Theses and dissertations (Health Sciences)

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The management of chronic pain in HIV by traditional complementary alternative medicine practitioners : guidelines for treatment and management
(2021-12-02) Abdul-Rasheed, Ashura; Sibiya, Maureen Nokuthula; Haffejee, Firoza
Background Chronic pain is a common clinical complaint and comorbidity that negatively affects the health-related quality of life of people with HIV across the world. The prevalence of chronic pain in HIV is high, with estimates that range from 25% to 85% of people. Chronic pain (CP) in HIV often results in impaired physical ability, a sequelae of clinical complaints and associated mental health problems. People with CP in HIV commonly seek alternative therapy parallel to their conventional therapy, such as opioid analgesics, to manage their pain. One such therapy is traditional complementary alternative medicine therapies (TCAM). Although widely utilised for CP in HIV, TCAM healthcare practices are understudied due to the limited knowledge of the efficacy and safety of these therapies in this field of healthcare. Aim The aim of this study was to explore the treatment and management practices for chronic pain in HIV by selected traditional alternative medicine therapies practitioners and to develop TCAM practitioner guidelines for CP management in HIV. Methodology A qualitative, explorative, descriptive contextual design, within an interpretivist paradigm, was employed to guide this study. Data were collected from 13 traditional complementary alternative medicine practitioners in the eThekwini Municipality, KwaZulu-Natal, South Africa, utilising purposive and snowball sampling strategies, respectively. These TCAM practitioners consisted of chiropractors, homeopaths, and traditional health practitioners. Semi-structured, face-to-face interviews were employed to collect data. Data were transcribed verbatim and analysed using Tesch’s eight steps of thematic analysis. Findings It emerged that TCAM practitioners are actively treating and managing chronic pain in HIV, through their various disciplines. The THPs prescribed various traditional herbs either orally or topically. The THPs also relied on ancestral intervention for treating chronic pain in HIV. The chiropractors utilised various manual techniques in their management of chronic pain, whilst the homeopaths made use of remedies, herbs, minerals and vitamins in their treatment protocols. Although referrals amongst and between the TCAM practitioners were common there were no active referral patterns between mainstream healthcare professionals and TCAM practitioners for chronic pain in HIV, which emerged as a barrier in the care for HIV patients suffering with chronic pain.
Critical evaluation of the influence of ideal clinic status on the quality of primary care services provision in eThekwini District, South Africa
(2024-10-17) Mazibuko, Ntombifuthi Norah; Ngxongo, Thembelihle Sylvia Patience; Sokhela, Dudu Gloria
Introduction and background As the global world commits to achieving universal health coverage by 2030, there is a growing acknowledgement that optimal cannot be delivered by simply ensuring the coexistence of infrastructure, medical supplies and providers. Improvement in delivery requires deliberate focus on quality of health services that include providing effective, safe, people-centered care that is timely, equitable, integrated and efficient. Global quality reports note that billions of people will not gain from potential universal coverage benefits unless improvements in health system quality are realised. In South Africa, several quality improvement initiatives have been implemented, the Ideal Clinic Realisation and Maintenance initiative being the latest initiative aimed at improving quality services provision, especially at primary care level as the entrance point into the system. Research on improved quality provision in facilities with ideal status is thus crucial to providing quality health services for all South Africans based on their needs, irrespective of socio-economic status. Aim of the study The study aimed to critically evaluate the influence of Ideal Clinic status on the quality of primary health care service provision in eThekwini District, South Africa, thereby proposing an Ideal Clinic practice framework that will enhance an improved quality of healthcare service provision in primary health care facilities. Objectives of the study The objectives of the study were to determine the current practices of providers and the status of user records in ideal primary facilities; to explore the perspectives of healthcare providers regarding the influence of Ideal Clinic status on quality of patient care; to ascertain the perspectives of the health care users on the quality of care received in facilities with ideal status; and, to propose an Ideal Clinic prctice framework that can be used to enhance improved quality healthcare service provision in primary health care facilities irrespective of Ideal Clinic status. iii Methodology A convergent parallel design, where both qualitative and quantitative methods were used to collect data within a short period to avoid potential threats to validity. The quantitative data collection consisted of (n = 360; 88.8%) retrospective record reviews of adult clinical records and (n = 45; 11.1%) children’s records and a self administered questionnaire from (n = 54; 85.7%) professional nurses and (n = 9; 14.2%) facility operational managers. The qualitative data collection consisted of semi-structured interviews with (n = 8) healthcare providers to explore their perspectives regarding the influence of Ideal Clinic status on the quality of care provision to healthcare users and (n = 14) healthcare users. The perspectives of the healthcare users regarding the quality of care received in facilities with ideal status were ascertained. Data analysis of the quantitative data was via descriptive and inferential statistics, and the qualitative analysis was via thematic analysis. The two data strands were analysed independently and inferences made from each strand were synthesized to form conclusions about the findings. The results of the two separate analyses were mixed for an overall interpretation of the findings. Findings Although the PHC facilities included in the study had been awarded Ideal Clinic status, it was evident that Ideal status did not automatically translate to quality of care in most facilities. There were important care assessments that had been inadequately performed or not done at all. These included physical examinations that were not performed, poor or no documentation on clinical records, shortage of medical supplies, and lack of training and support for staff. Recommendations Recommendations are of a short-term nature and can be achieved with buy-in from the policy makers. Long-term recommendations include renovation of primary health care facilities to cater for the full package of primary health care services, human resources and medical equipment. Conclusion Based on the findings, a practice framework was developed to provide structure using evidence-based practices on interventions that would assist policy makers and implementers to engage in relevant actions for improving quality service provision irrespective of the Ideal Clinic status.
Guidelines to facilitate collaboration between midwives and traditional birth attendants in KwaZulu-Natal
(2025-01-29) Ndaba, Nompumelelo Pearl; Ngxongo, Thembelihle Sylvia Patience; Sokhela, Dudu Gloria
Introduction: Perinatal deaths are untimely deaths and are a major public health concern in many developing countries. They have enormous economic, social and health implications for families and society. Over 300 000 women die annually due to pregnancy-related and childbirth complications in sub-Saharan African countries including South Africa, and about 2.6 million babies are stillborn, particularly during the third trimester, with the majority of these deaths occurring in low-socioeconomic communities. Midwives, with their training, and traditional birth attendants (TBAs), with their cultural experience, play a pivotal role in maternal and newborn health, especially in the rural communities where they both bring their expertise to the care of women and newborn babies. There is evidence that in most stettings these two groups coexist but work independently with no form of formal collaboration. Collaboration between these two groups could bridge the gap between formal and traditional health systems and ensure that women and babies receive quality healthcare support throughout pregnancy, labour and post-delivery. Therefore, strengthening collaboration between midwives and TBAs is crucial to reduce maternal and neonatal mortality rates and improve overall health outcomes especially in the rural settings where the services of both TBAs and midwives coexist. AIM: This study aimed to develop practice guidelines to facilitate collaboration between midwives and TBAs in KwaZulu-Natal. Method: A qualitative research design using explorative, descriptive, case study approaches was employed at uThukela District Municipality in KwaZulu-Natal, South Africa, guided by the structural functionalism theory of Talcott Parsons following the adaptation, goal attainment, integration, and latency process. The sample comprised 38 midwives and 18 women who were purposively sampled and 10 TBAs who were sampled using the snowball method. Data were collected between April and August 2023 following ethics approval (IREC 307/220) from the Durban University of Techology. Data were collected using interviews and focus group discussions and thematically analysed guided by the six steps of qualitative data analysis as described by Creswell and Creswell (2023). v Findings: The study findings confirmed that midwifery and TBA sevices coexisted in uThukela District and that women were utilising services from both groups during pregnancy, childbirth and the postnatal period. The study also confirmed that there was no existing collaboration between the midwives and TBAs in this district thus resulting in no formal communication between the two groups regarding the care of women and children. This had negative implications for the care of women and children, particularly regarding the continuity of care. However, midwives and TBAs expressed a willingness to collaborate because of their shared goal of reducing maternal and neonatal mortality rates in the district. The women also expressed their support for collaboration between the midwives and TBAs which they stated would address a number of challenges that they face as they sought healthcare from the two groups. Recommendations: The study makes several recommendations mostly related to policy formulation/revision to incoperate TBAs, training and inservice education, midwifery, and TBA practices, as well as further research. Most importantly, guidelines to facilitate collaboration between the TBAs and midwives were developed as part of the study. Conclusion: The findings from the study highlight the negative influences of lack of collaboration on the management of women and children and several benefits that could be achieved through collaboration. Benefits include establishing a shared vision, team work, benchmarking and sharing of good practices, all of which could have positive outcomes on the care of women and children. This could also aid in achievement of Sustainable Development Goals of the country especially goal number number 3 related to ensuring healthy lives and promoting the well-being of mothers and children. These guidelines are expected to assist in bridging the gap between midwives and TBAs, fostering a collaborative environment that leverages the strengths of both groups. Furthermore, the guidelines aim to foster community unity by involving various stakeholders, ultimately enhancing maternal and neonatal healthcare outcomes
Student nurses and educators’ experiences of clinical teaching and learning during COVID-19 pandemic in selected campuses of Gauteng College of Nursing
(2024-10-13) Malindisa, Zandile Goodness; Sokhela, Dudu Gloria; Ngxongo, Thembelihle Sylvia Patience
Background The Corona virus disease (COVID-19) pandemic, which was first reported in Wuhan in December 2019, spread to other countries in the world, including South Africa. When the infections were very high, different stages of national lockdown were put in place, to curb the rapid spread of the infection. All education institutions were closed, including Nursing Education Institutions for both theory and clinical practice. Student nurses could not practice for three months of level five lockdown. Once the infections started to subside, student nurses went back to clinical areas and some students cared for patients with COVID-19 disease, with no knowledge or adequate protection from the disease. Aim The study aimed to explore student nurses’ and educators’ experiences of clinical teaching and learning during the COVID-19 pandemic in selected campuses of the Gauteng College of Nursing. Methods A descriptive qualitative design was used to conduct face-to-face individual interviews with 15 purposively selected student nurses who were in their fourth-year of the R425 training programme and four clinical educators. Findings Three themes and 16 subthemes emerged. The themes were: clinical experiences during the COVID-19 pandemic, clinical teaching and learning during COVID-19 pandemic, and coping strategies that can be used in future pandemics or similar crises. Conclusion The findings from this study indicate that teaching and learning were very challenging during the COVID-19 pandemic due to the restrictive policies that were imposed in the country affecting nurse training and education.
Factors influencing work-related relationships between nurses and their line managers in public hospitals, Ugu District, KwaZulu-Natal
(2025-03-23) Mkhize, Sindisiwe Emgard; Sokhela, Dudu Gloria; Ngxongo, Thembelihle Sylvia Patience
Introduction Work-related relationships are unique interpersonal connections that hold significant implications for individuals and the organizations in which they exist. Employees often engage in various types of formal and informal relationships at work, such as those with peers, managers, subordinates, friends, and advisors. These relationships are crucial for fostering individual commitment to the organization, promoting positive attitudes toward work, and enhancing organizational outcomes. Aim of the study The aim of this study was to identify the factors influencing the work-related relationships between nurses and their line managers. Methodology A descriptive, quantitative, cross-sectional survey design was employed to investigate the factors that influence the work-related relationships between nurses and their line managers. Data were collected using a self-administered questionnaire from 406 nurses and managers, who were sampled through simple random sampling. The data were analyzed using SPSS version 29. Results The study achieved a 100% response rate. The majority of nurse respondents showed significant agreement with 21 out of 27 statements in the questionnaire (78%), with scores greater than 3 (p < 0.001). The highest levels of agreement were for statements regarding having individual discussions with managers (mean [SD] = 3.90 [0.45]), the ability to communicate problems affecting their duties with managers (mean [SD] = 3.83 [0.625]), efforts to establish working relationships with managers (mean [SD] = 3.78 [0.625]), and the perception of an open-door policy from managers (mean [SD] = 3.78 [0.686]). Nurse respondents showed significant disagreement with three (11%) of the 27 statements. Managers expressed concerns that nurses required additional training and skills to improve their performance and noted that some nurses exhibited rude behaviour. Conclusion Nurses enter the workplace with the intent to perform, earn, learn, and grow professionally. When these objectives are not met, frustration may arise. It is recommended that, upon assuming duties, managers should communicate their expectations clearly, including processes, procedures, and performance standards. Managers should also identify appropriate skills for the job, mentor nurses for professional growth, and address deviations from expected behavior to achieve the institution's goals. Ultimately, the relationships between nurses and their managers significantly impact patient outcomes
Experiences of KwaZulu-Natal diagnostic radiographers’ engagement in continuing professional development activities during the COVID-19 pandemic
(2024-05-07) Ogile, Yonela; Nkosi, Pauline Busisiwe
Introduction Continuing professional development remains a keystone for developing and maintaining professionalism of radiographers and other healthcare professionals throughout their career lifetime. It ensures that professionals retain their capacity to practice safely, effectively, and legally, within their evolving and advancing professional fields. Technological advancements and changes in the medical imaging field, necessitate and justify the need for diagnostic radiographers to engage in continuing professional development activities. The Corona Virus Disease of 2019 (Covid-19) has significantly disrupted all aspects of life globally. The Covid-19 pandemic transformed the way in which diagnostic radiographers engaged in continuing professional development activities. Many educational activities that have been traditionally designed for live interaction and in-person settings were moved to online platforms. However, in the South African context, no studies have been conducted to detail the effects of the Covid-19 pandemic on diagnostic radiographers’ engagement in continuing professional development activities. The current study filled this gap. Aim This study aimed to explore the experiences of KwaZulu-Natal (KZN) province diagnostic radiographers’ engagement in continuing professional development activities during the Covid-19 pandemic and to understand what could have been done to improve their engagement in continuing professional development activities . Methodology A qualitative descriptive phenomenological design was employed to conduct this study. A criterion sampling was used to select three public hospitals, within the eThekwini district in KZN. A sample size of 20 diagnostic radiographers selected using purposive homogenous sampling, participated in this study. Ethical approval to conduct the study was obtained from the Institutional Research Ethics Committee (IREC) at the Durban University of Technology (DUT). All participants participated voluntarily and gave their written consent. Data were collected using face-to-face, one-on-one, semi-structured v in-depth interviews using open-ended questions which were related to engagement in continuing professional development activities during Covid-19 pandemic. Interviews were transcribed verbatim before data analysis. Data were analysed using thematic data analysis method. Data were stored on a password-protected computer which can only be accessed by the researcher. The audio tape recorder was kept in the lockable storage that can only be accessed by the researcher. The data would be stored in this manner for 5 years. Findings The themes that emerged as findings in this study of radiographers’ experiences when engaging in continuing professional development activities during Covid-19 pandemic included: effects of this pandemic; barriers; facilitators; and recommendations on support needed to improve the engagement or in similar situations. These findings revealed that diagnostic radiographers’ engagement in continuing professional development activities was affected during the Covid-19 pandemic. One of the changes that the pandemic brought was the transition from face-to-face to virtual formats of engagement in continuing professional development activities. There was participation as well as lack of participation in continuing professional development activities during the Covid-19 pandemic. Either of the findings was linked to preferences in continuing professional development activities formats, barriers, and enablers for participants' engagement in continuing professional development activities. There was a general acknowledgment of the value of engaging in continuing professional development activities. Furthermore, participants recognised the obligation to fulfil the regulatory requirements of engaging in continuing professional development activities to remain registered as healthcare professionals. Participants in the current study highly recommended support for including time allocation, hosting of inhouse activities, and guidance from the Health Professions Council of South Africa (HPCSA) and accredited providers on how to engage in online activities. Conclusion and recommendations Continuing professional development remains important for diagnostic radiographers to professionally update their knowledge and skills so that they keep up with evidence-based practice and technological changes in their profession. The Covid-19 pandemic affected the diagnostic radiographers’ engagement in continuing professional development activities. In the current study this effect was noted through the transition of the continuing professional development formats which was followed by a lack of engagement by some participants. Support in the form of time allocation for continuing professional development activities and in-house continuing professional development activities is strongly recommended to facilitate better radiographer’s engagement. Employers, HPCSA, and accredited continuing professional development providers should take an active role in supporting diagnostic radiographers, so that they may better engage in continuing professional development activities.
A systematic review of the effectiveness of conservative therapy in the treatment and management of temporomandibular joint disorders
(2024-08-01) Hlongwane, Samukelisiwe Nokulunga; McCarthy, Peter; Thandar, Yasmeen
Background: Temporomandibular disorders (TMD) encompass neuromusculoskeletal conditions affecting the temporomandibular joint (TMJ) and surrounding orofacial structures, particularly the muscles of mastication. Despite numerous treatment options, there is a dearth of evidence-based conservative interventions. This systematic review aims to evaluate the level of evidence for conservative TMD interventions to inform clinical practice guidelines. Methods: A systematic search was conducted across databases including CINAHL, Cochrane Library, Medline, PubMed, ScienceDirect, Scopus, and Web of Science, supplemented by a hand search. The final search was completed on June 2022 and a supplementary search was performed in March 2023. Inclusion criteria encompassed studies evaluating conservative therapies for TMD in human subjects, while exclusion criteria included non-English studies, unavailable full texts, and studies not focused on conservative treatments. Risk of bias was assessed using the PEDro scale for RCTs, the Newcastle-Ottawa scale (NOS) for NRCTs, and the Liddle scale for case reports and series. Data were synthesized qualitatively. This review was registered in PROSPERO (CRD42023409560). Results: From 4,148 records, 789 duplicates and 3 retracted articles were removed. Title screening excluded 3,141 articles, abstract screening excluded 172 articles, and full-text screening excluded 9 articles, leaving 31 eligible articles. An additional study identified through a hand search brought the total to 32, comprising 19 RCTs, 10 NRCTs, 1 case report, and 2 case series. The interventions evaluated included dry needling, exercise, physical therapy, ischemic compression, manipulation/mobilisation, and manual therapy. Strong evidence supports the effectiveness of dry needling, while moderate evidence was found for exercise, manual therapy, and multimodal interventions, such as cervical spine manipulation combined with other therapies. Limited evidence supports thoracic spine manipulation, myofascial techniques, physical therapy, and proprioceptive neuromuscular facilitation. Conclusion: These findings highlight the potential benefits of conservative therapies in TMD management. Clinicians should prioritize dry needling, exercise, and manual therapy, particularly in combination with other modalities, to optimize patient outcomes. Researchers should focus on conducting high-quality RCTs with standardized protocols and larger sample sizes to strengthen the evidence base, particularly for under-researched interventions such as thoracic spine manipulation and proprioceptive neuromuscular facilitation. Policymakers should consider integrating the strongest evidence-based interventions into clinical guidelines to improve accessibility and standardization of conservative TMD treatments
Perceptions of isiZulu speaking homoeopathic students and practitioners on the need to translate the homoeopathic Materia medica into isiZulu in KwaZulu-Natal
(2025-06-18) Msomi, Sinenhlanhla; Sibiya, Maureen Nokuthula; Majola, Sindile Fortunate
Background Homoeopathy has been widely practiced in South Africa for a long time and is recognized as a legitimate type of Complementary and Alternative Medicine (CAM), but it remains unfamiliar to the general public. The current materia medica used in South Africa is in English. The aim of the study was to explore the perceptions of isiZulu speaking homoeopathic students and practitioners on the need to translate homoeopathic materia medica into isiZulu in KwaZulu-Natal. The majority of the population in KwaZulu-Natal communicates in isiZulu as their primary language, highlighting the crucial need to translate homoeopathic materia medica into isiZulu to enhance accessibility and comprehension. Methodology The study design employed in this study was qualitative, exploratory, and descriptive, with open-ended questions to elicit into participants' perceptions. The study population consisted of registered homoeopathic practitioners and students meeting specific criteria for inclusion. Sampling methods involved purposive and snowball sampling to recruit participants. The study conducted twelve semistructured interviews using Microsoft Teams with homoeopathic students and practitioners. Data saturation was reached after eight interviews, leading to four additional interviews for validation. Data collection included semi-structured interviews with consent obtained and confidentiality maintained. Data analysis followed Tesch's eight-step procedure for qualitative studies. Findings Four themes emerged from the thematic analysis, focusing on translation, language barriers, language-based programs and difficulties in translating medical textbooks. Participants expressed a strong desire for homoeopathy materia medica to be translated into IsiZulu to aid in patient consultations and remedy understanding. However, some participants raised concerns about potential misuse and the complexity of translating certain medical terms. Language barriers were highlighted as a significant challenge in prescribing remedies, with participants emphasizing the importance of accurate translations for effective case taking and repertorisation. The need for translated materials was underscored by the difficulties in understanding and translating the original materia medica. Overall, the study shed light on the importance of language accessibility in homoeopathic practice and the potential benefits of translation for both practitioners and patients.
Effectiveness of cervical, thoracic and cervico-thoracic spinal manipulation on pain and spinal kinematics in non-specific neck pain : a randomised controlled trial
(2025-04-07) Twiss, Dale Brent; Pollard, H.; O'Connor, Laura
Background: Neck pain is a musculoskeletal disorder that affects many people at some point in their lives. It has been demonstrated that up to 50% of adults in the general population may experience neck pain at some point during the year, with many going on to develop persistent chronic neck pain. Neck pain is associated with disability and activity impairment especially of the upper limb when performing functional movements. Spinal manipulation has been shown to help decrease pain intensity and disability and improve range of motion and the quality of life in individuals with non-specific neck pain. Few studies have examined range of motion beyond that of peak displacement and, thus, little is known if spinal manipulation therapy of the cervical and thoracic spine improves the quality of motion in those with neck pain. Aim: The aim of this study was to determine the effectiveness of cervical and thoracic spinal manipulation applied alone and in a combination. The groups were compared to a control group in terms of their effect on pain intensity, disability, cervical and thoracic kinematic outcomes during cervical range of motion and two upper extremity functional limb tasks in individuals with non-specific neck pain. Methods: The study is a quantitative, randomised, controlled, single-blinded study. Individuals with chronic non-specific neck pain between the ages of 18–50 were recruited and randomly assigned to one of four groups: control, cervical, thoracic spinal manipulation, or a combination of the two. The participants performed cervical range of motion and two upper limb tasks while motion capture technology collected cervical and thoracic spinal kinematics. A pain rating and spinal kinematics were obtained pre and post the intervention. The data were analysed using software SPSS and a p-value of 0.05 indicated significance. Results: A total of 47 participants were randomised. No significant difference was recorded for pain intensity across all four of the groups (F(3,42) = 0.41, p = 0.750). Spinal kinematics improved within the groups, with no differences between the groups during the cervical range of motion task. Between the groups, in the unilateral arm task, differences were found in the lower thoracic spine during the flexion-extension cycle for jerk, with the cervical and thoracic combination group being significantly greater than cervical manipulation group alone (F(3, 40) = 2.892, p = 0.047). In the cervical and thoracic combination group, for the bilateral arm task in the upper thoracic spine flexion extension range, it was found to be significantly greater than the control group (F(3, 40) = 3.127, p = 0.036). In the cervical and thoracic combination group, in the lower thoracic spine during the flexion-extension cycle for the jerk measure, it was found to be significantly higher than the control group (F(3, 40) = 2.902, p = 0.047). Conclusion: This study could not prove that spinal manipulation can result in a change in the spinal kinematics during cervical range of motion and two arm tasks in patients with non-specific neck pain following spinal manipulation of the cervical and thoracic spines.
A phenomenological exploration of the mental health and well-being experiences of radiology staff in the eThekwini District Of South Africa during a health crisis
(2025-07-02) Hundah, Shillah; Sibiya, Maureen Nokuthula; Khoza, Thandokuhle Emmanuel
Background Globally, one in 10 health workers contract nosocomial infections while on duty. In South Africa, frontline healthcare workers have a record of six times more hospital admissions for the management of extensively drug-resistant tuberculosis (XDR TB) compared to non-healthcare workers. As frontline health workers, radiology staff are at risk of nosocomial infections which are exacerbated during health crises such as the Coronavirus disease 2019 (COVID-19) pandemic. To date, approximately 10% of the COVID-19 cases globally are among healthcare workers. Health crises have also been associated with aggravated occupational stress levels, which negatively impact work competencies. However, no known study has examined the mental health and well-being experiences of the eThekwini district frontline radiology staff during the COVID-19 pandemic. Aim The aim of this study was to explore the mental health and well-being experiences of radiology staff in the eThekwini district of South Africa during a health crisis. Methods A social constructivist position was implemented with the qualitative, Interpretative Phenomenological Analysis (IPA) methodology. Data were collected in two independent phases in a multi-method approach, through the use of semistructured one-on-one interviews in the first phase and focus groups in the second phase. Non-probability sampling was implemented through use of maximum variation sampling. The sample comprised 24 staff working in private and public radiology departments within the eThekwini district of KwaZulu-Natal (KZN) province in South Africa. Phase 1 of data collection involved 13 participants who had one-to-one semi-structured interviews while Phase 2 constituted five and six participants for the two focus groups respectively. Audio recordings of the interviews were transcribed into text data, coded and categorised into themes through the use of the IPA. The Delphi method was employed to validate the resultant mental health support framework. Findings A detailed insight into the mental health and well-being experiences of frontline radiology staff during the COVID-19 pandemic was established. Resultantly, seven themes were developed, namely: duties and roles during the COVID-19 pandemic, personal and work-related challenges, emotional and psychological experiences when carrying out duties, impact on emotional well-being, impact of resultant mental health status on professional competencies, coping strategies, and interventions for mental health effects. The study evidenced that frontline radiology staff within the eThekwini district experienced mental health challenges such as stress, fear and anxiety. Clinical implications The developed mental health support framework could be adopted by radiology departments to enhance staff mental wellness and coping abilities during health crises. Resultantly, standards of radiological images, diagnosis and patient care will be maintained.
The clinical transition of graduate paramedics from dependent to independent practice : a critical participatory action study
(2024-08) Mosiane, Andrew Rammu; McInerney , Patricia; Sobuwa, Simpiwe
INTRODUCTION Independent clinical practice is the pinnacle outcome for graduate paramedics in South Africa and abroad. Undergraduate paramedic students train under supervision to acquire clinical skills, knowledge and competencies deemed essential to independently manage critical patients. Irrefutably, there is a paucity of research in the South African Emergency Medical Care (EMC) milieu exploring the clinical transition of graduate paramedics from supervised students to independent practitioners. AIM Through a Critical Theorist stance, this study aimed to explore the clinical transition of graduate paramedics from dependent to independent practice at a selected university in KwaZulu Natal, South Africa. The focus was on how graduate paramedics transition from dependent to independent clinical practice and what mechanism/s should be instituted within the South African EMC profession to support the transition. METHODOLOGY An exploratory sequential mixed method design was adopted. Semi-structured interviews, focus group discussions and reflective journals were used to collect qualitative data. A Delphi study was conducted to validate the recommended support mechanisms. Thematic analysis was used to analyse and interpret qualitative data. Descriptive statistics were used to set a consensus level for the Delphi study. RESULTS Three themes and seven sub-themes were identified in the qualitative data. The identified themes included: i) transitioning into independent practice, ii) employee and employer relations and iii) quality assurance. The Delphi experts reached a consensus on eight recommended praxes that may support the clinical transition of graduate paramedics into independent practice: i) introduction of an internship period, ii) introduction of a workplace clinical mentorship program iii) restructuring of the BHSc EMC program, iv) incorporation of non-clinical workplace orientation program, v) implementation of a clinical case review system, vi) implementation of a clinical iv consultation system, vii) EMS management competency development and viii) introduction of psychological and emotional support services for graduate paramedics. CONCLUSION The transition from students to professional practice is a crucial phase for graduate paramedics. This study highlights a need for all EMS stakeholders in South Africa to ensure consistent and standardized approaches to guide and support graduate paramedics as they transition to independent practice. Active involvement by the statutory regulators through the development of policies and systems to guide this critical stage of graduate paramedic’s professional development is paramount.
Effects and modifiers of experienced stigma among people living with drug-resistant tuberculosis in Lagos, Nigeria
(2025-07-21) Adejumo Adedeji Olusola; Haffejee, Firoza; Daniel, Olusoji; Jinabhai , Champaklal
Tuberculosis (TB) continues to be a disease of public health concern in Nigeria despite current efforts to increase notification rates in the country. In 2024, Nigeria recorded its highest TB notification and a treatment coverage rate of 79%. Despite these efforts, the country is yet to reach the global elimination targets due to several factors, including the effect of stigma on TB notification and treatment adherence. Previous studies have reported a high prevalence of TB-related stigma, mainly because of the close relationship between TB and HIV. People living with drug-resistant TB (PwDR-TB), however, experience more stigma compared to drug-sensitive TB patients because of the longer duration of DR-TB treatment. TB-related stigma is associated with decreased self esteem, poor quality of life, anxiety, feelings of guilt, isolation, loneliness, and depression. In addition, People with TB (PWTB) experience abuse, neglect, shame and social seclusion at home, work, community, or healthcare facilities. TB-related stigma undermines TB screening efforts and negatively impacts the disclosure of status, healthcare-seeking behaviours, care delivery, treatment adherence, and outcomes. Despite the importance of TB-related stigma on TB control and the quality of life among PwDR- TB in Nigeria, there is a paucity of literature on the subject. This study intends to contribute to the body of knowledge on TB-related stigma in Nigeria to understand the prevalence, effects, and modifiers of stigma among PwDR-TB in Nigeria
The isolation and assessment of the antimicrobial activity of bacteriolytic and bactericidal endolysins of enterobacteriaceae infecting bacteriophages
(2024-11) Naidoo, Keeran; Mbatha, Joyce Nonhlanhla; Van Staden, J.
Pathogenic bacteria pose a significant threat to the health and well-being of vulnerable populations, including newborns and young children, individuals with compromised immune systems as well as those hospitalized or recovering from surgery. The worldwide burden of communicable diseases driven by pathogenic bacteria continues to be a pressing global health issue, with a substantial impact on mortality rates. The presence of antimicrobial resistance further complicates the treatment of bacterial infections. The changing patterns of antimicrobial resistance have greatly decreased the survival rate of individuals with bacterial infections. Irresponsible stewardship of antibiotics, coupled with a lack of knowledge on the use of antibiotics by the public has further fueled the development of antimicrobial resistance. Furthermore, the World Health Organization's Review on Antimicrobial Resistance states that, if the current trend in antimicrobial resistance continues, it can lead to a staggering 10 million deaths per year by 2050. Given that antimicrobial resistance is a globally pressing issue, new and innovative strategies and treatments are required to combat the burden posed by antimicrobial resistance. Bacteriophage lytic enzymes offer a promising solution to curb the issue of antimicrobial resistance. Aim The primary aim of the present study was to evaluate the bacteriolytic and bactericidal activity of bacteriophage proteins against Enterobacteriaceae and Staphylococcus aureus. Methodology In the present study, the Escherichia T4 Bacteriophage along with its host, Escherichia coli (DSM No 613, ATCC 11303, respectively; Leibniz Institute DSMZ) formed the basis of the work. After reconstitution in nutrient broth, the E. coli was cultured on nutrient agar (1.5%) in a 90 mm petri dish, to which nutrient agar (0.6%) containing the T4 bacteriophage was added to enumerate the bacteriophage. Escherichia coli and bacteriophage T4 were then co-cultivated in one litre of nutrient broth and the salting out method and column chromatography was used to isolate the biologically active proteins from the nutrient broth and proteomic analysis was performed to confirm the presence of the endolysin protein. Liposomes were created using the thin film hydration method and 1 ml of purified protein in phosphate buffer was encapsulated within the liposomes. Liposome formation was confirmed by Transmission electron microscopy and successful encapsulation of the protein was confirmed by breaking open 200 µl of liposomes and performing the Bradford protein quantification assay. Antimicrobial activity of T4 proteins and T4 protein loaded liposomes was evaluated using either a spot lytic assay or microdilution bioassay. In the latter, 100 µl of the bacteriophage protein solution (maintained in PBS) or 50 µl of the liposomal protein were serially diluted two-fold with 100 µl and 50 µl of sterile distilled water, respectively, yielding concentrations ranging from 205.68 µg/ml to 3.22 µg/ml. These samples were tested against three Gram-negative organisms, Proteus mirabilis, Klebsiella pneumoniae, Escherichia coli and two Gram-positive organisms Staphylococcus aureus and Enterococcus faecalis. Results Bacteriophage T4 proteins demonstrated varying levels of effectiveness in inhibiting the growth of the bacteria assessed in this study. For instance, in a microdilution assay, while the protein was able to inhibit the growth of Staphylococcus aureus at a concentration of 12.87 µg/ml and Escherichia coli at 43.70 µg/ml, it was incapable of influencing the growth of Enterococcus faecalis, Proteus mirabilis and Klebsiella pneumoniae at the highest concentration tested (205.68 µg/ml). Notably, in every instance, the liposomes loaded with T4 protein were more effective at inhibiting the growth of the bacteria. Molecular interactions were determined through protein-protein modeling that revealed that the endolysin protein from bacteriophage T4 was capable of binding with strong affinity to penicillin binding proteins from S. aureus. Conclusion The results of this study demonstrated the capability of T4 protein loaded liposomes to interact with and inhibit the growth of important bacteria linked to the BPPL as identified by the WHO, providing a pathway for the development of novel drugs aimed at combating these devastating bacteria
A framework of a cooperative approach between parents and teachers in reducing violence among high school learners in Lamontville, eThekwini District, KwaZulu-Natal
(2025-06-06) Masuku, Andile Samkele; Adam, Jamila Khatoon; Nkosi, Pauline Busisiwe
Background Violence among school learners is a serious public health, human rights, and social issue with far-reaching consequences. It negatively affects learners’ academic performance, social development, and mental well-being. The alarming rate of school violence has become a major concern at both national and international levels, as it undermines the core purpose of schools as places of safety, learning, and growth. Schools should provide a welcoming environment where both teachers and learners can engage without fear of victimization or harm. However, the current prevalence of violence indicates that many schools are failing to offer such protection. Ensuring a secure and supportive school environment is therefore crucial for promoting academic success and holistic development. Aim The aim of this study was to explore and describe violence amongst high school learners in order to develop a framework of a cooperative approach between parents and teachers to reduce violence amongst high school learners and ultimately enhance the management of school violence at Lamontville Township in eThekwini District, KwaZulu-Natal. Methods A mixed-method participatory action research approach was employed, combining both quantitative and qualitative research methods to provide a comprehensive understanding of school violence. The theoretical foundation of the study was based on Bronfenbrenner's (1994) Ecological Systems Theory of Development, which highlights the complex interactions between individuals and their surrounding environments, including home, school, and community. The data collection process involved multiple methods: a questionnaire survey with 260 parents, semi-structured in-depth interviews with 18 teachers, and focus group interviews with 12 School Governing Body (SGB) members. The data were analyzed using both descriptive and inferential statistics for the quantitative component and Tesch’s eight-step thematic analysis for the qualitative data. iii Findings The findings of the study revealed that violence is a pervasive issue in many schools, significantly affecting learners' ability to achieve academic and personal success. Learners are exposed to various forms of violence, including peer conflict, learner teacher disputes, and other disruptive incidents, all of which contribute to an unsafe school climate. The causes of violence are multifaceted, originating from home, school, and community contexts. Factors such as negative peer influences, inadequate parental supervision, and poor school environments exacerbate the problem. Conclusion The study underscores the importance of collaboration between parents and teachers in addressing school violence. Both groups play a crucial role in shaping learners' behaviour and fostering positive attitudes towards education. By working together, parents and teachers can create a supportive and accountable environment that encourages learners to invest in academic excellence and self-discipline. Furthermore, partnerships with external stakeholders, including community organizations and government bodies, are essential in implementing sustainable programs to reduce violence and promote peace within schools.
Healthcare practitioners within the milieu of the COVID-19 pandemic : a holistic response to enable wellness
(2025-07-07) Subhan, Mary Shamane; Bhagwan, Raisuyah
The COVID-19 pandemic crippled healthcare systems globally, whilst exposing and exacerbating the weaknesses within the South African healthcare system. The virus overwhelmed the local healthcare system, reflecting that Africa has one of the weakest health systems globally. Within this milieu there was limited scholarly evidence at the onset of the pandemic related to how prepared South Africa was, for the onslaught of the virus. Undoubtedly the spread of the novel corona virus and the associated morbidity and mortality placed healthcare workers at increased risk because of their exposure to COVID-19 patients. There were several under recognized and unaddressed areas were the mental health sequelae linked to clinical and non-clinical stressors, such as the shortage of personal protective gear, deep fears of infecting loved ones, losing colleagues to the disease, personal struggles with COVID-19 infection and limited resources to address their recovery and wellness developed. This provided the impetus for the current study which sought to understand how the COVID 19 pandemic affected healthcare workers at a physical, psychological, social, and spiritual level and to develop recommendations that would enable their well-being. Guided by a qualitative case study research design, data was gathered from five samples. The first four samples included doctors, professional nurses, enrolled nurses and paramedics who all worked at the forefront of the pandemic. In total these four samples were made up of sixty five healthcare professionals, who were recruited from the uMgungundlovu health district in KwaZulu-Natal, South Africa. The latter reflected the boundaries of the case of this study. All four samples were recruited using purposive non-probability sampling strategies, from a variety of healthcare settings within the district, namely a tertiary hospital, a district hospital, a field hospital, two ambulance bases, and tracer teams. Data was collected using semi structured interviews for all four samples. The fifth sample was a group of wellness experts, who participated in a focus group discussion and contributed to the design of a wellness program. The latter was linked to a set of strategies that emerged to support the psycho social wellness of the health care practitioners. iv The data collected from the first four samples revealed huge deficiencies in the preparedness of healthcare institutions to manage the rapid onslaught of COVID-19. The study found significant shortages in essential resources, including hospital beds, adequately trained personnel, and adequate supplies of personal protective equipment (PPE). Moreover, the healthcare workers interviewed were found to have had little preparation to cope with a pandemic of this magnitude which contributed to increased psychological distress. Post-acute sequelae of COVID-19 commonly referred to as long COVID-19, were reported amongst the participants, together with mental health complications such as anxiety, depression and post-traumatic stress disorder. In addition, healthcare workers were found to be at increased risk of being long COVID-19 haulers, leading to deep levels of exhaustion amongst this cohort. The sheer volume of suffering and death witnessed by healthcare workers during the pandemic accentuated their psychological distress with many navigating personal and professional grief which emerged from the loss of loved ones, colleagues and their patients who rapidly succumbed to COVID-19. Of significance is several participants grappled with the virus themselves and spent time within the intensive care units in hospitals. Collectively these experiences underscored the complex toll of the pandemic on the healthcare workforce at a biopsychosocial and spiritual level. One of the salient threads within the data was the huge chasm within the healthcare sector with regards to psycho-social support or other wellness related mechanisms that would enable the health and well-being of these healthcare workers. Leaders seemed to have adopted a reactive management style during the pandemic, rather than a proactive approach focused on anticipating and mitigating psychological distress. Many healthcare professionals began relying on religious and spiritual practices and other holistic wellness activities linked to music, gardening, mindfulness, and yoga, to cope. These wellness strategies coupled with those derived from sample five, which was a group of wellness experts, coalesced into a multifaceted wellness program. The newly designed wellness program embodied a range of holistic wellness strategies that was intended to help healthcare workers transcend the huge levels of post-traumatic stress encountered during the pandemic, whilst supporting their overall biopsychosocial and spiritual wellness.
Childhood cancer within a family and medical context in eThekwini : strengthening psychosocial and spiritual interventions to enable coping and healing
(2025-07-22) Munshi, Neshika; Bhagwan, Raisuyah; Kgware, Moeti
Cancer is an ancient disease, with evidence of its existence tracing back to early human history. The earliest documented cases of cancer appear in the Edwin Smith Papyrus, an ancient Egyptian medical text dated around 1600 BCE. Childhood cancer affects not just the physical health of paediatric patients but has profound psychological, social, and spiritual effects, with far reaching implications for their families as well. This study, titled "Childhood Cancer within a Family and Medical Context in eThekwini: Strengthening Psychosocial and Spiritual Interventions to Enable Coping and Healing," explored the multidimensional effects of this disease on patients and their families and explored the psychosocial and spiritual support systems available within the hospital setting. Conducted at Inkosi Albert Luthuli Hospital in eThekwini, the study aimed to identify interventions that could support both patients and families through the cancer journey. Guided by a qualitative case study design, the study used non-probability purposive sampling, to recruit parents of paediatric cancer patients. Health and social service professionals who worked closely with these patients and their families, were also recruited to participate in the study. Data was collected through semi-structured interviews and analysed thematically to gather rich insights into the lived experiences of the parents and to explore their experiences, through the lens of health and social service professionals. Findings revealed that paediatric cancer patients experienced intense emotional distress and anxiety due to the fear of death, the aversion to medical procedures, social isolation, disrupted peer and social relationships, and stigma related to physical changes post-treatment. Families were further impacted because of strain within their marriage, the fear of losing a child, and financial hardship, all of which underscored the multifaceted impact of childhood cancer on paediatric cancer patients and their families. Despite these challenges, the study found that certain psychosocial interventions within the hospital context helped ease the emotional burden Participants emphasized the importance of securing access to therapies such as music and art therapy, yoga, and other spiritually based practices to help them cope. These interventions were seen as essential to promoting strength, comfort, hope and emotional stability for both children and their caregivers. The study concluded that medical treatment alone does not suffice to address the realm of paediatric cancer patient. Physical care must be integrated with psycho-social and spiritual care to ensure a more holistic healing process. Hope, resilience, and faith were central themes that emerged as powerful enablers of coping and survivorship. The findings advocate for the integration of spiritually grounded, psychosocial, and family-centred care, within standard oncology practice, with the goal of ensuring that the recovery journey is more manageable for paediatric cancer patients and their families.
Workplace violence towards emergency medical services staff in Gauteng
(2025-06-17) Mzimkulu, Dieketseng I.; Naguran, Sageshin; Arek-Bawa, O.
Paramedics are a crucial component of South African public health, medical and emergency services systems. While some interventions have been tried, it seems that violence against paramedics just keeps getting worse. In recent years, there have been an increasing number of newspaper reports suggesting that the rate of violent incidents against emergency medical services personnel in South Africa may be accelerating. With these acts of hostility and violence growing, job satisfaction amongst paramedics will invariably decline and further push them to consider leaving the profession. The aim of this study was to investigate workplace violence among paramedics during emergency call outs in Gauteng, South Africa. The study used a mixed-method approach, gathering data from paramedics through surveys and interviews. Semi-structured interviews and a questionnaire were used to gather the data. For the quantitative data, thematic analysis was used, and for the qualitative data, descriptive statistics. The results indicated that the number of women who took up the profession as paramedics was lower than that of men. The quantitative data revealed that workplace violence the emergency medical services was largely reported during on emergency assignments. Workplace violence exists and most of the employees have experienced it at some point while on duty. Verbal abuse was the most frequent kind of workplace violence, followed by physical violence, while sexual abuse was the least frequent. Very little has been done to safeguard emergency medical services employees from workplace violence and reporting the violence is met with a number of limitations. The study also found that the majority of emergency medical services workers did not know where or were not sure how to report workplace violence. In light of the above results, the study recommended a collaborative effort between regional and South African health organisations in providing site-specific education and policies. In addition, awareness programmes should focus on empowering victims to report workplace violence, as well as strategies to handle cases of workplace violence.
Experiences of biomedical sciences students and staff in blended learning during the COVID-19 pandemic lockdown in a University of Technology, Durban, KwaZulu-Natal
(2024-12-02) Ntimbane, Nonkululeko Protasia; Orton, Penelope Margaret
This study explored and described the experiences of biomedical sciences students and staff who used blended teaching and learning during COVID-19 pandemic. To follow social distancing protocol, limited number of students and staff were permitted on campus at a time, while others were online to limit the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus). The objective of this study was to determine and recommend the necessary resources and skills needed by biomedical sciences students and staff for blended learning at a historically disadvantaged university of technology and better prepare for future pandemics. The aim is to help the university stakeholders to budget, invest, and direct resources and skills for blended teaching and learning appropriately. Purposeful sampling was used to select 14 participants from biomedical science population of 100 students and 14 staff (eight lecturers, 3 laboratory technicians, two laboratory assistants and one secretary). Purposeful sampling was chosen as it is characterized by the intentional selection of units pertinent to the study issue as it strategically focuses on traits within a population, enabling researchers to gather rich, contextual data. Qualitative descriptive content analysis research method was chosen to make replicable and valid inferences of the phenomenon from texts. Semi structured individual interviews were used to collect data and data was analyzed continuously using descriptive content analysis. Participants were interviewed until data reached data saturation. The results of this study showed that staff and students were unprepared for the emergency transformation. There were disparities in students’ device access and availability, students' digital skills; some had basic knowledge of computers, while others had none. Students and staff had challenges of poor internet connection due to load shedding and poor infrastructure, but students in rural areas had worse network connections than those in urban areas. Students and staff had to learn how to navigate iv the learning management systems (LMSs) on the run, as most of them were unfamiliar with those systems. Laboratory practical experiments took longer as students were divided into small groups to observe social distancing protocol of COVID-19 pandemic, students worked individually rather than in pairs, and load shedding occasionally caused tests to be postponed. Online assessments compromised the quality of education, and some students cheated as staff could not monitor students online due to a lack of electronic proctoring tools. At times, students could not submit assignments and tests on time due to poor network connections or load shedding. Despite the challenges and unpleasant experience that students and staff faced during COVID-19 blended teaching and learning, blended learning achieved the learning objectives. The report makes several recommendations for infrastructure support, including giving out laptops and/or data to students in need, upgrading lecture halls to smart classrooms, offering computer training on learning management systems and continuous support to students and staff, to increase proficiency and preparedness, and lastly designing a blended learning approach suitable for biomedical science
The understanding, attitudes and perceptions of chiropractic master’s students regarding professionalism
(2025-06-12) Sithole, Thembekile Zamajobe; Nkosi, Pauline Busisiwe; Matsebula, L.
Introduction Professionalism is described as ethical behavior that is expected amongst the members of a profession, and refers to the conduct, qualities, vision and/ or goals that characterize or mark a professional person and ensures that there is quality workmanship or service. This research shows an insufficiency of studies on the understanding, attitudes and perceptions of Chiropractic master’s students regarding professionalism and its parts that may be improved. It is critical to comprehend this information to provide training for Chiropractic master’s students and ultimately improve the practice of professionalism so that unprofessional behavior is not perpetuated in the Chiropractic profession. Aim The current study aimed to explore and describe the understanding, attitudes and perceptions of Chiropractic master’s students regarding professionalism and to understand their views on what parts of professionalism may be improved at the selected University of Technology in KwaZulu-Natal. Method The study was conducted at a selected University of Technology in KwaZulu Natal, utilizing a qualitative descriptive and exploratory research approach to understand the professionalism phenomenon from Chiropractic master's students’ perspectives and responses. Purposive sampling was used to select 14 Chiropractic master’s students. However, data saturation was reached with the twelfth participant, and two more participants were interviewed to confirm data saturation. The participants who were willing to participate in the study were from the selected University of Technology in the eThekwini District in KwaZulu-Natal province. Semi-structured, face-to-face interviews using open-ended questions for data collection. A deductive thematic content analysis was employed for data analysis to identify themes for the study. The themes were discussed as findings, and the discussion and conclusion were made based on the findings. vi Findings The participants displayed a limited understanding of professionalism. However, their attitudes were positive and their perceptions varied according to each participant’s understanding of professionalism. Their overall interpretation omitted fundamental aspects that constitute professionalism. The themes that emerged during the analysis of data were: Chiropractic master’s students’ understanding regarding professionalism; Chiropractic master’s students’ attitudes regarding professionalism; Chiropractic master’s students’ perceptions regarding professionalism and its parts that may be improved. Conclusion Chiropractic master’s students must obtain a full understanding of professionalism as it could improve their competence during clinical training. The introduction of professionalism workshops, seminars and possibly a professionalism module in the Chiropractic program would benefit Chiropractic master’s students to ensure quality health services to their patients.
The experiences and practices of homoeopathic practitioners in the management of rheumatoid arthritis in KwaZulu-Natal
(2025-07-04) Khanyile, Sakhiwo Langalakhe; Khoza, Thandokuhle Emmanuel; Majola, Sindile Fortunate
Background Rheumatoid arthritis (RA) is a persistent autoimmune condition marked by joint inflammation, resulting in pain, swelling, and ultimately the deterioration of the joints. Although allopathic medication and physiotherapy are used to manage this condition, little to no research has been conducted in South Africa on the holistic approach that homoeopathic practitioners use to manage this condition. Patients with RA require prolonged treatment which comes with adverse side effects due to the multiple medications that are prescribed. In addition, these medications can be quite expensive. This has been one of the reasons why patients with RA frequently seek alternative treatment that has little to no adverse effects. The aim of this study was to explore the management and treatment practices that homoeopathic practitioners in the KwaZulu-Natal use to manage RA. Methodology The research methodology employed a qualitative, exploratory, descriptive approach that involved semi-structured interviews with 12 homoeopathic practitioners in the KwaZulu-Natal province, focusing on their treatment and management strategies for RA. Each semi structured interview was conducted at a location chosen by the practitioners for their convenience. The interviews were recorded, with each session lasting approximately 25 minutes and structured around the interview guide developed by the researcher. Purposive sampling was utilised. A pilot study was carried out to establish trustworthiness and also to validate the data collection tool. The researcher used qualitative thematic analysis to derive themes from the gathered data. Findings The findings of the study identified four themes: knowledge of rheumatoid arthritis, treatment approach used by homoeopaths in the management of rheumatoid arthritis, challenges in managing rheumatoid arthritis, and, outcomes of homoeopathic treatment. The findings of the study revealed that participants primarily use constitutional homoeopathic remedies which are chosen based on the patient's overall constitution and expression of symptoms. Adjunctive therapies employed include phytotherapy, gemmotherapy and biopuncture which contribute to inflammation reduction as well as detoxification processes. Additionally, vitamins and supplements are regularly prescribed to enhance joint health. Conclusion The study concluded that RA requires a multi-dimensional approach to treatment, with an emphasis on constitutional remedies tailored to individual patient symptom presentation. The incorporation of adjunctive therapies and lifestyle modifications illustrates the overall approach which focuses on alleviating symptoms and enhancing overall health.

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