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Identifying contributory factors to adolescents’ late utilisation of antenatal care at primary healthcare clinics in a sub district north of eThekwini District, South Africa.
(2020) Reddy , Preantha.; Baloyi , Olivia Baorapetse.; Jarvis , Mary Ann.
Background
The late utilisation amongst adolescents of Antenatal Care (ANC) has shown to be detrimental to the pregnancy and the mother as inappropriate screening, testing and management is done due to delayed initiation. This is especially so, in the vulnerable population of adolescents where they are more susceptible which can contribute to maternal and child mortality. The adolescent is exposed to many challenges during pregnancy that can affect their utilisation of ANC, resulting in late booking.
Aim
The aim of the study was to identify the contributing factors to the adolescent’s (15-19 years) late entry to ANC at the select Primary Health care clinics.
Methodology
A quantitative study was conducted with self-administered questionnaires to adolescents who had booked late (>20 weeks) for ANC. The questionnaire was adapted to identify the contributory factors to the late utilisation of ANC with adolescents in which the variables socio-economic factors, knowledge of ANC, experiences of ANC services and obstetrical history were examined. The questionnaire was structured to maintain anonymity and had asked short ended questions and has Likert scales. Content and face validity was used to verify the questionnaire and show evidence that the tool is measuring the target construct. Face validity was obtained with the help of three health care experts (Medical officer, Nursing service manager and Midwife). Data analysis was performed using IBM Statistical Package for the Social Sciences (SPSS) version 26. Descriptive statistics such as frequencies and percentages were used to summarise categorical variables. Central tendency and dispersion of data were measured using means and standard deviations for normally distributed variables and medians and interquartile ranges for skewed variables. The Anderson and Newman`s Health Utilisation model guided the study.
Results
The response rate was 88%, with 96 respondents completing the questionnaire (anticipated sample size of 109). The data was collected from participants (15-19 years) in 13 clinics (eight Primary Health Care Clinics and five Community Health Care Clinics). The demographics showed majority age group of 18 years (n= 27, 28.1%), 95.8% (n= 92), of participants were single and 85.45% (n= 82) unemployed. The obstetrical and current history results showed the majority of participants had not used any contraception method (n= 68, 70.8%), 88.5% (n= 85) had not planned their pregnancy and 77.1% (n= 74) had no health problems. The majority of participants reported that they were satisfied with the experiences at the clinics, with 78.1% (n= 75) and 65.6 % (n= 63) were satisfied with the privacy and the staff respectively. A quarter (n =24, 25%) of the participants did not know the importance of ANC for pregnancy, while a lesser number (n=18, 18.8%) were unaware of the significance of ANC for their unborn baby.
Conclusion
Study findings highlighted the contributory factors to adolescents’ late utilisation of Antenatal Care. Basic Antenatal Care Plus Programme (BANC PLUS) has been shown to be beneficial to the adolescent as early utilisation of ANC can reduce maternal mortality. However, based on the Anderson and Newman Health Utilisation framework contributory factors, specific to the select geographical area were identified for late ANC utilisation. The targeting of the contributory factors through the recommendations can add value to the maternal health of the adolescent and in so doing recognise the global goal of universal health coverage and achieving Sustainable Development Goal 3.1.
Recommendations
Recommendations included Antenatal learning and supports, strengthening of health care systems and promotion and recognition of staff.
Limitations
Only selecting one district from eThekwini and only including the Department of Health clinics.
Rural school learners’ experiences of social media bullying: a narrative inquiry.
(2024) Myeni, Sphelele Ncebo.; Hlalele, Dipane Joseph.
The purpose of this study was to explore rural school learners’ experiences of social media bullying which is a worldwide problem presenting a variety of negative experiences to learners, including those in rural areas. Therefore, this requires rural school learners to be proactive, cautious, and vigilant to combat bullying on social media platforms may affect their physical, emotional, and psychological wellbeing. Since the experiences of rural school learners concerning bullying on social media platforms remains under-researched, this narrative inquiry contributes to bridging this gap by dissecting the narratives of rural learners to emerge with incisive insight and strategies to mitigate social media bullying. Bronfenbrenner ecological theoretical framework underpinned this study which adopted a qualitative interpretivist paradigm which was found suitable for exploring rural school learners’ experiences of social media bullying and its effects. This qualitative narrative inquiry research design elicited data by conducting narrative interviews involving five rural school learners from the same school who were purposefully sampled. Thematic analysis was then applied to dissect the collected data. Six themes emerged from this analysis. The findings suggested that Facebook and WhatsApp platforms were mainly utilised by rural school learners to bully each other because of jealousy, boredom, and lack of knowledge which impaired victims physically, emotionally, and psychologically. Recommendations emanating from the findings were aligned to the training of learners on how to deal social media bullying, how to prevent being vulnerable to social media bullying, and learners can educate and assist one another to annihilate this scourge. Also, school officials should invite and collaborate with parents and teachers, the Department of Education that can appoint psychologists, psychiatrists, or counsellors, and the school community in the vicinity of the rural school, in addition to structuring school and national education policies that address social media bullying.
The molecular mechanisms of mycobacterium tuberculosis curli pili (MTP) in regulation of fatty acid metabolism, carbon metabolism, and bioenergetics of the pathogen and host during infection.
(2024) Ashokcoomar, Shinese.; Pillay, Manormoney.
Background/Aim:
The initial contact between pathogen and host is a vital step in the establishment of infection. Mycobacterium tuberculosis (M. tuberculosis) mediates adhesion to target hosts cells such as macrophages via various proteinaceous molecules known as adhesins, found on the cell surface. A distinguished adhesin of M. tuberculosis is M. tuberculosis curli pili (MTP). Previous functional genomics studies have described the involvement of MTP in bacterial aggregation and biofilm formation in addition to its role as an adhesin and invasin of epithelial cells and macrophages. Transcriptomic studies elucidated the importance of MTP in modulating host immune response in vitro and in vivo. Moreover, MTP was found to be present exclusively in the M. tuberculosis complex, and to bind to antibodies in patient sera. The use of metabolomics, bioenergetics and molecular biology will further improve current understanding of MTP as a virulence factor, thereby corroborating its role as a biomarker for the development of better tuberculosis diagnostics and therapeutics. Therefore, this study aimed to elucidate the effect of MTP on M. tuberculosis metabolism and expression of selected genes involved in fatty acid transport, β-oxidation, lactate oxidation, and gluconeogenic carbon flow. Furthermore, this study aimed to investigate the metabolomic and bioenergetic role that MTP plays in the pathogen-host infection model.
Methods:
Confirmed wildtype (WT) M. tuberculosis, mtp-deletion mutant (Δmtp) and mtp-complemented strains were used throughout this study. Bacterial cultures were standardised prior to harvesting of wet cell mass for metabolite and ribonucleic acid (RNA) extraction. The bacterial metabolite extraction was performed using a whole metabolome extraction method and the metabolites were detected using untargeted two-dimensional gas chromatography time-of-flight mass spectrometry (GC×GC-TOFMS) (Chapter 2). The RNA was extracted via the TriZol method for reverse transcription quantitative polymerase chain reaction (RT-qPCR) on selected genes to support metabolomic data (Chapters 2 and 6). Host THP-1 monocytes were differentiated into macrophages prior to infection. Each of the bacterial strains were used to infect macrophages at a multiplicity of infection (MOI) of five. After four hours of incubation, host cells were used for: a) metabolomics via whole metabolome extraction for either detection with untargeted GC×GC-TOFMS (Chapters 3 and 4) or targeted liquid chromatography tandem mass spectrometry (LC-MS/MS) with stable isotope carbon-13 (13C6)-glucose tracing (Chapter 5); b) bioenergetics through cell mitochondrial stress tests (CMSTs) and glycolytic rate assays (GRAs) performed in an extracellular flux analyser (Chapter 5); and c) lysis to harvest intracellular bacteria for RNA extraction to perform RT-qPCR (Chapter 6). All experiments were repeated to ensure reproducibility of the data, which were analysed by the appropriate statistical tests to highlight significant differences or similarities amongst the models, groups and samples.
Results/Discussion:
Bacterial RT-qPCR and functional metabolomics through GC×GC-TOFMS revealed that the Δmtp was associated with an altered cell wall composition. Of the 28 metabolites shortlisted, 19 of them were detected in elevated concentrations in the Δmtp compared to the WT, thus indicating that the lack of MTP reduces the overall ability of the pathogen to utilise these metabolites for biological processes. This was deduced from the high concentrations of carbohydrates involved in cell wall biogenesis and functions, and fatty acid metabolism. Additionally, alterations to amino acid concentrations further explained the previously reported growth retardation compared to the WT. Mycobacterium tuberculosis infected THP-1 macrophage models revealed significant alterations to central carbon metabolism (CCM), fatty acid metabolism and amino acid metabolism in the absence of MTP. In particular, the Δmtp infected THP-1 macrophages demonstrated that nine of the GC×GCTOFMS detected metabolites were significantly higher relative to the WT infected THP-1 macrophages. These altered concentrations were observed for metabolites involved in glycolysis/gluconeogenesis, tricarboxylic acid (TCA) cycle, fatty acid and amino acid metabolic pathways that feed into or are fed by CCM. Given that M. tuberculosis establishes contact with both macrophages and epithelial cells during infection, a comparison of two different host cells were performed. Metabolite concentrations compared between the THP-1 macrophage infection model and A549 epithelial infection model demonstrated that the macrophages are more likely to advocate for pathogen clearance through a more efficient pro-inflammatory response, particularly in the absence of MTP, relative to the epithelial cells. Data presented here demonstrated that the MTP adhesin plays a role in securing a protective environment for M. tuberculosis during initial stages of infection. Therefore, the THP-1 macrophage infection model was further investigated by targeted LC-MS/MS and bioenergetics to ascertain a more comprehensive understanding of the carbon flux, energy profiles and macrophage polarity in the absence and presence of MTP. The Δmtp infection model mimicked the oxygen consumption rate (OCR) for basal respiration, adenosine triphosphate (ATP) production, maximal respiration, and spare respiratory capacity of the uninfected THP-1 macrophages and had the highest compensatory glycolytic rate. Furthermore, the tracing experiments revealed that MTP has no effect on the flux of glucose, but rather has an impact on the total concentrations of the macrophage infection model. These findings indicate that MTP plays a role in modulating the macrophage respiratory parameters and dampens the pro-inflammatory response of the host. Hence, the macrophage host will be more proficient at launching an immune response if the adhesin is absent. The RT-qPCR performed on selected genes from pure bacterial culture and intracellular bacteria demonstrated that removal of MTP from M. tuberculosis alters lipid import, β-oxidation, and lactate oxidation of M. tuberculosis. Moreover, in all models in which the mtp-complement was used, partial restoration of the phenotype was observed as a result of the overexpressing episomal plasmid. Cumulatively, MTP was evidenced to play a multifunctional role for M. tuberculosis.
Conclusion:
The surface-located adhesin, MTP, is a virulence factor of M. tuberculosis as it initiates and facilitates attachment to, and invasion of hosts in addition to providing structural integrity to the pathogen. This adhesin enhances bacterial survival as it reprograms the M. tuberculosis and THP-1 macrophage metabolism to manipulate host effector functions. Collectively, this study provided metabolomic, bioenergetic and molecular evidence that MTP significantly contributes to the success of M.tuberculosis as an intracellular pathogen. Hence, the focus of TB intervention strategies should include intercepting the MTP interaction with the host to offset M. tuberculosis pathogenicity and confer an advantage to the host.
An exploration of young women’s menstrual experiences in the African context: a scoping review.
(2023) Pillay, Lorelle.; Valjee, Sachet Rabindranath.
Introduction: Limited research has been conducted on menstrual experiences and the impact of menstrual experiences on young women in the African context. Growing bodies of research show that young women experience menstruation negatively due to lack of knowledge and adequate resources within low- and middle-income countries. The research that currently exists around the topic of menstruation is mostly quantitative and the in-depth narratives of young women’s menstrual experiences are only minutely explored. It was found that socio-cultural beliefs and practices play a role in influencing certain negative menstrual experiences and perceptions of menstruation. This study aims to examine and map the impact of menstrual experiences on young women in Africa as well as the socio-cultural influences on menstrual experiences. Method and analysis: This study was conducted by means of a scoping review. Data was extracted from multiple databases on EBSCOHost. The process of data extraction was presented in the form of a PRISMA Flow diagram. A total of 15 articles were included in the present study. Results and Discussion: It was found that young women’s experiences of menstruation in Africa have mostly been negative and that these experiences were attributed to a lack of adequate water, sanitation and hygiene facilities in their respective environments, the misinformation about menstruation and menstruating females portrayed by cultural norms and the lack of education around menstruation and menstrual processes. The major themes identified from the thematic analysis were 1) The impact of menstrual experiences amongst young women in Africa and 2) The socio-cultural influences on menstrual experiences. The sub-themes identified in relation to the impact of menstrual experiences included 1) Attendance, 2) Mental distress, and 3) Lack of sanitary facilities. The sub-themes identified in relation to socio-cultural influences on menstrual experiences included 1) Lack of menstrual knowledge, and 2) Concealment. Conclusion and recommendations: Two overarching themes were identified during the process of analysis and were divided into a total of 5 sub4 themes. There exists a need for future research to focus on intervention, exploring qualitative research and expanding research in different countries within the African context.
A content analysis of child neglect in the international journal, child abuse & neglect (2013-2022).
(2023) Richards, Lynne Althea.; Collings, Steven John.
Introduction: Child neglect has disastrous consequences for the normal development of a child; however, child neglect has purportedly been overlooked in the extant literature (Tingberg & Nilsson, 2020; Wolock & Horowitz, 1984). Objectives: This study seeks to summarise the research conducted on child neglect in the international journal, Child Abuse & Neglect published between 2013 to 2022. Furthermore, it seeks to provide an overview of published empirical research conducted on child neglect in relation to other forms of child maltreatment, highlighting trends concerning the research methodology and sample. Method: A content analysis of the publications on child neglect in the international journal, Child Abuse & Neglect (2013-2022) was conducted using Krippendorf’s (2018) method. Krippendorf’s alpha was assessed to be a=0.92, p < .001, indicating high interrater reliability. Findings:While no significant relationship was found between the types of child maltreatment that were studied, child neglect was consistently assessed the least. Contrarily, child ‘physical and emotional neglect’ was assessed the most. The increased assessment of child physical and emotional neglect aligned with the predominant use of the Childhood Trauma Questionnaire (CTQ) and Adverse Childhood Experiences Questionnaire (ACEQ), which are both used to assess physical and emotional neglect. Child neglect studies published in the international journal Child Abuse & Neglect (2013-2022) predominantly used cross-sectional designs and convenience samples. Moreover, these studies predominantly assessed samples in high-income countries. Conclusions: The current study suggests that the ‘neglect of neglect’ remains an issue in the literature. There is an increasing need for a universal and culturally sensitive definition from which to develop a suitable measure of child neglect. Moreover, research in low- and middle-income countries is essential to investigate the proposed relationship between poverty and neglect.