4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
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Item Maternal death at Leratong Regional Hospital: a six-year retrospective review, South Africa(University of the Witwatersrand, Johannesburg, 2021-11) Motau, Tumelo Ngaka; Chauke, LawrenceBackground: 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.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 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, PatrickHealthcare 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 frequentlyItem Menstrual Hygiene and Management in Zamimpilo Riverlea Informal Settlement(University of the Witwatersrand, Johannesburg, 2021-08) Khofi, Lucy; Manderson, LenoreManaging 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.Item 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