College of Health Sciences

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Acceptability and effectiveness of rapid ART initiation: patients’ and healthcare workers’ perspectives.
(2022) Govere, Sabina May.; Chimbari, Moses John.
The Joint United Nations Programme on HIV/AIDS is leading the global effort to end AIDS as a public health threat by 2030. In achieving these goals, emphasis has been on the 95–95–95 targets that by 2030, 95% of people living with HIV know their HIV status. However, the focus is on achieving the second 95 and third 95; having 95% of people diagnosed with HIV initiating on treatment within the expected timeframe and 95% of those on treatment obtaining a suppressed viral load. Commendable efforts have been made in increasing HIV testing numbers however, same day initiation on treatment and achieving viral load suppression remains a challenge. According to the WHO recommendations; same day (ART) initiation should be offered to all people living with HIV following a confirmed diagnosis. This study determined the factors influencing the acceptability and implementation of Universal Test and Treat by both patients and healthcare workers. Universal Test and Treat is a prevention strategy encourages that if a person tests HIV positive, irrespective of the persons CD4 count and clinical staging at the time of testing they will have to begin treatment immediately. Furthermore, patient’s clinical outcomes following test and treat in eThekwini municipality in KwaZulu-Natal were determined. This study was cross-sectional and used prospective - mixed methodology to collect data from 403 patients who either accepted or deferred same day ART initiation from June 2020 to May 2021. A structured questionnaire was used to collect demographic information, sexual behaviour, acceptance of same day ART initiation and knowledge of Universal Test and Treat on the day of HIV diagnosis. Key informant in-depth interviews were conducted with healthcare workers and patients were followed up at 6 months after HIV diagnosis to determine clinical outcomes for both groups, rapid and deferred ART initiators using medical charts and electronic databases. Two different analysis univariate and multivariate logistic regression were performed to examine associations between same day ART initiation and several explanatory factors. Logistic regression was performed to examine associations between same day ART initiation and several explanatory factors, retention in care, clinical outcomes and facility related factors. Thematic analysis was used to assess experiences, knowledge and observations of healthcare workers in implementing the Universal Test and Treat policy. Among the 403 participants same-day initiation was 69.2% (n=279). In an adjusted analysis (age, gender, level of education were adjusted at 0.5 significance level in univariate level) number of sexual partners (aOR: 0.35; 95% CI: 0.15-0.81), HIV status of the partner (aOR: 5.03; 95% CI: 2.74-9.26), knowledge of universal test and treat (aOR: 1.97; 95% CI: 1.34-2.90), support from non-governmental organizations (chi-square = 10.18; p-value= 0.015 and provision of clinic staff (chi-square = 7.51; p value = 0.006) were identified as major factors influencing uptake of same-day ART initiation. In the bivariate analysis; gender (OR: 1.672; 95% CI: 1.002–2.791), number of sexual partners (OR: 2.092; 95% CI: 1.07–4.061), age (OR: 0.941; 95% CI: 0.734–2.791), ART start date (OR: 0.078; 95% CI: 0.042–0.141) and partner HIV status (OR: 0.621; 95% CI: 0.387–0.995) were significantly associated with viral load detection and retention in care. (All variables that were significant at e.g. 0.5 level in univariate). Our results suggest a steady increase in uptake of same day ART initiation with poor retention in care. The results also emphasise a vital need to not only streamline processes to increase immediate ART uptake further but also ensure retention in care in order to meet the 95-95-95 targets. The findings of the study contribute to knowledge useful for strengthening rapid ART initiation implementation by considering individual patient factors, healthcare workers’ perspectives and facility level factors. The qualitative findings revealed variations in UTT knowledge, experiences and observations among diverse healthcare workers from the four clinics in different geographical settings. While training on UTT and SDI of ART initiation was conducted at the inception of the implementation phase, the understanding and interpretation varied especially between clinicians and non-clinical healthcare providers. Denial, feeling healthy, fear of disclosure, limited knowledge about ART, fear of ART side effects, fear of stigma and discrimination were some of the factors HCW observed as hindering uptake of SDI. These findings relate to some of the reasons given by patients with fear of disclosure frequently mentioned by those who deferred SDI of ART.
Analyzing and strengthening the clinical support of undergraduate midwifery students and developing a mentorship training program at a higher education institution in KwaZulu-Natal, South Africa: a mixed method and action research design.
(2022) Amod, Hafaza Bibi.; Mkhize, Sipho Wellington.
The competence of midwifery students is highly dependent on the quality of clinical support they receive during clinical placement. Offering support and training to midwifery practitioners, who supervise students during placement, is necessary in South Africa. This study aimed to analyze and strengthen the clinical support of undergraduate midwifery students, and develop a mentorship-training program. This study adopted a mixed-method and action research approach incorporating a descriptive and exploratory design. A convenient and purposive sampling technique, multiple research tools (systematic scoping review protocol, questionnaires, interviews and focus groups), and three different study populations (60 midwifery students, 28 practitioners and 10 educators) complimented the aim of conducting a mixed-methods study. Data collection commenced for Cycle 1 in May 2019 and concluded with Cycle 4 in April 2022. Quantitative data was inserted into SPSS version 27 for descriptive and comparative analysis whilst qualitative data used a thematic content analysis approach. Cycle 1 results highlighted that 93% of students had support from midwifery practitioners and found that the clinical placement benefitted their learning outcomes. Although students received three types of clinical support, namely clinical supervision, mentorship and preceptorship, 80% of clinical support was clinical supervision. Postclinical placement, students were incompetent in 11.4% of their clinical requirements. In Cycle 2, a two-round Delphi method evaluated the quality of a mentorship-training program using midwifery experts in round 1 and midwifery practitioners in round 2. There was an overall quality score achieved of 81% round 1 and 96% in round 2. In Cycle 3, three themes emanated from the focus group discussions. Mentorship training was a new phenomenon, empowered mentorship abilities, and an investment toward midwifery leadership. Interview results showed that the mentorship training program was a new, well-structured and valuable program; a refresher course for midwifery clinical practitioners and educators, adequate to support midwifery practitioners in their mentorship roles and responsibilities, and produced recommendations for midwifery practice and education. Mentorship during clinical placement is likely to strengthen the clinical support of midwifery students. A mentorship training program for midwifery practitioners developed in this study is valuable to midwifery educators and practitioners in South Africa.
Challenges in developing and integrating community clinical psychology services in non-urban areas of KwaZulu-Natal.
(2023) Siyothula , Evy-Terressah Busisiwe.; Pillay , Anthony Lingum.
Abstract available in PDF.
Comparative study of covalent & non-covalent drug inhibitory mechanism investigation: targeting HSP72 protein in cancer therapy using molecular modelling techniques.
(2021) Aljoundi, Aimen Khalefa Misbah.; Soliman, Mahmoud Elsayed Soliman.
Cancer is the most complicated and diverse disease that has been menacing human beings worldwide. Up to date, important advancement has been done to improve the existing therapeutic interventions in the treatment and management of cancer. However, the side effect of these drugs that are mostly associated with the “off-target” effects is a perpetual failure in cancer drug development. Therefore, efficient regimen with minimal toxicities and high drug target selectivity should be achieved. Covalent inhibition is an emerging field in drug discovery and a very distinct category of therapeutics that reduces adverse side effects and possible interactions that lead to drug resistance due to its attainable reactivity and high selectivity. The Heat shock proteins (HSPs) play a crucial role in the clearance of damaged proteins by encouraging proteotoxicity and proteins acclamation. This process occurs by avoiding unsuitable stress-induced protein aggregation, ensure suitable refolding of denatured proteins, and promoting their degradation; thus, the involvement of this enzyme in many human diseases, including cancer. In this study, we delve into the structural features of one of the most crucial enzymatic targets of the stress proteins, the Heat shock proteins72. In drug development, the integration of computational techniques including molecular dynamic simulations, docking and molecular modelling has allowed drug developers to screen and syntheses millions of compounds and thus screen out possible lead drugs. Computer-Aided Drug Design has been validated as a cost-effective strategy to fast trace the drug discovery process due to these in silico methods. One of the characteristics of the HSP72 is its ability to be targeted either covalently or non-covalently through small drug molecules. Therefore, the above-mentioned methods, amongst several other computational tools were employed out in this study to provide insights into conformational changes that explain potential covalent and non-covalent inhibitory mechanisms, binding sites assessment features leading to promising small molecule inhibitor candidates. These combinatorial computational studies offer an inclusive in silico perspective to fill the gap in drug design studies about targeting protein degradation, thus providing insights toward the structural characteristics of the pivotal target and describing promising drug developments.
Concurrent treatment of in vitro cell lines with uthuli lwezichwe™, an African traditional medicine used in the management of diabetes mellitus in KwaZulu-Natal, with conventional treatments and their effects on glucose uptake and insulin secretion.
(2022) Hlatshwayo, Sphamandla.; Ngcobo, Mlungisi.; Gqaleni, Nceba.
Background: By the year 2025, prevalence of diabetes mellitus is estimated to reach 300 million globally; with type 2 diabetes mellitus comprising more than 90% of these cases. Due to the side effects which are sometimes adverse and gradual loss of efficacy with time, presented by conventional regimens; a number of diabetic patients have been reported to be using both traditional medicines and conventional regimens concurrently. Experimental and clinical experiments have yielded positive results on studies performed on conventional treatments in combination with traditional medicines and medicinal plant extracts. Most these studies have been performed using a single medical plant, whilst African traditional medicine (ATM) products constitute of a variety of medical plants. Aim: This study aimed to investigate the concurrent treatment of in vitro cell lines with Uthuli Lwezichwe™, an African traditional medicine used in the management of diabetes mellitus in KwaZulu-Natal, in combination with conventional treatments and their effects on glucose uptake and insulin secretion. Methods: Cell viability was used to establish the IC50 doses of Uthuli Lwezichwe™ for HepG2 liver, C2C12 muscle and RIN-5 pancreatic beta cell lines. The IC50 doses were used in combination with known effective doses of metformin, insulin and tolbutamide to treat liver, skeletal muscle and beta cells, respectively. Glucose uptake was monitored at 0, 6, 12 and 24 h time intervals. Changes in glycogen and glutathione (GSH) levels in treated liver cells were evaluated using a glycogen assay kit (MAK0160) and GSH Glo glutathione kits, respectively. Insulin secretion in treated pancreatic cells was assessed using an ultra-sensitive rat insulin ELISA kit. Results: In comparison to the untreated control, treatment with Uthuli LwezichweTM in combination with conventional drugs significantly increased (p<0.05) increased insulin secretion in comparison to all treatment groups. Conclusion: Interaction of anti-diabetic agents studied, resulted in ameliorated glucose metabolism, both via glucose uptake and insulin secretion. This could be beneficial both in modulating diabetes mellitus and its comorbidities.
Contraceptive use among adolescent girls in Zambia: a study on adolescents’ needs, preferences and perspectives on contraception methods=Ukusetshenziswa kwezivimbelakukhulelwa ngamantombazane angamatshitshi eZambia: Ucwaningo ngezidingo zamatshitshi, okukhethwayo nemibomo kwezindlela zezivimbelakukhulelwa.
(2023) Chola, Mumbi.; Ginindza, Themba Geoffrey.; Hlongwana, Khumbulani Welcome.
The fertility rate in Africa is among the highest in the world, and this trend is projected to continue unless drastic interventions are put in place to avert the situation. Contraceptive use among adolescents in sub-Saharan Africa remains very low despite various interventions to improve the uptake. The study aimed to examine the key determinants of contraceptive use among adolescent girls in Zambia; specifically, i) examining patterns, trends and factors that drive poor usage of contraceptives; ii) exploring the motivators and influencers of decision-making regarding contraceptive use among adolescent girls; and finally, iii) understanding their perspectives on existing contraceptive methods. The study examined patterns, trends and factors associated with contraceptive use among adolescents in Zambia, using data from 1996, 2001/2, 2007 and 2013/14 Zambia Demographic and Health Surveys. Qualitative data was collected through focus group discussions and analysed using thematic analysis. Permission to conduct the study was obtained from the Ministry of Health and the National Health Research Authority. Ethical approvals were provided by the Biomedical Research Ethics Committees (BRECs) of the University of Zambia and the University of KwaZulu-Natal in South Africa. Results revealed that contraceptive use among adolescent girls in Zambia remained low over the 18 years and increased by only 3%, particularly among younger, uneducated, and unmarried sexually active adolescent girls. Marriage or living with a partner contributed the most to the change in contraceptive use (44%), while living in a rural area accounted for approximately 20%. Adolescent girls' experience with contraceptives was affected by various factors such as knowledge of contraceptives, including sources of information and contraceptives, experience with using contraceptives, challenges with access to contraceptives, and misconceptions about contraceptives. The interaction of factors related to their personal experience, their community and the environment in which they access contraceptive services all contribute to the overall patient experience and influence the adolescent girls’ contraceptive decision. Most of the motivators for the use and/or non-use of contraceptives are intrapersonal and interpersonal. Contraceptive use among adolescent girls remains low and is determined by various factors. Key influencers and motivators for contraceptive use involve people in their lives, such as partners, family and community members. Interventions targeting increasing demand, access and use of contraceptives among adolescents must be innovative, participatory and implemented within the context of local cultural norms. IQOQA Izinga lokuvunda e-Afrika libalelwa kweliphezulu emhlabeni wonke, futhi le nkombamvama ihlelelwe ukuqhubeka ngaphandle uma kunokungenelela okunamandla okumele kufakwe ukuze kugwenywe isimo. Izimvimbelakukhulelwa ezisetshenziswa phakathi kwamatshitshi ase-Saharan Africa ziyohlala ziphansi ngale kokungenelela okwahlukene ukuze kuthuthukiswe lokho okukhona okuzosetshenziswa. Ucwaningo lwaluhlose ukuhlola izinkombamthelela ezisemqoka zokusetshenziswa kwezivimbelakukhulelwa phakathi kwamantombazane eZambia; ngokucacile i) ukuhlola izinhlelo, izinkombamvama noma izinto eziqhuba ukusetshenziswa kabi kwezivimbelakukhulelwa; ii) ukuhlola abagqugquzeli nabanomthelela ekuthathweni kwezinqumo ezimayelana nokusetshenziswa kwezivimbelakukhulelwa phakathi kwamantombazane angamatshitshi; ekugcineni, iii) ukuqonda imicabango yabo mayelana nezindlela ezikhona zezivimbelakukhulelwa. Ucwaningo lwahlola izinhlelo, izinkombamvama nezici ezihlobene nezivimbelakukhulelwa ezisetshenziswa phakathi kwamantombazane eZambia, lusebenzisa imininingo esukela onyakeni wowe-1996, 2001/2, 2007 kanye nowezi-2013/14 eZambia Demographic and Health Surveys. Kwaqoqwa imininingo yocwaningo lobunjalo botho kugxilwe ezingxoxweni zeqoqo okwakucwaningwa ngalo lahlaziywa kusetshenziswa uhlaziyongqikithi. Imvume yokwenza ucwaningo yatholakala kuNgqongqoshe WeZempilo kanye NeZiphathimandla Zocwaningo LweZempilo KuZwelonke. Isiqinisekiso SeNqubonhle sanikezelwa Amakomidi eBiomedical Research Ethics (BRECs) aseNyuvesi yaseZambia kanye neNyuvesi YakwaZulu-Natali eNingizimu Afrika. Imiphumela yocwaningo yaveza ukuthi ukusetshenziswa kwezivimbelakukhulelwa phakathi kwamantombazane angamatshitshi aseZambia kwahlala kuphansi esikhathini esingaphezu kweminyaka eyi-18 kwase kukhula ngama-3%, kwabancane, abangafundile kanye nakumantombazane abangamatshitshi angaganile kodwa alwenzayo ucansi. Umshado noma ukuhlala nomlingani wakho kube neqhaza elikhulu ezinguqukweni ezisetshenziswayo zokuvimbela ukukhulelwa (44%), ngenkathi ukuhlala endaweni yasemakhaya kubalelwa esilinganisweni esingama-20%. Lokho amantombazane asengamatshitshi aseke edlula kukho mayelana nokusetshenziswa kwezivimbelakukhulelwa kwaphazanyiswa yizinto eziningi njengolwazi lwezivimbelakukhulelwa kubandakanya nemithombo yolwazi nezivimbelakukhulelwa, odlula kukho uma usebenzisa izivikelakukhelwa, izingqinamaba zokusebenzisa izivimbelakukhulelwa kanye nemibono engemihle ngezivimbelakukhulelwa. Ukuxhumanakunikezelana kwezinto ezihlobene kulokho umuntu nomuntu adlule kukho, umphakathi wabantu kanye nendawo lapho abakwazi ukuthola khona izivimbelakukhulelwa konke kunomthelela kukho lokho isiguli esedlule kukho nalokho okuthinta izinqumo zokuvimbela ukukhulelwa ezithathwa ngamantombazane angamatshitshi. Abagqugquzeli abaningi bokusetshenziswa nokungasetshenziswa kwezivimbelakukhulelwa banobudlelwane bomuntu kanye nobudlelwane kubantu. Ukusetshenziswa kwezivimbelakukhulelwa amantombazane angamatshitshi kuhlale kuphansi futhi lokhu kudalwa yizinto ezahlukene. Abagqugquzeli nabakhuthaza ukusetshenziswa kwezivikelakukhulelwa basemqoka kufaka abantu ezimpilweni zabo, njengabalingani, umndeni namalunga omphakathi. Ukungenelela okuqonde ekukhuliseni isidingo, ukufinyelela nokusetshenziswa kwezivimbelakukhulelwa phakathi kwamatshitshi kumele kufake izindlela ezintsha, kubambe iqhaza futhi kuqaliswe engqikithini yenkambisonqubo yokuyisiko endaweni.
Critical care nurses’ perceptions of caring for patients at a selected hospital in KwaZulu-Natal.
(2022) Jugroop, Merashni.; Emmamally, Waheedha.
Background: Caring in a critical care setting requires a holistic process of individualised, patient-focused, and specialised care within a work intensive and technologically focused environment. These are what have an impact on how caring unfolds within a critical care environment. The COVID-19 pandemic has further altered the care relationship between critical care nurses, critically ill patients and their families. Aim: To determine critical care nurse’s perceptions of caring for patients at a selected hospital in KwaZulu-Natal Methods: A quantitative, descriptive, cross-sectional study was conducted on 139 participants in a tertiary quaternary hospital. Data collection used the Caring Assessment for Caregivers questionnaire, and analysis was with descriptive statistics. Results: Results revealed that most of the participants were females above 30 years, holding a Diploma in Nursing and had > 10 years of work experience. Participants had an overall high perception of caring, with a total mean score of 116.01 (range of 25- 125). Of the five subscales, the subscale of “Maintaining belief,” had the highest mean composite score 24.25(range of 5-25) and the subscale of “Being with,” had the lowest mean composite score 22.70. There was no significant relationship found between the critical care nurses’ socio-demographic characteristics, the overall score and the total scores of each of the five subscales. Conclusion: Whilst critical care nurses reported a high overall perception of caring, lower mean scores on the subscale “Being with” suggest that there areas for critical care nurses to grow in their role as carers. Further research is necessary for replication of the study using qualitative approaches to bring forth valuable findings on how the critical care environment has an impact on the caring experiences of critical care nurses.
Effect of HIV-1 subtype C Transactivator of transcription (Tat) A21P variant on TAR binding ability, nuclear levels of active positive transcription elongation factor b (P-TEFb) and viral latency.
(2023) Mkhize, Zakithi Zinhle.; Madlala, Paradise Zamokuhle.
The HIV-1 Transactivator of transcription (Tat) enhances the ability of the viral promoter 5’ long terminal repeat (LTR) to drive viral gene transcription and is important for HIV-1 pathogenesis. Tat binds to the transactivator RNA (TAR) element of the 5’LTR and subsequently recruits the host positive transcription elongation factor b (P-TEFb) for efficient viral gene transcription. Inter- and intra-subtype Tat genetic variation that translates to functional differences has been reported. Specifically, HIV-1 subtype C (HIV-1C) exhibiting Alanine at position 21 of the Tat protein (TatA21) was reported to be associated with reduced LTR transcriptional activity compared to Tat exhibiting Proline at position 21 mutation (TatP21). However, the effect of Tat variation on its ability to recruit P-TEFb is unknown. Therefore, this study seek to determine the effect of HIV-1 subtype C TatA21 mutant on the ability of Tat to recruit P-TEFb to 5’ LTR to enhance viral gene transcription. To this effect, site-directed mutagenesis (SDM) was performed on the Plasmid pcDNA3.1(+) HIV-1C BL43/02 TatA21 to introduce TatP21 alone or together with other mutations using designed primers and the Q5 DNA polymerase kit. The effect of Tat mutations was measured using Tat transactivation assay where the luciferase activity was the measured output in TZM-bl cell lines and the impact of TatA21 was further assessed on ability of the LTR to drive GFP and Gag expression in Jurkat and A72 cells respectively. Next, protein modelling was performed using Hdock software, followed by RNA immunoprecipitation (RNA IP) was performed using stably expressing TatA21 and TatP21 in Jurkat cells. Lastly, co-immunoprecipitation of TatA21 and associated with significantly reduced LTR transcription activity compared to TatP21 (p = 0.0004). TatA21 resulted in had significantly lower GFP expression Jurkat cells (p = 0.0439) and lower Gag expression in A72 cells compared to TatP21. Although TatA21 reduced the LTR transcription activity compared to TatP21, protein modelling using Hdock software revealed that TatA21 and TatP21 protein structures were the same. Consistently, molecular docking showed that TatA21 had a lower binding affinity than TatP21. The RNA IP showed that TatA21 had significantly reduced affinity to bind to TAR compared to TatP21 (p = 0.0151). Moreover, TatA21 and TatP21 formed a complex with cycT1 and CDK9. Taken together, our data shows that HIV-1C TatA21 significantly reduced its transactivation activity but does not affect its ability to recruit P-TEFb. Interestingly, TatP21 is able to bind TAR more efficiently than TatA21 thus revealing a possible mechanism but which the reduced functionality of SDMs and patient derived TatA21 variants was observed. The effect of TatA21 and TatP21 on the propensity of HIV-1 latency development or reversal. To this effect, a recombinant viral vector exhibiting either TatA21 (C731CTatA21C) or TatP21 (C731CTatP21C) were generated. The C731CTatA21C or C731CTatP21C were separately co-transfected together with VSV-G and R8.91 into Jurkat cells for virus production. This virus was then used to infect Jurkat cells for 3 days. Followed by cell sorting of GFP- cells, which represented either truly negative or latently infected cells was then performed. We were able to successfully generate C731CTatA21C virus and characterized it to a 1.2% reactivation. However, the generation of C731CTatP21C recombinant viral vector was unsuccessful and thus could not be used for comparison. Future studies should involve the characterization of TatP21 in the propensity of latency development and/ or reactivation.
Effective coverage of emergency obstetric and newborn care services in Wolaita Zone, Southern Ethiopia=Ukubhekana nesimo esiphuthumayo sokubelethisa nezinsiza zokunakekela izinsana endaweni iWolaita eNingizimu ye-Etopiya.
(2023) Arba, Mihiretu Alemayehu.; Khuzwayo, Nelisiwe.; Yota, Bereket Yakob.
Background: Despite the significant improvement in the availability and access of facilities in low and middle-income countries, a considerable burden of maternal and child morbidity and mortality exists, further suggesting the need for effective coverage of EmONC services. Understanding the extent to which the health system delivers quality service and the factors that predict the gap in providing the services are vital to evidence-based decisions at the local, national, and global levels. However, evidence is lacking on the effective coverage of EmONC services and factors influencing quality service provision. Objective: This study aimed to understand, explore, and describe the contexts, correlates, and levels of effective coverage of EmONC services in the Wolaita Zone, southern Ethiopia, and develop a model for effective coverage of EmONC services. Methods: After mapping the evidence for effective coverage of EmONC services in Africa, the study employed an explanatory sequential mixed-method approach. The quantitative study applied a cross148 sectional design, including 414 (facility-based survey) and 402 (house-to-house survey) study participants. The quantitative data were collected using an Open Data Kit (ODK) tablet phone software and exported to Stata version 17 for analysis. Simple and multiple linear regressions, along with p151 values, coefficients, and 95% confidence intervals, were used to declare the statistical significance and strength of the association. The qualitative study employed a case-study research design including 37 participants (selected using maximum variation sampling) to explore the barriers and enablers of EmONC services utilization. The coding and thematic analysis of the qualitative study were assisted by NVIVO version 12 software. The qualitative study assured trustworthiness by establishing credibility, transferability, conformability, and dependability. Result: The scoping review showed a paucity of evidence on the effective coverage of EmONC services in Africa. It also provided a summary of existing evidence on the crude coverage, quality of EmONC services assessed through diverse indicators, and factors linked with the quality of EmONC services. The household survey identified 72.1% crude coverage of EmONC services. The facility-based survey of EmONC services revealed that the indices of structural, process, and output quality were 74.2%, 69.4%, and 79.6%, respectively. Overall, 59.2% of women with EmONC service-need received poor quality services. Women’s education grade 1–8 (B=5.35, 95% C.I: 0.56, 10.14), and grade 9–12 (B=8.38, 95% C.I: 2.92, 13.85), age (B= 3.86, 95% C.I: 0.39, 7.33), length of stay at health facility (B= 3.58, 95% C.I: 2.66, 4.9), crowding in the delivery room (B= -4.14, 95% C.I: -6.14, -2.13), and health professional’s experience (B= 1.26, 95% C.I: 0.83, 1.69) were statistically significant predictors of observed EmONC service quality. Overall, the effective coverage (the crude coverage adjusted by the observed quality of care) of EmONC services in the Wolaita Zone was 50%, indicating half of the potential health gain loss in EmONC services. The qualitative study of barriers and facilitators of EmONC services utilization identified five themes that interacted at different levels. Theme one was women’s perceptions and experiences with EmONC services, including their knowledge and awareness of the availability of services, perception of the quality of care, reputation, respectful care, and care providers’ gender. Theme two was community-related factors encompassing misconceptions, traditional management of obstetric complications, the role of traditional birth attendants, and family and peer influence on EmONC services utilization. Theme three was the accessibility and availability of EmONC services, including infrastructure and delays in transportation. Theme four was healthcare financing which focused on drugs and supplies, out-of-pocket expenses, and service fee exemption. Theme five was the health facility-related factors related to the care provider, referral system, waiting time, and leadership. Conclusion: The study showed that the effective coverage of EmONC services in the Wolaita Zone (Southern Ethiopia) was low, where half of the potential health gain was lost due to barriers centered on the women, community, access and accessibility, healthcare financing, and health facility linked factors. The quality of EmONC services was sub-optimal, where women and newborns received inadequate services, and the care providers poorly adhered to the standard clinical actions. The study also underlined that the care providers’ adherence to the standard clinical actions was poor and is significantly associated with the age and education of women, length of stay in the facility, crowding of the delivery room, and health professionals’ experience. The inequitable effective coverage of EmONC services implied loose emphasis and suggested an urgent need for the health system’s intervention. Therefore, interventions directed at the identified bottlenecks can improve the utilization and quality of care, ultimately enhancing effective coverage. Furthermore, the model developed by the study can be utilized to enhance maternal and newborn health. Iqoqa Isingeniso: Nakuba kubonakala ukuthuthuka ekutholakaleni nasekufinyeleleni kwezikhungo emazweni anengenisomali ephansi nemaphakathi, kusenomthwalo omkhulu wokugula komama nokufa kwezingane okukhona, futhi kuphakamisa isidingo sokuhlinzekwa ngempumelelo kwezinsiza eziphuthumayo zokubelethisa nokunakekela izinsana (Emergency Obstetric and Newborn Care - EmONC) nezinto ezinomthelela ekuhlinzekeni ngensiza yezingabunjalo. Lolu cwaningo, lwaluhlose ukuqonda, ukuhlola nokuchaza ingqikithi, ukuhambisa, namazinga okufaka ngempumelelo izinsiza ze-EmONC endaweni iWolaita, eNingizimu ye-Etopiya. Izindlelakwenza: emva kokwenza inkombandlela yobufakazi yobungako bokusebenza kwezinsiza ze–EmONC e-Afrika, ucwaningo lusebenzise indlela echazayo ngokulandelanayo kwendlelakwenza eyingxube. Ucwaningo lwekhwantithethivu lusebenzise umklamomumo wocwaningo oyimpambanazigaba (isikhungo sezempilo nenhlwayalwazi yomuzi nomuzi) ngokuqoqa imininingo kusetshenziswa iOpen Data Kit yethabhulethi foni softhiwe nokuyihlaziya kusetshenziswa uhlobo lwe-17 software. Ucwaningo lwekhwalithathivu lusebenzise umklamomumo wocwaningo, futhi ukuhlaziya kulekelelwe ngeNVIVO yohlobo lwe-12 lwesofthiwe. Umphumela: ukubuyekezwa kokuhloliwe kukhombise ukuswelakala kobufakazi ngokufaka okusebenzayo kwezinsiza ze-EmONC e-Afrika. kuphinde kwabeka ngamafuphi ubufakazi obukhona nokwenza obala, ubunjalozinga bezinsiza nezinto ezihlobene. Kukho konke, ukufaka okusebenzayo kwezinsiza ze-EmONC. Inhlwayalwazi ebizinze esikhungweni idalule ukuthi izinkomba zesakhiwo, inqubo nezingabunjalo lokuphumayo kube ngama-74.2%, 69.4%, nama-79.6%, ngokulandelana. Imfundo yabesifazane, iminyaka yobudala, isikhathi sokuhlala esikhungweni sezempilo, ukuminyana endlini yokubeletha nolwazi lwabezempilo abangongoti kwakuqagula okubalulekile ngokwezibalo zezingabunjalo lokunakekelwa. Ucwaningo lwekhwalithethivu luhlonze izingqikithi ezinhlanu: imibono yabesifazane nolwazi oluhambisana nezinsiza ze-EmONC, izinto ezihambisana nomphakathi, ukufinyelela nokutholakala kwezinsiza ze-EmONC, ukufaka imali kwezempilo nezinto ezihlobene nesikhungo sezempilo. Isiphetho: Lolu cwaningo luhlonze ukubika okuphansi kokusebenza kwezinsiza ze-EmONC, ekubeni yingxenye yenzuzo yezempilo eyayingaba khona yalahleka ngenxa yemigoqo eyimixhantela. Ubunjalozinga bensiza belisezingeni eliphansi, lapho abesifazane nezinsana bethole izinsiza ezingenele, futhi abahlinzeka ngonakekelo bengagxilisisi kahle ezenzweni ezejwayelekile emtholampilo. Ukusatshalaliswa kokufaka okusebenzayo okungalingani kukhomba ukuyekethisa nokuphakamisa isidingo esiphuthumayo sohlelo lwezempilo ukuba lubhekane nezithiyo ezihlonziwe.
The effects of a lung cancer awareness intervention in KwaZulu-Natal (KZN): a stratified cluster based study in five representative communities=Imithelela yokungenelela ngokuqwashisa mayelana nomdlavuza wamaphaphu KwaZulu-Natali (KZN): Ucwaningo lwamaqoqo ngokohlelomikhakha emiphakathini emihlanu eqokelwe ucwaningo.
(2022) Dlamini, Siyabonga Blessing.; Ginindza, Bonginkosi Mfundza.
Abstract Background Lung cancer is the leading cause of cancer mortality worldwide, accounting for approximately 1.8 million cancer deaths in 2020. In South Africa, lung cancer is among the top four ranking cancers in terms of morbidity and mortality after breast, prostate, and cervical cancers. The objective of the study was, therefore, to investigate the level of awareness about lung cancer and its screening among communities in KZN, in an attempt to increase awareness of this disease across the province. Methodology A quasi-experiment study was conducted among the selected communities in KZN. In total, forty out of 879 clusters were selected, where a comparison between two cross-sectional surveys was done. An intervention employing community health workers aimed at raising awareness of lung cancer was developed, implemented and evaluated in these communities. A binary logistic regression model was used to measure the effects of the intervention. Results At baseline, approximately 59.9% (95% CI 52.0 - 67.3) of the participants had heard of lung cancer. About 5.7% (95% CI 3.9 - 8.1) were screened for lung cancer at the time. Coughing up blood was the most recognised symptom (61.0%, 95% CI 52.1 - 69.1). Post-intervention, the mean knowledge score increased to 59.9 (95% CI 53.8 – 66.0) (p<0.001). There was a reduction in the number of cigarettes smoked per day (p<0.001) and the number of packs smoked per week (p=0.026). However, the prevalence of smoking remained relatively the same before and after the intervention, at approximately 18% (p=0.958). The intervention had a statistically significant effect (aOR 4.370, 95% CI 1.477-12.928) on lung cancer knowledge in these communities (p<0.001). Conclusion The intervention in this study demonstrated the ability to raise awareness of lung cancer at a community level. It also reduced the number of cigarettes smoked among smokers. Therefore, integration into smoking cessation programmes should be explored. A national lung cancer screening programme should be introduced to encourage health-seeking behaviour. The integration of a lung cancer awareness intervention into the already existing community health worker programmes, such as the tuberculosis response strategy, is recommended. Iqoqa Isendlalelo Umdlavuza wamaphaphu ungenye yezimbangela eziphambili zokubulawa umdlavuza emhlabeni wonke jikelele. Kubantu ababulawa umdlavuza ngonyaka wezi-2020, bayi-1.8 wezigidi zabantu ababulawa umdlavuza wamaphaphu. ENingizimu Afrika umdlavuza wamaphaphu ungolunye lwezinhlobo ezine zomdlavuza ezihamba phambili eziphatha abantu futhi zibabulale emva komdlavuza webele, umdlavuza wamankwahlwa (iprostate), kanye nowesibeletho. Inhloso yalolu cwaningo kwakunguphenya ngamazinga olwazi mayelana nomdlavuza wamaphaphu kanye nokuhlolwa kwawo emiphakathini yaKwaZulu-Natali ngenjongo yokuqwashisa kabanzi ngalesi sifo esifundazweni jikelele. Indlelakwenza Kwenziwa ucwaningo oluyisingalinge emiphakathini eqokelwe ucwaningo KwaZulu-Natali. Esewonke kwakhethwa amaqoqwana angama-879 lapho kwaqhathaniswa khona amasaveyi amabili across-sectional. Kwathuthukiswa, kwasetshenziswa kwaphinda kwahlolwa ukungenelela konompilo ngenhloso yokuqwashisa ngomdlavuza wamaphaphu kule miphakathi. Kwasetshenziswa imodeli yesilinganisobudlelwane ukulinganisa imithelela yalokhu kungenelela. Imiphumela Ukusuka phansi, bangacishe babe ngama-59.9% (95% CI 52.0 - 67.3)kubabambiqhaza abake bezwa ngomdlavuza wamaphaphu. Okungenani u-5.7% (95% CI 3.9 - 8.1) wahlolwa umdlavuza wamaphaphu ngaleso sikhathi. Ukukhwehlela igazi yikhona okwakuyinkomba eyaziwayo (61.0%, 95% CI 52.1 - 69.1). Emva kokungenelela, imini yobungako bolwazi yanyukela ku-59.9% (95% CI 53.8 – 66.0) (p<0.001). Kwaba nokuncipha kwesibalo sosikilidi ababhenywa ngosuku (p<0.001) kanye namaphakethe abhenywa ngesonto (p=0.026). Kodwa-ke, ukuvama kokubhema akuzange kwehle ngaphambi kanye nasemuva kokungenelela; kwakumi ku-18% (p=0.958). Ukungenelela kwaba nomthelela omkhulu ngokwezibalomidanti (aOR 4.370, 95% CI 1.477-12.928)maqondana nolwazi ngomdlavuza wamaphaphu kule miphakathi (p<0.001). Isiphetho Ukungenelela kulolu cwaningo kwakhombisa okungenzeka uma kuqwashiswa abantu ngomdlavuza wamaphaphu ezigabeni semiphakathi. Kwaphinda kwanciphisa isibalo sikasikilidi obhenywayo kubantu ababhemayo. Ngakho-ke kumele kuhlolwe izindlela zokuhlanganiswa kwezinhlelo zokuyekiswa ukubhema. Kumele kuqaliswe ngohlelo lukazwelonke lokuhlola umdlavuza wamaphaphu kubantu ukuze kukhuthazwe umkhuba wokufuna usizo lwezempilo. Kuphakanyiswa ukuthi kuhlanganiswe ukungenelela ngokuqwashisa abantu ngomdlavuza wamaphaphu ezinhlelweni zonompilo ezikhona emiphakathini ezifana namaqhinga okuhlangabezana nesifo sofuba.
Evaluation of the addition of moringa oleifera as a nutritional supplement on the anthropometric, viral load, and cd4 counts of adult hiv patients on antiretroviral therapy.
(2022) Gambo, Aisha.; Gqaleni, Nceba.
Background: This thesis reports on studies conducted at the S. S Wali virology centre, Aminu Kano Teaching Hospital (AKTH), Kano State, Nigeria. The studies aimed to evaluate the addition of Moringa oleifera Lam. leaves powder as a nutritional supplement on the anthropometric and immune status of adult HIV patients on antiretroviral therapy (ART). The studies further assessed the quality of life (QoL) and dietary diversity of PLHIV. Method: The study was a six months double-blind randomized controlled trial conducted from December 2017 to November 2018. Two hundred consented patients on ART were randomly allocated to either Moringa oleifera Lam. group (MOG) or the control group (COG). The participants were followed for six months. The outcomes assessed were changes in anthropometric parameters (weight, body mass index [BMI], and mid-upper-arm circumference [MUAC], changes in immune status (CD4 cell count and viral load), and the impact of the intervention on quality of life (QoL) using the WHOQOLHIV-Bref questionnaire. Additionally, the dietary diversity of the patients was assessed using the FAO 24-hour dietary recall questionnaire. Results: One hundred and seventy-seven patients completed the six-month follow-up (89 MOG versus 88 COG). At study inception, both groups had similar socio-demographic, socioeconomic, nutritional status, and immunological characteristics. At both baseline and sixth month, a poor dietary diversity pattern was observed. The food groups most commonly consumed in both MOG and COG were cereals, spices and condiments, oils, fats and palm oil, and dark green vegetables. In both groups, participants were in the medium or low dietary diversity tercile. Over the study period, Moringa oleifera Lam. leaf supplementation did not have an impact on any of the anthropometric parameters measured. However, Moringa oleifera Lam. leaf supplementation intervention and ART were effective in improving the CD4 cell counts of the study participants. No effect was observed in the viral loads in both study groups. Supplementation with Moringa oleifera Lam. leaf for PLHIV that are on ART improves the quality of life (QoL) domains of physical, psychological, level of independence, and social relationships. Conclusion: The study suggests that nutritional supplementation with Moringa oleifera Lam. leaf has a beneficial effect among adult HIV patients on ART in a limited resource setting. In low-income settings like Nigeria, programs should consider nutritional supplementation as part of a comprehensive approach to ensure optimal treatment outcomes in people living with HIV and AIDS.
Experience of forgiving in Indian marriages: a qualitative inquiry.
(2022) Essop, Karshila.; Hlengwa, Wellington Mthokozisi.
This research study concentrated on understanding the experience of forgiving in Indian marriages in Durban, KwaZulu Natal. The qualitative research study involved eight participants who were interviewed using a semi-structured interview schedule. With the consent of each participant, every interview was recorded utilising an audio recorder and then later transcribed by the researcher. The ecological systems theory was utilised as a framework for the study. The data that was obtained during the data collection period was evaluated, analysed and organised through thematic analysis. This assisted the researcher to organise data into themes, sub-themes and sub-sub-themes. The five themes that were discovered and discussed are: Understanding forgiveness, the experience of forgiving, the psycho-social influences of forgiving, dominant cultural influence and improvement of forgiveness in Indian marriages. The research study found that the participants experienced forgiving more positively than negatively. Forgiveness allowed for trust to be rebuilt in marriages and paved the way for harmony in both spousal and/or family systems. The research study found that reconciliation in Indian marriages plays a vital role and affects every participant’s family system, spousal system, psychological health and well-being. A strong correlation between forgiveness and personality was drawn indicating that personality is one of the more significant influences on forgiving. More so, social, cultural and theological influences were seen as strong motivators of forgiving in Indian marriages. Participants recommended marital counselling and face-to-face conversations about transgressions created between spouses to assist marital forgiveness in Indian marriages. Through the limitations of the research study discussed in chapter six, it is proposed that further research on the experience of forgiving in Indian marriages should be conducted.
An exploration of binge drinking and coping behaviour during covid-19 among students in a major tertiary institution in KwaZulu-Natal.
(2023) Faborode, Joy Adebowale.; Kathree, Tasneem.
Background: The COVID-19 pandemic has profoundly impacted human lives. At the emergence of the novel disease, several restrictive measures, including lockdowns, were implemented to mitigate the spread of COVID-19. These measures created stressful challenges that affected people’s mental wellbeing, including that of tertiary students. There is a dearth of information on the strategies students use to cope with COVID-19-related stress. This study aimed to understand how students experienced and coped with changes attributed to the lockdowns in South Africa, including factors that influenced alcohol use among students at a major tertiary institution in KwaZulu Natal during the COVID-19 lockdown. Method: A qualitative approach was used. Twenty students were recruited from two campuses at the University of KwaZulu-Natal (UKZN), Durban, South Africa, using purposive sampling. Individual indepth interviews were conducted using a semi-structured interview guide comprising open-ended questions. The NVivo software program was used for analysis. Results: The majority (60%) of participants were male and ranged from 20 to 36 years old. The results of this study indicate drinking patterns among the study sample. Results indicate that despite implementing an alcohol sale ban during the COVID-19 lockdowns, alcohol use was not eliminated, but there was some reduction in the intake of alcohol. Apart from alcohol restrictions, some factors influencing drinking included drinking location and people with whom participants consumed alcohol. Many participants also indicated that they preferred to consume alcohol with friends because it helped them to bond with their friends and improved their social interactions. In addition, over 50% of the students stated that they drank alcohol because they felt happy, socialized with others, had fun, and that they enjoyed the taste. In contrast, only a few (four) reported drinking as a coping mechanism. Respondents were also aware of the negative consequences of drinking alcohol, especially when it is in large quantities. Results also indicate that half of the participants felt stressed, depressed, anxious and sad during the lock down. In addition, they also experienced problems related to eating and sleeping. The study highlighted the various coping mechanisms participants used to deal with stress. These included emotion-based coping strategies such as social support, sleeping, exercise, reading, watching television, listening to music, and maintaining a positive attitude, problem-based coping strategies (e.g., positive thinking and planning), as well as avoidance forms of coping (such as ignoring the situation). Conclusion: This study found that alcohol misuse was common in this sample of university students prior to the onset of COVID-19, and they experienced some distress during the COVID-19 lockdown. Factors that influenced alcohol use were also identified in this study sample which provided insight into how they experienced and coped with changes directly caused by the lockdowns in South Africa. 11 Despite these findings, sampling students from only one tertiary institution in KwaZulu Natal and being unable to interview students in their home language or the language of fluency if this was not English are identified as limitations. This study recommends that health promotion and education on alcohol use and coping strategies should be encouraged at tertiary institutions to curb alcohol misuse and improve students’ wellbeing.
Exploring burnout among frontline healthcare workers during covid-19 pandemic in Mthatha, Eastern Cape, South Africa.
(2023) Fathuse, Noluyolo.; Ginindza, Themba Geoffrey.; Hlongwana, Khumbulani Welcome.
Introduction: Burnout prevalence among healthcare workers (HCW) is high and has a negative impact on individuals’ health, patient care and, ultimately, organizational efficiency. Burnout is a state of emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment (1). While the 2019 Coronavirus (COVID-19) exacerbated the burnout prevalence among HCWs, limited studies have explored this phenomenon using qualitative methodologies in the Eastern Cape Province and South Africa generally. This study explored how frontline HCWs experienced burnout during the COVID-19 pandemic in Mthatha Regional Hospital (MRH). Methods: Ten face-to-face in-depth interviews were conducted with non-specialized medical doctors and nurses who directly cared for COVID-19-infected patients during the pandemic in MRH. Indepth interviews were digitally recorded and transcribed verbatim. Data were managed through NVIVO 12 software before being thematically analyzed using Colaizzi’s analysis method. Results: Four main themes emerged from the analysis. These themes were burnout manifestation (emotional strain, detachment and irritability, uncertainty-induced fear and anxiety, physical exhaustion, yet, low job accomplishment, dread and professional responsibility), precursors of burnout (occupational exposure to high mortality, staff shortages, elongated high patient volume and workload, disease uncertainties and consistent feeling of grief), alleviating factors of burnout (time off work, psychologist intervention, periods of low infection rate and additional staff), and the last theme was every cloud has a silver lining (improved infection prevention and control (IPC) measures, learning to be more empathetic, the passion remains and confidence grows). Conclusion: The COVID-19 pandemic brought about a rapid change in the work environment of healthcare workers who are the backbone of efficient healthcare services, thereby rendering them vulnerable to increased burnout risks. This study is expected to provide comprehensive information on burnout, its predisposing factors, its manifestations, and alleviating factors. And also, these findings are anticipated to contribute to the strategic development and strengthening of welfare policies to promote and protect frontline HCWs wellbeing and well-functioning at work during the COVID-19 pandemic and future pandemics.
Factors influencing intention and uptake of COVID-19 vaccines on the African continent: a scoping review.
(2022) Naidoo, Damian.; Meyer-Weitz, Anna.
The COVID-19 pandemic is a severe concern worldwide, particularly in Africa. Vaccines are crucial in the fight against the COVID-19 pandemic. This scoping review examined existing literature on factors influencing intention and uptake of COVID-19 vaccines in Africa. Arksey and O'Malley's five-stage methodological paradigm was applied. A comprehensive search was undertaken from October 1st to 13th, 2021, using EBSCOhost, PubMed, Web of Science, and Google Scholar regarding the factors influencing intention and uptake of COVID-19 vaccines for studies conducted in Africa. A total of fifty published academic articles were reviewed, with many conducted in Nigeria and Ethiopia. The data analysis revealed five themes: attitudes & perceptions towards COVID-19 vaccines, intention to uptake COVID-19 vaccines, factors associated with acceptance/non-acceptance, socio-demographic determinants affecting the intention and uptake, and information sources for COVID-19 vaccines. The intention for uptake ranged between 21% and 90.1 %. Factors that promoted vaccine acceptance included confidence in the COVID-19 vaccine and the desire to protect vulnerable people. Age and sex were the most common factors significantly associated with vaccine acceptance. In contrast, most studies revealed that respondents' primary reasons for non-acceptance were safety and effectiveness concerns. The primary source of knowledge for the COVID-19 vaccines came from mass and social media. The vast majority of studies examined revealed that considerable barriers to vaccine uptake exist in Africa, contributing to the public's apprehension in this regard and resulting in a suboptimal uptake intention. To encourage vaccine uptake, governments should pay attention to refuting misinformation through integrated community-based approaches.
Host immune responses to plasmodium berhei ANKA and trichinella Zimbabwenisis infection in balb/c mice.
(2015) Nyamongo, Onkoba Wycliffe.; Chimbari, Moses John.; Mukaratirwa, Samson.
Four objectives were pursued in this study; (i) metabolic and adaptive immune responses induced in BALB/c mice infected with a tissue-dwelling nematode, Trichinella zimbabwensis were measured, (ii) differential cytokine and antibody responses induced in mice infected with T. zimbabwensis were determined, (iii) cytokines, anti-Trichinella and anti-Plasmodium antibody responses in mice mono- and co-infected with Trichinella zimbabwensis and Plasmodium berghei ANKA were determined and (iv) the effect of antihelminthic treatment against T. zimbabwensis on immunity and malaria disease outcomes was determined. Groups of BALB/c mice were mono- or co-infected with a crocodilederived T. zimbabwensis (Code 1SS1209) and P. berghei ANKA parasites. At various time points, metabolic parameters such as levels of water and food intake, glucose and insulin were measured. Cytokine and antibody responses were also measured by ELISA. Parasite burden and survival rates were used to determine malaria disease outcomes. The results showed that primary T. zimbabwensis infection was characterised by significantly elevated levels of insulin (p < 0.001) that were accompanied with hypophagia, weight loss, altered host compensatory feeding mechanisms. Parasite specific antibodies and Th1/Th2/Th17 and T-regulatory immune responses were elevated. In co-infection, it was observed that T. zimbabwensis induced immunomodulation that conferred protection against Plasmodium growth and early death. Anti-helminthic treatment enhanced antibody and cytokine production in mono- and co-infection mice (p < 0.001) and negatively affected malaria parasite multiplication by improving survivorship of co-infected mice by 42.85% (p < 0.001). From the study, it was concluded that T. zimbabwensis parasites induce mixed Th1/Th2/Th17 immune responses, alter host glucose metabolism and trigger immunomodulation that ameliorated malaria disease outcome. Anti-helminthic treatment acted as an immunomodulator for cytokine and antibody production, ameliorated malaria infection and improved survivorship of co-infected mice. The study shows that malaria coinfection with T. zimbabwensis and anti-helminthic treatment improves survival, enhances immunity and ameliorates malaria. It further shows that deworming may be used as an integrated control measure in areas where malaria and helminths are co-endemic.
Immune biomarkers of pulmonary tuberculosis treatment response and disease severity among HIV-infected and uninfected individuals from Kwazulu-Natal, South Africa.
(2023) Rambaran, Santhuri.; Sivro, Aida.; Naidoo, Kogieleum.
Background: Tuberculosis is one of the major causes of morbidity and mortality worldwide. The COVID -19 pandemic has had a devastating impact on TB, contributing to increased incidence of both TB and drug-resistant TB. Identification of host immune biomarkers of TB risk, treatment outcome and disease severity are key to the development of more efficient diagnostics and treatment modalities. There is an urgent need for accurate and easily detectable non-sputum-based biomarkers that can correlate with the activity or burden of Mycobacterium tuberculosis. Here, we characterised soluble and cellular phenotypes during active TB and TB/HIV co-infection and assessed their associations with time to negative culture conversion and disease severity. Methods: The study was performed utilizing stored plasma and peripheral blood mononuclear cells from the Improving Retreatment Success (IMPRESS) trial. Multiplex immunoassays and ELISAs were used to evaluate 24 cytokine and chemokine expression during active TB (n=132). Flow cytometry was used to evaluate phenotypic profiles of monocytes, dendritic cells (n=90) and CD4+ T cells (n=75). A Cox proportional hazards and logistic regression models were used to assess the associations between the measured cytokines and chemokines, phenotypic profiles of monocytes, dendritic cells and CD4+ T cells and time to negative culture conversion and lung cavitation in individuals with TB and TB/HIV co-infection. Results: We identified soluble inflammatory signatures of treatment response and disease severity. IP-10 expression during active TB was associated with increased odds of sputum culture conversion by 8-weeks in the total cohort and among the HIV-infected individuals. Increased MCP-3 expression was associated with a shorter time to culture conversion in the total cohort. While among the HIV-infected individuals, higher expression of IL-1RA, IP-10 and IL-1α associated with a shorter time to culture conversion. Higher expression of IL-6 was significantly associated with shorter time to culture conversion and increased risk of lung cavitation in the overall cohort and among TB/HIV co-infected individuals. Additionally, higher IL-1RA expression was associated with the presence of lung cavitation in the total cohort and in HIV-infected individuals. We observed distinct monocyte and dendritic cell profiles in TB/HIV co-infection. Individuals with TB/HIV co-infection had a significantly higher percentage of total monocytes and dendritic cells compared to healthy controls. Increase in CCR2, CD11b and CD40 was associated with active TB while decrease in CX3CR1 and increase in CD163 was associated with HIV infection. Expression of CX3CR1 on non-classical monocytes was associated with longer time to culture conversion while expression of CD86 on intermediate monocytes was associated with presence of lung cavitation. With respect to CD4+ T cells HIV positive individuals with active TB had significantly lower percentage of CD4+ T cells and significantly higher proportion of activated CD4+ T cells compared to TB and healthy control groups. Percentage of CD4+ T cells was significantly associated with increased risk, while the percentage of activated CD4+ T cells was associated with decreased risk of lung cavitation. Integrin α4β7 expressing CD4+ T cells were increased in TB/HIV compared to TB group and was associated with longer time to TB culture conversion in co-infected individuals. Conclusion: The data from this study provides valuable insight into the role that plasma immune biomarkers, monocytes, dendritic and CD4+ T cells play in TB treatment response and disease severity in active TB and TB/HIV co-infection.
Integrating knowledge-to-practice for occupational therapists working with high-risk infants in the KwaZulu-Natal public health sector: a qualitative explorative inquiry.
(2020) Dawood, Ayesha.; Naidoo, Pragashnie.; Ogunlana, Michael Opeoluwa.; Rencken, Gina.
Introduction: Neonates are an at-risk population due to their increased susceptibility of mortality and morbidity. Occupational therapists have an important role in Early Childhood Intervention (ECI) and implementing Neurodevelopmental Supportive Care (NDSC) for high-risk infants whilst they are admitted in the Neonatal Intensive Care Unit (NICU). To the best knowledge of the author there is a paucity of literature available within the South African context in the use of evidence-based practices (EBP), and the integration of knowledge translation (KT) amongst occupational therapists who provide therapeutic management to high-risk infants and their families. Aim: This study aims to explore the knowledge to practice gaps experienced by occupational therapists who support high-risk infants in different levels of care in the public health sector of KwaZulu-Natal South Africa. Methods: A qualitative exploratory research design was used for this study. A nonprobability sampling technique was used. Seventeen occupational therapists who have more than two years of experience and are employed on a full-time basis in the public health sector of KZN participated in this study via online focus group discussions. Data were analysed using thematic analysis with inductive deductive reasoning, guided by a combined theoretical framework using the Appreciative Inquiry (AI) approach and KT process as a methodological orientation to the study. Research Ethics: Principles of confidentiality, autonomy, informed consent, beneficence, non-maleficence, and justice were adhered to. Participants were not of a vulnerable population and therefore support was not offered upon completion of the research discussions. Results: Five themes emerged in this study, namely, occupational therapy (OT) and neonatal care in the public health sector, Knowledge Acquisition and Knowledge Synthesis, Knowledge Translation/Utilization, Contextual barriers/adaptation, and the ideal OT in the ideal neonatal setting. Therapists outlined the facilitators, inhibitors, referral pathways and their personal interests in OT neonatal care. Supportive management and multidisciplinary teams (MDT) were highlighted as facilitators in the hospital environment whilst OT staff shortages, insufficient undergraduate training in the field and a lack of funding for courses for postgraduate OT training were regarded as inhibitors to practice. OTs source and synthesise knowledge from multiple sources to integrate, utilise and translate into neonatal practice. Contextual barriers are identified in various levelled facilities with acquired neonatal knowledge being adapted by therapists for low resourced settings. Participants envision the dream of the ideal day and therapist to intervene with neonates in the public health sector of KZN. Conclusion: Findings have identified several knowledge-to-practice gaps for OTs who support neonates in low resourced settings. Therapeutic resources and funding for postgraduate training, an improvement in the undergraduate curriculum, and policy development appear to be necessary to inform a standard of care across the province.
Mapping the integration of the fields of mental health and psychosocial support with peacebuilding through co-creation.
(2022) Dlamini, Noxolo Zanele.; Sliep, Yvonne.; Makhakhe, Nosipho Faith.
Protracted conflict, combined with the resultant psychological scarring have been a part of present life for many societies. Historically Peace Building and MHPSS (Mental Health and Psychosocial Support) have been used to address the effects of conflict separately, yet they offer different yet complementary solutions to the problem. The purpose of this research was to explore the integration of MHPSS and PB from the viewpoint of the participants of cocreation workshops conducted in 2019 and 2021 on the same topic. A qualitative descriptive design was utilised in this study as it allowed the researcher to explore how the participants responded to the co-creation methodology used in the workshops while gaining insight into their opinions on integration. The study was conducted using documented reports and transcripts of the co-creation workshops, followed by in-depth online interviews. A thematic analysis was used, and findings show that changing funding mandates were necessary as these impact on what humanitarian work is done. Through advocacy, information sharing, and policy change, the way in which donors approach this work could be changed. Much needs to be done to capacitate those working in the field and to raise awareness of the value of linking these disciplines. Greater understanding between the two fields and knowledge of the language, theories and tools used will need to be shared. The co-creation method that was used for the present study seems to have benefitted the process of integration in the participating organisations, through reflection, information sharing, research and writing.
Molecular epidemiology of Antibiotic-Resistant Escherichia coli from companion animals attending veterinary practices in Durban, KwaZulu-Natal, South Africa.
(2023) Ntuli, Nondumiso Lungile.; Essack, Sabiha Yusuf.; Mbanga, Joshua.; Abia Akebe, Luther King.
Background: Companion animals are globally documented to harbour antibiotic-resistant E. coli. This study aimed to investigate the molecular epidemiology of antibiotic-resistant E. coli from companion animals presenting at veterinary practices in Durban, KwaZulu-Natal, South Africa. Methods: E. coli were isolated on selective media from rectal swabs sampled from dogs and cats attending veterinary practices in Durban, KwaZulu-Natal, South Africa. All isolates were confirmed using real-time polymerase chain reaction (PCR) of the uidA gene. Antibiotic susceptibility testing was done against 20 antibiotics using the Kirby-Bauer disk diffusion method. Selected antibiotic-resistance genes (ARGs) that confer resistance to third-generation cephalosporins (blaTEM, blaSHV, and blaCTX-M), tetracycline (tetA, and tetB), and tigecycline (tetX/X2, tetX3, and tetX4), were detected using conventional PCR. PCR amplicons were confirmed by DNA sequencing and bioinformatics analysis. Enterobacterial Repetitive Intergenic Consensus Polymerase Chain Reaction (ERIC-PCR) was carried out to determine the clonality of E. coli (101) isolates that showed resistance to at least one antibiotic. Results: A total of 330 E. coli isolates from dogs (234) and cats (96) formed the study sample. Overall resistance was high in tetracycline (24.2%), ampicillin (18.8%), trimethoprim-sulfamethoxazole (14%), cephalexin (11.2%) and nalidixic acid (9.7%). Whilst lower resistance was observed in amikacin (0.3%), ceftazidime (0.3%), and piperacillin-tazobactam (0.6%). Third-generation cephalosporin-resistant E. coli retrieved from cats (26%) was more prevalent compared to dogs (9.8%). E. coli from dogs (2.1%) and cats (2%) were resistant to forth-generational cephalosporins. E. coli (3%) retrieved from dogs was resistant to tigecycline, which is regarded as a medically important antimicrobial (MIA) in human medicine. No resistance was observed against carbapenems. Thirty-five (10.6%) E. coli were multidrug-resistant (MDR) and exhibited twenty-two different phenotypic patterns. Amongst the E. coli that were not susceptible to third-generation cephalosporin, and tetracycline, it was observed that the blaCTX-M-15 (8%), and tetA (24%) were the most prevalent resistance genes. Thirty-one (9.3%) isolates were non-susceptible to third-generation cephalosporins and had the corresponding extended-spectrum beta-lactamase (ESBL) genes. The blaCTX-M-15 type gene was prevalent in all 25 E. coli isolates that tested positive for the blaCTX-M. The blaTEM-1 (17) was the second most prevalent β-lactamase gene. A total of 80/330 (24%) isolates were phenotypically not susceptible to tetracycline and carried either one, or both of tetA and tetB resistance genes. Only one tetracycline-resistant E. coli isolate did not harbour either tetA, or tetB genes. The blaSHV, tetX/X2, tetX3, and tetX4 were not detected in all the isolates. Using a 75% similarity cut-off, forty-eight clusters with isolates from both dogs and cats were identified. The ERIC-PCR types depicted a variety of clusters within veterinary practices in Durban, indicating that a high diversity of E. coli is in circulation in Durban, South Africa. Conclusion: Companion animals are reservoirs of antibiotic-resistant E. coli and ARGs. However, there was no evidence of transmission of antibiotic-resistant E. coli in Durban, South Africa. Resistance of E. coli from companion animals to MIA for humans is of particular concern and requires measures to control the spread of antibiotic-resistant bacteria, and ARGs between companion animals, veterinary practice personnel, and owners.

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