Doctoral Degrees (Behavioural Medicine)

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Biopsychosocial changes in the human stress response, with specific reference to stress measurement and certain moderating variables.
(2005) Bosch, Brenda Ann.; Schlebusch, Lourens.
This empirical double-blind multi-centre empirical study assessed the sources of stress, stress-related symptoms, role of psychosocial moderating variables and the role of micronutrients (specifically the effect of intervention with micronutrient supplementation) on stress levels and symptoms in South Africans. The sample consisted of 300 volunteer, English-speaking South Africans from two centres (KwaZulu-Natal and Gauteng) who had predetermined stress levels. The participants were evenly divided between the two centres (N=150 each). The Experimental Group (Active group) who comprised 151 participants received a multivitamin and mineral combination, while the Control Group (Placebo) group received a placebo. The research dealt with perceived stressors, coping resources and outcomes in the general population (both at baseline and after intervention). Outcome was assessed using standardized self-report instruments which examined stress levels and symptoms, perception of stress levels, anxiety, psychological general well-being and neurocognitive functions (verbal and visual memory). Univariate and multivariate correlational analyses were performed to investigate correlations and the predictive value of risk and rescue factors for the outcome variables. The findings indicate that there were no significant differences in the number of stressors between the two groups at baseline, although they differed in respect of two particular stressors (A>P regarding concern over children's future; P>A regarding life decisions). An interaction of stressors and moderating variables (life orientation and perceived coping incapacity) have an important role in predicting stress and stress outcome, and outcomes themselves may function as stressors. The bidirectional, circular interactive effects of stressors, moderators and outcomes are important in the stress and coping process. The study failed to find any effect of stress on the neurocognitive functions assessed. No significant treatment effect for the micronutrient was found, but a number of trends in respect of efficacy were suggested by the findings. The findings also suggested particular patterns of interactions in this regard for predicting pre-post differences (delta). Strengths and limitations of the study are highlighted and implications for intervention in respect of a stress management programme are also discussed.
HIV/AIDS knowledge, attitudes and sexual practices among intellectually impaired and mainstream learners in selected schools in Oyo state, Nigeria.
(2011) Aderemi, Toyin Janet.; Pillay, Basil Joseph.
In the absence of a cure and/or vaccine, the best approach to HIV is to focus on prevention. However, preventative measures that are presently available in Nigeria do not target persons with intellectual disability despite their vulnerability to HIV infection. This study sought to compare the HIV knowledge, attitudes, and sexual practices of mildly/moderately intellectually impaired learners (IIL) and mainstream learners (ML) in Nigeria; to explore the contextual factors informing these, as well as both groups‗ exposure to HIV education. It also tested the relevance of the I-Change Model in predicting sexual abstinence among learners with intellectual disability. Findings can assist in developing tailored HIV prevention education for Nigerian learners with intellectual impairment. This cross-sectional, comparative study utilised mixed methods to investigate HIV knowledge, attitudes, and sexual practices among mildly/moderately IIL and ML in Nigeria. Mildly/moderately IIL (300) and ML (300) within the age range of 12-19 years in special and regular schools completed a questionnaire based on the I-Change Model. Focus group discussions and in-depth interviews were used with learners to explore contextual factors informing their HIV knowledge, risk perception, sexual behaviours and access to HIV education and services. Key informant interviews were used as independent sources of the same information with their teachers. Learners with intellectual impairment were less aware of HIV/AIDS than their non-disabled peers (p < 0.001), had lower HIV knowledge scores (p < 0.001) and lower HIV risk perception scores (p < 0.001). Sexual experience was reported by 79 (26.3%) of the IIL sample compared to 48 (16.0%) of the ML sample (p = 0.002). Girls with intellectual disability were 3.71 times more likely to report a history of sexual abuse than non-disabled girls (p = 0.041). Inconsistent condom use with casual partners (p < 0.001) and non-use of condoms during the last sexual activity (p < 0.001) was higher in IIL. The I-Change Model was most effective in predicting sexual abstinence among IIL, particularly regarding factors related to motivation and intention. Intellectually impaired learners were more vulnerable to HIV infection due to neglect, poverty, sexual abuse/exploitation, stigmatisation, pressure from non-disabled peers, denial of HIV education, and inaccessible HIV-related services. Teachers only provided them with sexuality and HIV education when sexual activity was suspected and/or from age 18. The content of such education comprised mainly warnings, misinformation and corporal punishment to instil fear and desexualise them. Thus, this group of learners was limited in the way they experienced and expressed their sexuality. Unlike with their non-disabled peers, teachers attributed sexual activity among IIL solely to natural urges without emotional involvement. Contrary to teachers‘ opinions, some IIL were involved in symbiotic, loving relationships with their II peers. In addition, those that were not yet in such relationships expressed the desire to find non-discriminatory partners in the future. They explored their sexuality through intimate relationships, sexual intercourse, peeping at the opposite sex, pornography, and masturbation. Condoms were less available to IIL than ML, and they lacked the self-efficacy to use them. They were also less available to II girls than II boys. Female learners with intellectual impairment often had older sexual partners due to sexual abuse/exploitation, unlike their non-disabled peers, who embarked on such relationships for financial/material gains. The findings of this study indicated that IIL were sexual beings, just like their non-disabled peers, and at higher risk of HIV infection than the latter. Stigma and discrimination are the root causes of all the disadvantages/barriers that IIL experience in accessing HIV information, education and related services. Therefore, there is the need to put stigma reduction strategies in HIV response to safeguard the health of IIL. In addition, there is a need for the development of a gender-sensitive, tailored sexuality and HIV/AIDS educational format for learners with intellectual disability in Nigeria.
Perceived stress, coping behaviour, and health outcomes among South African undergraduate medical students.
(2003) Vawda, Naseema B. M.; Schlebusch, Lourens.
This empirical study assessed the perceived stressors in medical school environment and psychological outcomes in undergraduate medical students in a non - western sample. The sample consisted of African and Indian students in the Clinical group (N = 149) and a matched Control group, the Pre-clinical group (N = 158) bringing the total number of participants to 307. The research dealt with perceived stressors, coping mechanisms and outcomes in a medical school environment. Outcome was assessed using self-report instruments which examined stress symptoms and psychological distress. Both bivariate and multivariate correlational analyses were performed to investigate correlations and the predictive value of risk factors for psychological distress. The findings indicate that there are no significant differences in the perception of stressors in the medical school environment between the Pre-clinical and Clinical groups. Maladaptive coping strategies, perceived stressors and female gender have important roles to play in predicting psychological distress. High self-esteem and good social support for both groups, as well as optimism in the Clinical group protects against psychological distress. Strengths and limitations of this study as well as implications for intervention strategies among undergraduate medical students are also discussed.
The psychosocial effects of cancer on children and their families.
(2004) Jithoo, Vinitha.; Schlebusch, Lourens.
Psychosocial oncology is well established in Europe and in America. Similar initiatives are, however, rare in Africa. On the African continent, psychosocial services are scarce and often a luxury although the importance of psychosocial variables as mediators in the paediatric cancer outcomes have been widely recognised. The apartheid system in South Africa was instrumental in causing major disparities in health, education and socioeconomic status. In order to provide a more holistic service it becomes imperative to assess not only the psychosocial needs and resources of both children and parents who endure the disease but also the influence of socio-demographic variables such as race, educational level and socioeconomic status. This research was limited to collecting baseline information on how parents and children communicate about the illness, emotional responses and the psychological resources that they utilise to deal with the childhood cancer trajectory. The study group consisted of 100 children between the ages of 5 and 16 years who had been diagnosed with cancer and one or both parents of those children. Data was collected through semi-structured interviews and standardised self-report measures. The results of the study indicate that both parents and children did not suffer disabling psychopathology, but certainly evidenced symptoms of depression and anxiety indicative of adjustment difficulties. Communicating about the illness was generally limited to physiological aspects of the disease and medically related matters, while emotional issues were rarely articulated. Children, parents and their siblings relied heavily on medical staff for their information needs. The age of the child was a significant factor with reference to amount and complexity of information imparted to children: adolescents were given more information about the treatment and prognosis; while younger children were given a limited amount of information. Race, socioeconomic status and educational levels of parents not only influenced the meanings and beliefs families developed around the cancer experience, but also the manner in which they expressed their emotions and the coping strategies that they employed.
An investigation of psychological stress, coping styles/strategies and psychological adjustments in a sample of Indian South African women with breast cancer in different developmental stages of the life-cycle.
(2013) Selmer, Colette Anne.; Schlebusch, Lourens.
The purpose of this research was to examine some major themes of stress, coping styles/strategies, and psychological adjustment to breast cancer, of 116 English speaking, low socioeconomic status Indian South African women at different developmental stages of the life-cycle. The sample was drawn from a population of hospital outpatients receiving treatment for breast cancer at three academic hospitals in Durban, South Africa. Convenience sampling was employed, and a battery of six questionnaires was completed in addition to the collection of demographic data. Descriptive statistics, correlational analysis, multivariate analysis and regression analysis was used to analyse the data. The results suggested both similarities and differences between the younger and older groups of patients with regard to the disruption of life-tasks by breast cancer. However, the younger group, on average, experienced significantly greater disruption with regard to the following ‘themes of stress’: interpersonal relationships, achievement-oriented goals/activities, body or sexual image and integrity, and existential issues. In addition, the younger patients, on average, experienced a greater degree of overall disruption to life-tasks. The disruption of life-tasks was only associated with psychological morbidity in the younger patients, and the overall extent of disruption to life-tasks was shown to directly contribute to the younger patients’ depressive symptomatology. Both groups demonstrated elevated stress reactions and psychological symptoms in comparison to norms generally, however the younger patients demonstrated higher levels of ‘psychological’ stress and depressive symptomatology. With regard to coping styles, the younger group, on average, demonstrated a greater prevalence of ‘fighting spirit’ and ‘anxious preoccupation’, while the older group contained a significantly greater percentage of patients demonstrating a problematic combination of coping styles. The coping style ‘helpless or hopeless’ was associated with various stress reactions and psychological symptoms for both groups, although this association was less prevalent for the older group. The coping strategy ‘escape-avoidance’ was associated with overall psychological distress only for the younger group. The results suggested that there may be other, more significant predictor variables for psychological distress in older breast cancer patients – a potential area for future research.
Frontal network syndrome testing : a hierarchical and time orientated approach.
(2014) Hoffmann, Michael Wolfgang.; Robbs, John Vivian.; Pillay, Basil Joseph.
Abstract available in PDF file.
Neuropsychological functioning and adjustment in spinal cord injured patients.
(2010) Moodley, Nancy.; Pillay, Basil Joseph.
Abstract available in PDF file.
Stress and ill health associated with fungi, indoor environmental factors and personal factors in hospitals.
(2003) Shadwell, Anthony.; Schlebusch, Lourens.; Gqaleni, Nceba.
Abstract available in PDF.
Testing deficits in behavioural planning, set- shifting/ cognitive flexibility and working memory in children with high levels of Attention Deficit/Hyperactivity Disorder symptoms=Ukuhlola ukusilela ekuhlelweni kokuziphatha, ukuguquka ngokuqonda/ukuseka ukushintsha kanye nenkumbulo yokusebenza ezinganeni ezinamazinga aphezulu ezimpawu ze-ADHD.
(2022) Boshomane, Tshikani Theodore.; Pillay, Basil Joseph.; Meyer, Anneke.
Attention Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterised by age-inappropriate symptoms of inattention, impulsiveness and hyperactivity that persist into adulthood. The symptoms are thought to result from a deficit in executive functions (EFs), such as inhibition, working memory, planning and set-shifting or cognitive flexibility. The study was aimed at investigating deficits in behavioural planning, cognitive flexibility and working memory in children with ADHD, with the use of specific neuropsychological tests, designed to measure deficiencies in the cortical areas of EFs, and compare this performance with a neurotypical control group. Further, the study investigated whether commonly used EF measurements were able to predict the core symptoms of ADHD. One hundred and fifty-six Sepedi and Xitsonga speaking primary school children (78 with ADHD and 78 matched controls without ADHD) aged between 6 and 15 years (M=11.7 years, SD=1.7), both males and females, participated in the study. The Tower of London (ToL) was used to measure planning, Memory for Digits (MFD) was used to measure working memory, Trail Making Test (TMT) to measure cognitive flexibility and Wisconsin Card Sorting Test (WCST) to measure set-shifting. Our results showed that, on the ToL, children with ADHD, especially ADHD-PI and ADHD-C, used more moves and took a longer time to complete the task compared to the neurotypical controls. There were no differences in the number of moves and time taken by the ADHD-HI when compared to controls. Further, the results showed that, on theWCST, children with ADHD presentations /subtypes (ADHD-Hyperactive/impulsiveness, ADHD-Inattention and ADHD-combined) met with more set-shifting problems than the neurotypical comparison group, as they made more total errors, perseverative responses, perseverative errors and nonperseverative errors. Children with ADHD also exhibited poorer performance on both the Digits Backwards (DB) and Trails-B when compared to the control group. No significant effect between the ADHD and control group were found on the Trails-A test. Sex and age did not influence the performance of set-shifting, working memory and cognitive flexibility tasks. All the tests (ToL, DF and DB, Trails-B and WCST) were found to predict ADHD symptomatology, except Trails-A. The WCST (total errors and perseverative errors) was the best predictor of ADHD symptomatology and H/I, followed by DB and Trails-B which predicted more inattention. In conclusion, the study revealed behavioural planning, set-shifting and working memory deficits in children with ADHD compared to neurotypical comparisons. The study also showed commonly used EFs tests could predict ADHD symptomatology. Since children with ADHD show behavioural planning, cognitive flexibility and working memory deficiencies which affect their academic and social functioning, it is recommended that tests of EF are included in the assessment to complement the diagnosis of ADHD. Iqoqa Isifo sokuba nenkinga yokugxila kulokhu okwenziwayo, i-Attention Deficit-Hyperactivity Disorder (ADHD) yisifo esijwayelekile esithinta ingqondo esihambelana neminyaka ethize. Izimpawu zaso ukuhluleka ukugxila kokwenziwayo, amatata, nokuqina kakhulu okuqhubeka kuze kube sebudaleni. Izimpawu zaso kukholakala ukuthi zihambelana nokuhluleka ukwenza izinto ezibalulekile empilweni, ezaziwa nge-executive functions (EFs), ezintweni ezifana nokuziqoqa, ukukhumbula izinto, ukuhlela nokuhlunga izinto engqondweni. Lolu cwaningo beluhlose ukucubungula ubuthakathaka bokukwazi ukubamba indlela yokuziphatha, ukukwazi ukucabanga ngokuvulelekile, nokukhumbula izinto ezinganeni eziphila ne-ADHD, kusetshenziswa indlela yokuhlola ingqondo, eyenzelwe ukukala izinga lobuthakathaka ezindaweni zomqondo i-EFs, kuqhathaniswe ukusebenza kwazo nalezo zingane ezinezinkinga ezihambelana nemizwa. Futhi, lolu cwaningo belucubungula ukuthi ingabe indlela ejwayelwe ukusetshenziswa yokukala i-EF iyakwazi yini ukuqagula izimpawungqo ze-ADHD. Izingane zesikole zamabanga aphansi eziyikhulu namashumi ayisihlanu nesithupha (ezingama-78 zazo zine-ADHD kanti ezingama-78 azinayo i-ADHD) ezineminyaka esukela kweyi-6 kuye kweyi-15 (M=11.7 eminyaka, SD=1.7), zobulili besilisa nobesifazane, ezikhuluma izilimi iSepedi neXitsonga, zazibandakanya nalolu cwaningo. Kwasetsheziswa indlela yokukala ebizwa nge-Tower of London (ToL) ukukala ukukwazi ukuhlela izinto, ukukwazi ukukhumbula, i-Memory for Digits (MFD), ukukala ukuthi ukukhumbula abanako ngokwesikhathi esingakanani. Kanti i-Trail Making Test (TMT) yona yasetshenziswa ukukala ukucabanga ngokukhululeka, bese i-Wisconsin Card Sorting Test (WCST) yona yakala ukukwazi ukuhlukanisa izinto. Imiphumela etholakele iveza ukuthi izingane ezine-ADHD ikakhulukazi i-ADHD-PI ne-ADHD-C zathatha isikhathi esithe xaxa ukwenza umsebenzi ezazinikezwe wona uma ziqhathaniswa nalezo ezingenayo i-ADHD. Kanti awukho umehluko owaba khona mayelana nesikhathi ezinganeni ezine- ADHD-HI uma kuqhathaniswa nalezo ezingenayo. Okunye okwavela ukuthi izingane ezine-ADHD zaziba nenkinga yokuhlukanisa izinto kunalezo zingane ezazinenkinga yemizwa ngenxa yamaphutha amaningi ezaziwenza kanye nokungakwazi ukuhluza kahle imicabango yazo. Izingane ezine-ADHD zazibuye zibe nenkinga yokufunda izinombolo ezihlanazelwe, i-Digits Backwards (DB) ne-Trails-B uma kuqhathaniswa nezingane ezingenayo. Awukho umehluko ongako nokho phakathi kwezingane ezine-ADHD nezingenayo mayelana nesivivinyo se-Trails-A. Ubulili kanye neminyaka akwenzanga mehluko ekukwazini ukuhlukanisa izinto, ukukhumbula nokwenza imisebenzi edinga ukucabanga ngokuvulelekile. Izivivinyo zonke (ToL), i-DF ne-DB, i-Trails-B ne-WCST kwahlonzwa njengezinto ezikwaziyo ukuqagula izimpawu ze-ADHD, ngaphandle kwe-Trails-A. I-WCST (inani lamaphutha nokugcina ulwazi) yayiyindlela engcono kakhulu ukuqagula izimpawu ze-ADHD ne-H/I, ilandelwe yi-DB ne-Trails-B eyaveza kakhulu ukuhluleka ukugxila kokwenziwayo. Uma sekuphethwa, lolu cwaningo luveze izinkinga zokuhlela, ukukwazi ukuhlukanisa, kanye nokukhumbula ezinganeni ezine-ADHD uma kuqhathaniswa nalezo ezinenkinga yezemizwa. Lolu cwaningo luphinde lwaveza ukuthi indlela ejwayelwe ukusetshenziswa yokukala i-EFs iyakwazi ukuqagula izimpawu ze-ADHD. Njengoba izingane ezine-ADHD zikhombisa ukuba nenkinga yokuhlela, eyokucabanga ngokuvulelekile nokukhumbula okuyizinto ezinomthelela ezifundweni zazo nasekwazini ukuphilisana nabanye abantu, kunconcwa ukuba indlela yokuhlola ye-EF isetshenziswe uma kuhlohlwa i-ADHD.
Psychosocial factors and trauma in Rwandese refugees living in Lusaka, Zambia=Izimo zempilo yengqondo kanye nokwethuka kubabaleki baseRwanda abahlala eLusaka, eZambia.
(2021) Mwanamwambwa, Victor.; Pillay, Basil Joseph.
The 1994 genocide left many Rwandan refugees to undergo many adverse experiences. The transition from Rwanda to other countries of asylum was often punctuated with a lot of immeasurable challenges. Traumatic experiences encountered by refugees, such as torture and the atrocities witnessed from the genocide, have negatively impacted the refugees. Like other countries in Sub Saharan Africa, Zambia has had political, social and economic challenges. The current state of refugees in Zambia presents different challenges that impact refugees’ wellbeing. Exposure to traumatic experiences creates a range of mental health challenges. These challenges affect both those who had a direct experience of the genocide and their children born in the post-genocide era. This Thesis aimed to examine mental health, psychological distress and coping mechanisms in Rwandan refugees. The differences in symptomology between the older and younger refugees were examined. In addition, the study examined the association between socio-economic factors and psychological distress among Rwandan refugees. An examination of the existing literature indicates that the topics covered in this research are still under-studied in Zambia as well as many other African countries. The research will contribute to a greater understanding and awareness of refugees’ mental health and coping. Mixed method research was utilised involving a quantitative cross-sectional survey and qualitative design involving Focus Group Discussions (FGDs). Two hundred and sixty-seven refugees consisting of 128 (47.9%) males and 139 (52.1%) females purposively sampled participated in the study. Different statistical models were used to assess mental health and psychological distress in the refugees. Further, different coping mechanisms used by the refugees to cope with adversity were evaluated. The results from the study posit that Rwandan refugees have experienced adverse trauma emanating from atrocities of the 1994 genocide. The study further indicated that there is a significant number of participants that reported PTSD and psychological distress. Lower education, lack of financial support and larger family size were positively associated with PTSD and psychological distress. In addition, the study revealed that social support, religion and/or spirituality were the main practices that Rwandan refugees utilise to cope with adversity. Among the key limitations of the study is the small sample size. Future studies should consider using a bigger sample size to improve the generalisability of results. Intervention strategies aimed at improving the lives of refugees should be ongoing. They must encompass a well-structured refugee policy that defines and emphasises refugees’ mental health and psychosocial needs. IQOQA Ukubulawa kwabantu ngokobuhlanga ngonyaka we-1994 kwashiya izakhamizi eziningi zaseRwanda ezibalekele kwamanye amazwe zibhekene nezimo eziningi ezingezinhle. Ushintsho lokusuka eRwanda beya kwamanye amazwe okubhaca kwakuhlangabezana njalo nezingqinamba ezingalinganiseki. Izimo zokuhlukumezeka ezabhekana nababaleki, ezifana nokuhlukunyezwa kanye namazinga empilo okwaba khona ngenxa yokubulawa kwabantu ngokobuhlanga, kwaba nemiphumela emibi kakhulu ezimpilweni zababaleki. Njengamanye amazwe aseSub-Saharan Africa, iZambia seyibe nazo izingqinamba zezepolitiki, ezenhlalakahle yomphakathi kanye nezomnotho. Isimo samanje sababaleki eZambia siveza izinkinga ezahlukene ezihlukumeza impilo yababaleki. Ukubhekana bukhona nezimo ezibuhlungu kudala izinhlobonhlobo zezinkinga zesimo sempilo yengqondo. Lezi zinkinga zihlukumeza bobabili labo ababhekane ngqo nesimo sokubulawa kwabantu ngokobuhlanga kanye nabantwana babo abazalwe emva kwesikhathi sokubulawa kwabantu ngokobuhlanga. Lolu cwaningo luhlose ukuhlola impilo yengqondo, ukuhlukumezeka ngokomqondo kanye nezindlela abazisebenzisayo zokubhekana nesimo kwababaleki baseRwanda. Umehluko okhona phakathi kwezinkomba phakathi kwababaleki asebekhulile kanye nabasebancane kwahlolwa. Okunye futhi, ucwaningo luhlole ubudlelwane phakathi kwezimo zempilo yomnotho kanye nokuhlukumezeka ngokomqondo phakathi kwababaleki baseRwanda. Ukubuyekezwa kwemibhalo esivele isikhona kuveza ukuthi izihloko okukhulunywa ngazo emibhalweni zisacwaningwa eZambia kanye nakwamanye amazwe ase-Afrika. Ucwaningo luzonezezela ekuqondeni okungcono kanye nokuqwashiseka ngesimo sempilo yengqondo sababaleki kanye nezindlela ababhekana ngazo nalezi zimo. Ucwaningo lwendlela engxube lusetshenzisiwe kubandakanye nengxenyana esabalele yenhlolovo kanye nohlaka lwekhwalithethivu olubandakanye izingxoxo namaqoqo acwaningwayo, ama-Focus Group Discussions (FGDs). Ababaleki abangamakhulu amabili namashumi ayisithupha okubalwa kubo abesilisa abayi-128 (47.9%) kanye nabesifazane abayi-139 (52.1%) baqokwa ngenhloso ukubamba iqhaza ocwaningweni. Amamodeli ezinombolo ehlukene asetshenziswa ukuhlola izinga lempilo yengqondo kanye nokuhlukumezeka ngokwengqondo kubabaleki. Okunye futhi, izindlela zokubhekana nezimo ezahlukene ezisetshenziswa ababaleki ukubhekana neshwa labo kwabhekwa. Imiphumela yocwaningo iveza ukuthi ababaleki baseRwanda sebebhekene nesimo esingesihle nesiwumphumela wamazinga empilo okubulawa kwabantu ngokobuhlanga kwa-1994. Ucwangingo luphinde luveze ukuthi kubabambiqhaza abaningi ababika i-PTSD kanye nokuhlukumezeka ngokwengqondo. Amazinga aphansi emfundo, ukwesweleka kosizo lwezimali kanye nemindeni emikhulu kwakuhlobene nesimo se-PTSD kanye nesokuhlukumezeka ngokomqondo. Okunye futhi, ucwaningo luveze ukuthi ukwesekwa ngokwenhlalakahle yomphakathi, ezenkolo kanye/noma ngokomoya kwakuyizinto ezisemqoka eziyimikhuba ababaleki baseRwanda abazisebenzisayo ukubhekana nesimo sabo saleli shwa. Phakathi kwezingqinamba ezinqala zocwaningo kwaba ubungakho bukasayizi. Ucwaningo olulandelayo kumele lubheke ukusebenzisa usayizi othe ukuba mkhulu ukuthuthukisa ukusabalalisela kwemiphumela. Amasu okubhekana nalesi simo ahlose ukuthuthukisa izimpilo zababaleki kumele aqhubeke. Kumele ahlanganise inqubomgomo ehleleke ngendlela yababaleki nechaza futhi igcizelele kabanzi ngezidingo zempilo yengqondo kanye nesimo sokusebenza kwengqondo.

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