Masters Degrees (Public Health)

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Investigating the implementation of malnutrition guidelines in children aged between 6 months and 59 months at primary health care clinics in eThekwini health district, KwaZulu Natal, South Africa.
(2022) Grootboom, Busi.; Taylor, Myra.
Abstract available in a 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.
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.
Immunomodulatory and anticancer potential of a traditional medicine product from a traditional healer against MCF-7 breast cancer cells.
(2021) Sithole, Siboniso Percival.; Ngcobo, Mlungisi.
The incidence of breast cancer in South Africa is expected to rise dramatically in the forthcoming decade. In 2018, approximately 2 088 849 new cases and 626 679 cases of deaths from breast cancer alone were reported worldwide. Among African countries, the incidence of cancer is higher in southern Africa with an estimate standard rate of 235.9 per 1000, 0000 people. Currently breast cancer is treated with either chemotherapy, surgery, radiotherapy or immunotherapy. All this conventional treatment options available for breast cancer have some limitations and drawbacks. Therefore, there is an urgent need for the development of novel breast cancer therapy that will potential kill tumour cells more effective and selective. The use of traditional medicine as an alternative source of healthcare is gaining an increasing interest in many countries including South Africa. This is due to their accessibly and perceived effectiveness. However, the majority of these traditional medicines have not been scientifically validated. Aim: The purpose of this study was to determine immunomodulatory and anti-cancer activity of an African traditional medicine product from a traditional healer (Product Nkadinde, a traditional medicine composed of four medicinal plants) on MCF-7 breast tumour cells. Methods: Normal peripheral blood mononuclear cells (PBMCs) were used initially to establish the IC50 dose of Product Nkabinde using the Celltiter-Glo™ ATP assay. Conditioned media from PBMCs was then prepared by treating a separate set of normal PBMCs using the IC50 dose and the positive control, camptothecin (1μM). For the anticancer assays, the Celltiter-Glo™ ATP assay was used to determine the cytotoxicity effects of conditioned media from PBMCs with Product Nkabinde against MCF-7 breast cancer cells. Antioxidant levels (changes in intracellular glutathione (GSH) levels) were measured using GSH-Glo™ Glutathione assay kit. The mechanism of cell death was determined using the Caspase 3/7 and DNA fragmentation assays. Immunomodulation studies was carried out using a multi analyte cytokine ELISA assay kit. Results: The results obtained from this study revealed that Product Nkabinde was cytotoxic to MCF-7 and an IC50 dose was established at 344 μg/ml in treatment PBMCs. Product Nkabinde was able to induce caspase 3/7 activity, decrease intracellular GSH levels and induce DNA fragmentation comparative to the positive control, thus showed potential to induce apoptosis in breast cancer cells. Inflammatory cytokines secretion studies indicated that Product Nkabinde did not significantly change the secretion of all 12 inflammatory cytokines analyzed in treated PBMCs. However, Product Nkabinde was shown to increase the secretion of IL 1β, IL 8 and GM-CSF in treated MCF-7 cells, although this was not significant. Conclusion: The results of this study showed that Product Nkabinde induced immunomodulatory effects through changes in cytokines secretion and direct anticancer effects through activation of caspase 3/7 enzymes, decreasing GSH levels and induction of DNA fragmentation in treated MCF-7 cells. This traditional medicine has the potential to be developed and optimized as an alternative anticancer medicine.
Vitamin A supplementation in children aged 12 to 59 months in Amajuba Health District in 2016.
(2017) Mdlalose, Mbalenhle Luthando.; Knight, Stephen Eric.
Background: Vitamin A is required for normal development, defence of the immune system and for maintaining good eye health in infants and children. Vitamin A deficiency is a major public health problem globally and in South Africa. Routine supplementation with high-dose Vitamin A has been a strategy employed to reduce the burden of Vitamin A deficiency in children aged from six to 59 months. Coverage of vitamin A supplementation (VAS) however remains low in older children in South Africa particularly in Amajuba Health District. Objectives: The objectives of this study were to measure VAS coverage and factors associated with poor VAS uptake in this District. Methods An analytic cross sectional study design was used. A two-stage cluster-sample method was used to select the participants. The study population involved mothers and caregivers of children aged 12 to 59 months residing in Madadeni, a township in the District. The study sample of 198 participants was obtained from 33 randomly selected clusters within each of which 6 households were approached. Data was collected using a field-worker administered structured questionnaire. The study received ethical approval (BE 368/15) and was conducted with participant’s consent. Results The coverage of VAS amongst these children was 57% (95% CI: 49 - 63). Younger children (18 to 23 months) had better (Prevalence Ratio (PR) 1.2 (95% CI: 0.8 - 1.6) coverage than older children. Children who were up to date with VAS coverage were significantly more likely to have received a measles vaccine (p<0.01). A significant association was found between VAS status of children and caregivers being able to identify the blue capsules as the 6 to 11-month dose and the red capsules as the 12 to 59-month Vitamin dose capsule. There was a non- iii significant but positive association of a child having received VAS and higher level of education of the caregivers, shorter distance from health facilities, living in an urban area and having received information about VAS from a health worker Conclusion and Recommendations Amajuba Health District had a VAS coverage of 57%, which is below the national target of 65%. The low levels of knowledge about Vitamin A among caregivers is a concern, despite knowledge being weakly associated with VAS uptake in children. Health workers need to provide better education for caregivers about Vitamin A. Focus should also be placed on accessing older children as they are more likely miss VAS doses. (385 words)
A description of growth monitoring and promotion activities at primary care level in Grahamstown, Makana Sub-District, Eastern Cape.
(2017) Mfono, Zitandile Hlombekazi.; Voce, Anna Silvia.; Chhagan, Meera Kurson.
Aim To describe growth monitoring and growth promotion (GMP) activities in children aged 0-24 months at primary healthcare facilities in Grahamstown, Makana Sub-District, Eastern Cape. Methods A cross-sectional descriptive study design was implemented. A sample of one hundred and sixty-four children from birth to twenty four months attending seven clinics in Grahamstown for well-baby visits, sick visits and growth monitoring and promotion from November 2012 to January 2014were included in this study. A Road-to-Health Booklet audit checklist and caregiver questionnaire were used to collect the data. Frequency distributions were reported for appropriate GMP activities. Appropriate GMP was defined as: correct use of weight-for-age index; growth interpreted correctly and discussed with caregiver; interventions promoted or given as indicated; and follow-up scheduled according to the relevant Department of Health policies. Results From the Road-to-Health Booklets sampled at the seven clinics and from caregiver interviews forty-seven (28.7%) of the children had evidence of appropriate GMP, although the majority of children sampled were weighed at their clinic visit. One hundred and twenty (80.0%) of the caregivers reported that their children were weighed by community health workers. The prevalence of appropriate GMP was significantly different according to the primary healthcare facility attended by the child (p=0.046 for the seven facilities using Fisher’s exact test). In the children sampled, seventeen (18.1%) had a recorded length in their Road-to-Health Booklet and for only nine (10.0%) of the children was the length for age plotted. There was no documented evidence in any of the Road-to-Health Booklets indicating that length measurements were interpreted. Discussion There is over emphasis on the technical aspects of GMP such as weighing of children, i.e. growth monitoring compared to growth promotion. Optimal GMP practice requires growth measurement, interpretation and intervention, e.g. nutritional counselling for growth promotion, with caregiver engagement in discussions about child growth. Sub-optimal GMP persists after the implementation of the new Road-to-Health Booklet, as evidenced by: inadequate interpretation of growth indices; lack of appropriate interventions for growth faltering; and poor follow-up. Length-based measurements are not used routinely in child growth assessment since their addition to the RTHB in 2010. Conclusion Implementation of quality growth monitoring and promotion activities at primary care facilities in Grahamstown remains problematic after the introduction of the revised Road-to-Health Booklet and additional growth indices.
Comparing the outcomes of nurse initiated management of antiretroviral therapy in Tuberculosis - Human immunodeficiency Virus (HIV) co-infected patients Vs HIV mono-infected patients.
(2016) Jithoo, Niraksha.; Knight, Stephen Eric.; Naidoo, Kogieleum.
No abstract available.
Promoting sanitation and nutrient recovery through urine separation: the role of health and hygiene education in the acceptance, utilisation, and maintenance of Urine Diversion Toilets (UDDT) in rural communities of KwaZulu-Natal (KZN).
(2017) Mkhize, Nosipho Nonhlakanipho.; Taylor, Myra.
Introduction This study was part of the VUNA project which aimed to develop an affordable solution system that produces a valuable fertilizer, reduces pollution of water resources and promotes health. South Africa is one of the countries that is affected by water scarcity due to climate change, dwindling rain, rapid urbanization and the increasing population size. Due to the latter South Africa is looking at new affordable sanitation systems to not only save water but that will promote health like the UDDT. The eThekwini Municipality (EM) introduced the UDDT in it rural areas because it offers the latter and also allow for nutrient recovery from urine to be used as a fertiliser. The UDDT is a new technology and for the facility to be sustainable, social acceptance is vital, properly use and maintenance. A cross sectional study was undertaken, using mixed methods to explore the acceptance, use and maintenance of the UDDT. Key findings indicated that there was a low level of acceptance amongst users due to the poor communication and education, poor design of the toilet and aspirations to own a flush toilet. There is an urgent need for EM to address the misconceptions and the communication gaps through health and hygiene education so to improve the level of acceptance, use and maintenance of the toilet. Aim The study aimed to explore the acceptance, use and maintenance of the Urine Diversion Dry toilet (UDDT) and to use the findings to develop health and hygiene education. Methods Mixed methods were used: both quantitative and qualitative research approaches were used in this study in order to assess the condition of the UDDT and understand the target population’s perceptions, attitudes and behaviour in relation to the UDDT in eThekwini KwaZulu-Natal. Initially a brief questionnaire was administered to assess the condition of the UDDT in 40 households in the three target areas, in total 120 households were visited. This was followed by twelve focus group discussions which were made of one family of the households visited. 25 in-depth interviews were conducted with community members were actively involved in the roll-out of the UDDT’s i.e. the ward councillor, the previous health and hygiene educators and ward committee members with community members. The data from the qualitative research were analysed through content analysis as emphasised by the theoretical framework that words create meaning. Results The results clearly indicated that although education was provided at the time of UDDT installation, the majority of respondents did not have comprehensive information in terms of how to operate and maintain the UDDT. The study also found that the majority of community 2 members had not accepted the UDDT as a permanent household asset. Eighty percent of UDDTs were in a bad condition. The study also found that in all areas very few households were not using the UDDT. Furthermore, the facilitators on the health and hygiene education programme reported that they had not been trained properly for this task. The findings also showed that community members were not aware of the water scarcity in the country and how this related to the introduction of the UDDT. There was also a high level of migration both out of and into the UDDT homestead areas. Conclusion The lack of proper training of the facilitators, inadequate sharing of information within the household and the migration of the original householders resulted in a lack of information within the household and community at large about the use and maintenance of the UDDT. This information gap largely contributed to community members’ poor maintenance of their UDDT. This created negative attitudes towards the UDDTs since users felt that the toilet could not be kept in proper adequate sanitary conditions. It is crucial that communities are included as part of the sanitation provision process and are constantly informed and updated, in order to facilitate community adoption and ownership of the sanitation solutions being offered to them. Recommendations The information about the UDDT needs to be constantly and consistently shared with the households and community at large. The facilitators need to be properly trained on sanitation, health and hygiene, so that they can relay the information competently and effectively. New strategies need to be developed where communities participate in their own development. This process will allow communities to take ownership of their sanitation solutions and develop positive attitudes towards Urine Diversion Dry toilet (UDDT).
Nurses’ knowledge, attitudes, and practices of pressure ulcer prevention in the Pietermaritzburg Metropolitan Hospital Complex in 2016.
(2016) Malinga, Sanelisiwe.; Dlungwane, Thembelihle Patricia.
Introduction Pressure ulcers are a growing problem for health institutions worldwide. Increased length of stay, litigation, increased workload, and diminished quality of life of individuals are implications of pressure ulcers. Nurses require good knowledge, attitudes, and practices to implement effective pressure ulcer prevention strategies. The purpose of the study was to determine nurses’ knowledge, attitudes and practices of pressure ulcer prevention in the Pietermaritzburg Metropolitan Hospital Complex in 2016. Methods The study was quantitative in nature and an observational, cross-sectional, descriptive design with an analytical component was implemented. A self-administered questionnaire was used to collect information on nurses’ knowledge, attitudes, and practices. The two-sample t-test and analysis of variance were used to determine the relationships between demographic characteristics and knowledge, attitudes, and practices of pressure ulcer prevention. Results Nurses’ knowledge and practices of pressure ulcer prevention were unsatisfactory at 69.2% and 58.2% respectively whilst attitudes were satisfactory at 88.8%. The analysis of variance revealed a significant difference in knowledge in terms of rank, years of experience, previous PU knowledge and ward while the two-sample t-test revealed no significant difference in knowledge, attitudes and practices with gender. Conclusion Nurses’ knowledge and attitudes regarding pressure ulcer prevention are limited while their attitudes are positive. An intervention is required to educate and empower nurses to improve care. Keywords: attitude; knowledge; nurse; practice; pressure ulcer prevention
Traditional medicine use in patients on antiretroviral therapy: a cross-sectional study at Thembalethu Wellness Centre, Northdale Hospital.
(2017) Mazibuko, Zethu Yvette Patronica.; Gray, Andrew Lofts.
Introduction Adherence is the primary predictor of treatment success with antiretroviral therapy (ART). It is not known whether the use of traditional medicine use predicts non-adherence to ART. Traditional medicine use has been reported to be common among individuals with moderate and advanced HIV disease. There is some data available on the prevalence and patterns of African Traditional Medicine (ATM) use in patients with HIV/ AIDS. Aim The aim of this cross-sectional study was to describe the prevalence of traditional medicine use amongst patients on antiretroviral therapy, aged 18-49 years and to assess any association between the use of traditional medicines and adherence to antiretroviral therapy in patients seen at Thembalethu Wellness Centre, Northdale Hospital, in KwaZulu-Natal, South Africa. Methods Using systematic sampling, 75 HIV-positive patients on antiretroviral therapy were selected from the pharmacy queue. Data was collected using primarily a semi-structured questionnaire with closed and open-ended questions during a face-to-face interview. The questionnaire was translated to Zulu. Pre-testing of the questionnaire was completed with 5 HIV-infected persons not involved in the study from another hospital. Data from closed-ended questions was collected, coded and captured on computer using the Microsoft Excel spreadsheet programme then all data was imported to SPSS programme for analysis. Results The study findings showed that, of the seven individuals who reported using traditional medicines, three (42.9%) also reported to have missed ART doses with one who reported missing more than three doses in the preceding month. Traditional medicines were mostly used by African men who followed Christian religion. iii Traditional medicines were mainly used for cultural purposes specifically; cleansing purposes for different reasons. Male sex and the use of African traditional medicines were shown to be associated with poor adherence to antiretroviral therapy. Conclusion Although many previous studies have shown that traditional medicines were commonly used concomitantly with antiretroviral drugs by HIV positive patients; in this study only 9.3% of participants admitted having used traditional medicines in the 28 days preceding the survey. Participants were more likely to be non-adherent to ART if they were male and self-reported using traditional medicine.
Predictors of adherence to antiretroviral therapy among people living with HIV and AIDS at the Quthing District Hospital and Villa-Maria Health Centre, Lesotho.
(2016) Abiodun, Oluwasola Afolabi.; Tsoka-Gwegweni, Joyce Mahlako.
Background: The introduction of antiretroviral drugs generated much optimism in the survival of people living with HIV. The optimism had been dissipated in the light of enormous challenge being faced by ART patients in maintaining a perfect adherence since successful treatment is dependent on the maintenance of a near perfect adherence. In the context of Lesotho, there is hardly any study done on factors influencing adherence to antiretroviral drugs yet it is widely known that adherence to ART is influenced by numerous factors. These factors could be health system related, patients related and the medication itself. The study, therefore, sought to assess the factors that affect adherence to ART and also, determine the level of adherence to ART among people living with HIV and AIDS at Quthing District Hospital and Villa Maria Health Centre, Lesotho. Method: An analytical cross-sectional study was used to determine the predictors of adherence to ART among PLWHA who had been on ART for not less than three months before the study. The study was conducted among 382 participants between April 2016 and June 2016. Results: A considerable number of participants were found to comply with global adherence using pill count adherence, appointment adherence, and self-report as adherence instruments. Of the 382 participants recruited for this study, the majority (63.6%) were females out of which 156 (40%) of them were married. The majority of the participants were on first line regimen (92.1%) and have been on ART for more than three years 228 (59.7%). The majority of the respondents lived in urban areas 296 (77.5%) and had formal education 343 (89.8%). The results of the study indicated global adherence to be 85.1%. The bivariate analysis showed significant relationships among all the variables. However, when subjected to multivariate analysis, three factors were significantly associated with global adherence to ART. These are: educational level (p<0.000; aOR = 87.9), knowledge of HIV status of sexual partner (p<0.020; aOR = .090), and ART perception (p<0.000; aOR = 0.005). Conclusion: The proportion of adherent participants in this study is sub–optimal, but relatively higher compared to most studies. A lot still needs to be done for the participants in this study especially those living in the rural areas to ensure improvement in the sub-optimal level of adherence obtained in this study. Thus it is important that recommendation such as health education campaigns, psychosocial support and the needs of the patients be utilised to improve adherence.
An implementation evaluation study of a nurse initiated and managed antiretroviral therapy (NIMART) program in primary health care clinics in the Ugu district of KwaZulu-Natal.
(2016) Xaba, Pearl.; Kerr, Jane.
AIM The purpose of this study was to conduct an implementation evaluation study of Nurse Initiated and Managed Antiretroviral Therapy (NIMART) program in Primary Health Care (PHC) clinics in the Ugu district of KwaZulu-Natal. METHOD A quantitative non-experimental descriptive approach and evaluative design consisting of self-administered questionnaires was used to conduct the study to evaluate the availability of the latest Antiretroviral Therapy Guidelines, to evaluate the implementation of the Nurse Initiated and Managed Antiretroviral Therapy (NIMART) program and to evaluate the knowledge and practice of professional nurses towards the NIMART program in the 56 clinics of the Ugu district. Information leaflets were given to the participants and informed consent was obtained from each participant. The number of participants that were enrolled in the study was 52 because they met the inclusion criteria of working in the PHC clinics in the Ugu district and were trained in the NIMART course. The other 4 participants were not trained in the NIMART course and were excluded according to the exclusion criteria. RESULTS The study revealed that in 98% (n=51) of the clinics in the Ugu district, nurses were initiating adults on ART and only 2% (n=1) were still being initiated by the doctor. Furthermore, the majority of respondents indicated that children were initiated on ART in their clinics, while some respondents reported that in their clinics children are still initiated by the clinic visiting doctor or hospital doctor. The findings indicated that 98% (n=51) of clinics have the latest ART Guidelines available, while only 2% (n=1) of clinics indicated that they have outdated ART Guidelines available in the clinic. The study revealed that most respondents knew the correct ART regimens, ART eligibility criteria and when blood for CD4 count and viral load is taken, while there were still some respondents who did not know. CONCLUSIONS AND RECOMMENDATIONS The District HAST Manager and clinics’ Operational Managers must ensure that the latest 2015 National Consolidated Guidelines for PMTCT are available in all the PHC clinics. More nurses should be trained in NIMART. All the nurses that are NIMART trained should receive mentorship after the training so that they become competent and confident in initiating and managing HIV-positive patients on ART. The findings of this study revealed that there were some gaps in nurse’s knowledge around ART regimens, blood tests and eligibility criteria. This study can be used as a baseline to evaluate all the professional nurses trained in NIMART in Ugu district. The District Training Coordinator must arrange a workshop regarding the 2015 National Consolidated Guidelines to refresh NIMART nurses about ART regimens, about blood tests to be done and about the ART eligibility criteria.
Prevalence and risk factors associated with musculoskeletal pain among KwaZulu-Natal public sector oral health workers, 2016.
(2017) Govender, Treshina.; Dlungwane, Thembelihle Patricia.
Musculoskeletal pain (MSP) is a public health concern that affects millions of people in developed and developing countries. In 2015, MSP was ranked among the top ten leading causes of years of healthy life lost due to disability globally. In addition, the consequences of MSP include a wide range of negative effects such as absenteeism, increased work restriction and reduced productivity. Musculoskeletal pain is a major threat in the workplace among oral health workers (OHW). Studies that have been identified from South Africa focus mainly on OHW in the private sector. It remains unclear what the prevalence and risk factors of MSP are among OHW in the public sector. Aim: To determine the prevalence and risk factors associated with musculoskeletal pain among oral health workers in public health facilities in KwaZulu-Natal. Methods An observational, cross-sectional study with an analytical component was implemented. Self-administered questionnaires were utilized to determine the risk factors among dentists, dentist (specialists), dental therapists, oral hygienists, and dental assistants employed in the public sector in KwaZulu-Natal. Descriptive and inferential statistics were used to analyse data. Alpha level was set at p<0.05. Results A total of 266 questionnaires were analysed (response rate 83%). The prevalence of current MSP among OHW was 50.9% and the chronic prevalence of MSP reported for the previous 12 months was 60.6%. A higher prevalence of current (47.2%) and chronic (46.9%) MSP was reported among dentists when compared with dentist (specialists), dental therapists, oral hygienists, and dental assistants. The most common sites for MSP were the lower back, neck, and shoulder. Occupational, environmental, and psychological factors were strongly associated with MSP. Conclusion MSP is an occupational hazard for OHW. There is a need for educational programs and adoption of strategies to reduce occupational injuries. Key words: Musculoskeletal pain, prevalence, work-related, oral health workers, risk factors, dentist, dental therapist, oral hygienist.
The epidomiology of childhood tubercolusis and clinical outcomes in South Africa 2008 - 2012.
(2017) Smith, Jacqueline.; Knight, Stephen Eric.
Tuberculosis (TB) in children, particularly in those under five years is regarded as an indicator of there being an infectious pool in the community. The World Health Organization (WHO) has focused on childhood tuberculosis, recognizing its contribution to the overall TB burden and to child survival. The Roadmap for Childhood Tuberculosis identifies the need to know the incidence of childhood TB in order to design and implement specific public health interventions to limit the spread of the disease and orientate health services in early TB detection, treatment and retention in care to prevent on-going transmission. Aim The aim of this research is to investigate the epidemiology of childhood TB in South Africa (SA) from 2008 to 2012 in order to inform TB control policy and practice. Methods An observational analytical cross sectional study design was used. The Electronic TB Register was used as the source of the data. Records from 1 January 2008 to 31 December 2012 were used. STATA and Excel were used to describe and analyse data. Results The proportion of children aged 0 to 14 years with TB in SA has fluctuated between 19.2% in 2008, reaching a high of 22.3% in 2009 and reducing to 18.8% in 2012. Testing children with TB for HIV has increased steadily from 17.9% in 2008 to 68.5% in 2012. The HIV prevalence in tested cases aged ten to fourteen years in 2012 was the highest at 42.6% with the lowest prevalence found in the zero to four year age group in 2012 of 16.7%. In analysing treatment outcomes, the children aged five to nine years had 21% (0.79) less risk of death compared to the children less than 5 years whereas the age group ten to fourteen had 1.33 times the risk of death.
Antiretroviral therapy initiation of pregnant women before and during the implementation of Nurse Initiated and Management of Antiretroviral Therapy in eThekwini District Community Health Centres.
(2016) Nozulu, Nomonde.; Gaede, Bernhard Martin.
When the Prevention of Mother to Child Transmission of HIV programme was introduced in South Africa in 2002, doctors were the health professionals tasked with Antiretroviral Therapy (ART) initiation and management of patients. In a country with a known shortage of doctors and in which about 80% of the healthcare workers are nurses, the dependency on doctors negatively affected management of patients needing ART. The introduction of the Nurse Initiated Management of ART (NIMART) programme expanded the healthcare skill set necessary for ART initiation. With the implementation of NIMART, pregnant women who are regarded as a priority group in the country‟s ART programme would have ART initiation services offered as part of the antenatal care package. Aim The aim of this study was to evaluate ART initiation of pregnant women attending antenatal care in eThekwini district Community Health Centres (CHCs) between the Financial Years (FY) 10/11 (when NIMART was newly introduced) and FY13/14 (when NIMART was in full implementation). Methods An observational descriptive retrospective chart review study was conducted in 2015 at four eThekwini district CHCs. From these CHCs, records of pregnant women living with HIV that initiated ART in FY10/11 and FY13/14 were evaluated and compared. Results Approximately, 2749 pregnant women who attended antenatal care at the study sites during the two years were eligible for ART. Of the eligible women, 49% (N = 1334) attended antenatal care in FY10/11 while, 51% (N = 1414) attended in FY13/14. In FY10/11, 46% (n = 610) of the eligible women were initiated while 60 % (n = 855) of the1414 eligible in FY13/14 started ART during pregnancy. All women seen in FY10/11 were initiated at ART clinics. In FY13/14, 97% (n=826) of women initiated ART within the antenatal care clinics. ART in FY10/11 was started within 38 days after antenatal care booking while in FY13/14 initiations were within 4.12 days. Antenatal care booking before 20 weeks was found to have improved between the two years from 39 % to 58%.
Prevalence and intensity of Schistosoma haematobium in KwaZulu-Natal, South Africa.
(2016) Banhela, Nkosinathi.; Taylor, Myra.
Background and objectives: Urogenital schistosomiasis is a neglected tropical disease caused by the parasite Schistosoma haematobium, which is receiving increased attention, due to its reported association with diseases such as the Human Immunodeficiency Virus, genital cancers, sexually transmitted diseases and liver diseases. Symptoms of urogenital schistosomiasis include haematuria, frequent urination, tiredness and a decrease in the cognitive ability of children. The prevalence of S. haematobium infection needs to be known and mass treatment programmes against the disease implemented. The aim of this study was to investigate the prevalence and intensity of S. haematobium infection. The objectives were to determine the prevalence and intensity of S. haematobium among school going children in ILembe and uThungulu Health Districts of KwaZulu-Natal province, to determine if there is an association between school location, sex, altitude, temperature and the prevalence of schistosomiasis and to assess the need for mass treatment campaigns. Methods: In this study, 6265urine samples were collected for analysis using dipsticks from boys and girls attending rural public schools in these health districts. The prevalence and intensity of S. haematobium infection was calculated and thereafter associations with temperature, altitude and distance to the nearest river were investigated. Descriptive and analytical statistics were undertaken, the latter using a correlation coefficient and a linear regression (p˂0.05) (Confidence Interval (CI) 95%). Results: The prevalence of schistosomiasis for boys in ILembe was 40% and girls 39% and in uThungulu was 56% and 53% in girls and boys respectively. Most infection was the dominant intensity in both the Districts. There was a significant inverse relationship between prevalence of schistosomiasis and altitude (p˂0.05). Associations between prevalence and distance of school to the nearest river were non-significant, and the average minimum summer temperature also showed a positive relationship but that was non-significant (p˃0.05). Conclusion: In both the Districts, the prevalence fell in the category that is recommended by the World Health Organisation for mass treatment. This information alerts health care workers to take the necessary actions to combat schistosomiasis infection and the transmission of urogenital schistosomiasis by providing mass treatment with praziquantel. Mass treatment in endemic communities impacted by schistosomiasis can significantly reduce the morbidity caused by the disease. Furthermore, treatment at an early age can help avoid complications that would predispose individuals to the risk of HIV. In endemic areas, public education about the disease should be prioritized. Furthermore clean water sources should be provided for communities at risk to prevent reinfection
Health seeking behaviour in men presenting with sexually transmitted infections at Prince Mshiyeni Gateway Clinic and KwaMashu Community Health Centre in 2015.
(2015) Nyalela, Mpumelelo.; Dlungwane, Thembelihle Patricia.
Background: South Africa’s burden of disease due to sexually transmitted infections (STIs) is currently one of the largest in the world, with an estimated 11 million cases detected per year. There is evidence suggesting that early recognition of symptoms, and early presentation to health facilities with effective treatment would reduce the spread of treatable STIs. Aim: The aim of the study was to assess the factors associated with the health seeking and sexual behaviour of men presenting with STIs at Prince Mshiyeni Gateway Clinic and KwaMashu Community Health Centre, eThekwini. Method: This was an observational, descriptive and analytical cross-sectional study. Participants were systematically selected from patients who presented at the clinic with confirmed signs or symptoms of an STI, aged between 18 and 49 years, who agreed to participate. In total 134 questionnaires were collected. Results: Most of the participants were between ages of 26-35 (41%), the majority single (78.4%). Participants were knowledgeable about STIs, knew that they can get STIs by unprotected sex (88.1%) and through multiple partners (85.1%), and that to be protected a condom should be used at every sexual encounter (86.6%). The majority (68.7%), however, did not use a condom the last time they had sex, and 67.1% had more than ten lifetime partners. Over half of participants (53%) delayed presenting themselves to the clinic after noticing signs and symptoms of an STI, despite knowing about STIs. There was a significant association between delayed health seeking behaviour at the clinic and an initial visit rather to a traditional healer (p = 0.004). Participants at PMG clinic were less likely to delay seeking medical help than those from KCHC (OR 0.30; 95%CI: 0.15-0.62; p=0.001). Participants who visited traditional healers more than seven times a year were more likely to delay seeking medical help (OR 1.75; 95%CI: 1.07-2.89). When participants were asked “what would prevent them from coming to the clinic”, over half of participants (56.7%) reported fear of staff stigmatization and bad attitude. Importantly, most men stopped using condoms once they experienced erectile dysfunction. Conclusion: This study indicates the need to deal with men’s attitudes, because despite knowing about STIs and their prevention, men still engage in risky sexual behaviour. The health system needs to improve the standard of services provided, and to deal with health workers’ negative attitudes. Key words: Health seeking behaviour, delay health seeking behaviour, men, sexually transmitted diseases, HIV prevention, men’s roles, sexual health
The birth prevalence of congenital CMV infection in HIV-exposed newborns in Cape Town, South Africa : a pilot study. The "CYPREHEN" (Cytomegalovirus prevalence in HIV-exposed newborns) study.
(2014) Manicklal, Sheetal.; Knight, Stephen Eric.; Boppana, Suresh B.
Background Congenital cytomegalovirus infection (CMV) is a leading non-genetic cause of sensorineural hearing loss worldwide. The birth prevalence of congenital CMV infection correlates positively with the level of CMV seroimmunity in the adult population. In addition, women infected with Human Immunodeficiency Virus (HIV) constitute a special at risk subpopulation for the intrauterine transmission of CMV. Despite a high prevalence of both HIV and CMV, the birth prevalence of congenital CMV infection has not been assessed in sub-Saharan Africa. Purpose The purpose of the study was to determine the birth prevalence of congenital CMV infection among HIV-exposed newborns born in a public sector hospital in the Western Cape in 2012, during the era of prenatal antiretroviral therapy. Objectives The objectives of this study were: To determine the prevalence of congenital CMV infection among HIV-exposed newborns; To assess the predictors of congenital CMV infection transmission among HIV-infected women; and To inform the design of an analytic study to determine if newborn CMV screening should be implemented in this population. Study design An observational descriptive cross-sectional study design was used. Settings The study was conducted at Mowbray Maternity Hospital (MMH), which serves the Cape Town Metropole area. Study population The study population comprised infants born to HIV-infected mothers delivering at MMH. Study sample Non-probability convenience sampling was used to enroll 750 newborns. Methods HIV-infected mothers were recruited in the immediate postnatal period at a referral maternity hospital between April and October 2012. Maternal and infant clinical data and newborn oral swabs (saliva) were collected. Saliva was assayed by real-time PCR for CMV. Data were analysed using univariate and multivariate logistic regression analyses to determine specific demographic, maternal and newborn characteristics associated with congenital CMV infection. Results CMV was detected in 22/748 newborn oral swabs (2.9%; 95% Confidence Interval (CI), 1. 9%-4.4%). Maternal CD4 count less than 200 cells/μL during pregnancy was independently associated with congenital CMV infection (adjusted Odds Ratio (aOR) 2.9; 95% CI, 1.2-7.3). A negative correlation between CMV viral load in saliva and maternal CD4 count was observed (r = -0.495, n = 22, p = 0.019). Conclusions The birth prevalence of congenital CMV infection was high despite prenatal ARV prophylaxis, and was associated with advanced maternal immunosuppression.
Challenges in the integration of TB and HIV care : evidence for improving patient management and health care policy.
(2016) Naidoo, Kogieleum.; Abdool Karim, Salim Safurdeen.
TB infection remains a leading cause of morbidity and mortality among patients with HIV infection, while HIV is the strongest risk factor for development of active TB. Integration of HIV and TB treatment is key to reducing mortality in co-infected patients; but many obstacles stand in the way of effective scale-up of this approach to HIV-TB treatment. The challenges associated with HIV-TB integration extend from clinical complexities in individual patient management, to impediments in health service organization and prioritization to address this urgent public health priority, especially in sub-Saharan Africa where TB-HIV co-infection rates reach 80%. The purpose of this study was to assess and identify strategies to overcome the challenges in immune reconstitution and drug safety/tolerability when integrating HIV and TB care in a cost-effective manner to reduce co-infection mortality. Clinical and operational service data from the Starting Antiretroviral therapy at three Points in Tuberculosis Treatment (SAPiT – CAPRISA 003) study, a 3-arm, randomized control trial in 642 newly diagnosed sputum smear-positive TB-HIV co-infected adult patients with screening CD4+ cell count < 500 cells/mm3, were analysed. In addition, the incidence rate of unmasked clinical TB following ART initiation was assessed through a retrospective chart review conducted in HIV infected patients enrolled at the rural CAPRISA AIDS Treatment Programme. Overall, mortality was 56% lower (RR=0.44; 95% CI: 0.25 to 0.79; P = 0.003) in patients initiated on ART during TB treatment compared to ART deferral to after TB treatment completion. However, the risk of immune reconstitution inflammatory syndrome (IRIS) was higher (incidence rate ratio (IRR), 2.6 (95% CI, 1.5 to 4.8); P < 0.001, in patients initiating ART within the first 2 months compared to later ART initiation during TB treatment. In the most severely immuno-compromised patients (CD4 counts <50 cells/mm3) early ART integration was associated with an almost five-fold increased risk of IRIS (IRR 4.7 (95% CI, 1.5 to 19.6); P = 0.004. Patients initiating ART in the first 2 months of TB therapy had higher hospitalization rates (42% vs. 14%; P = 0.007) and longer time to resolution (70.5 vs. 29.0 days; P = 0.001) than patients in the other two groups. When assessing available evidence, these results indicate that ART initiation in patients with CD4 cell counts >50 cells/mm3 would be most appropriate after completion of intensive phase of TB therapy, a strategy that was found to cost $1840 per patient treated. Among HIV infected patients initially screening negative for TB there was a fourfold higher incidence rate of unmasking TB in the first 3 months after ART initiation, compared to the subsequent 21 months post-ART initiation. The new information generated by this study provides important evidence for policy and clinical management of patients with HIV and TB co-infection. Firstly, careful clinical vigilance for ‘unmasked’ TB is required in patients initiating ART. Secondly, the survival benefit of AIDS therapy in TB patients can be maximized by initiating ART as soon as possible after TB therapy has been started in patients with advanced immunosuppression, i.e., those with CD4+ counts <50 cells/mm3. However, patients with higher CD4+ cell counts should delay ART initiation to at least 8 weeks after the start of TB therapy to minimize the incidence and duration of immune reconstitution disease and consequent hospitalization. Thirdly, this approach, which is at variance with current World Health Organization policy and guidelines, is cost-effective and readily implementable within the clinical setting. Finally, addressing the operational challenges to HIV-TB treatment integration can improve patient outcomes with substantial public health by reducing mortality by the most important causes of death in South Africa.
Predictors of HIV acquisition in high risk women in Durban, South Africa.
(2015) Naicker, Nivashnee.; Kharsany, Ayesha Bibi Mahomed.; Abdool Karim, Salim Safurdeen.
In South Africa young women bear a disproportionate burden of HIV infection however, risk factors for HIV acquisition are not fully understood in this setting. In a cohort of 245 HIV negative women, we used proportional hazard regression analysis to examine the association of demographic, clinical and behavioural characteristics with HIV acquisition. The overall HIV incidence rate (IR) was 7.20 per 100 women years (wy), 95% Confidence Interval (CI) 4.20–9.80]. Women 18 to 24 years had the highest HIV incidence [IR 13.20 per 100 wy, 95% CI 6.59–23.62] and were almost three times more likely to acquire HIV compared to women 25 years and older [adjusted Hazard Ratio (aHR) 2.61, 95% CI 1.05–6.47]. Similarly, women in relationships with multiple sex partners [IR 8.97 per 100 wy, 95% CI 5.40–14.0] had more than twice the risk of acquiring HIV when compared to women who had no partner or who had a husband or stable partner (aHR 2.47, 95% CI 0.98–6.26). HIV prevention programmes must address young women’s vulnerability and promote safer sex practices for high risk women.

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