School of Nursing & Public Health

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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.
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.
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.
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.
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.
Non-communicable diseases among people living with HIV at Chitungwiza central hospital in Zimbabwe.
(2022) Cheza, Alexander May.; Tlou, Boikhutso.
Background The incidence of non-communicable diseases (NCDs) has been reported to be on the rise in the years preceding 2010. Over the years, NCDs have become a global public health burden and a leading cause of premature death, mainly in low to middle-income countries (LMICs). Additionally, sub-Saharan Africa has shown a rise in morbidity and mortality due to NCDs. In Zimbabwe, only a few studies have been conducted to examine the incidence of NCDs in people living with HIV (PLHIV). The study objectives included determining the incidence of NCDs in PLHIV on ART over a ten-year period and the associated risk factors. Furthermore, the study explored physicians’ perceptions on the availability and quality of clinical care for the management of NCDs, in addition to evaluating the knowledge and perceptions of PLHIV towards NCDs. Methods The study encompassed a mixed methods approach using both quantitative and qualitative methods. The thesis is based on three different articles each built from a different study design. Reliability of the questionnaire and the data collection sheet were determined by calculating the Cronbach alpha which exceeded 0.8 in both cases. In addition validity of the tools went through a panel of experts before being approved and also pilot studies were conducted to validate the tools before actual data collection. The title of the first article was: Incidence of non-communicable diseases (NCDs) in HIV patients on ART in a developing country: Case of Zimbabwe’s Chitungwiza Central Hospital—A retrospective cohort study (2010–2019) and it addresses the first two objectives of the thesis. This was a retrospective analysis of data from ongoing longitudinal population-based cohorts from Chitungwiza Central Hospital (CCH) in Zimbabwe, focusing on PLHIV receiving antiretroviral therapy (ART) at the opportunistic infections clinic (OIC) housed at CCH, covering the period 2010-2019. This was crucial for long-term follow-ups and determining the associated risk factors. The intention was to first establish the incidence of NCDs in PLHIV, as well as the association of the incidence with several factors such as age, geographic location of residence of the study participants and their gender. The incidences of NCDs namely cancers, cardiovascular diseases, diabetes mellitus and hypertension were determined and generalized estimating equations (GEE) were used to estimate the association between NCDs and the selected risk factors. Article 2 which addresses objective 3 was published in the Globalization and Health Journal and was entitled: A qualitative exploratory study of selected physicians’ perceptions of the management of non-communicable diseases at a referral hospital in Zimbabwe. This was a qualitative exploratory study meant to obtain expert perceptions of care delivery for NCDs in one Zimbabwean referral hospital setting. Data was collected from participants who consented. A four-point Likert scale was used to categorize different levels of perceived satisfaction and analysis was done using Stata version 13. The third article making up the thesis and addresses objective 4 is entitled: Knowledge and Perceptions about Non-Communicable Diseases by people living with HIV: A descriptive cross-sectional study from Chitungwiza Central Hospital Zimbabwe. The article has been accepted by the African Health Sciences Journal and is pending publication. This was a cross-sectional explanatory study using a mixed methods approach to describe-the participants’ responses. The study explores and descriptively documents the perceptions and knowledge of PLHIV on their exposure to the NCDs burden. Results Data collected at the study’s baseline (2010) showed that the most prevalent NCD was hypertension, found in 8.9% (18/203) of the study participants, followed by diabetes (6.9%), then cardiovascular diseases (CVD) (3.9%). The least common NCD was cancer (1.9%). Incidences of all of these NCDs showed an increasing trend as the time of follow-up progressed. The associated risk factors found to be significantly associated with the development of NCDs were gender, with females being 2 times more likely than males to develop NCD (p = 0.002) and follow-up time (p<0.001). Moreover, geographical location was a significant risk factor as urban patients were more likely to develop hypertension as compared to peri-urban patients (p = 0.001). Nineteen of the doctors were general practitioners, whilst four were specialists. The findings indicated that both general and specialists perceived some shortfalls in clinical care for NCDs. Moreover, the perceptions of general practitioners and specialists were not significantly different. Doctors perceived cancer care to be lagging far behind the other three NCDs under study. Care for cardiovascular diseases (CVDs) and diabetes showed mixed perceptions amongst participants, with positive perceptions almost equalling negative perceptions. Furthermore, hypertension was perceived to be clinically cared for better than the other NCDs under study. Reasons for the gaps in NCD clinical care were attributed by 33% of the participants to financial challenges; a further 27% to patient behavioural challenges; and 21% to communication challenges. The study also found a moderately good level of knowledge (65%) and very high levels of positive perceptions (81%) on NCDs. Participants <40 years of age were more knowledgeable (p=0.003) and a history of NCD in the family had a positive influence on knowledge (p=0.001). Females showed a more positive perception (p=0.043), whilst both increasing age and low education negatively impacted perceptions (p<0.001) as well as knowledge (p=0.020). Conclusion The study concluded that NCDs and HIV comorbidity is common with women, who are more likely than men to develop NCDs as they advance in age. There is need to devise targeted intervention approaches to the respective NCDs and risk factors since they diversely affect people with different demographic characteristics. Moreover, the care delivery for the selected NCDs under study at CCH need to be improved. It is crucial to diagnose NCDs before patients show clinical symptoms. This helps disease prognosis to yield better care results. The evaluation of doctors’ perceptions indicates the need to improve NCD care at CCH in order to control NCD co-morbidities that may increase mortality. Patients’ knowledge and perceptions were moderately high but reduced with decreasing levels of education and increasing age. The study recommends educational campaigns to disseminate information about NCDs in PLHIV, targeting the least educated population groups and those older than 40 years of age.
The parenting experience: an exploration study of coping mechanisms of young parents.
(2022) Nombewu, Gladys Nompumelelo.; Hlengwa, Wellington Mthokozisi.
This study aimed to understand experiences of young parents, and how they coped with parenting challenges in Quarry Heights. Furthermore, this study sought to determine coping techniques used in dealing with parental challenges. The study employed a qualitative approach, where a total of ten participants were interviewed, using an interview schedule. Thematic analysis was used to analyse the data collected and various themes emerged. The findings indicate that the transition to parenthood was an unplanned difficult event. Lack of knowledge and parenting skills, lack of financial resources and negative emotions emerged as main challenges. As a result, academic performance was disrupted, social networks were disconnected and parents felt socially isolated. The study found that, parents do not have sufficient coping resources to handle the transition. Coping strategies utilised were not effective in dealing with the challenges. However, social and financial support from family members made the transition process manageable. Therefore, research at government level is recommended to determine the feasibility of developing mentoring programs for teaching parenting and life skills. Furthermore, establishment of counselling centres in schools is recommended for psychological support. Based on the limitation of this study, it is recommended that a diverse sample with different race, gender and socio-economic status for diverse views be used for future research.
Workplace risk factors associated with extra-pulmonary tuberculosis among healthcare workers in eThekwini health district, KwaZulu-Natal.
(2022) Bhengu, Nontuthuzelo May.; Naidoo, Rajen.
Background Tuberculosis (TB) can be categorized as pulmonary tuberculosis (PTB) and extra-pulmonary tuberculosis (EPTB) involving other organs besides the lungs. Healthcare workers (HCWs) are at increased risk of tuberculosis exposure. The average burden among healthcare workers is 2% compared to 0.9% in the general population. EPTB constitutes about 16% of all TB cases. This study aimed to examine occupational, environmental, and demographic risk factors associated with EPTB among healthcare workers. Methods This was a retrospective case referent type study with two control groups (one without tuberculosis and the other with pulmonary tuberculosis) and cases defined as those with EPTB. 282 records of healthcare workers were reviewed from January 2009 to December 2017.The study reviewed available medical records of healthcare workers from various categories and departments, both clinical and non-clinical. in health facilities within eThekwini Health District, Durban, South Africa. Data was analysed using a chi-square test, t- test and multivariet analysis. Results The mean incidence of TB in 2016 was 908/100 000 and for EPTB, was estimated at 87.2/100 000 HCWs in eThekwini Health District. Cases without respiratory protective equipment (RPE) use were more than three-fold suceptible (aOR 3.5 95%CI 1.0 – 11.4) compared to a PTB control. Working in a clinical department increased the odds for developing EPTB almost three-fold when compared to those with PTB (aOR 2.9 95% CI 0.6 – 13.2) than among those with no TB (aOR 1.4 95%CI 0.1– 13.8). As expected, HCWs diagnosed with HIV were almost two-fold likely to be exposed to EPTB when compared to thosed with PTB (aOR: 1.9 95% CI 0.9 – 4.0), however, when comparing EPTB to no TB, HIV positivity had a wide confidence interval (aOR: 23.4 95% CI 8.1 – 67.7) rendering the results indeterminate. Conclusion Occupational risk factors for EPTB are similar to that of pulmonary tuberculosis, however, risk estimates may be greater than those for PTB. Human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) infection increases the odds of exposure to EPTB in HCWs.

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