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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.
Antioxidant and antihypertensive activities of bioactive peptides derived from fish collagen and milk lactoferrin
(2025-05) Elisha, Cherise; Pillai, Santhosh Kumar Kuttan; Bhagwat, Prashant
Bioactive peptides (BPs) are short sequences of amino acids known for their physiological benefits, including antioxidant, antimicrobial, antihypertensive, and antidiabetic properties. BPs can be derived from various food proteins; from plant, meat, milk, and marine sources, through methods such as microbial fermentation or enzymatic hydrolysis. This study explored the potential of BPs derived from milk lactoferrin (LF) and fish collagen using in silico and in vitro analyses. The inhibitory potential of BPs derived from LF, a multifunctional milk glycoprotein found in bovine and human milk, against angiotensin-converting enzyme (ACE) and dipeptidyl peptidase-IV (DPP-IV) enzyme were analysed. Initially, in silico digested bovine and human milk-derived-LF sequences were screened for potential ACE and DPP-IV inhibitory activity using AHTpin and StackDPPIV, respectively. Molecular docking results revealed that bovine LF peptides ‘EPYF’ (−10.1 kcal/mol) and ‘WQWR’ (−9.3 kcal/mol) had significantly lower binding energies with ACE and DPP-IV, respectively. In addition, in vitro analysis of bovine LF hydrolysates demonstrated IC50 values of 0.48 ± 0.01 mg/ml (ACE) and 0.93 ± 0.02 mg/ml (DPP-IV). Liquid chromatography-mass spectrometry (LC-MS/MS) analysis identified the peptides ‘EPYF’ and ‘WQWR’ which are potential inhibitors of ACE and DPP-IV, respectively, present within the parent peptide sequences of the bovine LF hydrolysates. These findings suggested that bovine LF peptides, due to their bioactive potential and functional similarities to human LF, may serve as a viable alternative to human LF. Subsequently, the research evaluated the inhibitory potential of BPs derived from fish collagen. The first step involved extracting collagen from the pretreated snapper salmon skin using an acid-solubilisation technique, followed by characterisation through biophysical analyses, such as SDS-PAGE and CD spectroscopy. Thereafter, the extracted collagen was hydrolysed using a pre-digestive approach. Papain was used as the pre-digestive enzyme due to its broad specificity, which effectively breaks down collagen and releases a range of BPs. Pepsin and trypsin were also key enzymes utilised in the in vitro digestion process to mimic human gastrointestinal conditions, since they are present in the stomach and small intestine, respectively. In this regard, snapper salmon skin collagen was hydrolysed using two approaches: pre-digestion followed by pepsin-trypsin digestion (PDPTD) and pepsin-trypsin digestion alone (PTD). This yielded fish collagen hydrolysates (FCH), and the peptides were fractionated using various cut-off membranes (<3 kDa, 3–10 kDa, and >10 kDa). xv The FCH that did not undergo pre-digestion exhibited IC50 values of 0.54 ± 0.03 mg/ml (ACE inhibition), 2.25 ± 0.02 mg/ml (DPP-IV inhibition), and 0.04 ± 0.01 mg/ml (ABTS antioxidant activity). In contrast, pre-digested FCH showed lower IC50 values of 0.33 ± 0.06 mg/ml, 1.67 ± 0.08 mg/ml, 2.38 ± 0.31 mg/ml, and 0.03 ± 0.00 mg/ml for ACE inhibition, DPP-IV inhibition, DPPH antioxidant activity, and ABTS antioxidant activity, respectively. FCH (from both PDPTD and PTD methods) were subjected to peptide identification and the identified peptides underwent in silico analyses to assess their physicochemical properties and potential bioactivities. Molecular docking analysis of pre-digested FCH peptides identified the peptide, IGFPGFPG, with significant ACE and DPP-IV inhibitory activities, exhibiting low binding energies to ACE (−11.2 kcal/mol) and DPP-IV (−9.1 kcal/mol). The study concluded that pre digested collagen peptides demonstrated improved bioactive potential, as reflected by their lower IC50 values and docking score. Overall, the study concluded that BPs derived from bovine milk LF and fish collagen have potential as antioxidants and inhibitors of ACE and DPP-IV. These findings underscore their potential for use in developing dietary supplements and functional foods, which could offer a myriad of health-promoting properties.
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.