4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
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Item Tobacco use among healthcare professionals and their readiness to implement cessation treatments among patients in Primary Care facilities in Soweto, Johannesburg(University of the Witwatersrand, Johannesburg, 2024) Alagidede, Ann Nhawinei; Omole , Olufemi B.Background: Despite its hampering influence on healthcare professionals’ (HCPs) willingness to implement tobacco cessation treatments (TCT), tobacco use remains understudied in South Africa. Objective: To determine the prevalence of tobacco use among HCPs and its influence on their readiness to implement TCT for their patients. Methods: This cross-sectional study sampled 444 HCPs in five Community health centres in Soweto. A self-administered questionnaire collected information on socio- demography, tobacco use, quit attempts and HCPs’ readiness to implement TCT for their patients. Readiness was defined as a construct of HCPs’ rating of the importance of TCT and their confidence in implementing it. Results: The mean participant age was 41 years. Most were female (80%;n=355), single (54.1%;n=240) and black (91.6%;n=405). About 22%(96) were ever-users of tobacco, 12.6%(n=56) current users and 9%(n=40) ex-users. Among current users, 64.3%(n=36) smoked only cigarettes, 17.9%(n=10) used only snuff, and 14.3%(n=8) used other products. About 56.6%(n=30) of current users had contemplated quitting in the past year. Approximately 68%(n=300) and 82.2%(n=365) of participants were ready and willing to implement TCT, respectively. Only 32%(n=143) and 25%(n=107) of participants had received any training on tobacco use and TCT, respectively. There was no significant association between tobacco use and readiness to implement TCT (p=0.50). Conclusion: Tobacco use is prevalent among HCPs and has no influence on the implementation of TCT in South African primary health care. Although most HCPs reported readiness and willingness, there is a need to scale up training, both during formal health professions education and in continued professional development. Contribution: This is one of few recent studies demonstrating the concerning rate of tobacco product use among HCPs in South African PHC. Although there is a high level of readiness to implement TCT for their patients, most HCPs still need training to ensure their self-efficacy.Item Laboratory Evaluation of Aspergillus Galactomannan Lateral Flow Assays(University of the Witwatersrand, Johannesburg, 2023) Ubbink, Anja; Chibabhai, Vindana; Nana, TrushaBackground Invasive aspergillosis diagnosis is based on a combination of clinical, radiological, and mycological factors, including the detection of Aspergillus galactomannan antigen in serum and bronchoalveolar lavage fluid (BALF). Lateral flow assays (LFA) introduced for rapid detection of galactomannan in serum and BALF include the IMMY sōna Aspergillus LFA (IMMY LFA) and the Dynamiker QuicGMTM Aspergillus Galactomannan Ag LFA (QuicGM LFA). Objective To evaluate the performance of the IMMY LFA and QuicGM LFA in South Africa. Methods Serum and BALF samples previously tested by Platelia BioRad Aspergillus GM-EIA were analysed using the two different LFAs. Percentage agreement and precision was assessed. Results Forty-six serum- and 13 BALF samples were tested using the IMMY GM LFA and 48 serum- and 6 BALF samples were tested using the QuicGM LFA. Using an optical density ≥0.5 as positive, results were compared to the BioRad Aspergillus GM-EIA. For the IMMY LFA, serum samples had a positive percent agreement (PPA) of 0% (0/1); negative percent agreement (NPA) of 91% (41/45) and overall percent agreement (OPA) of 89% (41/46). BALF samples had a PPA of 75% (3/4), NPA 50% (5/10) and OPA of 57% (8/14). For the QuicGM LFA, serum samples had a PPA 0% (0/3), NPA of 96% (43/45) and OPA of 90% (43/48). BALF samples had a PPA of 100% (1/1), NPA of 100% (5/5) and OPA of 100% (6/6). For the IMMY LFA, between-day reproducibility for 72% (13/18) and 63% (5/8) for serum iii and BALF samples, respectively. Between-batch reproducibility was 89% (16/18) and 50% (4/8), respectively for serum and BALF samples. For the QuicGM LFA, between-day reproducibility was 75% (9/12) and 75% (3/4) for the serum and BALF samples, respectively. The between-batch reproducibility was 100% (8/8) for serum and 100% (3/3) for BALF. Conclusion A follow-up evaluation with a larger sample size utilizing clinical, radiological, and laboratory data is warranted to determine the assays’ clinical utility. What this study adds Invasive aspergillosis is a life-threatening disease, where a prompt diagnosis improves outcome. Currently there is no Aspergillus galactomannan assay available in the South African state sector. This study evaluates two lateral flow assays for the detection of Galactomannan in South Africa.Item The effect of Neodymium Yttrium Aluminium Garnet laser capsulotomy on intraocular pressure and retinal nerve fibre thickness(University of the Witwatersrand, Johannesburg, 2024) Carey, Angelika Ursula; Ally, Naseer; Alli, Hassan DawoodPurpose To study the effect of Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser capsulotomy on intraocular pressure (IOP) and retinal nerve fibre layer (RNFL) thickness in all patients and diabetic patients with post-cataract posterior capsule opacification (PCO). Design Prospective cohort study Methods In all the patients, including the diabetic patients, the IOP and RNFL were measured and the PCO graded before Nd:YAG laser capsulotomy (baseline), and the IOP measured at 15 minutes, 2 hours, 1 week and 1 month after laser capsulotomy. Additionally, the RNFL was measured at 1 month after laser capsulotomy. The IOP and RNFL at the aforementioned timepoints after laser capsulotomy was compared to the baseline IOP and RNFL in all patients and in diabetic patients. Results Compared to baseline there was a significant increase in IOP of 0.9mmHg at 2 hours (p = 0.01) after laser capsulotomy in all patients. In diabetic patients there was a significant increase in IOP of 1.58mmHg at 15 minutes (p = 0.01) and 1.21mmHg at 2 hours (p = 11 0.006). There was a significant decrease in the RNFL thickness in diabetic patients 1 month after laser capsulotomy (p= 0.009); there was no decrease in RNFL thickness in all the patients at this time point. Conclusion The prolonged (15 minutes to 2 hours) increase in IOP and the decrease RNFL thickness at 1 month in diabetic patients suggest that these patients are at increased risk of glaucoma. Further longitudinal studies are required to determine if diabetic patients develop glaucoma after Nd:YAG laser capsulotomy.Item A randomised controlled trial comparing erector spinae and transversus abdominis plane blocks for postoperative analgesia after elective caesarean section(University of the Witwatersrand, Johannesburg, 2024) Eksteen, Aidan; Wagner, Janine; Kleyenstuber, ThomasBackground Peripheral abdominal nerve blocks contribute to multimodal postoperative analgesia that enhances early recovery after caesarean sections. The transversus abdominis plane (TAP) block is an established technique that offers somatic abdominal analgesia. The erector spinae plane (ESP) block is a novel fascial plane block that may offer additional visceral analgesic effects. This study aimed to compare the postoperative analgesic efficacy of bilateral ultrasound-guided TAP blocks to ESP blocks in women undergoing caesarean sections under spinal anaesthesia Methods Sixty-six ASA grade 1-3 (≥18 years) patients undergoing elective caesarean section under spinal anaesthesia were randomly allocated to receive either TAP blocks (n =33) or ESP blocks at the T9 vertebral level (n =33). The primary outcome measure was 24-hour cumulative morphine consumption. The secondary outcomes included the time taken to perform blocks, numeric rating scale (NRS) pain scores at 6- and 24-hours, effect of pain on activities of daily living (ADLs) and care for the newborn, time to first analgesic request, severity of opioid-related side effects, and patient satisfaction. Results There was no statistically significant difference in mean (SD) 24-hour cumulative morphine consumption between the ESP blocks and TAP blocks: 27 mg (14) vs 32 mg (15) (p=0.185). ESP blocks took longer to perform: 10.7 minutes (2.2) vs 9.0 minutes (2.5) (p<0.01). There were no significant differences in the other secondary outcomes. Conclusion The TAP block and ESP block were equally effective for postoperative analgesia after elective caesarean section under spinal anaesthesia. The ESP block did not demonstrate significant additional visceral analgesic effects.Item Remediating health science students’ perceptions of factors contributing to their successful completion of physiology and biochemistry courses at the University of the Witwatersrand(University of the Witwatersrand, Johannesburg, 2024) Erlwanger, Kennedy Honey; Ndofirepi , ElizabethBackground: A significant proportion of students who enrol for courses in the health sciences either do not complete them or have to remediate the courses before succeeding. However, they often fail to remediate successfully. In order to meet the increasing demands for qualified health care practitioners, there is need to ensure that all students complete their degree programmes. Understanding factors which contribute to successful academic throughput is therefore essential. Aim: This study explored factors which health sciences students perceived to have contributed to their successful progression after remediating medical biochemistry and physiology. Methodology: For this qualitative non-intervention study, phenomenography was used. Students were purposively sampled and semi-structured interviews conducted online or in-person. They were asked what they felt contributed to their poor academic performance initially, then what they attributed to their success in the remediation year as well as their emotions and advice they would give to remediating students and to faculty. The interview audios were transcribed and a systematic thematic analysis undertaken to explore themes and sub-themes. Findings: The reasons proffered for initially failing included poor study techniques, lack/inappropriate use of teaching and learning resources, failure to adjust to remote learning due to covid-19 lockdown restrictions, heavy workload, neglect of the course due to wrongly perceiving it as easy compared to the other courses and the innate difficulty of the course. Factors perceived to have resulted in successful academic progression in the remediating year included, increased self-efficacy, increased and purposeful use of teaching and learning resources (tutorials, past exam papers and eQuip), use of institutional support systems (Office of Student Success, academic advisors, course coordinators and tutors) and tapping into social support systems (family, peers, clergy and senior students). The students’ emotional feelings during remediation included, fear, isolation, stigmatisation, embarrassment and stress. They generally recommended that remediating students should use the interventions that they used in order to succeed. Advice to faculty centred on providing academic and emotional support to remediating students as well as to actively monitor their progress. Conclusions: There is need to review the workload of the medical biochemistry and physiology course. Students need to be equipped early with appropriate study skills and how to make the most of the support systems available to them in order to iv increase their prospects for academic success. Remediating students are under emotional strain and strategies to alleviate it need to be implemented.Item Exploring Oral Hygiene Educators` use of reflective practice on their teaching(University of the Witwatersrand, Johannesburg, 2024) Kearney, Angelique; Dreyer, AbigailReflecting on teaching helps educators develop an understanding which will enable them to assess their growth, develop informed decision-making skills, as well as become proactive and confident in their teaching. However, there is a gap in literature concerning the use of reflection by professional oral hygiene and dental therapist educators. For educators who aspire to elevate their teaching standards to enhance students’ learning outcomes, a comprehensive understanding and correct implementation of reflective practice is imperative. Therefore, it is important to explore the current application of reflective practice by oral hygiene educators. This study’s aim is to explore oral hygiene educator`s use of reflective practice on their teaching. The study uses a qualitative approach with an exploratory descriptive design. The research population consists of professional oral hygiene and dental therapists who were teaching oral hygiene at a South African higher education institution. Data collection was conducted through semi-structured interviews and analysed using Braun and Clarke’s six steps of thematic analysis. Findings reveal that educators had superficial to moderate levels of reflection on their teaching practices. While they acknowledged the benefits of reflection for personal and professional development, they lacked prior knowledge on how to reflect or access resources for reflective practices in teaching. Additionally, educators believed that the department in which they taught was under-valuing reflection, as a learning strategy. This study recommends the department, where the educators taught, to prioritise reflection by offering formal learning opportunities for educators and establishing clear guidelines for its practice.Item A 20-year audit from 2000 to 2020 of the management and treatment outcomes of temporomandibular joint ankylosis among a cohort of patients at Wits Oral Health Centre(University of the Witwatersrand, Johannesburg, 2024) Rudzani, Lalumbe RofhiwaBackground: Temporomandibular joint ankylosis (TMJA) is a pathologic condition characterised by fusion of the condyle to the fossa by bony or fibrotic tissue. The severity of the condition depends of the age of onset and whether it is unilateral or bilateral. The aim of this study was to report on management and outcomes of patients with TMJA in our unit. Method: A retrospective analysis of the demographic, risk factors, clinical presentation, treatment modalities and outcomes of patients treated in the department of Maxillofacial and Oral Surgery from January 2000 to December 2020, at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwaneth Academic Hospital (CHBAH), University of the Witwatersrand. Results: The study included 71 cases. The age ranged from 4 years to 70 years. 49.3% (n=35) of the patients were female, while 50.7% (n=36) were male. Majority of patients (39.44%) (n=28) presented with left TMJ ankylosis, followed by right TMJ ankylosis (38.03%) (27) and bilateral TMJ ankylosis (22.54%) (n=15). Trauma was found to be the leading cause of TMJ ankylosis at 77.46% (n=55) while the cause of ankylosis in 18.31% (13) of patients was unknown and 4.23% (n=3) was caused by infection. The treatment modalities were Gap Arthroplasty, Costochondral Graft and Total Alloplastic Joint Reconstruction. Majority of patients 57,75% (n=41) had isolated GAP as the treatment modality, followed by 26.76% (n=19) who had TAJR, and 15.49% (n=11) who had CCG. Six of the nine patients who had recurrent ankylosis were treated by CCG. Conclusion: Data analysed in this study indicate that trauma is the leading cause of TMJ ankylosis. From the findings of the present study, revealing no difference between GAP, CCG and alloplastic joint reconstruction, we conclude that irrespective of the treatment modality executed, early surgical intervention, radical and sufficient resection of ankylosed mass, early postoperative exercises, active physiotherapy and follow-up are imperative for successful rehabilitation and prevention of reankylosis of patients with temporomandibular joint ankylosis.Item The analysis of a student-led university screening and testing programme for cardiovascular disease and diabetes(University of the Witwatersrand, Johannesburg, 2024) Qureshi, Umara Bibi; Orchard, AnéNon-communicable diseases (NCDs) have become the primary cause of both mortality and morbidity globally. Due to their insidious progression, regular screening and monitoring is imperative. The notable surge in these diseases may be attributed to the ongoing global and epidemiological transitions, leading to changes in people’s behaviours and lifestyles. Typically, these diseases remain undetected until they manifest clinically, often leaving limited opportunity for prevention or reversal of damage. Hence, the goal is to prevent, delay the onset and treat these diseases before irreversible end-organ damage occurs. As NCDs typically develop over decades, the presymptomatic phase is often undetected by individuals, with individuals unknowingly exacerbating their conditions through lifestyle choices, such as physical inactivity, unhealthy diets, tobacco consumption and harmful use of alcohol. The university environment, with its academic demands and stressors, often fosters these habits, thus contributing to the proliferation of NCDs. To address this NCD epidemic, empowering students to conduct screening and health promotion initiatives within the academic environment could prove beneficial in building a health enabling environment. Providing students with opportunities to practice their clinical skills and complement their theoretical knowledge with practical experience through work- based learning initiatives could be mutually beneficial to the public and the students. Students gain valuable skills and experience, while the public receives free screening, lifestyle advice, and early detection of CVD risk factors. This study aims to identify the occurrence of CVD related risk factors at a student-led screening event. The Wits university clinical pharmacy department initiated a work-based learning program for the fourth-year pharmacy students to improve their clinical skill set. After training in the clinical skills required to conduct Point-Of-Care Testing (POCT) services, understanding the clinical threshold values and the lifestyle advice regarding each condition, the students underwent competency assessment before participating in the screening event. There were 767 participants in this study, with their medical histories and demographical information collected using a questionnaire, followed by relevant tests such as blood pressure, blood glucose, blood cholesterol and their anthropometric measurements. Additional tests such as the glycated haemoglobin A1c (HbA1c) test and full lipid panel testing was offered to some viii participants. Following the screening, results were explained to the participants, who were then referred or offered appropriate lifestyle education. Those that were referred for CVD-related risk factors, were telephonically surveyed about their clinical findings and their interventions post-screening. The occurrence of self -reported hypertension (6.5%), diabetes (2.09%), cholesterol (2.87%) and obesity (3.91%) were lower in comparison to the measured results. Screening results show that there were 18.25% abnormal blood pressure readings, 2.83% had hyperglycaemia, and 11.36% had high cholesterol readings. Control levels amongst participants with self-reported diagnosed conditions were suboptimal, with 56% potentially having uncontrolled hypertension, 18.75% uncontrolled diabetes, 18.18% uncontrolled cholesterol and 50% confirmed obesity. In this sample, tobacco and alcohol consumption did not significantly influence CVD risk factors. However, the age and designation were significantly (P < 0.05) associated with disease occurrence, while obesity was strongly associated with all demographic characteristics (gender, ethnicity, age range and designation). Follow-up surveys revealed significant findings among 35% of the participants. Among them, three participants (43%) were diagnosed with hypertension or diabetes, two participants (29%) had uncontrolled conditions which required upscaling treatment and the remaining two participants were advised to monitor their conditions and implement lifestyle modifications to prevent disease progression. Most participants cited reasons such as the lack of perceived need, cost, and time constraints for not pursuing routine screening. Those who utilized this service appreciated the convenience offered by a screening event held at their working and study environment. It was found that most people are unlikely to pursue screening services unless they are offered screening at their education and working environment. This highlights the importance of creating a health enabling environment, encouraging proactive health behaviours among participants.Item Patient knowledge, attitudes, and perceptions towards cardiovascular disease, medication compliance and lifestyle modifications in a tertiary hospital in Johannesburg(University of the Witwatersrand, Johannesburg, 2024) Ayob, RumaanahBackground and Aim: Cardiovascular disease (CVD) is the leading cause of mortality in sub- Saharan Africa and the leading cause of disability adjusted life years worldwide. The burden of CVD varies across countries with over three quarters of deaths occurring in lower-to-middle-income countries (LMICs). Despite the effectiveness of medication, adherence to therapy is a challenge. The paucity of information of CVD in South Africans and low cardiovascular literacy highlights the knowledge gaps of CVD disorders and the overlooked risk factors which are significant barriers. An analysis of the disparities in the vulnerable communities may guide the prioritization of interventions and allow disadvantaged groups to be reached. Therefore, this study aimed to determine patients’ knowledge, attitudes, and perception of their disease as well as the need for regular monitoring, medication compliance and the impact of lifestyle modification, in a public tertiary hospital in Johannesburg, South Africa. Methods: A cross-sectional study with convenience sampling was conducted in the vascular and diabetic outpatient clinics at a state tertiary hospital. A questionnaire was used to gather responses and a point of care test (POCT), assessing blood pressure, glycated hemoglobin (HbA1c) and lipogram was done to assess patient perception of their disease control. Results: Of the 191 participants (64%-woman, mean age 54 years), 57% were familiar with the term CVD, and 97% acknowledged the importance of follow-up visits. L evel of education, socio- economic status, monthly income, and residential area were associated with CVD knowledge levels. Participants with increased CVD knowledge were more physically active. Although the negative implications of smoking were acknowledged, they were not eager to quit. Participants with higher levels of knowledge were more aware of the indication of their medication. Patient’s perceptions of their disease were not aligned with the values measured by the POCTs. One-third of the population achieved target blood pressure levels and a quarter of the population achieved target HbA1c levels. Conclusion: Low to moderate levels of knowledge of CVD were found; most participants understood the significance of follow- up visits and treatment adherence. Insufficient knowledge of CVDs continues to be important factors in health behavior. Knowledge levels were influenced by the level of education, place of residence and type of employment, therefore targeted educational material may improve level of comprehension and understanding. Awareness strategies should emphasize at end organ damage is preventable and strategies to assist individuals to comprehend and manage the risk factors.Item Knowledge, attitudes and beliefs of pharmacy students towards influenza vaccination in South Africa(University of the Witwatersrand, Johannesburg, 2024) Moyo, Princess Ayanda; Padayachee, NeelaveniBackground: Influenza poses a great threat due to its prevalence, severity, and tendency for antigenic shifts that increase pandemic potential. This virus causes a respiratory illness that spreads quickly through droplets or contact with contaminated surfaces. Outbreaks are seasonal, and vaccination (ideally before the season begins) remains the most effective preventive measure, along with cough etiquette, handwashing, and avoiding ill individuals. Globally, influenza causes millions of severe infections annually, and in South Africa, it places a significant burden on healthcare systems and individual households. Healthcare workers' (HCWs) risk is elevated, and their vaccination is recommended to protect vulnerable patients and maintain uninterrupted medical services. Pharmacy students are future pharmacists and custodians of medicines who will advise and assist various communities. Therefore, there is a need to assess influenza vaccine acceptability in this priority group since HCWs are widely involved in and are significant advocates for different vaccination initiatives, especially now that the world is still dealing with the residual effects of the coronavirus disease (COVID-19) pandemic. Aim of study: To investigate the knowledge, attitudes and beliefs of pharmacy students at nine pharmacy schools in South Africa regarding the influenza vaccine. Methods: A descriptive quantitative study was conducted among undergraduate Bachelor of Pharmacy (BPharm) students in universities across various provinces including Limpopo, KwaZulu-Natal, Western Cape, North-West, Gauteng and Eastern Cape in South Africa. While nine pharmacy schools were approached, only eight universities participated. The inclusion criteria was limited to those in the BPharm programme and 18 years old and above. Those that had participated in the pilot study as well as participants that had more than ten unanswered questions were excluded from the study. A participant information sheet with details on the purpose of the study was adapted from a WITS template to provide further information to those invited to participate in the study. A questionnaire was adapted from a similar survey to suit the needs of this study and used to collect data. The questionnaire was piloted prior to administration to a sample population for study data collection. To assess the pharmacy students' knowledge, affected by their year of study and Work Based Learning (WBL) experience, a nominal scale (correct and incorrect) was used. The participants had to decide which answer most applied to the specific question. A five-point Likert scale was used to examine students' attitudes and beliefs about influenza vaccination. This method had five viii options: “strongly disagree, disagree, neutral, agree and strongly agree” to assess students’ agreement with the statements provided. All analyses were performed using STATA version 14 (StataCorp, USA), and statistical significance was determined at a 5% level. Results: A total of 278 pharmacy students participated in the study. There were 77 questionnaires excluded, resulting in a total of 201 participants. Just over sixty percent were between 18 and 21 (123, 61.2%) years of age, with most participants being female (150, 74.6%). The study identified good knowledge among all participants with a mean average score of 5.7 out of 7. Almost all of the participants (195, 97.0%) expressed that they believed the influenza vaccine to be safe. The participants showed a positive attitude towards influenza with a mean score of 16.2 out of 20. Among the 83 participants who reported to have medical aid, 46 (55.40%) had been vaccinated for influenza. Among those who had been vaccinated before (102, 50.70%), only 47 (46.10 %) indicated that they had received influenza vaccines regularly while growing up. Of the 99 participants that did not vaccinate, (44; 44.44%) indicated that they did not vaccinate due to the low priority assigned to influenza prevention and 29 (29.29%) believed that their natural immune system offers sufficient protection from the flu. Conclusion: There is a disconnect between knowledge and action regarding influenza vaccination among pharmacy students. Despite above-average understanding of influenza and vaccines, vaccination rates remain low. This may affect their advocacy for vaccination amongst patients attended to during WBL. While factors like medical aid coverage play a role, the study suggests the potential for long-term benefits from childhood vaccination. Limited support for mandatory vaccination policies highlights a distinct perspective within pharmacy education. This underscores the need for multifaceted interventions that dispel misconceptions, emphasise the crucial role of pharmacists in promoting vaccination and foster discussions around policy considerations. Further research is needed to pinpoint barriers and design tailored strategies to increase vaccination uptake among pharmacy students for improved public health outcomes.