Theses and dissertations (Health Sciences)

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An evaluation of water, sanitation and hygiene interventions towards effective response to infectious diseases : a case study of schools in Uasin Gishu, Kenya
(2025-11-03) Mooka, Gladys Chepkorir Seroney; Mchunu, Gugu G; Magak, Ng’wena Gideon
Background Access to safe water, sanitation, and hygiene (WASH) is essential for improving health and educational outcomes, particularly in low- and middle-income countries (LMICs). In Kenya, school WASH implementation remains uneven, with persistent gaps in infrastructure, hygiene practices, and policy implementation. The COVID-19 pandemic exposed these weaknesses and highlighted the need for sustainable WASH interventions to strengthen infection prevention and pandemic preparedness in schools. This study aimed to develop and validate an appropriate WASH intervention for primary schools in Uasin Gishu County, Kenya. Methods A multi-phase mixed-methods case study design was employed. Phase 1A involved a systematic review of WASH interventions in primary schools in LMICs, resulting in 69 eligible studies. Phase 1B comprised a mixed-methods case study in 51 proportionally sampled primary schools (24 rural and 27 urban) selected from 498 schools in the county. Quantitative data were collected using questionnaires and observation checklists, while qualitative data were obtained through focus group discussions with teachers. Phase 2 utilized a two-round Delphi consensus technique involving 20 purposively selected WASH experts to identify, refine, and prioritize key intervention components. Phase 3 consisted of a stakeholder validation workshop with 15 experts from the education, health, water, and school management sectors to assess the feasibility, relevance, and acceptability of the proposed intervention. Results The systematic review demonstrated that effective school WASH programs are characterized by integrated approaches combining infrastructure improvement, behavior change, and governance support. Promising interventions included hand hygiene promotion, health education, peer-led approaches, menstrual hygiene management, and group handwashing facilities. The school case study revealed important gaps in WASH provision. While 61% of schools had access to piped water and 67% reported water availability for handwashing throughout the day, 59% lacked soap at handwashing stations and 73% lacked disability-friendly water access infrastructure. Although 75% of schools provided menstrual products, only 22% had changing rooms and 25% had sanitary disposal facilities. In addition, 67% of schools lacked a school WASH policy. Key deficiencies were identified in menstrual health management, disability-inclusive infrastructure, water quality monitoring, and policy implementation. Delphi findings showed strong expert consensus (74–100% agreement) on the need for dedicated WASH budgets, clear governance structures, inclusive infrastructure, menstrual hygiene management, curriculum integration, monitoring systems, capacity building, and multisectoral collaboration. These findings informed the development of a three-pronged intervention comprising a learner-centred menstrual health guide, a WASH Pyramid Framework, and a policy brief. Stakeholder validation confirmed the relevance, feasibility, and sustainability of these interventions, while identifying inadequate funding, policy gaps, cultural barriers, and sustainability concerns as potential implementation challenges. ii Conclusion This study provides comprehensive evidence on WASH conditions in primary schools and highlights critical inequities in infrastructure, service delivery, and governance in Uasin Gishu County, Kenya. Through a rigorous multi-phase process, it developed and validated a context-specific three-pronged WASH intervention consisting of a menstrual health guide, a WASH Pyramid Framework, and a policy brief. The findings demonstrate that integrated WASH approaches combining infrastructure, behavior change, governance, and policy support are essential for strengthening infection prevention, enhancing school resilience, and improving preparedness for future public health emergencies.
Patient knowledge and care of surgical site infections at a selected regional hospital in KwaZulu-Natal Province, South Africa
(2026-07-27) Naidoo, Niroshni; Adam, Jamila Khatoon; Moodley, Y; Kader, S S
Background: Surgical site infection (SSI) is a common post-operative complication and can develop after a patient has been discharged from the surgical ward. Being comfortable with their SSI knowledge can empower patients and encourage them to engage in healthy behaviours that could lower the risk of this complication. Poor knowledge of wound care practice (WCP) among surgical patients could place them at risk of SSI, particularly once they have been discharged from hospital and are expected to care for their own surgical wounds. The study aimed to establish South African surgical patient knowledge and awareness of surgical site infections and wound care practices at a regional hospital in KwaZulu-Natal Province, South Africa. Methods: This prospective cross-sectional study involved two quantitative questionnaire surveys of general surgery patients at a regional hospital in Durban, South Africa (7 January 2025 - 24 April 2025). Each survey consisted of a socio-demographic questionnaire, and an adaption of a pre-existing questionnaire assessing comfort with SSI knowledge or assessing WCP. Univariate and multivariate data analyses, namely chi-squared tests and logistic regression, was used to test potential associations between patient characteristics and comfort with SSI knowledge or poor WCP knowledge. Results: Of the 255 survey participants included in the analysis, 48.2% did not feel comfortable with their SSI knowledge. Comfort with their SSI knowledge was predicted by: healthcare workers discussing SSI with them on two or more occasions (Odds Ratio, OR: 8.93), receipt of an informational flyer on SSI while in hospital (OR: 11.40), learning about SSI outside hospital via another clinic/healthcare worker (OR: 7.37), and learning about SSI outside hospital via another non-healthcare source (OR: 5.18). Of the 255 participants, 23.92% had poor WCP knowledge, the univariate analysis finding two potentially important patient characteristics being associated with poor knowledge: Black African race (p=0.153), and completion of high school education (p=0.001). When they were entered into a multivariate logistic regression model, only completion of high school was found to be a statistically significant predictor of poor WCP knowledge (OR: 0.34, p=0.001). Conclusion: Patients knowledge of SSI requires improvement, as it has implications for their wound care knowledge and practices, improving their quality of life and preventing avoidable illness and premature deaths. Measures to improve both should focus on providing verbal and hard copy messages while patients are still in hospital to enable them to ask questions and take information home.
Assessment of Beta-2 Microglobulin, serum creatinine and creatinine clearance in chronic kidney disease patients in KwaZulu-Natal
(2026-03-12) Mtshali, Phumlani; Benjamin, Sherilene; Assounga, A G; Madala, N D
Background: Chronic kidney disease (CKD) is a major and escalating global health burden, affecting 8-16% of the population and disproportionately impacting low and middle-income countries such as South Africa. KwaZulu-Natal, in particular, bears a high CKD prevalence, with 67% of patients hypertensive, 24% diabetic, and 23% HIV-positive in this cohort. Conventional biomarkers like serum creatinine (sCr) are late indicators of renal dysfunction, often rising only after substantial nephron loss. Beta-2 microglobulin (B2M), a low molecular weight protein filtered by the kidneys and independent of muscle mass, may provide earlier detection of kidney impairment and improved risk stratification, but its clinical utility remains underexplored in routine clinical practice and in African populations. Aims and Objectives: This study aimed to assess the clinical utility of B2M, alongside serum creatinine and creatinine clearance, for the diagnosis and staging of CKD in KwaZulu Natal. The specific objectives were: (1) to evaluate the association between B2M levels and leading CKD aetiologies (hypertension, diabetes and HIV); and (2) to determine the correlation between B2M levels and estimated glomerular filtration rate (eGFR) calculated with the CKDEPI 2021 equation. Materials and Methods: A retrospective cross-sectional study was performed on 173 CKD patients (53% female, mean age 54.3±15.8 years) from the Clinical Medicine Research Laboratory, University of KwaZulu-Natal. Serum samples were analysed for B2M concentrations using enzyme-linked immunosorbent assay (ELISA). Clinical and biochemical data, including sCr and eGFR, were extracted from laboratory databases. Participants were stratified by key comorbidities (hypertension, diabetes, and human immunodeficiency virus). Statistical methods included descriptive statistics, ANOVA, bivariate and multivariable regression, and correlation analysis to explore associations between biomarkers, CKD stages, and clinical variables. Results: B2M concentrations demonstrated a distinctive J-shaped distribution across CKD stages: elevated in Stage 1 (mean 0.19±0.32 μg/mL), dipping in Stage 2 (0.12±0.21 μg/mL), and rising sharply in Stage 3 (0.30±0.41 μg/mL) and Stage 4 (0.52±0.46 μg/mL) (p = 0.032). B2M showed a robust inverse correlation with eGFR (r = -078, p = 0.001), particularly in ii hypertensive (r = -0.20, p = 0.034) and diabetic (r = -0.36, p = 0.021) subgroups. By contrast, serum creatinine showed significant increases only at advanced stages of CKD. Multivariable regression confirmed CKD stages 3-4 as independent predictors of higher B2M after adjusting for demographic and clinical covariates. B2M was not significantly influenced by sex or muscle mass. HIV-positive patients exhibited higher B2M, but without a significant correlation to eGFR. The overall pattern supports B2M as a more sensitive marker for early nephron stress and risk stratification in multi-morbid cohorts. Conclusion: B2M is a sensitive, early-stage biomarker for CKD in KwaZulu-Natal, outperforming sCr in early detection and disease monitoring, particularly among hypertensive and diabetic patients. Its independence from demographic confounders and strong association with CKD severity support its integration into local diagnostic pathways. Routine B2M testing could enable earlier intervention, improved risk stratification, and optimisation of outcomes in high-risk, resource-constrained settings. Further research is warranted to validate B2M’s predictive value and cost-effectiveness in larger, prospective cohorts and to define its role in multi-marker diagnostic panels.
Factors influencing elderly patient perceptions and experiences of clinical service quality in a private and a public radiology facility in the eThekwini District
(2025-05-25) Seeparsad, Nikita Shah; Khoza, Thandokuhle Emmanuel
Background: Over the years, South Africa’s ageing population has grown, resulting in vulnerable elderly individuals who require frequent use of healthcare. It is therefore important to ensure that these citizens receive the correct level of health services as they generally need more attention, effort and compassion in ensuring a pleasant healthcare experience. In line with the above, radiology healthcare specifically can be a more intensive process to the elderly individual. Hence it is important to know the elderly patient's clinical service requirements in order to improve their experiences when visiting radiology facilities. With a lack of literature on elderly patient satisfaction with clinical service quality in private and public radiology facilities specific to the Ethekwini district, the current study used the SERVQUAL model's five dimensions (tangibles, reliability, responsiveness, assurance and empathy) as the theoretical framework to quantify the service delivery of private and public radiology facilities, thereby attaining elderly patients’ perceptions and experiences. Aim: This research study aimed to determine the factors influencing elderly patient perceptions and their experiences of clinical service quality in a private and a public radiology facility in the Ethekwini district in order to identify, improve and enhance clinical care for elderly individuals. Methodology: A quantitative research methodology with a descriptive research design and a positivist paradigm was used in this study. A convenience sampling technique of all the elderly patients was used to collect data that was analyzed using the latest version (26) of SPSS (the Statistical Package for the Social Sciences). The tests used were the t-test, one sample t-test, paired sample t-test, independent sample t-test, the Analysis of Variance Model (ANOVA), Cronbach’s alpha and the Mann Whitney U test. Results: An independent sample t-test was performed across demographics and payment types, revealing that the gap for all items under tangibles for expectations and experiences was far greater for outpatients than for inpatient respondents, and those paying cash perceive the gap between their experiences and expectations to be significantly larger than those who use medical aid in private. Paired t-tests and Cronbach's alpha were used to assess each individual question's expectations and experiences across all domains and to determine internal consistency. A paired t-test was then performed on the entire domain, revealing a significant difference in the elderly's expectations and experiences with private and public radiology facilities, as well as their degree of clinical service quality. A one-sample t-test was used to analyze composite variables to determine significant differences in each overall domain, which revealed that the "mean" values were higher for the gap in expectations of elderly people, implying that while the elderly population agrees to some extent with the help/services they receive, their expectations are still higher than their experiences. A Mann-Whitney U test was used to compare each item within each domain across facilities. The mean rank values for these items with significant p-values were greater in private facilities than in public facilities, indicating that private facilities have a better level of agreement. To compare expectations and experiences across domains, the Mann-Whitney test was used for each item, comparing mean rankings rather than mean scores. All but two dimensions vary considerably amongst facilities: EXPECT_TAN (.058) and EXPECT_ASS (.146). The private Radiology facility had a greater agreement than the public Radiology facility. For each domain, the Mann Whitney test was used to compare the mean ranks of private and public facilities. According to the p-value, four significant results were found: GAP_TAN (.044), GAP_REL (.010), GAP_ASS (.013) and GAP_EMP (.006) demonstrated a considerable discrepancy between the public and private facilities. In all categories, individuals who use public facilities perceive a substantially larger difference between what they get and what they anticipate obtaining than those who use private facilities. Conclusion: The conclusion based on the first objective was that while there may be various factors impacting elderly patients’ perceptions of clinical care quality, not all of them can be addressed as some are influenced by personal socio-economic conditions. The second objective result was that while the six domains of healthcare quantification may be applicable to current healthcare systems to some extent, there are still areas for development.
The status of cervical screening and breast cancer healthcare services among incarcerated women in Westville Correctional Facility KZN, South Africa
(2026-06) Dube, Lindokuhle Winnie; Pillay, P.; Mkhize, Brenda Thabisile
Background: Incarcerated women represent a vulnerable population with severe health problems, including a heightened risk of cervical and breast cancer. The provision of comprehensive healthcare, including cancer prevention services, within prisons is a critical yet often neglected issue. Aim: This study investigated the status of cervical screening and breast cancer healthcare services among incarcerated women at Westville Correctional Facility in KwaZulu-Natal, South Africa. Methods: A mixed-methods approach was utilised, including a cross-sectional survey of 145 incarcerated women, a retrospective review of 1,639 Pap smear results from Westville Correctional Facility laboratory records (2013–2022) and in-depth interviews with healthcare workers (HCWs). Data analysis included descriptive statistics, chi square tests, and thematic analysis. Results: Retrospective data had a high HIV prevalence (54%). Despite this risk, cervical screening was low, with only 21.4% of women receiving a Pap smear during incarceration and 43.4% with no screening history. Breast cancer screening was virtually non-existent (1.4%). Knowledge regarding both cancers was low, with most of the incarcerated women unaware of risk factors, symptoms, and screening methods. Retrospective data revealed an erratic, campaign-based screening pattern, with a screening rate of less than 5% per year. Critically, 23.3% of women with a clinically healthy cervix had a cytological abnormality. A significant association between a healthy cervix and antiretroviral (ARV) treatment (X² (8) =61.907, p<0.001) was found. Findings from HCWs contextualised these results, revealing severe structural barriers including skeletal staffing, outdated equipment, and a protracted referral process that forces a reactive, crisis-driven care model. Furthermore, HCWs reported internalised stigma among offenders, something which actively suppresses health-seeking behaviour. Conclusion: An implementation gap exists in cancer prevention services, driven by non-systematic screening, critical health literacy deficits, and a carceral environment that erodes patient agency. The rate of occult cytological abnormalities underscores the inadequacy of visual inspection.
Artificial intelligence in medical imaging : knowledge and perspectives of South African radiographers
(2026-03-12) Mutambara, Precious; Khoza, Thandokuhle Emmanuel
Background: This study focused on determining the perspectives of Radiographers in relation to the integration of AI into medical imaging. Artificial intelligence (AI) is the use of technology and computers to replicate intelligent behaviours and analytical thoughts that are similar to that of humans. Several studies indicate that medical imaging professionals, such as Radiologists and Radiographers, are seeing an increase in the use of AI applications in clinical settings. Diagnostic Radiographers are pivotal for the integration of AI systems into medical imaging as they serve as an interface between technology and patients. Although some studies have examined the perspectives of Radiographers on AI in some African countries, there is still no clear picture of the Radiographers’ perspectives towards AI in the most technologically advanced country in Africa. Aim of study: The study aimed to ascertain the knowledge and perspectives of South African Radiographers regarding the integration of AI in diagnostic imaging in order to provide unique recommendations to support the training of Radiographers. Methodology: A quantitative cross-sectional research design was used. Non-probability purposive sampling was employed as it is the most appropriate approach for a content analysis inquiry. A self-administered questionnaire containing closed-ended questions was used to collect statistical data from Radiographers that statistical data from Radiographers that met the requirements for participation. On completion of the questionnaires, the results were tabulated and graphically demonstrated. Data was analysed using the latest version 27 of SPSS (the Statistical Package for the Social Sciences). Findings: SPSS version 27 was used to analyse the data and various statistical tests such as Descriptive statistics, the Analysis of Variance Model, the Binomial test, Pearson's correlation coefficient, One-sample t-test, Cronbach alpha and Independent samples t-test were adopted to analyse the data yielded by the collection tool. The findings indicated that over 90 % of Radiographers in South Africa are aware of the concept of AI. The majority of Radiographers in South Africa have a positive attitude towards AI as there was significant agreement that AI is beneficial to the various aspects of diagnostic Radiography. While AI possesses many benefits, Radiographers also acknowledge the various barriers affecting the implementation of AI in the medical imaging profession. Conclusion: It can be concluded that Radiographers recognize general AI concepts and are aware of some of AI’s functional roles within the field but are unfamiliar with the more technical components of the technology. Therefore, the introduction of AI in the Radiography curriculum is pivotal to ensuring that Radiographers have a strong foundation for understanding AI. It was noted that Radiographers in South Africa believe that AI will have multiple benefits for their job performance. Inasmuch as AI is equipped with benefits for Radiographers, several barriers that hinder the implementation of AI in Radiography were also noted.
A cross-sectional study on the use of traditional, complementary, and alternate medicine amongst pregnant women in the eThekwini District
(2025-12-17) Steele, Chrissandra Lorell Megan; Naranjee, N.; Mhlongo, X. L.
Traditional, complementary, and alternative medicine (TCAM) is widely used during pregnancy, yet little is known about its scope and determinants within South African contexts. This study examined the frequency, influencing factors, and types of TCAM used by pregnant women in the eThekwini District. Reported usage ranged between 66% and 99%, with natural products such as vitamins, probiotics, and herbs, as well as mind-body practices including massage and meditation, being the most common. A cross-sectional design was employed, focusing on pregnant women accessing maternal healthcare services within the district. The study analysed predisposing, enabling, and need-related variables shaping TCAM use. Findings revealed that cultural beliefs, spiritual practices, family influence, health-related anxieties, and preferences for autonomy and holistic care were major drivers. Structural challenges within conventional healthcare, including medication shortages, financial barriers, and access difficulties, also contributed to reliance on TCAM. Importantly, TCAM use was observed across socio-demographic groups, including women with higher education, reflecting the persistence of cultural and health beliefs beyond formal training. The study concludes that while traditional African remedies remain culturally significant, there is an emerging trend towards integrative care models that blend TCAM with biomedical approaches, motivated by safety and holistic concerns. Recommendations include advancing nursing research, incorporating TCAM screening into maternal healthcare, fostering interprofessional collaboration, developing policy frameworks, and raising public awareness to promote safe and informed use.
Factors influencing radiography students’ experiences of e-learning : a study conducted at a University of Technology in KwaZulu-Natal
(2026-05-29) Patel, Aisha; Gam, Nkululeko
E-learning and the use of technology is rapidly increasing in the Health Sciences field. E-learning, also known as electronic learning, can be defined as a technology-mediated approach of great potential from an educational perspective. E-learning refers to online learning that provides students with a virtual learning environment that is different from traditional methods of learning. E-learning is flexible and accessible and is used globally because it offers opportunities to meet significant educational outcomes, including long-term learning and increased participation. Notably, e-learning allows educational content to be adjusted to fit individual learning styles. Varying results have been attained regarding the correlation between students and their ease with using technology. Whilst various authors have discovered that some students experience poor commitment and motivation in the e-learning experience, other students were found to value the interactive and visual elements of e-learning. Younger students have easily adapted to the use of technology for e-learning. The most common challenge that students experience in a developing country are accessibility issues, whereas the main issue in developed countries is high dropout rates. Several scholars have reported on the high levels of e-learning implementation at Universities of Technology in South Africa. The university of interest has also vastly increased their reliance on technology for e-learning since the onset of COVID-19. The theoretical framework adopted in this study was the Technology Acceptance Model (TAM) developed by Fred Davis in 1986. The TAM is an information technology framework for analysing users’ acceptance and use of new and updated technologies, particularly in a working environment, which in this case was the university of interest. This model has three main constructs: perceived usefulness, perceived ease of use and actual use of e-learning. Attitude to use is a fourth factor which is influenced by the other three factors. Aim of the study The aim of this quantitative, cross-sectional study was to identify the factors influencing Radiography students’ experiences of e-learning at a university of technology in KwaZulu-Natal to improve e-learning methods such that e-learning is both beneficial and straightforward for students. Methodology This study used a quantitative approach, which is the technique of using numerical values derived from observations to explain phenomena through observations, and conclude thereupon. The collected data is then analysed using mathematical methods. The positivism paradigm was selected to conduct this study because it was appropriate for a quantitative research approach. The positivism paradigm revolves around the researcher working with observable reality within the society, which in this research will be the factors influencing Radiography students’ acceptance of technology for e-learning. This study was a descriptive cross sectional study as the researcher was able to determine and outline the factors affecting Radiography students’ acceptance of the technology used for e-learning at a specific point in time. There was no repetition of measurements amongst the research participants. The setting for this study was the Radiography department at a University of Technology in KwaZulu-Natal. The researcher chose this particular setting because this is where research participants could be found, as information is required on the students’ use of e-learning at this institute. The target population for the study was Radiography students studying at this university. This included first-, second-, third- and fourth-year students. The Radiography students targeted were from the Diagnostic, Sonography, Radiotherapy and Nuclear Medicine disciplines. The sample size for the main study was 206 students. A non-probability convenience sampling technique was used. The ethical approval number IREC 119/24 (Appendix 1) was provided when full approval was granted for the research to be conducted. Approval was obtained from the Director of Research and Postgraduate Support (Appendix 2a) at the university of interest to conduct this research study on first-, second-, third- and fourth-year Radiography students. Data analysis was performed using the following tests: descriptive statistics, ANOVA, Pearson’s correlation coefficient, one sample t-test, independent samples t-test, factor analysis and linear regression. Findings A total of 206 participants were selected to provide their inputs regarding the research topic. There was no significant difference in the demographic constructs across gender, age, year of study or discipline. Results from ANOVA to determine whether there are any significant differences in these constructs across race shows that PEOU (perceived ease of use) differs significantly across race (F (3, 202) = 5.367, p=.001). Tukey’s post hoc analysis shows that Indians (mean = 3.42) perceive e-learning to be easier to use than Blacks (mean = 3.04), p<.001. The results depicted significant agreement that participants thought of e-learning as useful; that it was easy to use; and that they intended to use it more in the future. On the other hand, there was significant disagreement on whether participants had a good attitude towards e-learning. The independent variables PEOU, PU and ATT account for 48.9% of the variance in ITU (intention to use), F (3, 202) = 64.437, p<.001. PU (β = .578, p<.001) and ATT (β = .190, p<.001) are both significant predictors of ITU. Conclusion In conclusion, it can be stated that the purpose of the research, which was to identify the factors influencing Radiography students’ experiences of e-learning at a university of technology in KwaZulu-Natal, has been achieved. Radiography students from the university generally have a positive experience when using technology for e-learning. Participants perceived e-learning to be useful. However, poor connectivity was an issue for most students. Participants also found e learning platforms easy to use and their skills with technology sufficient. There were also contradicting attitudes towards e-learning. However, most participants eventually adjusted to e-learning. Future recommendations are that the results obtained in this study encourage further research into this topic and that another similar study may be conducted in more detail with a larger sample size, as research is essential for the progression of existing literature. More advanced technological programs can be developed to better suit Radiography students in order to achieve online educational goals with greater efficiency.
Preparedness of professional nurses to recognise and respond to gender-based violence in higher education institutions in the city of Cape Town, South Africa
(2026-04-15) Hlophe, Siphesihle Delani; Naidoo, Vasanthrie; Naranjee, N.
Background: Gender-based violence (GBV) is a widespread problem worldwide, deeply affecting public health and touching people in many areas, including healthcare and universities. In South Africa, GBV rates are exceptionally high, and universities face these challenges too. Nurses working in campus health clinics are vital in identifying and addressing GBV, which makes proper training and readiness essential. Aim: This study focused on evaluating how well professional nurses at certain higher education institutions are prepared to identify and respond to gender-based violence, exploring nursing lecturers' recommendations for enhancing nursing curricula to effectively address GBV, and developing guidelines for integrating comprehensive GBV management into nursing education. Methodology: The study used a qualitative case study approach, conducting semi structured interviews with professional nurses and nurse lecturers from two higher education institutions in Cape Town, South Africa, along with reviewing relevant curriculum documents. Data was collected until saturation was reached, and thematic analysis was used to identify key themes and patterns. Findings: The study identified significant gaps in the preparedness of professional nurses to address GBV, including insufficient knowledge, skills, and resources, as well as limited GBV-related content in existing nursing curricula. Based on these gaps, this study proposes guidelines for HEIs that include integrating formal GBV education, establishing dedicated GBV modules, incorporating ethical and human rights considerations, promoting interdisciplinary teaching, and implementing practical training and simulation exercises. The guidelines also emphasise the need for accurate documentation protocols, regular in-service training, innovative teaching methods, and continuous curriculum review. Conclusion: This study underscores the importance of integrating comprehensive GBV education into nursing curricula and provides practical guidelines for curriculum planners, policymakers, and administrators to enhance the preparedness of nursing professionals in addressing GBV effectively and ensuring empathetic and competent care for survivors.
The management of Attention Deficit Hyperactivity Disorder by homeopathic practitioners in South Africa
(2026-08-16) Malati, Mantua; Sibiya, Maureen Nokuthula
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition defined primarily by developmentally unsuitable and enduring symptoms of inattention and/or hyperactivity that initiate in childhood, persist through numerous settings and lead to substantial impairment in academic, social, occupational or other functional aspects. ADHD is diagnosed in predominantly, predominantly hyperactive/impulsive or combined presentations and it is heterogeneous. Although conventional pharmacological treatments remain widely used, increasing interest has emerged in complementary and alternative approaches such as homeopathy. This study explored how homeopathic practitioners in South Africa understand and manage ADHD, with the aim of providing insight into their conceptual frameworks, consultation processes, treatment strategies and long-term management perspectives. A qualitative, exploratory approach was utillized and semi-structured interviews were conducted with practicing homeopaths across different settings. Data was analysed thematically. The findings revealed that practitioners conceptualise ADHD largely in alignment with orthodox biomedical definitions, recognising core symptoms such as inattention, hyperactivity and impulsivity, while integrating holistic interpretations that consider emotional, behavioural and contextual influences. Consultation approaches were found to be highly individualised and comprehensive, with practitioners employing detailed case-taking methods that incorporate family dynamics, environmental factors, and lifestyle patterns. Treatment strategies reflected a multimodal approach combining constitutional remedy selection; adjunctive therapies such as dietary and behavioural guidance; and adaptive potency and dosage decisions tailored to the child’s evolving presentation. Long-term management emphasised sustained lifestyle modification, parental support, and the creation of stable routines to promote lasting behavioural and emotional improvement. Overall, the study demonstrates that homeopathic practitioners adopt a holistic, integrative, and child-centred approach to ADHD management, complementing orthodox diagnostic perspectives while addressing broader determinants of behaviour and wellbeing. These findings highlight the potential contribution of homeopathy within multidisciplinary ADHD care, especially in contexts where families seek personalised and non-pharmacological support options.
The epidemiology of soccer-related injuries in adolescent male scholars in Ndwedwe District, KwaZulu-Natal
(2026-06-22) Dube, Nkosikhona Lwazi; Varatharajullu, Desiree; O’Connor, Laura
Soccer is the most played sport in South African schools, with adolescents actively engaging in the sport. The existing literature highlights a high injury rate related to soccer, with most studies conducted in high-income countries and urban areas. In contrast to these settings, rural areas have fewer resources and limited access to healthcare facilities; therefore, those findings cannot be extrapolated to rural settings. Thus, this study aims to determine the prevalence (point and at 12 months), selected risk factors, and impact of soccer-related injuries in rural adolescent male scholars in Ndwedwe District, KwaZulu Natal, South Africa, to further enhance literature regarding soccer-related injuries. METHODS The study used a descriptive, quantitative, cross-sectional survey design to collect information from rural adolescent male soccer players from the Ndwedwe District, KwaZulu Natal. A stratified random sampling technique was used to select schools in the district to partake. The questionnaire was hand-delivered and distributed, with a response rate of 82.7% (n=233). Data were captured and analysed using IBM SPSS (version 26). RESULTS The lifetime prevalence of soccer-related injuries was 70.4%, with a point injury prevalence of 36.1%. Most injuries occurred during matches (71.1%), particularly on hard playing surfaces (p=0.016), and predominantly affected the lower limbs, especially the knee and foot (28.8% and 24.5% respectively). A lack of medical support was evident, with 71.3% indicating that no medical personnel were present at the time of injury and 38.4% reporting that they received no treatment. Injuries negatively affected participation, with 62.8% of injured players taking a break from soccer as the injury resulted in a financial burden, of travel and treatment costs, on their families. CONCLUSION Soccer-related injuries among rural male adolescent soccer players in Ndwedwe District are common and were associated with environmental and contextual factors and resulted in substantial personal and financial consequences. These findings highlight the need for improved playing surfaces, enhanced access to medical support, and targeted injury prevention strategies in rural school sports settings.
The effect of Magnesium Chloride liquid on post-inflammatory hyperpigmentation
(2026-04-21) Scheepers, Ashurah; Mpofana, Nomakhosi
Introduction: Post-Inflammatory Hyperpigmentation (PIH) in higher Fitzpatrick skin phototypes is a challenging condition to treat, and existing treatment modalities may exacerbate PIH post treatment. Post Inflammatory Hyperpigmentation (PIH) is reported to have a negative impact on the quality of life of those affected. Topical treatments are available to improve the appearance of PIH, but may not be suitable for use in a Somatology clinic as they are classed as scheduled drugs and require a prescription. The need to treat PIH in populations with higher phototypes remains unmet. Studies have shown that Magnesium Chloride is effective in treating inflammatory conditions, however there is paucity of data validating the effects of MgCl2 liquid on PIH. Aim: The aim of this research was to investigate the effects of MgCl2 liquid on PIH in higher Fitzpatrick skin phototypes. Objectives: The objectives of the study were: ● To determine the clinical effect of topical magnesium chloride liquid on PIH in higher phototypes. ● To evaluate the tolerability of massaged magnesium chloride on higher phototypes ● To explore the impact of post-inflammatory hyperpigmentation on quality of life. Methodology: The research followed a quantitative, experimental research design. The study was conducted in Cape Town, Western Cape, at SCIN Medispa in Wembley Square. The study included twenty (n= 10) participants who had completed participant questionnaires and Quality-of-Life questionnaires. The participant’s skin was cleansed with a micellar water and the MgCl2 liquid was applied onto the cheeks in weekly intervals for three months. The participants underwent six skin analysis sessions. Session one was the baseline measurements and follow up measurements were conducted on a monthly basis for six months. The skin analysis was done using a Visia® Skin Complexion Analyser. Descriptive data was collected using Pain Intensity Scales, Pigmentation Severity Scales and Erythema Grading Scales. Results: The results of the study yielded a statistically significant difference in the Quality of Life before versus after (t (9) = 2.400, p = 0.040). The mean difference of 4.300 (95% CI [0.253, 8.347]) indicates a substantial increase in the Quality of Life post-intervention. A substantial reduction in the erythema scores was observed (t (9) = 4.810, p < 0.001). The mean difference of 1.200 (95% CI [0.636, 1.764]) signifies a substantial reduction in erythema post-intervention. Oedema scores did not reveal a statistically significant difference (t (9) = 1.410, p = 0.193). The mean difference of 0.300 (95% CI [-0.183, 0.783]) suggests a minimal change in Oedema post-intervention. Overall disease severity scores did not yield a statistically significant difference (t (9) = 1.460, p = 0.177). The mean difference of 0.500 (95% CI [-0.273, 1.273]) indicates a modest change in Overall Disease Severity post-intervention. Pigmentary intensity scores did not reveal a statistically significant difference (t (9) = 1.410, p = 0.193). The mean difference of 0.300 (95% CI [0.183, 0.783]) suggests a marginal change in pigmentary intensity post-intervention. No discernible change was noted in scores denoting the area of hyperpigmentation (t (9) = 0.000, p = 1.000). The mean difference of 0.000 (95% CI [-0.337, 0.337]) suggests no discernible change in the Area of Hyperpigmented Lesions post-intervention. Contrastingly, the pain intensity scoring revealed a statistically significant improvement (t (9) = 3.000, p = 0.015). The mean difference of 1.000 (95% CI [0.246, 1.754]) denotes a considerably positive impact on tolerability post-intervention. Conclusion: Magnesium Chloride liquid used in the treatment of PIH in higher phototypes displays tolerability with frequent usage and an increase in the quality of life however, minimal effect on the reduction of PIH. This study contributes valuable insights into the effects of MgCl2 liquid on PIH in higher skin phototypes. While improvements in quality of life, pain intensity, and erythema were notable, the study underscores the necessity for further research to optimize treatment outcomes, address patient satisfaction, and increase overall understanding of dermatological interventions for higher skin phototypes. The findings create avenues for future research, aiming to bridge the existing gaps in knowledge and provide safer and more effective treatments for individuals with PIH in higher skin phototypes.
Exploring the perceptions and experiences of chiropractors in the eThekwini Municipality regarding interprofessional referrals
(2026-01-21) Kolia, Amina; Varatharajullu, Desiree
Background Interprofessional collaboration refers to the collaboration among various healthcare practitioners with the intention of providing patients with the most effective and appropriate form of care. These collaborations can be defined as interactions and relationships formed among various healthcare practitioners. This collaboration allows for improved patient outcomes, cost effective healthcare, allocation of resources, and improved satisfaction for the patient and practitioner. A referral among various healthcare practitioners can enable and facilitate interprofessional collaboration. The perceptions and experiences of South African chiropractors needed to be explored and understood. Many studies have focused on how other healthcare practitioners view chiropractors and their perceptions and experiences from the collaboration. Referrals occur when healthcare practitioners interact with one another to provide their patient with the best possible care. Understanding interprofessional referral networks requires a comprehensive analysis of all parties involved in the referral process. The perspectives and experiences offer valuable insights into barriers and challenges encountered in the interaction and collaboration among healthcare practitioners. In South Africa, chiropractors are trained to diagnose any physical defect, illness or deficiency. The treatment for these conditions may be outside chiropractors’ scope of practice, necessitating the use of the referral network. Exploring the perceptions and experiences of South African chiropractors facilitates the identification of potential barriers and challenges, as well as the development of solutions to address them. Aim of the study The aim of this study was to explore the perceptions and experiences of chiropractors with respect to their interprofessional referrals to healthcare practitioners. Methodology This study entailed a qualitative design, using an explorative study design. The study population was qualified chiropractors registered with the Allied Health Profession Council of South Africa, in the location of the eThekwini Municipality, KwaZulu-Natal, South Africa. Purposive and snowball sampling strategies were used to recruit participants. A sample size of 13 participants was used and one-on one interviews were conducted using a semi-structured interview guide. The interviews were approximately 30 to 40 minutes long and were transcribed verbatim. The transcripts were analysed and a list of topics were made. The topics were abbreviated into codes and these were arranged in alphabetical order. The codes that were similar and regular were grouped to form categories. Themes or concepts were made from the categories and a theoretical construct was formed. Thematic analysis was conducted using Tesch’s method of thematic analysis. Results The study identified four main themes, namely interprofessional collaboration and referral dynamic, patient perspectives on referral and continuation of care, challenges encountered in the referral process, and enhancement of the referral network. The participants expressed reasons for patient referrals in the chiropractic profession, as well as other professions. They emphasised their personal networks and expressed shared values on interprofessional interactions, with noted positive outcomes. The participants noted a correlation among patient preferences and their healthcare decisions. Obstacles encountered by patients impacted their referrals and the participants emphasised the relevance of these obstacles to patient care. A variety of obstacles encountered by the participating chiropractors were discussed, including stereotypes, misconceptions surrounding the chiropractic scope of practice, geographical location, communication barriers, chiropractic jargon, other practitioners age and sense of ownership, as well as the exclusion of chiropractic from the public healthcare system. Methods to improve interprofessional referrals and collaboration were then outlined and discussed in detail. Conclusion This qualitative study explored the perceptions and experiences of chiropractors in eThekwini Municipality regarding interprofessional referrals and collaboration. This study emphasised the importance and value of referrals when patient care falls outside the scope of chiropractic and emphasised that positive working relationships facilitate evidence-based and patient-centred care. Several challenges to collaboration were found to be stereotyping, communication barriers, and exclusion from the public healthcare system. This study outlined the need for better communication, new graduate guidance and clinical training to facilitate and improve the collaborative relationships among chiropractors and other professions. It offers insights from the perspective of South African chiropractors and recommends further investigative studies in other municipalities.
The value of the strengths-based approach at residential child and youth care facilities in eThekwini, KwaZulu-Natal
(2025-06-20) Khumalo, Nkosingiphile; Dewan, Fathima
The child and youth care profession has always existed to provide services for children and youth who are vulnerable, orphaned or at risk, as well as for their families. However, there is insufficient information on the approaches utilised by child and youth care professionals to ensure optimum growth and development in residential child and youth care facilities. The findings of this study intend to provide knowledge about the application and challenges child and youth care professionals may encounter when using the strengths-based approach, which is an approach that seeks to empower children by focusing on their existing capabilities and resources, rather than solely focusing on their deficits or problems. The study’s aim was to explore the value of the strengths-based approach at residential child and youth care facilities and provide recommendations to enhance and inform strengths-based work in child and youth care. The study adopted a phenomenological research approach using eighteen locally based child and youth care workers from three child and youth care centres in the eThekwini region, Durban, KwaZulu Natal. The study participants were purposively chosen to participate in semi-structured in-depth interviews. Data was analysed using thematic analysis. All the ethical considerations, such as voluntary participation, anonymity, informed consent, and confidentiality, were thoroughly followed and adhered to. The research study results highlighted the significant value of strengths-based work in residential child and youth care settings. Notably, this approach has been instrumental in promoting language and age-appropriate programmes, interventions, and assessments tailored to the unique needs of young people. Moreover, strengths-based work has fostered growth and development in the lives of young people, yielding positive outcomes. Participants emphasised that the strengths-based approach is a valuable tool in child and youth care because it governs the way they think about children and young people and the way they go about their life-space work daily. This approach is responsible for meaningful behavioural changes in young people which is the core objective for child and youth care work. Participants in the current study also highlighted the disadvantages of employing this approach stating that strengths-based work is time-consuming, requiring significant investment in building relationships and implementing individualised plans. Additionally, participants reported difficulties in the implementation of the strengths-based approach, highlighting the negative behaviours and attitudes they encounter from children, which hinders progress and create challenges for practitioners. There is also inadequate emotional and financial support offered by the organisation. According to the study results, it was established that many problems in the strengths-based approach can be solved by training, support or education. A better understanding of strengths-based work and the value of this approach may strengthen and improve strengths-based services, broaden knowledge, and enable child and youth care workers to provide thorough treatment and appropriate interventions for children’s developmental needs. It is therefore recommended that future studies evaluate the effectiveness of strengths-based approaches from the perspectives of children and young people in residential care and compare outcomes across different settings and populations to further inform best practices.
The prevalence and risk factors of muscle dysmorphia in amateur male bodybuilders in the eThekwini Municipality
(2025-07-18) Govender, Sachin; Pienaar, Cindy; Van Heerden , Kirsten; Prince, Cleo
Background Muscle dysmorphia (MD), which falls within the spectrum of Body Dysmorphic Disorder, is an increasingly common psychological condition worldwide. Within the bodybuilding community, “bigorexia” manifests when bodybuilders perceive themselves as having much less muscle mass than they actually do, which resorts to the use of performance enhancing drugs (PEDs). Although PEDs are prescription based, illegal use/excessive use can result in physiological and mental complications. Furthermore, the lack of research on MD in developing countries, such as South Africa, warrants investigations pertaining to the development of certain risk factors as well as the pathogenesis of the preoccupation of muscularity in MD. This will assist medical practitioners, such as chiropractors, in identifying and understanding MD risk factors and lead to improved patient management. Methods: The research utilised a quantitative, descriptive, cross-sectional survey approach. The study targeted enrolling at least 196 amateur male bodybuilders from five chosen gymnasiums within the eThekwini Municipality area. Following the acquisition of informed consent, participants completed the modified Adonis Complex Questionnaire (ACQ). The collected questionnaire data were analysed using IBM SPSS version 25. Results: The main findings of this study showed that most participants (65.8%) reported a minor concern of MD, 32.1% reported a moderate concern of MD and only 2% reported a serious concern for MD in the eThekwini Municipality. The prevalence of MD in amateur male bodybuilders showed a weak positive correlation with selected self-reported risk factors (low self-esteem, childhood victimisation, anxiety, perfectionism, eating disorders, PEDs and social media. The regression analysis revealed that unhealthy eating behaviours accounted for 19% of the variance, followed by anxiety, victimisation, and social media influence, which accounted for 10.4%, and self-esteem and perfectionism, which accounted for 3.9%. Only 2% of participants expressed having a serious concern of body image dissatisfaction, therefore, MD was found to not have any influence on the quality of life of majority of the selected participants in this study. The quality of life of the 2% of participants with a serious concern of MD may have been influenced psychosocially and physically. The aim, objectives one, two, three as well as the alternate hypothesis, which states that MD is present in some amateur male bodybuilders in the eThekwini Municipality were achieved in this study. Conclusions: The key findings showed that there was a 2% prevalence of MD amongst the participants in this study. There was a weak positive correlation of self reported risk factors for developing MD which included low self-esteem, anxiety, depression, childhood victimisation, perfectionism, social media influence and an unhealthy relationship with food. In terms of quality of life, MD did not have a significant influence on the participant’s perception of their quality of life. Chiropractors play an essential role in patient care due to injuries caused by over-exertion/over-training as a result of MD. Therefore, collaborative treatment plans with other healthcare professionals, such as psychologists, nutritionists and physicians is necessary to provide full comprehensive care for individuals with MD. By working together, healthcare professionals can create integrated treatment plans that consider all aspects of an individual’s health. This holistic approach can improve overall treatment outcomes as it ensures that all contributing factors to MD can be addressed.
Detection of potentially pathogenic bacteria on emergency care personnel's safety protective footwear and evaluation of infection, prevention, and control procedures in the uMgungundlovu district of KwaZulu-Natal
(2025-10-16) Gengan, Jerry Devraj; Sobuwa, Simpiwe; Reddy, Poovendhree
Emergency Care Personnel (ECP) within KwaZulu-Natal Emergency Medical Services (KZN EMS) consistently respond to medical, trauma, and disaster emergencies. Emergency care personnel often serve as primary responders responsible for providing specialised care and life-saving interventions, which may increase their risk of exposure to healthcare-associated infections. Emergency care personnel are equipped with official attire and Safety Protective Footwear (SPF), which are part of their Personal Protective Equipment (PPE) for duty. Working in the pre-hospital setting presents challenges due to the lack of patient history provided to ECPs’ upon initial contact, increasing the risk of Healthcare-Associated Infections (HAIs). Emergency care personnel may unintentionally facilitate transmission of diseases. In the pre hospital setting, there is a scarcity of information regarding disease transmission. Emergency care personnel are restricted in their ability to sanitise and disinfect their vehicles and SPF because of high-priority cases and limited turnaround times. In the absence of an Infection Prevention and Control (IPC) policy regarding cleaning procedures for EMS personnel, there is a potential risk of HAIs. KZN EMS does not possess an adequate IPC system, in contrast to hospitals. The purpose of this study was to evaluate ECPs' SPF for the presence of microorganisms related to bacterial infections and to determine whether EMS KwaZulu-Natal uMgungundlovu district has any infection prevention and control procedures or policies. This study employed a prospective cross-sectional quantitative approach and was conducted in two phases. The initial phase involved swabbing of 53 selected ECPs’ SPF at the EMS Grey’s Hospital base to identify bacterial contamination. This was followed by data collection using a questionnaire distributed to all EMS bases in the uMgungundlovu District, aimed at assessing ECP's ICP awareness and practices among 165 staff members. After distributing the questionnaire to all bases in the uMgungundlovu district, a total of 303 participants were surveyed, with 165 (54%) responding. A considerable proportion of participants were uninformed of EMS policies and practices due to the absence of an EMS IPC policy. Inadequate ICP awareness, insufficient disinfection practices, unavailable PPE, and inaccessible cleaning supplies were all prevalent issues. The study employed an aerobic culture-based method consisting of 53 samples. The bacterial analysis revealed six pathogens (11.3%) in seven (13.2%) SPF samples. Pasteurella canis, Enterococcus faecium, Enterococcus casseliflavus, Escherichia coli, Pantoea agglomerans, and Acinetobacter radioresistens were all identified as potential pathogenic organisms. This study demonstrated the prevalence of microbial contamination on ECPs’ SPF, which may act as a reservoir for transmitting potential infections to patients and healthcare personnel. Emergency medical service personnel showed significant non compliance in cleaning and disinfecting practices. KwaZulu-Natal EMS uMgungundlovu District lacks an effective cleaning protocol for decontaminating SPF. Further research is necessary to determine whether contaminated SPF contributes to the transmission of infectious pathogens in pre-hospital settings. Additionally, KZN EMS must address the insufficient supply of cleaning materials, inadequate IPC training, and poor procedural guidelines.
The epidemiology of musculoskeletal pain in dressage riders in KwaZulu-Natal : a cross sectional study
(2026-04-07) Alberts, Jessica; Chetty, Sean; Varatharajullu, Desiree
Background: Previous studies indicate that horse riders experience a high prevalence of equestrian related injuries and back pain; however, these studies have combined different horse-riding disciplines, assessed back pain only in elite dressage riders, or reported on the prevalence of equestrian-related injuries. There is a scarcity of research on dressage horse riders in South Africa and on musculoskeletal pain in this population. Therefore, this study addresses the prevalence of musculoskeletal pain in dressage riders in South Africa, thus bridging the gap between research done on horse riders in other countries and horse riders in South Africa. Aim: To investigate the prevalence of musculoskeletal pain in dressage horse riders in KwaZulu Natal. Objectives: To determine the point and period (one year) prevalence of musculoskeletal pain in dressage riders in KwaZulu-Natal. To investigate the selected risk factors (the velocity of horse riding, the time spent horse riding, the type of saddle being used, the number of horses being ridden, the mechanical differences in the horse’s movement, history of previous horse-riding injury) on the prevalence of musculoskeletal pain in dressage horse riders in KwaZulu-Natal. To determine the impact of musculoskeletal pain in dressage riders in KwaZulu Natal. To determine the association between the prevalence of musculoskeletal pain and selected risk factors. Results: A total of 89 participants completed the questionnaire, resulting in an 81.65% response rate. The majority of riders (83%) had a history of experiencing musculoskeletal pain at some point during riding, with low back pain being the most common region (65%). A majority of 89% of riders were currently experiencing musculoskeletal pain, with low back pain being reported as the most common region (48%), followed by neck pain, mid-back pain and knee pain (25%). The musculoskeletal pain was most described as being sharp (62%) and tight/spasm (57%). Strenuous riding (28%) and riding multiple horses a day (28%) were reported to be the most contributing factors for aggravating musculoskeletal pain. Conclusion: This study has revealed the prevalence of musculoskeletal pain in the different anatomical regions in dressage horse riders, adding to the body of literature on musculoskeletal pain in horse riders. The study emphasised the different biomechanical demands on dressage riders and how the rider is impacted, adding to the importance of adequate treatment methods for the different sporting disciplines.
A study on the management of hyperpigmentation in skin types IV to VI AT aesthetics clinics in eThekwini, KwaZulu-Natal
(2026-02) Memela, Simphiwe Nokwanda; Ghuman, Shanaz
Hyperpigmentation is a skin disorder caused by the increase of melanin production in the skin, caused by different internal (e.g. hormones) and external (e.g. UV exposure) stimuli. Different types of hyperpigmentation, namely melasma, post-inflammatory hyperpigmentation and solar lentigines, may be found amongst individuals. Persons with darker skin tones (greater melanin production) are more susceptible to hyperpigmentation due to their melanocytes being slightly larger and easily triggered by internal and external stimuli, compared to individuals with the skin type I-III. In relation to the treatment of hyperpigmentation in skin of colour, extra precautions should be taken due to the skin being easily irritated, resulting in the increase of pigmentation as a mechanism of the skin protecting itself from further damage. Therefore, professional treatments would include micro-needling and gentle chemical peels, which have been explored in this study during treatment, in addition to tyrosinase inhibitors which were used during treatments, as well as a home supportive treatment regime. With the use of an appropriate treatment plan and home-care regime, the individual noticed improvement in their skin with reduced pigmentation, an evened-out skin tone and reduced fine lines and wrinkles as an additional benefit. The tool used for data analysis was a semi-structured questionnaire and open-ended statements. Questions were developed by the researcher in line with the objectives employed to gather qualitative data. The questions were based on the hyperpigmentation typologies, current skin treatment, as well as homecare. These were distributed to the participants to complete during Phase (1), and Phase (2) entailed the researcher conducting the qualitative component. The study was conducted within eThekwini, in KwaZulu-Natal. The study constituted 30 participants who were undergoing hyperpigmentation management programs, who consented to participate in the study. Census sampling was implemented as every participant’s responses were utilised during data collection and analysis. The study explored the different hyperpigmentation treatment approaches that were offered to individuals with Fitzpatrick Skin Types IV to VI. The treatment approaches proved to be a success as participants were satisfied with their results. The participants did point out that it is a gradual process that needs patience from the professional as well as from the individual that is on the journey.
A probabilistic and epidemiological assessment of health risks associated with recreational exposure to contaminated surface water : a case of the uMsunduzi River
(2026-02) Mdluli, Zinhle Pearl; Sibiya, Maureen Nokuthula; Amoah, Isaac Dennis; Pillai, Sheena Kumari Kuttan
Water quality degradation and scarcity have become prominent global concerns. In South Africa, poorly treated effluent from wastewater treatment facilities has contributed to the deterioration of river water quality, often exhibiting elevated levels of microorganisms. This study evaluated the microbial water quality of the uMsunduzi River and established a correlation between exposure to the river and the incidence of diarrheal infections among Dusi Marathon participants. In addition, the study conducted a theoretical assessment of the pre-and post-exposure risk reduction interventions that have the potential to safeguard participants of the canoe race The study employed a comprehensive approach, which included a water quality analysis using Escherichia coli, Pseudomonas aeruginosa, and Cryptosporidium spp. as reference pathogens. The detection of E. coli and P. aeruginosa was conducted using IDEXX Colilert-18 and Pseudolert detection and enumeration kits, and digital droplet Polymerase Chain Reaction (ddPCR) for Cryptosporidium spp. An exposure and diarrheal incidence assessment through a prospective survey methodology and a Quantitative Microbial Risk Assessment (QMRA). Data analysis and interpretation for the exposure and incidence assessment were accomplished using the most recent IBM® SPSS® VERSION 27. The probability analysis for the QMRA was conducted using the distribution fitting capability included in the @Risk 7.5 program developed by Palisade Corporation. The study detected elevated levels of E. coli, Pseudomonas aeruginosa, and Cryptosporidium spp. in the river water, exceeding acceptable limits set by World Health Organization and Department Water Affairs and Forestry. The exposure diarrheal incidence assessment revealed a significant association between river exposure and diarrheal infections, with a 97% increased risk of developing diarrhea among those who ingested water from the river. The QMRA indicated a significant risk of infection for populations who depend on the uMsunduzi River for recreational activities, primarily associated with Cryptosporidium spp. The conclusions drawn suggest that regular monitoring is crucial to ensure the safety of water for leisure activities such as swimming, boating, and fishing. Monitoring systems may identify possible health threats and apply appropriate mitigation actions by testing for pathogens, biological contaminants, and chemical pollutants. Recreational bodies of water may act as a reservoir for waterborne infections, offering significant health risks to persons. This primary data analysis provided a comprehensive overview of the incidence of diarrhea among Duzi Canoe Marathon participants in 2022. We identified participant demographics and exposure assessments, key factors contributed to this health concern. As the Duzi Canoe Marathon continues to attract diverse participants, understanding and addressing health challenges is paramount. This analysis is a valuable resource for future event planning and underscores the commitment to participant welfare.
The treatment practices of homoeopaths, phytotherapists and traditional healers with regards to female infertility in the KwaZulu-Natal province
(2026-01-28) Mtolo, Xoliswa Princess; Hall, Cornelia Maria
Background David Hoffmann (1997: 97) writes: "More than any of the other systems, the reproductive system shows the miracle of life at work. It is a miracle that we can wonder at, can analyse in terms of tissue and hormone function, write poetry about, but which in the end will leave us speechless." Reproduction is an important biological event in human beings, so anything that threatens reproduction, for example infertility, will trigger a significant response. Infertility is a disorder of the reproductive system and is defined as an inability to achieve and keep a pregnancy after a year or more of consistent, non-contraceptive and unprotected sexual intercourse involving a biological male and female of reproductive age. There are different treatment approaches to female infertility depending on several factors including the aetiology and the duration of the infertility. South Africa has different healthcare approaches, comprising allopathic medicine, complementary medicine and traditional medicine. Homoeopathy and phytotherapy fall under complementary medicine, while traditional medicine is also a recognised form of medicine that is culturally very accepted and popular. Aim of the study The study aimed to explore different treatment practices of homoeopaths, phytotherapists and traditional healers with regards to female infertility, with the objective of expanding the treatment options that are available for women diagnosed with infertility. Methodology A qualitative and explorative study design was utilised. Twelve participants were selected by virtue of their capacity to provide precise information, with the aim of increasing the efficiency of the study. Respondents were interviewed individually using an interview guide and each of the interviews were audio recorded and transcribed. The transcripts were analysed using Tesch's (1992) 8-step approach to qualitative research, whereby specific recurring themes are extracted from the data. Results After the 12 participants were interviewed, data was analysed, and four major themes emerged. The participants demonstrated a strong understanding of female infertility, including its causes, contributing factors and diagnostic procedures. The practitioners interviewed in the study described various treatments or management strategies for female infertility. Findings were that the main treatments of three modalities were: homoeopathy – Natrum muriaticum, Sepia officinalis and Pulsatilla pratensis; phytotherapy – Agnus castus, Actaea racemosa (black cohosh), and Asparagus racemosus (shatavari); traditional medicine – imbiza and isihlambezo. All participants confidently stated that their treatment methods were safe and had a high success rate in helping women achieve pregnancy and eventually parenthood. Conclusion The salient themes of this study strongly suggest that homoeopaths, phytotherapists and traditional healers have an in-depth understanding of female infertility with a wide range of trusted and safe treatment methods that have proven to help females achieve a longed-for pregnancy and parenthood. Based on these findings the researcher recommends that interprofessional interaction and referrals between conventional and CAM practitioners be broadened so that treatment practices evolved from this study can be pursued.

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