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

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Subject: search.filters.subject.South AfricaSubject: search.filters.subject.SDG-3: Good health and well-beingStart date: 2022End date: 2022

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Now showing 1 - 6 of 6
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    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.
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    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.
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    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
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    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.
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    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
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    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, Warren
    Environmental, 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 2020