Theses and dissertations (Health Sciences)

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The psycho-social challenges of working at the forefront of the Covid-19 pandemic : a survey of emergency care services personnel in the Eastern Cape EMS
(2023-05) Mfanafuthi Mavuso, Patrick; Bhagwan, Raisuyah; Abdullah, Naseef
Introduction The COVID-19 pandemic, which emerged in early 2020, has caused a surge in patient numbers and crippled healthcare systems. South Africa has had more than 2.9 million positive COVID-19 cases, resulting in over 89 000 deaths. Healthcare workers (HCWs) have been under insurmountable mental and psychological pressure, leading to depression, anxiety and ultimately, burnout. Emergency Medical Services (EMS) personnel play a pivotal role in managing and caring for ill and injured patients in the pre-hospital setting. These practitioners are at the forefront of the fight against COVID-19. Despite the role they play in improving the health outcomes of these patients, there is a paucity of research on the effect of COVID-19 on EMS personnel working and living in the rural areas of low-and-middle-income countries like South Africa. Gaining insight into the daily challenges faced by HCWs and the coping strategies adopted will assist EMS personnel in mitigating physical and emotional stressors, as well as long-term psychological effects. Aim of the study To investigate the psycho-social influence of working at the forefront of the COVID-19 pandemic amongst EMS personnel in the Eastern Cape. Objectives This study aimed to: I. Identify the working conditions that exacerbate the stress of working within the context of the COVID-19 pandemic; II. Ascertain the factors that reduce stress amongst EMS personnel; III. Identify the psychological stressors amongst EMS personnel in the Eastern Cape during the COVID-19 pandemic; IV. Identify the coping mechanisms/strategies used by EMS personnel in the Eastern Cape during the COVID-19 pandemic; and V. Make recommendations on providing support and improving the working conditions of EMS personnel in the Eastern Cape. Methodology The study was conducted using a quantitative, cross-sectional descriptive survey design guided by a post-positivist paradigm with a deductive approach. Data was collected from 368 participants who worked in the Eastern Cape during the start of the COVID-19 pandemic. Participants were presented with an online survey questionnaire, which was subsequently analysed using the Statistical Package for the Social Sciences (SPSS) statistics software, and the results were presented by tables, charts and descriptive summaries. Results An overwhelming 80.4% (n=296) of EMS personnel showed dedication to their work (patient care), despite working under immense pressure. The findings showed moderate agreement to different stressors, indicating that EMS personnel do not suffer from existential fears but are somewhat worried about their own risk of infection and that of their family. The main stress factors included the availability of PPE, infection and treatment protocols, recognition of their work by EMS management, and the perceived risk of infection to themselves and others. Motivational factors that encourage EMS personnel to work in future outbreaks or pandemics were not significantly related to attitudes within the context of the COVID-19 pandemic. Conclusion As a direct and immediate consequence of providing care to COVID-19-infected patients, frontline HCWs put themselves at risk of various adverse physical and emotional effects. An already stressful situation becomes extremely precarious as a result of the escalating negative impacts on mental and physical health experienced by EMS personnel, a crucial demographic, used to fight the pandemic. The findings of this study are consistent with what was already known from previous studies conducted on HCWs during previous pandemics, thereby being relatively predictable. This emphasizes the importance of basing pandemic planning and reactions on the most current and reliable data.
A work integrated learning content framework for clinical neurophysiology technology in South African universities of technology
(2024-08) Van der Walt, Christelle; Orton, Penelope Margaret; Prakaschandra, Dorcas Rosaley; Marais, S
INTRODUCTION Clinical technology (CT) is a group of seven specialist professions dealing with diagnosis and monitoring of human organ system function and diseases. Clinical neurophysiology (CN) is one of these professions and uses multi-modality test investigations of the brain, peripheral and central nervous system, and muscular system, to diagnose and monitor neurological disease. Since the origin of formal training, specialist learning in one of these categories has occurred during a period of work-integrated learning (WIL) after a combined didactic period at one of the three South African universities of technology that offer this qualification. The duration of this period has fluctuated over time. Currently this is set at 3 840 hours over a 24-month placement period as per the South African Qualifications Authority (SAQA) course registration documents. No previous investigations have been conducted to determine the industry required content of this WIL period or how the testing and monitoring modalities taught support specialist learning. No category specific training frameworks exist to aid training units at any of the current three universities offering this qualification. AIMS AND OBJECTIVES The purpose of this study was to determine the current industry requirements for graduates to integrate into Clinical Neurophysiology private practice upon graduation. This study aimed to determine the core testing modalities to include in an undergraduate clinical technology qualification and how each modality can support learning of related modalities. Related to this, this investigation also aimed to determine embedded skills, knowledge, and personal graduate attributes required for mastering of each of the core modalities. The final objective was to design a learning framework based on the interconnected learning affinity of modalities that incorporates all the required graduate skills that drive achievement of graduate level outcome skill levels as determined by industry requirements. METHODOLOGY A Delphi research study was designed to firstly investigate the historic development of the profession and training, and secondly determine the core testing modalities and related knowledge and skills a current industry aligned qualification should include. A round of unstructured interviews and desk research was undertaken to identify all modalities currently included in university of technology course documents. A total of 23 modalities were identified. This round of data gathering was followed by two Delphi questionnaires. The first questionnaire (Q1) provided clinical neurophysiologists (CNPs) currently in private practice an opportunity to select their preferred core modalities from the list of modalities identified during the first data gathering round. Participants were also able to contribute current industry required outcome skill levels and embedded skills and knowledge required to master each modality. Fifty participants identified a list of 15 modalities as potential core modalities and contributed approximately 1 600 comments on prerequisite skills and embedded knowledge and graduate attributes. The second questionnaire (Q2) reported the findings of the first and provided the 36 participants with the opportunity to evaluate the learning and prerequisite dependence or affinity of interrelated modalities. The participants also reevaluated the required outcome practice skill level for each modality and how knowledge and practical skills from Q1 drive learning of the core modalities. RESULTS At the end of the second questionnaire a total of 13 modalities were identified as core modalities that are essential to master during undergraduate WIL. It was determined that students must be able to perform, report, and interpret the results of the 13 core modalities. Dependence affinity of the 13 core modalities for learning of related modalities was confirmed and the embedded and prerequisite skills driving the mastering of each modality were combined into a learning framework. Results confirmed the historic foundational importance of electroencephalography (EEG) as a prerequisite to learning all the other core modalities. CONCLUSION This was the first study investigating industry required graduate outcome skills for an undergraduate qualification in clinical technology. Through a Delphi study 13 core outcome modalities were identified and the required outcome skills level for integrating into private practice was determined. Participant skills and knowledge contributions were drawn upon to design a driver-based learning framework that can guide the universities and training units in structuring the WIL period for most efficient clinical training time management to achieve the required graduate skills outcomes during the 3 840 clinical training hours.
Speckle tracking evaluation of right ventricular function post left-sided valve replacement
(2024-08) Dlamini, Nompilo; Prakaschandra, Dorcas Rosaley; Koshe, J J; Gojo, Mawande Khayalethu Edson
Background: The right ventricle dilates due to increased pulmonary wedge pressure caused by mitral and/or aortic valve disease, which lowers the right ventricular (RV) ejection fraction. This dilation can lead to tricuspid regurgitation (TR) with secondary right ventricular volume overload. Surgically correcting the left heart valves is thought to result in more favourable RV reverse remodelling, however, a growing number of patients have been observed in the cardiac unit at Port Elizabeth Provincial Hospital (PEPH) with worsening symptoms after left valvular correction. Due to the idea that tricuspid regurgitation (TR) would disappear after the original left-sided valve disease was corrected, surgical correction of the tricuspid valve (TV) has, up to now, been avoided in patients with secondary STR at the time of left valvular surgical correction. Much too little is known about how critical right ventricular (RV) function is and how it affects the cardiovascular patient’s prognosis. When selecting surgical procedures for the mitral valve (MV) and/or aortic valve (AO), RV performance is not the key determining factor. Aims: To determine changes in the right heart after mitral and/or aortic valve surgery, as well as to determine predictors of early signs of tricuspid regurgitation progression post-left valve surgery using two-dimensional Doppler and speckle tracking echocardiography. Study population and design: This study included 30 patients, 12 males and 18 females between the ages of 18 and 65. This was a prospective clinical study on the preoperative and postoperative echocardiographic parameters and their interaction in patients with severe mitral and/or aortic valve disease who were candidates for valve surgical correction. All echocardiographic examinations were conducted in the cardiac clinic of Port Elizabeth (Gqeberha) Hospital in the years 2020 to 2022. Subjects and methods: Participants were subjected to complete clinical examination and transthoracic echocardiography using the Ultra-Premium Aloka Prosound F75 Hitachi system, equipped with S3 transducer under very strict COVID-19 protocols. Standard 2D, M-mode, right ventricular global longitudinal strain, right ventricular free wall longitudinal strain, and Doppler echocardiography in the parasternal and apical views were recorded. Results: The population comprised 30 patients undergoing cardiac surgery for severe mitral and or aortic valve surgery. The study’s results revealed that the mean age of patients was 45.83 years with the majority being females (60%) and males at 40%. The predominant aetiology of valve diseases was degenerative valve disease (43.3%), and the most common valve disease was mitral regurgitation and aortic regurgitation, respectively at 23.3%. Tricuspid valve replacement reduced tricuspid regurgitation significantly, however, due to the small number of patients (n = 1) who progressed to significant tricuspid regurgitation further analysis was not undertaken. All correlations between tricuspid valve annulus, right ventricular systolic pressures and right ventricular diameter 6 months post-op were significant with a p-value of < 0.001. There were significant differences in left ventricular end-diastolic diameter (LVEDD) [5.46 ±.867vs 5.11 ±.850, (p=0.027)] as well as ejection fraction (EF) [65.33 ± 11.902 vs 61.50 ± 15.543, (p=0.037)] 6 months post op. There was no significant global longitudinal strain (GLS) change demonstrated in right ventricular function using speckle tracking imaging [-5.02 ± 7.400 vs -6.07 ± 9.373, p>0.005). The study demonstrated a significant decline in regional basal inferior septum (BIS) segments at 6 months follow-up [-9.67 ± 19.626 vs -4.86 ± 23.126 (p 0.034)]. The study also demonstrated a significant decrease in right ventricular function measured with TAPSE [23.20 ± 6.483 vs 19.182 ± 5.7738 (p<0.001) and FAC [60.63 ± 17.76 vs 41.33 ± 19.62 (p=0.18) 6 months post-op, with an immediate decline in mean measurements directly (72 hours) after surgery, a slight gradual mean increase was noted at 6 months follow up after surgery. A significant negative correlation was seen between RV dimensions and TAPSE 6 months post-op. There was no correlation seen between EF and GLS and TAPSE, LVEDD and GLS 72 hours post-op and again 6 months post-op (p >0.05). Conclusion: The global and/or regional systolic RV function was appropriately estimated using the 2D Doppler measurements and speckle tracking imaging. Together, these echocardiographic parameters measurements allowed for an accurate RV evaluation, improving disease diagnosis and management. Immediately following surgery, a thorough examination that includes TAPSE, S', and RVFAC assessment should be conducted. This examination should be repeated in three and six months to verify whether RV longitudinal function may have fully recovered and to enhance early management of RV failure.
The antimicrobial effectiveness of Tulbaghia violacea and Allium sativum on the in vitro growth of Candida albicans
(2024-03) Reddy, Wesley; Ross, Ashley Hilton Adrian; Pillay, Charlene
Aim This study sought to compare the antifungal potential of Tulbaghia violacea to that of Allium sativum. Mother tinctures and a respective selection of homoeopathic potencies were evaluated in terms of their inhibitory effect on the growth of Candida albicans in vitro. Methodology This experimental study employed microbiological assays to evaluate the antifungal potential of Tulbaghia violacea (wild garlic) while comparing this activity to Allium sativum (garlic) against Candida albicans in vitro. Allium sativum bulbs and fresh Tulbaghia violacea bulbs and leaves were processed into 1:2 ethanolic extracts. These were diluted into 1:10 mother tinctures in 8% ethanol and succussed to prepare respective 3CH, 5CH, 8CH, 13CH and 21CH homoeopathic potencies (CHcentesimal Hahnemannian – diluting substance by a factor of 100 followed by rigorous shaking before the next dilution). The inhibitory effect of the respective preparations was investigated using the microtitre plate assay. The absorbance of Candida albicans, in Sabouraud dextrose broth, was measured at 630 nm with a Multiskan Go microplate spectrophotometer in the presence and absence of selected test substances. The absorbance readings of the test groups were compared to the negative control (Candida albicans left untreated). Additionally, disc- and well diffusion assays were used to further explore the antifungal effectiveness by measuring the zones of inhibition in Sabouraud dextrose agar plates. Quantitative data analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 25. Descriptive statistics were used to analyse the sets of data produced from the microtitre assay. The differences between the Pre- and postincubation absorbance was analysed. Results The microtitre assay produced data, which was used for the comparative analysis of the 1:10 mother tincture, 3CH, 5CH, 8CH, 13CH and 21CH test groups indicated that the 1:10 mother tinctures were the most statistically significant test group as p = 0.006. Additionally, the analysis confirmed that the inhibitory properties of Allium sativum were better than that of Tulbaghia violacea. The pairwise comparative analysis found that all tested groups were statistically significant when compared to the negative control (Candida albicans left untreated). Both the well and disc diffusion assay did not produce measurable zones of inhibition and therefore no comparative data were obtained from this investigation. Conclusion The study found that Tulbaghia violacea mother tinctures and homoeopathic potencies were effective in inhibiting the growth of Candida albicans. It can be concluded that Tulbaghia violacea does indeed contain antifungal properties, which can be further investigated by means of in vivo testing. According to the comparative analysis Allium sativum demonstrates better antifungal effectiveness than Tulbaghia violacea.
An investigation into ambulance laryngoscopes as a potential source of infection amongst emergency medical service personnel in a private ambulance service in the eThekwini Municipality of KwaZulu-Natal
(2023-12) Pillay, Sugandran; Naguran, Sageshin; Tshabuse , F.
Background Emergency care practitioners (ECPs) provide specialised treatment and management to a great number of critically ill and injured patients in the pre-hospital setting. Overall, these patients have the potential to have a higher incidence of infectious and emerging diseases. Part of patient management is securing the patient’s airway through the placement of an ETT into the trachea. This process involves the use of a laryngoscope which is an invasive tool that comes into contact with blood and other biological agents and can provide a medium of transportation of infections if not decontaminated adequately. Disinfection and infection control is a fundamental practice in emergency medical care (EMC) that is often underrated. To date, there is no consistency and an overall lack of consensus with regards to a formalised infection control policy with specific reference to decontamination practices of the laryngoscope in the pre-hospital emergency medical care sector in KwaZulu-Natal. There are limited published research studies investigating ambulances decontamination practices regarding laryngoscope blades and handles. Purpose: This study aimed to investigate the microbial composition of ready-to-use ambulance laryngoscopes, determine the common decontamination practices, and establish the minimum concentration of disinfectants required to clean this pre-hospital equipment. Methodology: This experimental study used a descriptive design, as the purpose was to identify and quantify the microorganisms isolated from samples of laryngoscope blades and handles, and determine the most efficient disinfection agents required to render these microorganisms harmless using minimum inhibitory concentration (MIC) assay. A questionnaire was used to assess EMS personnel's decontamination practices regarding the disinfection of the equipment. The study was be conducted in a private EMS sector setting in KwaZulu-Natal province area. This service is a 24-hour private EMS, with 27 emergency care practitioners who uses laryngoscope blades and handles to help in AM. vi Results: The results presented in this study showed clearly that there was a high bacterial load found on the ambulance laryngoscope blades and handles under study. This was evident in the colony enumeration as well as the gram stain processes. Furthermore, there was a high level of potentially pathogenic species, namely, Salmonella, Shigella and Pseudomonas sp., which is of great concern. This is an indication of substandard hygiene practices IPC practices. It is evident from the results and the interpretation above that the IPC knowledge and practices regarding laryngoscope blades and handles in the selected EMS in the eThekwini District of KwaZulu-Natal is poor. Conclusion Ambulance laryngoscope blades and handles have been found to have an unsatisfactory level of pathogenic micro-organism contamination, and may be a reservoir in the transmission of potentially serious infections to patients and ambulance staff. This underlines the urgent need for the development and implementation of evidence-based ambulance IC guidelines pertaining to the airway tool. These findings should be taken into consideration and used to urgently address the problem of ambulance laryngoscope blades and handles decontamination and infection control.
Towards integrated care of the breast cancer patient : perspectives on the challenges and opportunities of medical pluralism in a disparate society
(2024-07) Ducray, Jennifer Frances; Ross, Ashley Hilton Adrian; Jinabhai, Champaklal C.
“Medical Pluralism” refers to the co-existence of many different medical systems, practices and products within a healthcare landscape. Whilst in most countries, mainstream biomedical treatment protocols dominate, many practices exist which are not routinely incorporated into these treatment protocols. For the ease of academic discourse, this large array of practices and products are often referred to collectively as “Traditional, Complementary, and Alternative Medicine” or “TCAM”. Patients with cancer, and specifically women with breast cancer, are some of the highest utilisers of TCAM as they battle the disease and mainstream treatment side-effects. Concurrent use alongside conventional oncology treatments however can hold risks, yet many patients do not disclose TCAM use to oncologists, and many oncologists do not engage in TCAM discussions with patients. “Integrative Oncology” incorporates a variety of evidence-based practices from across the pluralistic landscape, neither rejecting mainstream treatments nor accepting alternatives uncritically, and could potentially offer clarity to patients and oncologists in navigating medical pluralism. Whilst many studies have investigated patient TCAM use elsewhere in the world, there is a dearth of data on the choices and experiences of cancer patients and oncologists navigating the local pluralistic landscape. This study sought to describe aspects of current practice and lived experience of eThekwini breast cancer patients and their oncologists with respect to TCAM use. In doing so, it also sought to throw light on the incorporation of holistic or integrative practices by way of ascertaining the status of formalised Integrative Oncology in eThekwini, as well as outlining some of the challenges and opportunities for its growth in the local setting. The study utilised a mixed-methods sequential explanatory design which consisted of patient and oncologist surveys, followed by patient and oncologist interviews. Participants (316 patients and 18 oncologists) were recruited from government (GOV) and private (PVT) facilities in eThekwini by snowball and convenience sampling. Patients reported incorporating a range of lifestyle modifications and interventions as a way to gain control, combat side-effects and support the body in healing. These included dietary approaches, supplements, cannabis, exercise, meditation, yoga, psychological counselling, support groups, relaxation techniques, and prayer. Apart from spiritual support practices, frequencies of inclusion were consistently and significantly lower in the government cohort. Thirteen percent of government patients and 53% of private patients also consulted with TCAM practitioners. This included massage therapists, African traditional healers, chiropractors, homeopaths, aromatherapists, and acupuncturists. Most patients are incorporating additional practices in a self-directed fashion with varying levels of disclosure and reports of very limited to no patient practitioner discussions on TCAM. Many patients expressed the need for more information and guidance. Oncologists were divided as to the role of various TCAM inclusions. In terms of lifestyle modifications, the majority (79%) supported the role of nutrition in oncogenesis and healing, and 58% reported having a nutritionist associated with the practice. Fifty-three percent believed supplements are an important consideration in cancer management, with 79% discouraging supplement use during active mainstream treatments. All oncologists supported the vital role of exercise and 95% report raising this with their patients. Regarding TCAM practitioners, oncologists described their knowledge as “very little” or “none” for all the fields included in the survey and remain divided on the role that these practitioners can play in oncology. Oncologist reservations were rooted in previous negative experiences where patients had incorporated TCAM practices (mainly African traditional medicine); in proponents of questionable practices with unfounded claims of cure; and in a perceived lack of evidence for TCAM inclusions. Formalised Integrative Oncology is currently not evident in oncology care in eThekwini. There are, however, oncologists who strive towards a holistic model of patient care and are open to other evidence-based inclusions and collaborations. With the disparate nature of medical provision in South Africa, the government sector holds more challenges for both oncologists and patients. As such, the private sector is more suited to the growth of Integrative Oncology. Medical pluralism brings many challenges and opportunities. Empowering patients through accessible evidence-based health literacy remains a priority for them to navigate the health landscape of South Africa safely and effectively, avoiding risk whilst optimising quality of life and clinical outcomes across the cancer continuum.
An injury profile of musculoskeletal injuries in CrossFit athletes in KwaZulu-Natal
(2024-08) Simmons, Nicholas; Pillay, Julian David
Background- Musculoskeletal injuries are frequently reported amongst CrossFit athletes. This study aimed to determine an injury profile of CrossFit athletes in the KwaZulu-Natal area, to identify any associated risk factors, and explore possible treatment approaches. Currently, there is a paucity of information regarding the incidence of musculoskeletal injuries in KwaZulu-Natal. Objectives- The objectives of this study were to determine the prevalence of musculoskeletal injuries in CrossFit athletes and to identify and create a profile of musculoskeletal injuries among CrossFit athletes, including the location, nature, and severity of these injuries. Additionally, the study aimed to identify any associations between injury profile and selected risk factors for injury, such as age, gender, height, weight, and race. Finally, another objective was to investigate the type of care and management sought by CrossFit athletes for different types of injuries. Methods- The study was a quantitative-, retrospective study utilising a descriptive questionnaire administered in the form of a survey at four selected CrossFit affiliated facilities on CrossFit athletes. Results- Among the 181 participants, 29% (n=53) reported on lifetime musculoskeletal injuries. This suggests that injuries are relatively common in the sport. The most frequently reported type of injury was a strain or tear in 64.1% (n=34), with the shoulder being the most commonly affected area at 37.7% (n=20). Participants reported moderate pain levels in 49% of cases, indicating that injuries were not severe enough to result in significant discomfort, most injuries were acute (up to 3 months) and required medical attention (79.1%, n=48). The majority of injuries (73%, n=39) were caused by weightlifting, highlighting the importance of proper technique and safety measures when performing this type of exercise. Conclusion- This study sheds light on the prevalence, causes, and management of musculoskeletal injuries in CrossFit athletes. The findings emphasise the need for injury prevention strategies and proper training techniques to ensure the safety and wellbeing of individuals who participate in this sport.
Living with co-morbidities during the COVID-19 pandemic : a qualitative study of the heightened physical and psychosocial challenges emerging from the virus
(2024-08) Neerputh, Sunil; Bhagwan, Raisuyah; Haffejee, Firoza
The COVID-19 pandemic created unprecedented challenges for people with comorbidities. Those with co-morbidities faced mental and physical health consequences, and their family life, social life and healthcare were affected. The presence of co-morbidities was a compounding factor that led to deleterious consequences for this vulnerable group of people. This study sought to explore the various challenges from the experiences and perspectives of people living with comorbidities during the COVID-19 pandemic in South Africa. A qualitative research methodology was utilised in this study, with an exploratorydescriptive design, as well as non-probability and snowball sampling. Two samples were recruited namely, those affected by COVID-19 and those infected by COVID-19 post three months. Both samples had one or more co-morbidities. A total of 26 participants eventually participated. The study employed a semi-structured interview schedule to attain the required data, that allowed for a good conversational exploration into participants’ experiences during the COVID-19 pandemic. The data was analysed using thematic analysis, which yielded eight themes, all of which had sub-themes. The key findings from the study were multifactorial, as there were considerable effects on participants’ physical health, whereby an intensity of COVID-19 symptoms occurred and long-term COVID symptoms persisted for long periods of time, which resulted in a difficult journey to recovery. The COVID-19 pandemic and the virus had a substantial impact on mental health, as participants endured intense bouts of fear and anxiety with persistent mental trauma post-COVID. Additionally, issues around isolation and concurrent loneliness from lockdown measures took a toll on their health. Empirical evidence shows a worsening of co-morbidities due to declining mental well-being. Family and social lives were vastly affected by the pandemic, causing a multitude of problems relating to finance, bonding, conflicts and bereavement. Obtaining adequate healthcare was difficult during the pandemic, as participants encountered staff shortages, extended wait times, a lack of medication, the sharing and borrowing of medication and a lack of care from medical staff. Participants who were hospitalised faced further challenges that affected their healthcare and overall sense of well-being. Despite the challenges that people with co-morbidities faced, they were hopeful as they began adopting healthier eating habits, exercising and sharing responsibilities iii within the home. Having supportive family and friends proved to be a significant benefit. The lockdown also gave people an opportunity to improve familial relationships. Community and religious organisations assisted those in need and people relied on faith and spirituality for a sense of peace and comfort. The data also indicated that many individuals embraced holistic health by incorporating complementary and alternative medicine into their practices. The use of these practices enabled a sense of good physical health among the participants. This study has provided a new insight into the lives of people with co-morbidities during a period of intense turmoil. The data obtained in this study can be used as a stepping stone to further explore the long-term effects of COVID-19 on people with comorbidities who are vulnerable to the effects of disasters such as the COVID-19 pandemic, thereby improving their quality of life and health.
An interpretative phenomenological analysis of family involvement in the hospital nursing care of children with autism spectrum disorder within eThekwini District
(2024) Williams, Neil Arnold; Ngxongo, Thembelihle Sylvia Patience; Sokhela, Dudu Gloria
Autism spectrum disorder (ASD) is characterised by dramatic impairments in communication, social interaction and repetitive patterns of behaviour, resulting from a neuro-developmental disorder of the brain. Hospitalisation for children with autism spectrum disorder (ASD) can be very stressful because of sensory overload, their impaired ability to communicate, disruption of routine, a new unfamiliar environment and the illness for which the child was admitted. These factors can provoke difficult behaviour in these children such as uncontrolled crying, screaming, biting, scratching and other self-injurious behaviour. For these reasons, a nurse who is not knowledgeable about ASD often finds it very difficult to nurse a child with ASD in hospital. Nurses’ lack of knowledge about ASD results in poor nursing care of children with ASD. Literature has shown that this poor nursing care can be resolved by effectively involving parents in the care of their children. In South Africa and especially in KwaZulu-Natal there have been no studies conducted to corroborate these findings and therefore a gap exists in the literature. Aim of the study: The study aimed to develop in-depth insights into family involvement in the provision of in-hospital nursing care for children with ASD in the South African context, in order to develop a framework for the improvement of family involvement in the hospital nursing care of a child with ASD Objectives of the study: The study’s objectives were to critically assess the perceptions of professional nurses and families regarding the involvement of families in the hospital nursing care of a child with ASD; identify and describe the challenges perceived by professional nurses and families, in the involvement of families in the hospital nursing care of a child with ASD, explore participant perceptions on the range of corrective interventions and actions to overcome challenges and promote effective family involvement in the hospital nursing care of a child with ASD then develop a framework for the improvement of family involvement in the hospital nursing care of a child with ASD. Method: The study design was interpretative phenomenological analysis (IPA), which is a qualitative approach. Sampling was achieved utilising the maximum variation purposive sampling method and data were collected from ten nurses and ten families of children with ASD, using semi-structured interviews. The “Neil Williams framework for the improvement of family involvement in the hospital nursing care of a child with ASD”, was developed, utilising the Gray and Grove framework development process. Findings: The data collected were categorised into four themes, seventeen subthemes and 6 codes. The findings highlighted the nurse’s perceived lacked knowledge and time, and they were not listening to parents. Nurses had an uncaring attitude toward children with ASD. However, both nurse and family participants acknowledged the importance of family involvement in the care of a child with ASD in hospital. Family participants made several suggestions to improve family involvement in the hospital nursing care of the child with ASD. In order to overcome the identified challenges and incorporate the participants suggestions, the “Neil Williams framework for the improvement of family involvement in the hospital nursing care of a child with ASD”, was developed, utilising the empiric data from this study and the theoretical frameworks of the Neuman’s systems model, Bowen’s family systems theory and the theory of family care during critical illness. This framework was validated using the Delphi method of validation. Conclusion: The study findings confirm that nurses lack knowledge on hospital nursing care of a child with ASD, and it is important to involve family who know better about the child. This involvement can be strengthened by the empowerment of nurses and family members. This empowerment can be achieved by implementing the four components of empowerment, namely: information sharing, proximity, attitude and garnering resources. The framework developed in this study can contribute to improving nursing practice for paediatric ward nurses in the eThekwini region of KZN and may improve the in- patient experience of children with ASD and their families. It can ensure that families are meaningfully involved in the treatment of their children which may lead to improved health outcomes for children with ASD and increased positive work experience for nurses in this region, if implemented correctly.
Chiropractic manipulation and mobilization for postpartum low back pain : a systematic review
(2024) Phakathi, Londeka Nokulunga; Thandar, Yasmeen; Venketsamy, Yomika
Background: Prior research has documented empirical support for the effectiveness of chiropractic treatment for postpartum low back pain (PLBP), mostly in pregnancy but very few in postpartum. Nevertheless, the trustworthiness and calibre of the evidence from these studies has not been adequately scrutinised to authenticate their conclusions and determine whether clinical efficacy or effectiveness is present. Therefore, the objective of this study was to assess the current evidence in the literature about the therapeutic effectiveness of chiropractic manipulation and mobilisation for chronic lower back pain/pelvic girdle pain in postpartum women. Method: This study employed a qualitative evidence synthesis methodology, specifically utilising the Cochrane systematic review strategy. The literature was sourced via an electronic literature search (e.g. Google Scholar, PubMed, Medline, ProQuest Health, etc). The key search terms used were ‘low back pain’, ‘pelvic girdle pain’ together with ‘postpartum’, ‘chiropractic’, ‘manipulation’, and ‘mobilisation’. In addition to the key terms listed above, the search strategy for postpartum low back pain encompassed the following terms: ‘post-natal mechanical low back-ache’ or ‘sacroiliac syndrome/dysfunction’ or ‘sacral subluxation’ or ‘sacral pain’ or ‘lumbopelvic’ or ‘lumbar facet syndrome’. For manipulation and mobilisation, the search encompassed ‘sacral adjustment’ or ‘spinal manipulative therapy’ or ‘manual therapy’. A total of 2127 articles were identified, however 8 were suitable for inclusion. Data was extracted from each included study onto a prepared data extraction sheet. There were 4 reviewers that reviewed the 8 (4 RCTs and 4 CRs) articles included. The independent reviewers only reviewed the 4 RCTs. For Critical Appraisal and Quality of Evidence, Rev Man “Risk of Bias” was used tool for randomised controlled trials (RCTs) and for case reports (CRs), the Joanna Briggs Institute Critical Appraisal Tool (JBICAT) was selected was used. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used to rank the evidence on various levels of clinical strength in relation to treatment outcomes. Results: While 3 of the 4 RCTs demonstrated no significant evidence to support a superior effectiveness of chiropractic manipulation and mobilisation in postpartum low back pain, Pritchard (2001) showed statistically significant evidence in supporting the improvement chiropractic manipulation and mobilisation provided in this demographic. The outcomes in all 4 CRs showed large degrees of favourability to the effectiveness of chiropractic manipulation and mobilisation. However, the quality of the evidence was low to moderate at most, thus affecting the extent to which generalizability can be made, in to relation to postpartum low back pain. Conclusion: This study highlighted a dearth in literature and the need for conducting research of higher quality within this demographic. There were also discrepancies in the utilisation of the LBP term and its clinical scope. It is highly important that these discrepancies are resolved by establishing a more concrete and deliberate guideline or definition of this phrase. The production of more RCTs with larger sample sizes that include a variety of demographic characteristics (race, socioeconomic status, age, etc.), was recommended.
Systematic review of the sensitivity, specificity and validity of the active straight leg raise test in low back pain
(2024) Lee, Andrew Christopher; Korporaal, Charmaine Maria; Jack, D. A.
Background The active straight leg raise test (ASLR) is a commonly used clinical diagnostic test in a heterogenous group of conditions classified as low back pain. It may be used in a battery of tests to obtain a clinical diagnosis or to aid in the assessment of motor control in the lumbopelvic hip complex in the sagittal plane. A few variations of the ASLR exist in the literature. There is therefore a need to analyse the literature to determine to the most appropriate clinical application and interpretation of the test as the incorrect and/or ineffective application of the ASLR may influence patient outcomes. Data sources A systematic review of PubMed, Google Scholar, Cochrane Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus. Study selection All electronic or paper, English articles, which possessed the required key indexing terms and represented randomised and non-randomised controlled study designs were included. Data extraction and synthesis The blind review of the 25 articles was conducted by three independent reviewers (nine reviewers in total) using the non-randomised controlled trials (NOS) and Liddle scales. This allowed the methodological rigour of the article to be ranked. This ranking was compared to a critical appraisal of the article in order to achieve an overall decision with regards to the contribution of the article to the level of evidence for ASLR test. Results The evaluations and combined evidence were then determined for the ASLR under the heading non-pregnancy related PGP, LBP, and LPP, and various lift heights <10cm, 10-30cm, 30-60cm, full available range of motion, and unspecified range of motion. Due to study design (observational), no study exceeded level 3 evidence. Conclusion The ASLR was found to have a valid face construct, but assertions made in relation to its constructed validity in non-pregnancy related LBP is limited and conflicting. It is unclear if a positive ASLR result is from failure form closure of the public symphysis or the SIJ and if motor control is a contributing factor or product of pain.
A model to develop and promote knowledge and practice of breast self-examination among African women in rural KwaZulu-Natal province of South Africa
(2024) Sarmah, Nelisha; Sibiya, Maureen Nokuthula; Khoza, Thandokuhle Emmanuel
Background Breast self-examination (BSE) is considered one of the screening methods used for the early detection of breast cancer in addition to mammography. BSE is a safe, easy, free, and painless method used to identify any abnormalities of the breast and it is highly recommended for breast cancer screening among women in low resourced areas. Despite these recommendations, a low uptake of BSE in low middle-income countries (LMIC) is of concern. To date, a lack of knowledge, awareness, cultural influences, and socio-demographic factors have been highlighted as an influence on the uptake of BSE globally. However, much uncertainty still exists from a South African viewpoint, considering the different sociocultural backgrounds. Aim This study aims to explore and describe knowledge, perceptions, and factors that influence BSE uptake among rural African women in the KZN province of South Africa, and ultimately develop a model to develop and promote the knowledge and practice of BSE. Methodology The research was guided by the Care-Seeking Behaviour (CSB) theoretical framework. The research objectives were achieved by employing a qualitative case study design and an interpretivist paradigm. The data collection process consisted of an in-depth semi-structured one-on-one interview. The sample was selected based on a purposive sampling approach. This study was conducted in the iLembe District of KZN province of South Africa, a predominantly rural district. Study participants were African women aged 20 or older who resided in the rural iLembe District of the province of KZN. Data saturation was achieved with 22 participants. After the data were collected, they were transcribed verbatim and analysed using deductive thematic analysis. Findings In this study, several factors were found to influence the practice of BSE among rural South African women. This included, knowledge and awareness, clinical and socio-demographic influences, preventative healthcare habits, sociocultural factors, breast cancer beliefs, healthcare perception, and delayed healthcare services. In this study, the researcher noted that participants with higher levels of education were more likely to practice BSE. In addition, several participants had various traditional interpretations of breast cancer. Furthermore, there were participants who reported using complementary and self-treatment practices as a habit for health-related concerns. The findings of this study also indicate that participants perception of breast cancer and breast cancer screening may influence their willingness to participate in BSE programmes. Moreover, it was found that social support from family, friends, and community members encourage women to discuss their breast health. A lack of confidence in conventional medical methods of preventative health practices (BSE) was also attributed to clinical and socio-demographic factors and delayed access to healthcare services. Based on the findings of this study, a model was developed to promote BSE knowledge and practice among rural African women in KZN.
An investigation of rejection rates, sources thereof and methods to reduce specimen rejection
(2024) Ballim, Afsana; Mbatha, Joyce Nonhlanhla
Background Specimen rejection occurs when specimens are sent to a medical diagnostic laboratory and are deemed unsuitable for analysis based on specimen acceptability criteria. Patient care may be hindered due to rejections. Specimen rejections impact negatively on patients, healthcare workers and the diagnostic laboratory. The aim of this study was to investigate specimen rejection rates, the contributing factors, and methods to reduce the number of rejected specimens, thereby improving healthcare for the patient as well as improving the financial and quality standing of the laboratory. Materials and methods Rejection statistics were obtained for King Dinuzulu Hospital Complex (KDL) and RK Khan Hospital (RKK) for a period of six months. An investigation of the rejection rates and common causes for rejection was conducted. The information gathered from the rejection statistics was used to create training material for training workshops. Pre training and post-training questionnaires were completed to determine the effectiveness of the training. Rejection statistics were re-collected for two months post the training workshop sessions to evaluate the rejection rates for improvement. Results The initial rejection rates indicated that KDL and RKK exceeded the allowable limit of rejections (National Health Laboratory Service allowable limit < 3%). The primary reason for specimen rejections was identified as errors that occur in the pre-analytical phase, with haemolysis emerging as the predominant contributing factor. Training workshops were conducted, although the improvement in assessment score for the workshop was 49.6% (p < 0.001), the rejection statistics collected post-training workshop showed an insignificant change in overall rejection rates at KDL and RKK (p-value = 0.139 and 0.242 respectively). Conclusion Specimen rejection is a growing problem that requires mitigation. Structured training has shown to improve pre-analytical knowledge, however, it was noted that the interventions taken by offering training workshops did not reduce the rate of specimen rejections.
Assessing the burden of hepatitis B in South Africa, predicting disease prevalence and modelling the impact of hepatitis B birth dose vaccination
(2024) Moonsamy, Shelina; Prabdial-Sing, Nishi; Pillay, Pavitra
In 2016, WHO adopted a resolution to eliminate hepatitis B by 2030, targeted at reducing disease burden. In South Africa, HBV disease burden has largely been estimated from community-based or sentinel studies, thereby limiting its accuracy. Since 2009, the WHO recommended the addition of a birth dose of the HBV vaccine to current vaccine schedules to mitigate the risks of vertical transmission. This intervention is crucial to reduce disease burden, given the increased risks of developing chronic disease if contracted at birth or infancy. Despite the introduction of the HBV vaccine into their EPI schedule in 1995, South Africa is yet to fulfil this recommendation. In this study, our objective was to assess HBV disease burden in the public health sector of South Africa through meticulous analyses of an extensive national dataset spanning 2015 to 2019. Additionally, we aimed to model the potential impact of a birth dose of the HBV vaccine using country-specific HBV prevalence data obtained from our own testing conducted on women attending antenatal care in 2017. Over the five years, the national HBV prevalence was 9.02%, declining gradually each year. Overall, males had consistently higher prevalence rates than females. The observed lower infection and higher immunity rates among vaccine-eligible individuals clearly demonstrated the positive impact of the HBV vaccine. Nevertheless, HBV infection among these individuals was quite concerning, highlighting the roll-over effects of suboptimal vaccine coverage rates. The prevalence of HBsAg among pregnant women was alarmingly high at 11.24%, further compounded by the high HBeAg prevalence among these women. These findings alerted us to the increased probability of vertical transmission, representing a concerning source of disease burden in the country. Among vaccine-eligible women under 19 years old, HBsAg prevalence was surprisingly high at 8.08%, noting that these women still had approximately 30 more years of potential child-bearing. These findings pose a serious threat to achieving, or even nearing, WHO elimination goals. Using a deterministic HBV transmission model to simulate the impact of a birth dose of the HBV vaccine, we estimated more than a three-fold reduction in chronic HBV infections and HBV-related deaths, specifically when considering new cases from initiation of our model. In essence, this represents a greater than three-fold reduction in HBV disease burden. Our findings are unique for South Africa given their national representation and country-specific model inputs. Despite the introduction of the HBV vaccine in 1995, hepatitis B remained highly endemic in South Africa. Adding a birth dose to the current HBV vaccination schedule and achieving optimal vaccine coverage rates will markedly reduce country HBV burden. We therefore recommend prompt implementation of a birth dose of the HBV vaccine, together with increased efforts aimed at improving HBV vaccine coverage rates to optimal levels.
Homoeopathic perceptions of gut dysbiosis as a clinically significant obstacle to cure
(2024) Hendriks, Marizel; Ghuman, Shanaz
Echoing Hippocrates' notion that “All diseaes begin in the gut”, recent scientific research strengthens the connection between gut microbial health with overall well-being. This study delves into how South African homoeopathic practitioners address gut dysbiosis, a microbial imbalance within the gut linked to various chronic conditions. Homoeopaths interviewed for this study observed a rise in gut dysbiosis, attributing it to factors like lifestyle choices and medication use. Their treatment approach emphasizes individualized remedies and therapies tailored to each patient's unique physical, mental, and emotional symptoms. Treatment plans often incorporate dietary modifications, alongside the use of probiotics and prebiotics to support gut health. The study reveals gut dysbiosis as a significant obstacle to cure in homoeopathic treatment. The high cost of stool analysis tests restricts their use in assessing gut health, making it challenging for the interviewed homoeopaths to arrive at a diagnosis. Participants expressed a strong need for more comprehensive education on gut dysbiosis and bowel nosodes within the South African homoeopathic training curriculum. In conclusion, this study suggests that gut dysbiosis presents a clinically significant obstacle to cure in homoeopathic treatment for chronic conditions. A holistic approach combining homoeopathic remedies with dietary and lifestyle changes appears to be effective. Further research is warranted to enhance homoeopathic education on gut health and its impact on chronic diseases.
Practice-related hygiene behaviours utilized by Chiropractors pre, during and post the COVID-19 pandemic in South Africa.
(2024) Enslin, Jan-Frederik; Krishna, Suresh Babu Naidu; O’Connor, Laura
Background: The COVID-19 pandemic had an impact on the delivery of healthcare services worldwide. The Allied Health Professions Council of South Africa implemented regulations to control the spread of the virus, including social distancing, face masks/shields, hand sanitisation, surface disinfection, and protective shields. Chiropractors had to incorporate new hygiene measures to ensure the safety of their patients and themselves. Without adherence to proper hygiene protocols, manual therapy poses a substantial risk of transmission for both the practitioner and the patient. There is limited information available regarding the changes made by chiropractors to their practices in response to the pandemic and if these changed behaviours are still being implemented. Exploring and understanding changes in behaviour can help identify areas where chiropractors may need additional support or resources to adapt to new circumstances and can provide valuable information on how the pandemic has impacted the field of chiropractic care. Additionally, by studying how chiropractors adapted during the pandemic can help gain insight into best practices for future challenges or crises that may arise, as well as can help improve patient care and outcomes in the future. Aim: To determine the practice-related hygiene behaviours of chiropractors before, during and post the COVID-19 pandemic in South Africa. Methodology: An anonymous online survey was completed by registered Chiropractors in South Africa (n=119) registered with the Allied Health Professions Council of South Africa, having provided informed consent. The survey consisted of questions related to practice hygiene behaviours pre, during and post the COVID-19 pandemic and distributed via a link on QuestionPro®. The survey closed on 02/02/2024. Results: The study examined the distribution of hand and equipment disinfection in a healthcare setting, before and after the COVID-19 pandemic. The response rate for the survey was 22.45%. A total of 36% of chiropractors had been practicing for seven years and 60% lived in urban or major cities. Most practitioners returned to their work in level 4 of lockdown and practiced as a sole practitioner. The study found a significant statistical difference that sanitiser availability and the use of personal protective equipment were less prevalent before and after the pandemic than during the pandemic. Most chiropractors (78%) felt that the COVID-19 hygiene protocols made them more aware about practice hygiene behaviours. However, 30% of chiropractors believed they were likely to contract COVID-19 if they did not adhere to proper hygiene practices. Barriers to implementing hygiene practices during COVID-19 included patient reluctance, lack of time, resources and difficulty in adhering to hygiene practices. Half of the chiropractors agreed to continue with good hygiene practices post COVID-19. Conclusion: The COVID-19 pandemic resulted in increased adherence to practice related hygiene behaviours with the implementation of safety precautions such as protective screens and face masks. Many of the chiropractors continued to utilise these behaviours after the pandemic.
An exploration of the adoption of personal nonpharmaceutical intervention measures by students at a university of technology in response to the COVID-19 pandemic
(2024) Kell, Colette Melissa; Haffejee, Firoza; Jinabhai, Champaklal C.
Background In March 2020 the World Health Organisation (WHO) declared coronavirus disease (COVID-19) to be a global pandemic. Due to the novel nature of the virus, there was no effective vaccine or established treatment methods, and public health officials turned to the personal non-pharmaceutical protective intervention (NPI) measures of physical distancing, hand sanitisation and the wearing of masks to interrupt disease transmission and ‘flatten’ the pandemic curve. Despite the WHO recommendation that NPIs should be included as part of any pandemic response, prior to the COVID-19 pandemic, little behavioural science research had been conducted on how to improve NPI adoption. During the COVID-19 pandemic, many Knowledge, Attitude and Practice (KAP) surveys investigated NPI compliance, but there is a dearth of qualitative literature to provide insight into the barriers and facilitators to adoption in specific populations. Over the past two decades, the South African Higher education sector has largely been transformed to accommodate students from poor and rural backgrounds. As a result, students requiring accommodation in the urban centres where universities are often based, has dramatically increased. During the COVID-19 pandemic these students effectively became mobile members of their households, returning home at various times and lockdown levels, potentially spreading the disease to relatively isolated areas. In addition, studies have consistently found that young people were more likely to be considered non adopters of the COVID-19 NPIs, partly due to the increase in risk taking behaviour associated with adolescence. In South Africa, the risk behaviour of young people is also of significant public health concern in the context of HIV/AIDS, teenage pregnancy, substance abuse and violence, this is compounded by the limited success of large research interventions. Yet, despite the acknowledgement of the need for specificity in designing youth targeted interventions, there has been little exploration of how and why South African adolescents adopt positive behaviours. Knowledge of which would be useful to better understand behaviour motivation and inform strategies for positive behaviour change. Aim This study aimed to gain an understanding of the factors influencing the adoption of the personal NPIs in response to the COVID-19 pandemic, among students at a University of Technology (UOT). Insight into these factors was used to develop guidelines to inform the design of targeted interventions to promote positive behaviour change by South African adolescents. Methodology This exploratory, qualitative study sought to understand behaviour change using the Capability, Opportunity, Motivation, Behaviour (COM-B) model. Eighteen student participants at a UOT were selected using purposive, maximum variability sampling. Each participant was interviewed individually via Microsoft Teams. Data was transcribed verbatim and analysed both deductively and inductively. Deductive analysis was guided by Theoretical Domains Framework which was developed to integrate with the COM-B model. Where possible, participant statements were coded to the appropriate domain, statements relevant to the aim of the study but did not align with the TDF domains which were inductively analysed using the Tesch approach to qualitative analysis and Braun and Clarke (2006) thematic approach. Findings This study found that NPI adoption among students evolved over time, closely aligned to the available published literature regarding NPI efficacy and WHO recommendations, but not necessarily aligned to or in compliance with government regulations. A notable exception was the reduced compliance when interacting with loved ones. In these circumstances, despite high levels of both the psychological and physical capability to perform the protective behaviours, the participants lacked the social opportunity and emotional motivation to do so. Notable factors that facilitated NPI adoption included trust in international health organisations, personal experience of COVID-19 and an altruistic desire to protect others. Factors that acted as barriers to NPI adoption included in-group trust, government distrust and social disapproval for adoption. The major themes that emerged included the need for autonomy in adolescent health decision making, the importance of social connection, the influence of social media, and the need to include young people in the development of targeted behaviour change interventions (BCIs). Conclusion This study contributes to the limited body of knowledge regarding the factors that served as barriers and facilitators to the adoption of positive health behaviours by South African adolescents in the context of the COVID-19 pandemic. These factors contributed to the development of guidelines which can be utilised by the relevant stakeholders when designing BCIs targeting this group.
Primary caregiver experiences and perspectives on caring for a child with chronic kidney disease within a South African context
(2024) Govender, Shamanie; Adam, Jamila Kathoon
Background: Informal and unpaid caregivers play an important role in the management of paediatric patients who have chronic kidney disease (CKD). The burdens that the caregivers experience during their caregiving roles and responsibilities have not been extensively researched, particularly within this patient population. The high physical, psychosocial and economic burdens experienced by the caregiver can in turn lead to negative impact on the child’s health outcomes and medical treatment. This study ascertained the burdens that caregivers experienced, in their care of paediatric CKD patients, who were receiving haemodialysis, in the renal unit of a large public hospital in KwaZulu Natal, South Africa. Methods of communication and types of information provided by the renal healthcare team and the support needs of caregivers to reduce burden, anxiety and social dysfunction was elicited. Methods: Two standardized instruments, namely, the General Health Questionnaire - 12 and the Paediatric Renal-Care Burden Scale were used to ascertain burden, anxiety, and social dysfunction experienced among caregivers of CKD paediatric patients on haemodialysis. Two semi-structured questionnaires were administered. In the first instance, caregivers were asked to provide information on areas that could assist them to alleviate the burden of caregiving and the second questionnaire was used to ascertain from renal staff, the methods they used to communicate with, and the information they provided to caregivers. Results: Twenty-one caregivers participated in the study, with females providing most of the caregiving duties (76.2%). Using the PR-CBS, financial burden emerged as the highest burden experienced (mean = 4,86 and SD = 0,77). The use of the GHQ – 12, revealed that anxiety and distress were significantly high in caregivers (mean = 0.95 and 0.85) respectively. Overall, 18 caregivers had moderate to high burden. The total mean burden score for the PR-CBS for females was significantly higher than that for males (11.30; SD = 6.11 vs 7.83; SD = 4.70). This is confirmed by the total mean burden score declared by females for GHQ – 12, which was also significantly higher than that declared by males (6.58; SD = 2.83 vs 3.75; SD = 1.80). There was significant positive correlation between GHQ-12 anxiety score (p= 0.003) and PR-CBS burden score (p = 0.005). Conclusion: The prevalence of burdens, anxiety and social dysfunction was significantly high among caregivers of CKD paediatric patients and is often overlooked by the renal Background: Informal and unpaid caregivers play an important role in the management of paediatric patients who have chronic kidney disease (CKD). The burdens that the caregivers experience during their caregiving roles and responsibilities have not been extensively researched, particularly within this patient population. The high physical, psychosocial and economic burdens experienced by the caregiver can in turn lead to negative impact on the child’s health outcomes and medical treatment. This study ascertained the burdens that caregivers experienced, in their care of paediatric CKD patients, who were receiving haemodialysis, in the renal unit of a large public hospital in KwaZulu Natal, South Africa. Methods of communication and types of information provided by the renal healthcare team and the support needs of caregivers to reduce burden, anxiety and social dysfunction was elicited. Methods: Two standardized instruments, namely, the General Health Questionnaire - 12 and the Paediatric Renal-Care Burden Scale were used to ascertain burden, anxiety, and social dysfunction experienced among caregivers of CKD paediatric patients on haemodialysis. Two semi-structured questionnaires were administered. In the first instance, caregivers were asked to provide information on areas that could assist them to alleviate the burden of caregiving and the second questionnaire was used to ascertain from renal staff, the methods they used to communicate with, and the information they provided to caregivers. Results: Twenty-one caregivers participated in the study, with females providing most of the caregiving duties (76.2%). Using the PR-CBS, financial burden emerged as the highest burden experienced (mean = 4,86 and SD = 0,77). The use of the GHQ – 12, revealed that anxiety and distress were significantly high in caregivers (mean = 0.95 and 0.85) respectively. Overall, 18 caregivers had moderate to high burden. The total mean burden score for the PR-CBS for females was significantly higher than that for males (11.30; SD = 6.11 vs 7.83; SD = 4.70). This is confirmed by the total mean burden score declared by females for GHQ – 12, which was also significantly higher than that declared by males (6.58; SD = 2.83 vs 3.75; SD = 1.80). There was significant positive correlation between GHQ-12 anxiety score (p= 0.003) and PR-CBS burden score (p = 0.005). Conclusion: The prevalence of burdens, anxiety and social dysfunction was significantly high among caregivers of CKD paediatric patients and is often overlooked by the renal healthcare team. The experiences of this unique population of caregivers are complex and multifaceted, but despite the various challenges they encounter, they continue to provide care and support for their young patients. Renal healthcare practitioners may use the findings to develop and provide suitable supportive interventions and resources for these caregivers. It is essential that these be included in treatment guidelines for the ill child, not only to reduce caregiver burdens but also to improve the overall CKD paediatric patient outcomes.
The assessment of intensive care unit-acquired weakness in adult patients at risk of post intensive care syndrome
(2024) Van Vuuren, Noline; Prakaschandra, Dorcas Rosaley; Memela, Mduduzi E.; Van der Merwe, E.
Intensive care unit-acquired weakness (ICUAW) is a syndrome of generalised neuromuscular weakness that develops in critically ill patients for which there is no alternative explanation other than the critical illness itself, and which has a prevalence of 25% to 80% in ICU survivors. The diagnosis and grading of ICUAW is made by excluding other causes of neuromuscular weakness and by repetitive clinical examination of muscle strength using the Medical Research Council Sum-Score (MRC-SS). The aim of the study was to evaluate ICUAW, and diagnostic methods available for this condition, in ICU survivors at risk of post intensive care syndrome (PICS) in a South African tertiary public sector hospital. METHODOLOGY: A prospective, single-centre observational study was conducted in a multi-disciplinary tertiary ICU in Eastern Cape. Patients at risk for post intensive care syndrome were included in the study. Patients were evaluated for ICUAW at six weeks and six months post-hospitalisation with the MRC-SS and handheld dynamometry (HDD). Full criteria ICUAW is defined as an MRC-SS of less than 48 out of 60. RESULTS: We enrolled 150 patients in the study, of which 103 patients completed the six month follow-up. At six weeks and six months, respectively, 3 and 2 patients’ MRC SS were less than 48/60. The median MRC-SS was 58/60 (IQR: 52-60) at six weeks and 60/60 (IQR: 58-60) at six months. There was an average change of 32,75% in the mean force from six weeks to six months for all muscle actions on both sides, with p < 0.001 indicating a significant difference. Fair correlations (r = 03-0.5) were observed between the MRC scale and HHD measurements for each muscle action from six weeks to six months. The correlation between the MRC scale and HHD proved to be significant (p < 0.001). CONCLUSION: There is a low incidence of the full criteria of ICUAW in relatively young and previously healthy ICU survivors at risk for PICS. Both the MRC-sum scores and HHD measurements showed a significant improvement over six months and there was an acceptable correlation between them. The findings of this study indicate that the strength assessed by both methods is related and tends to change in a similar direction over time.
Exploring factors influencing patient safety incident reporting by nurses in primary health care facilities in King Sabata Dalindyebo sub-district, Eastern Cape
(2024) Tolobisa, Patiswa; Naranjee, N.; Moonsamy, S.
Patient incident reporting is a crucial activity for enhancing healthcare standards and ensuring patient safety. Reporting patient safety incidents offers a comprehensive overview of incidents, detailing what occurred and how it happened, thereby facilitating learning and improvement. The study identified several factors influencing patient safety incident reporting, including a lack of understanding of incident reporting, a blame culture, minimal support by managers, a lack of training, inadequate facilities, a lack of feedback and debriefing, and the absence of rewards and punishment system. A necessary positive activity to improve health care standards and patient safety is patient incident reporting. Patient safety incidents provides a broad picture of what has happened, how it happened and facilitates learning. AIMS AND OBJECTIVES OF THE STUDY The aim of the study was to explore and describe factors influencing the reporting of patient safety incidents in primary health care facilities from nurses’ viewpoints. The objectives were to explore factors influencing PSI reporting behaviours in primary health care facilities in King Sabata Dalindyebo sub-district, OR Tambo District, Eastern Cape, to explore nurses’ knowledge and understanding of PSI reporting, and to provide recommendations for improving PSI reporting. METHOD In this study, a qualitative, exploratory, descriptive design assisted the researcher in exploring the factors influencing reporting of patient safety incidents by nurses in primary health care facilities. The target population was all 48 nurses permanently employed in the primary health care facilities in Mqanduli cluster, King Sabata Dalindyebo. A non probability, purposive sampling method was used to select the participants for the study, where 10 nurses were interviewed as determined by data saturation. Individual interviews were conducted using semi-structured interviews in English based on an interview guide which lasted for 15-20 minutes for each participant. The data was analysed using the thematic data analysis method. FINDINGS Five themes emerged from the thematic analysis, with 19 subthemes. Themes were: (1) Experiences of patient safety incident reporting, (2) contributory factors to patient safety incidents, (3) importance of patient safety incident reporting (4) barriers to PSI reporting, and (5) recommendations by participants.The reporting process for patient safety is influenced by a number of factors, such as nurses' reluctance to report for fear of punishment, the emphasis placed on unclear reporting systems, management behaviour, lack of training and education, and fear of lawsuits. The experience of implementing patient safety incident reporting necessitates support from management in the form of training and provision of resources, creating a positive work environment and safety culture by not punishing those who make errors, and rewarding those who report patient safety incidents. CONCLUSION The nurses at Mqanduli cluster, King Sabata Dalindyebo Sub-District had challenges regarding the reporting of patient safety incidents due to a number of issues tabled by the participants that were influencing factors to patient safety incidents that should have been prevented such as negligence. The participants proposed recommendations such as development through training of the nursing staff regarding how to report patient safety incidents and provision of resources.

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