such as advancing age and an extended use of ART, have an increased the risk of developing various types of hearing loss. Conclusion: Current findings highlight the importance of preventive tailored care for adults living with HIV. The study indicated that middle ear pathologies and hearing loss are high in adults living with HIV. The development of these pathologies is associated with comorbidities and other risk factors. Wideband absorbance measures appear to offer promise as a diagnostic measure for middle ear pathologies in this population. However, wideband absorbance must be used in conjunction with other middle ear measures such as video otoscopy to improve early identification and intervention of middle ear pathologies. While this study indicates that middle ear pathologies are common in adults living with HIV, the patterns of wideband absorbance suggest that middle ear function in this population may not be different to HIV negative control group. Findings of this study also highlighted the importance of training facilitators to capture quality video otoscopic images that can be used for tele practice in a South African context where demand versus capacity challenges exist in as far as ear and hearing care healthcare practitioners are concerned. Finally, this study raises implication for resource distribution, ensuring that accurate measures such as wideband absorbance measures are available in clinical setting, which will improve early identification and intervention in adults living with HIV.
Regulating mental illness in the South African workplace — lessons from Canada
(University of the Witwatersrand, Johannesburg, 2022-12-20) Mylchreest, Aidan; Pillay, Karmini
In post-Covid-19 South Africa, an already stressed population has returned to work. A mental health crisis is emerging and this is evident amongst employees who are struggling with mental illnesses such as depression. In these circumstances, both employers and employees will need guidance when faced with mental illness in the workplace. The recent matter of Jansen v Legal Aid South Africa (2018) 39 ILJ 2024 (LC) (‘Jansen’) is an example of a dispute that arose out of allegations of unfair discrimination and unfair dismissal, due to an employee’s depressive condition. This paper will examine the decisions of the Labour Court and the Labour Appeal Court in Jansen with a view to analyse the approach of the respective courts, in the context of disability and unfair discrimination. This paper identifies the shortcomings of the Jansen judgements and argues that both courts missed an opportunity to provide certainty to both employers and employees. This paper goes on to consider Canada’s progressive approach to mental health and the legal mechanisms developed to provide protection to employees. Canadian jurisprudence will serve as a source of comparison, with a view to extract lessons in managing mental illness in the workplace. Finally, this paper recommends that legislators consider Canada’s legal approach to mental illness with a view to develop a Code of Good Practice focused on mental illness in the workplace

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

Browse

Filters

Settings

Sort By

Results per page

Search Results