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

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Pelvic floor dysfunction in female patients at two academic hospitals in Johannesburg, three months post-pelvic fracture
(University of the Witwatersrand, Johannesburg, 2024) Chopdat, Nazreen; Brandt, Corlia
Background: Research is sparse on PFD* in females who sustained a pelvic fracture in South Africa. This study aimed to determine PFD symptoms and associated factors among females aged 18 years three months post-pelvic fracture Method: A three-month quantitative longitudinal study was conducted over 19 months, at two South African teaching hospitals. History obtained from medical records and patient questioning; APFQ* used for PFD symptoms. Correlation tests and linear regression analysis were used. Results: Of 44 participants recruited, 37 completed the three-month follow-up. Median age was 37 (interquartile range 30.5-58) years. PVA* accounted for 87.50% of multiple fractures (P=0.040). Bladder and bowel dysfunction were most common, with sexual avoidance a significant outcome following pelvic trauma. The injury directly or indirectly limited sexual activity in 45.45% participants. Significant changes were noted in Total (p=0.0216), Bladder (p=0.0062) and Sexual (p=0.0087) domain APFQ scores from preinjury to three months post-injury; and between subacute and three months post-injury, APFQ* Total (p=0.0361), Bladder (p=0.0002) and Bowel (p<0.0001) domain scores. Prolonged urinary catheter use, increased risk for higher scores of bladder PFD* (n=37, r=0.1585). Factors associated with less PFD at three months included number of vaginal deliveries preinjury (p-value 0.026, coeff -2.77, (95%CI: - 5.17 to -0.36), and bedrest with non-weightbearing choice of treatment (p-value 0.046, coeff -4.00, 95% CI: -7.92 to -0.08). Conclusion: PFD is present prior to and at three months post pelvic fracture with an increase in frequency and severity at three months. Symptoms are most prevalent in the subacute phase. The results of this study support the relevance of screening for PFD* within the early period and at three months for females following orthopaedic trauma. Clinical implications: Screening for PFD should become standard practice for females’ post-pelvic fracture in hospital and during outpatient follow-ups. Duration of catheterisation should be justifiable. Screening for bladder dysfunction is pertinent in patients requiring prolonged catheterisation, and patients requiring less conservative management. Guidance on safety to return to sexual activity is important to include as vi part of routine follow-up orthopaedic sessions. Integrating PFD screening and management into standard orthopaedic practice can improve outcomes and quality of life of affected individuals.
The association between poor sleep quality and cardiometabolic risk in HIV+ individuals and the general population living in a rural area of South Africa
(University of the Witwatersrand, Johannesburg, 2024) Reddy, Tracy; Scheuermaier, Karine; Karstaedt, Alan
Studies show that both poor sleep quality and HIV infection independently increase cardiometabolic risk (CMR). Additionally, poor sleep quality is common with HIV infection. Our study investigated whether HIV infection interacts with poor sleep quality to affect CMR in people living with HIV (PLWH) in a rural area of South Africa. We recruited 200 HIV+ participants and 200 controls from Qwa Qwa in Free State in South Africa and assessed their CMR, sleep quality, daytime sleepiness, risk of obstructive sleep apnoea and degree of depressive symptoms. Sleep quality (p = 0.15), daytime sleepiness (p = 0.31) and the cardiometabolic risk score (MetScore) (p = 0.93) were similar between HIV+ and control participants. Fewer HIV+ participants had a high risk of sleep apnoea (p = 0.019) but more HIV+ participants had symptoms of clinical depression (p = 0.0007). Poorer sleep quality in the HIV+ participants was associated with pain (p = 0.0006), more severe depressive symptoms (p<0.0001) and longer HIV duration (p = 0.011). However, HIV infection was not associated with a higher MetScore (p = 0.18) once age, sex and sleep and depression markers were adjusted for. Additionally, HIV infection increased the risk of hypertension (p = 0.016). HIV status did not interact with sleep quality (p = 0.32) to affect CMR. Our findings indicate that healthcare facilities should consider monitoring CMR factors in HIV+ individuals.
Investigating Knowledge, Attitudes, and Perceptions of SARS-CoV-2 Vaccine Hesitancy among Pregnant Women in Soweto, South Africa
(University of the Witwatersrand, Johannesburg, 2024) Maccarthy, Samuel Oluwasegun; Myburgh, Nellie
Pregnant women face heightened risks of severe COVID-19 consequences, making vaccination vital for their protection. In South Africa, despite government initiatives, vaccine hesitancy persists among pregnant women, hindering widespread coverage. This study delves into the knowledge, attitudes, and perceptions of COVID-19 vaccines among 60 unvaccinated pregnant women in Soweto, South Africa. It aims to identify influencers shaping their vaccine decisions, addressing a critical gap in understanding hesitancy in this vulnerable group. Data from a validated questionnaire reveal diverse information sources, with media being primary. Safety concerns emerge as the foremost hesitancy factor, and "personal decision" is a key influencer. Applying the 3C Model, the study unveils crucial factors guiding pregnant women's COVID-19 vaccination choices, providing insights for targeted public health strategies to address hesitancy in this susceptible population.
Business Case: Green-Certified Buildings in South Africa’s Residential Rental Market
(University of the Witwatersrand, Johannesburg, 2025) Roodt, Ilona
In this paper, the characteristics of the Excellence in Design for Greater Efficiencies (EDGE) green building certification system is explained, and the energy and water savings in a portfolio of residential units in the EDGE-certified residential building portfolio in South Africa was investigated. This research analysed the efficiency of energy and water usage, following certification, and the contribution to lowering building running costs and increasing property values was investigated. The research revealed that the portfolio design of EDGE-certified buildings results is, on average, a 42% energy saving and a 54% water saving across the portfolio. The research explores the overall reduction in building operating costs and the impact on property return by considering the payback period of the additional investment. The US Green Building Council indicate operating costs drop by 13%, with a drop of 10.5% in the first year and then an average of 16.9% over five years. The research revealed that overall cost savings are significant, the cost of greening is recouped on average over 6 years and this means that property returns increase. The US Green Building Council indicate that property values increase by between 4%-6% for a study relating to LEED-certified buildings. The research signifies the importance of bringing down energy and water costs to preserve and increase return and value, and this may be catalytic in increasing affordable housing investment and tenant standards of living. Where this activity is at scale within the right policy framework, an overall reduction in emissions may occur.
The Clinical Genomics of African Oesophageal Cancer
(University of the Witwatersrand, Johannesburg, 2024) Ngundu, Nerija Lamantha; Mathew, Christopher; Penny, Clement
In South Africa, oesophageal cancer is responsible for the 6th highest cancer-related deaths, with oesophageal squamous cell carcinoma (OSCC) being the most prevalent type at an incidence rate of 8.6/cases/100,000 for males and 4.7/cases/100,000 for females. It is often diagnosed at a late stage due to its asymptomatic nature, making it too late for any form of therapeutic interventions to be introduced. Information regarding the genetics of this disease on the African continent is limited, even more so in South Africa. This makes the task of identifying molecular markers, development of diagnostic and monitoring tools quite difficult. Therefore, the aim of this study was to identify the somatic mutation profiles of African patients with OSCC, thereby assisting in the expansion of knowledge regarding the genomic landscape as well fostering the development of molecular markers that could be useful in the diagnosis and treatment of this cancer. This was done by isolating DNA from blood, saliva and tumour samples and conducting whole exome sequencing (WES) on 21 matched blood/OSCC tumour samples. Data analysis was performed using R. The WES from 21 matched blood/tumour pairs revealed that somatic single nucleotide variants (SNV) were much more prevalent in comparison to somatic insertions or deletions (indels). The tumour mutation burden (TMB) was ~2 mutations per Mb. Tumour Protein 53 (TP53) was the most commonly mutated gene with 11 of the 12 mutations occurring in the DNA binding domain of the protein. Mutations in TP53, Titin (TTN) and Mucin 19 (MUC19) suggested that these genes were involved in relatively early events in the development of the tumours. Analysis of copy number alterations revealed a high degree of complexity in the tumour genome, with frequent amplification detected on chromosomes 1p33, 11q23.3 and 21q22.2, and common regions of deletion on chromosomes 5q31.2 and 7q32.3. Three mutational signatures were identified and the molecular pathway analysis showed that the NOTCH, RTK-KAS, and TP53 pathways were the most significantly altered pathways. The alterations discovered in this study have contributed to the greater scheme of the molecular landscape of OSCC.
Internal migration and sexual partnerships and practices: Findings from a South African Cohort
(University of the Witwatersrand, Johannesburg, 2024) Nyanisa , Yandisa; Ginsburg, Carren; Levin, Jonathan
Introduction There are high levels of geographic movement of people within South Africa’s borders, especially from rural to urban areas of the country. Such movements have an impact on sexual partnerships and practices. The aim of this study is to determine the relationship between internal migration and sexual partnerships and practices in a cohort of migrants and residents of the Agincourt study site (non-migrants) in South Africa’s rural northeast over two survey waves from 2018 to 2019. Methods This study used data from the Migrant Health Follow-Up Study (MHFUS) which commenced in 2017. The MHFUS is a 5-year cohort study that is nested within the Agincourt Health and Demographic Surveillance System (HDSS) longitudinal research platform. The cohort is based on a simple random sample of 3800 Agincourt HDSS residents and migrants aged 18 – 40. The Agincourt HDSS is located in a 420 square kilometre area of the Bushbuckridge district, Mpumalanga Province. Descriptive statistics, logistic and ordinal regression models were used to describe the characteristics of migrants and non-migrants in the cohort as well as sociodemographic factors associated with the number of sexual partners reported by participants, their type of recent sexual partners (whether a partner was regular or casual) and their calculated risk score (based on condom use and HIV testing). Results Sexual partnerships and practices differed by migration status and gender. A larger proportion of migrants than non-migrants had more than one partner in the last 12 months in both study waves. Of those migrants who had sexual partners in the last 12 months (n=1265), 11.2% had partners in both their place of origin and their current place of residence (migrant destination) in Wave 1. Nine or more total sexual life partners were reported more frequently by migrants (16.8%) compared to non-migrants (8.9%) in Wave 1. More males (31.6%) than females (5.3%) had two or more partners in Wave 1 and there were more males (15.6%) who reported having partners in iii both the origin and current locations compared to females (4.9%). Not using a condom was more common among non-migrants than migrants in both waves, with females being less likely to have used a condom in their last sexual intercourse compared to males. Ordinal logistic regression analysis indicated that the number of sexual partners in the last 12 months was associated with migration status, age, gender and employment status in Wave 1, while in Wave 2 it was also associated with level of education. Most recent partner (whether a partner was regular or casual) was associated with gender, education and employment in Wave 1 while associated with age, gender and employment in Wave 2. Risk score was associated with age and education in Wave 1 while associated with migration status, age, gender and education in Wave 2. Conclusion The study showed that sexual partnerships and practices differed by migration status and gender with non-migrants and females reporting more risky sexual practices compared to migrants and males. Internal migration can introduce risky behaviors that are related to sexual partnerships and practices. The study shows that the effect of migration can vary widely depending on factors such as gender dynamics, employment and education. A study of the relationship between internal migration and sexual relationships sheds light on this population's possible susceptibility to HIV/STIs. The evidence in this study also adds to the knowledge base needed for guidance in areas of prevention of STI, while future South African research focused on sexual partnerships and practices should incorporate measures of migration. Understanding these factors is essential for researchers, policymakers and health organizations involved in managing and providing support to migrants.
The association between substance use and HIV in two Sub-Saharan African countries, 2014 - 2016
(University of the Witwatersrand, Johannesburg, 2024) Jack, Samantha Louise; Mall, Sumaya
Background People Living With HIV/AIDS (PLWHA) are recognized to have an increased risk of substance abuse - alcohol heavy episodic drinking (HED), tobacco smoking, and illicit drugs. Substance use amongst PLWHA is associated with poorer antiretroviral treatment (ART) adherence, increased risk of cancers, and worse morbidity and mortality. Substance use is also associated with an increased risk of HIV infection amongst those who are HIV negative. The majority of this research is focused outside of the African continent and in high-income countries; thus, this study aims to contribute towards research in low-middle income African countries such as South Africa and Kenya. Aim This study aims to investigate the association between HIV and substance use in South Africa and Kenya, and the possible associated covariates. Methods The study population for this secondary data analysis included n=7919 men and women participants drawn between the ages of 40 and 60 recruited between August 2013 and August 2016. The Mann-Whitney test was used for continuous variables and all other categorical variables were analysed using a chi squared test or Fisher’s exact test. Predictive factors for the logistic regression models were informed by the literature review and conceptually modelled using a Direct Acyclic Graph. An overall logistic regression model was run which included both countries, and then separate logistic regression models were run for Kenya and South Africa. Results The prevalence of substance use in the overall sample was 54.30%. In Kenya it was 51.33% and in South Africa (SA) 55.60%. The prevalence of HIV in the overall sample was 20.94%. In Kenya HIV prevalence was 13.66%, and in SA 23.35%. PLWHA had a 1.22 greater odds of substance use than those who were HIV negative in the overall sample (p=0.012, 95%CI 1.04 - 1.43). In Kenya, PLWHA had a 1.49 higher odds of substance use (p=0.013, 95%CI 1.09 - 2.03). In SA, there was no significant association found between HIV status and substance use. In the Kenyan logistic model HIV status, sex, marital status and employment status were found to be associated with substance use. Full-time employment and marriage presented as protective factors against substance use in Kenya. In the SA logistic model age, sex, marital status and employment status were associated with substance use. Marriage was also a protective factor for the SA model. Self-employment and informal employment increased the odds of substance use by more than two-fold in the SA model (aOR=2.27, p<0.001, 95%CI 1.63-3.16; aOR= 1.50, p=0.0008, 95%CI 1.19-1.91 respectively). The factor with the largest odds for substance use across all three models was being male, with increased odds of 15.5 in the overall model (p<0.0001, 95%CI 13.4-17.9), 11.6 in Kenya (p<0.0001, 95%CI 8.65-15.5) and 17.7 in South Africa (p<0.0001, 95%CI 14.9-21.1). Conclusion Treatment of substance use disorders should become a staple in integrated routine ART care as the prevalence of substance use in PLWHA in this study and across the literature is high, especially in men The implementation of the substance use treatment should be tailored to the unique gendered and socioeconomic factors that are present in each country.
HIV-exposure as a risk factor for mortality among neonates with culture- confirmed bloodstream infection and meningitis in South Africa, 2019- 2020
(University of the Witwatersrand, Johannesburg, 2024) Marumo, Andani Ronel; Musenge , Eustasius; Mashau, Rudzani
Background: HIV-exposed but uninfected neonates (HEU) are a growing population. Exposure to HIV has been associated with increased mortality and morbidity. We aimed to determine the effect of HIV-exposure as a risk factor for mortality in neonates admitted with bloodstream infections (BSIs) and/or meningitis at non-academic hospitals in South Africa. Methods: We conducted a retrospective cohort study using data from the Baby GERMS-SA surveillance project of hospitalised neonates with culture-confirmed BSI and meningitis at six non-academic hospitals in South Africa from October 2019 to September 2020. A multivariable Cox proportional hazards regression was used to determine the effect of HIV- exposure regardless of HIV-status as a risk factor for mortality. We further examined the effect of HIV-exposure using a multivariable logistics regression. Results: Of 697 neonates with a known maternal HIV status and in-hospital outcome, 34% (239/697) were exposed to HIV and 1% (4/239) were HIV PCR-positive. The HEU neonates had significant low gestational age (77% (184/239) vs. 66% (296/458), p=0.001) and very low birth weight (48% (115/239) vs. 40% (184/458), p=0.016) compared to HIV-unexposed uninfected (HUU) neonates. Exclusive breastfeeding was more common in HUU neonates (44% (202/458) vs. 32% (77/239)). We did not observe significant differences in age at the time of infection (median age 6 vs. 6 days p=0.14), and duration of hospitalisation (median length of 17 vs. 15 days p=0.12) between the HEU and HUU neonates. The crude in-hospital mortality among HIV-exposed neonates and HUU neonates was 26% (63/239) and 23% (104/458), respectively. After adjusting for relevant confounders such as birth weight, timing of infection, use of invasive devices, breastfeeding, and maternal age, there was no difference in the risk for mortality between HEU neonates and those who were HUU (HR 1.12, 95% CI: 0.76-1.67, p=0.549) at 28-days. The odds of mortality were 1.21 (95% CI 0.72–2.05, v p=0.467) times more among HEU neonates than among HUU neonates in the exploratory analysis. Conclusions: We did not find a difference in mortality between HEU and HUU neonates with culture-confirmed invasive infections in our study. Regardless of their HIV exposure status, approximately a quarter of these neonates died in hospital.
Factors Associated with Uptake of HIV Testing Services among Men in South Africa
(University of the Witwatersrand, Johannesburg, 2024) Khoza, Samson S.; Christofides, Nicola
Background: In 2016, the overall Human immunodeficiency virus (HIV) prevalence rate was estimated at 12,7% and the total number of people living with HIV was estimated at approximately 7,03 million in the South African population in 2016. The World Health Organization recommends that people know their HIV status by getting tested and those who are found to be HIV positive get initiated on treatment early. However, HIV testing rates are below the 90% target and reportedly lower among males in South Africa. Aim: The study aimed to investigate factors associated with HIV Counselling and Testing (HCT) among men aged 18-34 years in South Africa. Methods: The study is a cross-sectional study using secondary data from Testa Boy study conducted by the Centre for Communication Impact in collaboration with Genesis Analytics between April and May 2017. The primary study employed a three multistage sampling approach, where at the first, the country was stratified into nine provinces, with sample size proportional to the population size of each province. After that an initial sub-place (district) was selected randomly from each province. Households were then randomly selected from the enumeration area (EA) or Primary Sampling Unit (PSU) in each sub-place (township/village). Finally, following the household selection, one eligible respondent from each household was selected randomly to participate in the study using a KISH grid that was used to draw a sample of PSUs. Data was collected using a self-administered questionnaire. The primary study constituted of a total of 3,000 male and female participants across all provinces in South Africa. We restricted our study to 1, 388 male participants. The outcome variable of this study was “uptake of HIV Counselling and Testing in the past 12 months”. The data was analysed using Stata SE version 14. Both univariable and multivariable analyses were employed. Results: About 52% of total of 1,388 men had HCT uptake in the past 12 months. Rates of HCT uptake at the provincial level ranged from 41% and 60% with Western Cape recording the high levels and North-west recording the lowest levels. In the multivariable analyses, men residing in provinces outside of the Western Cape demonstrated significantly lower odds of HCT uptake. The odds of HCT uptake was significantly lower among men in the Eastern Cape (AOR0.33, 95%CI 0.33-0.94), Limpopo (AOR0.54, 95%CI 0.30-0.99) and North-west (AOR 0.43, 95%CI 0.22-0.83) compared to the men in Western Cape. Employed men were 1.34 times significantly more likely to receive HCT compared to unemployed men (AOR1.34, 95% CI 1.01-1.77, p=0.039). Middle income (AOR 1.51, 95% CI 1.01-2.27) and low-income men (OR 1.60, 95% CI 1.16-2.21) had significantly increased odds of HCT uptake than rich-income men. With regards to sexual history, men who did not report condom use at first (AOR 0.71, 95% CI 0.53-0.93) and at last sex (AOR 0.68, 95% CI 0.52-0.90) exhibited significantly reduced odds of HCT uptake compared to those who reported condom use. Knowing someone who is HIV positive (AOR 1.40, 95% CI 1.09-1.82) was significantly associated with increased HCT uptake among men. iii Conclusion: The study provides important insights into the patterns and determinants of HCT uptake among men in South Africa. Geographic residence emerged as a key factor, with men from most provinces outside Western Cape exhibiting substantially lower odds of HCT uptake compared to those in Western Cape. Risky sexual behaviours such as not using condoms during sexual intercourse were correlated with low HCT uptake. Targeted interventions, such as expanding community-based HCT initiatives, strengthening health system infrastructure in underserved areas and tailor-made combinations of prevention interventions such as HCT and condom prevention strategies could contribute to increased HCT uptake and better control of the HIV epidemic in the country.
Constructed Wetlands: Additional heterogeneous configurations on existing infrastructures in Silvertown, Alexandra Township, Johannesburg
(University of the Witwatersrand, Johannesburg, 2024-09) Sepeng, Motshwaedi Collen; Thatcher, Andrew
Greywater disposal is a service issue that has yet to be addressed fully in urban informal settlements of South Africa. Greywater exposure poses great health dangers if this wastewater is disposed of incorrectly. Silvertown proved to lack infrastructure for greywater disposal and showed prevailing evidence of physical exposure to disposed greywater. There are no formally defined manners of greywater disposal in Silvertown. Therefore, there is a need for infrastructural development to support safe greywater collection, disposal, and possible treatment. Heterogeneous Infrastructure Configuration (HIC) scholars have pointed out that empirical work still needs to be done to validate the theoretical arguments that infrastructural growth in the Global South does not emphasise uniformity and standardisation. To address the greywater disposal problem, constructed wetlands (CWs) were implemented in Silvertown (a section of an informal settlement) as a proposed solution for greywater disposal. This study investigated how the CWs integrated with existing infrastructure over three years. A participative, iterative design process was implemented to help create links between the residents and the existing heterogeneous infrastructure. In this research, HIC was used as a theoretical framework to help understand the dynamics that shape the engagement with the CWs by the residents of Silvertown and integration with existing infrastructure. Notably, in the absence of the provision of infrastructure and services, the people of Silvertown have actively constructed the environment around them to provide the required services and infrastructure. It was also evident that “people as infrastructure”, as Simone (2004) phrases it, emerged as a prominent process in the provision of services. A qualitative study which included semi-structured interviews, unstructured interviews, and observations collected over three years was used to collect data from Silvertown. The research findings showed that CWs made significant progress beyond just offering a solution for greywater disposal and the controlled/treated release of contaminated water through integration with related infrastructure and services. However, it was also noted that the effectiveness of the CWs was hindered by challenges such as vandalism and negligence. A collective effort was needed from the service providers and the residents to ensure the functionality and sustainability of planned infrastructures such as CWs in Silvertown.

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

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