Theses and dissertations (Health Sciences)

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Healing with horses : equine-based therapy as a therapeutic modality in social work practice in the South African context
(2023-09) Naidu, Lyrise; Bhagwan, Raisuyah
INTRODUCTION Recently published research studies have delved into how the connection between humans and horses can address social, educational, and emotional challenges among distressed individuals. The current body of literature falls short of adequately explaining the mechanisms that underlie these therapeutic approaches, particularly when it comes to understanding the role of equines in facilitating the therapeutic and learning processes. This comprehension is crucial for establishing a strong foundation for such therapeutic efforts and for broadening its application within the field of social work. It is important to note that previous research has not deeply explored the complexities of equine-based therapy or the methods that practitioners use when working with their clients. The current study was undertaken with mental health practitioners who are engaged in equine-based therapy. It sought to understand equine-based therapy and its potential as a healing tool in the social work. PURPOSE OF THE STUDY The purpose of the study was to explore the potential of equine-based therapy as a therapeutic modality in social work practice. It sought to understand the principles that guided equine-based therapy. It further explored the processes underpinning equine-based therapy. The study also looked at the emotional and social problems that were most suited for equine-based therapy and sought to understand the benefits individuals experienced through equine-based therapy. It also focused on the experiences that mental health practitioners had with regard to their use of equine based therapy. Finally, it explored how equine-based therapy can be used to enhance social work practice. METHODOLOGY This study adopted a qualitative exploratory-descriptive design as it sought to extract rich information pertaining to the process of equine-based therapy, its benefits, and its significance in social work. The study was further guided by an instrumental case study approach. The study consisted of one sample of mental health practitioners who used equine-based therapy as a therapeutic tool. Semi-structured interviews were used as the technique for data collection. Data was collected till saturation. In total, fifteen mental health professionals were interviewed. Data collection occurred in person at the offices of the mental health professionals. Data collection was conducted in four provinces, namely, Gauteng, KwaZulu-Natal, Eastern Cape, and Western Cape. The process of data analysis was guided by the steps of thematic analysis. This enabled the transcripts to be reduced to patterns and similar themes. Words and phrases were generated to represent these themes and sub-themes. The themes served to illustrate the essence of the mental health practitioners’ responses to how they worked with equine-based therapy. FINDINGS The major themes that emerged from the analysis, were namely. the values and principles which were guiding equine-based therapy, the process underpinning equinebased therapy, the facilitation of equine-based therapy, clients who are suitable for equine-based therapy, and the benefits of engaging in equine-based therapy and equine-based therapy in social work. The study found that a diverse range of values and principles were used to guide the practice of equine-based therapy. Some of the critical values and principles that emerged were humility, respect for clients and horses, maintaining a non-judgemental attitude, maintaining professionalism, confidentiality, self-determination, and no harm to clients. The process underpinning equine-based therapy included the use of different approaches to equine-based therapy. Clients had to be oriented into equine-based therapy before they started engaging with the horse. The clients also had to follow a specific procedure before they could be part of a therapeutic session. The process also involved a check-in session between the mental health practitioner and the horse. Moreover, it was found that when conducting equine-based therapy, the setting for the session should be considered as it plays a role in the process. Sessions were also found to be set up within specific time frames. One of the key findings in the process was that it was compulsory to have three partners in the equine-based therapy process i.e., the horse, horse professional and the mental health practitioner. Furthermore, the facilitation of equine-based therapy was found to involve the inclusion of structured activities and various techniques and interventions such as play therapy, counselling interventions, the use of storyboards and spiritual interventions. The inclusion of equine-based therapy in social work found several benefits for various groups of clients and indicated significant value in the social work field. CONCLUSION Equine-based therapy has shown promise for its inclusion in the field of social work practice. The study highlighted the understanding of equine-based therapy, its process, the key values, and principles as well as the benefits of equine-based therapy. The study further highlighted stories of healing from the perspective of the client and mental health practitioners involved in equine-based therapy. Moreover, the study gave an overview of the significance of horses in social work and the value of equinebased therapy in social work. It also included the education and training required for social workers to practice equine-based therapy effectively.
Towards the conceptualization and institutionalization of community engagement in India : an exploratory study at Indian Higher Education Institutions
(2023-12) Singh, Wafa; Bhagwan, Raisuyah
Human existence, despite being the most advanced today, finds itself at a crossroads and in a state of turmoil and turbulence. The same stands true for India, which, notwithstanding its tremendous human capacities, faces multifaceted challenges with respect to human and social development. These challenges are reinforced when a valuable concept like ‘knowledge’, with a potential to steer societies amidst these challenging times, in terms of addressing problems and providing solutions; is boxed, siloed and created and shared in a unilateral manner. The role and functioning of Indian Higher Education Institutions (HEI’s), within this context is of paramount importance, especially in its capacity as an institution, serving public good. Further, given the demographic dividend that the country is witnessing; Indian HEI’s have an enormous responsibility to nurture the massive pool of young graduates into becoming active, responsible and global citizens; through their knowledge production and dissemination function. It is in this context, that the concept of Community Engagement (CE) in higher education, linked to the broader mandate of academic social responsibility, has gained traction worldwide, and in India as well. However, while the practice of CE has advanced at a much greater pace globally; its trajectory in the Indian higher educational context has lagged behind. Among the many reasons for this, one of the primary ones have been the absence of national empirical studies in this context, which has resulted in the practice being fraught with gaps and inadequacies. Further, the absence of any national framework or guiding model to aid and support the implementation of CE in Indian HEI’s, has added to the problems plaguing the practice. It is against this background that this research study was undertaken, in order to fill the existing gaps in theory and practice of CE in the Indian context, by exploring aspects related to its conceptualization, institutionalization and operationalization. Most importantly, the study developed a framework for guiding and strengthening this area of work in Indian HEI’s. To achieve these objectives, the study was situated within an interpretivist paradigm, and adopted qualitative research methodology to explore this topic at eight best-practice Indian HEI’s. Semi-structured in-depth interviews, supported by an interview guide, was used to collect data and insights from two set of academics (sample 1 belonging to university administrators (vicechancellors/registrars/deans) and sample 2 belonging to faculty members at the department level). The data was then analysed using thematic analysis to collate and present the findings, which was used to develop the framework for guiding and strengthening CE at Indian HEI’s. The findings of the study shed light on nuanced and exclusive perspectives with respect to the conceptualization, institutionalization and operationalization of CE in the Indian context. This assumes special importance, considering the somewhat thin Indian literature in this context and on such aspects. The study’s findings reiterated the importance of institutional core values and clarity on the practice, as building the core of the conceptualization of CE. Further, complete and dedicated institutional commitment, towards adopting a cultural change, and devising mechanisms for placing CE as a core academic practice, is key to its institutionalization. Similarly, operationalization of CE is driven by how well an institution imbibes and adopts the values of dynamism, innovation and creativity, for making its core functions more socially engaged and contextually relevant. Building on these findings, the study developed a framework for guiding and strengthening the practice of CE in Indian HEI’s, while situating the latter within the broader national higher education policy and the institutional policy environment. In particular, the model focuses on the reciprocal and value-driven interplay between the institutional vision, personnel, structures and functions; for producing engaged teaching-learning practices, with the ultimate objective of creating a socially responsible HEI. By articulating critical aspects in relation to formalizing and formulating the practice of CE; the model can serve as an effective guide and a handy tool for academic stakeholders at Indian HEI’s. In doing so, the framework aims to support academics in India and beyond, in practicing CE, more meaningfully and effectively for achieving both academic and social development outcomes in the bargain.
Exploring the vulnerabilities of homeless women in the Sisters’ of Mercy Homeless Shelter during the COVID-19 pandemic in Johannesburg
(2023-12) Makabate, Sanelisiwe Portia; Bhagwan, Raisuyah
Abstract Background: Homelessness has multiple physical, psychological and emotional effects on those who have experienced it. In addition to directly harming public health, the lockdown measures put in place at the COVID-19 pandemic's peak to stop the virus's transmission had severe negative repercussions on the social, psychological, and economic spheres, especially for homeless women. There is a deficiency in South African literature that examines the distinct health, economic and social challenges that homeless women experienced during the COVID-19 pandemic. Aim: To explore and understand the vulnerabilities of homeless women in the Sisters’ of Mercy Homeless Shelter during the COVID-19 pandemic. Methodology: The study was driven by a qualitative inquiry. To decide on the participants, non-probability purposive sampling was employed. One-on-one, in-depth interviews with twelve homeless women who lived in the Sisters of Mercy homeless shelter were used to gather data. Face-to-face interviews were conducted using an interview schedule that was translated to isiZulu and Sesotho to gather data, which was then thematically analysed. To take into consideration ethics in this research, the researcher was aware that subjects were real people whose rights and dignity must always be respected, and protection of their confidentiality was significant. The researcher kept the written notes inside a lockable cabinet and the recorded data was kept in the researcher’s computer under a folder that required a password, this ensured trustworthiness which is the integrity of qualitative findings. Findings: Five broad themes and sixteen subthemes emerged from the data collected. Findings indicated that women who participated in this study missed hospital appointments and their healthcare needs were unmet, because of overcrowding and prioritization of those infected with Coronavirus in hospitals. This exacerbated chronic illness because they could not afford transport and administration fees linked with their health care needs. Their inability to pay these costs, was attributed to their loss of income during the pandemic. such circumstances, endured anxiety, depression and other psychological forms of distress. The study further found that those at the Sisters of Mercy Homeless Shelter, had to vacate the shelter during the day, which resulted in little access to water which consequently affected their hygiene and sanitization of their hands. Amidst the COVID19 pandemic, the individuals involved in this study were totally displaced from the shelter, which resulted in many having to secure alternative shelter. The findings further indicated that the participants who were employed in feminized sectors such as retail, food, hospitality and as domestic workers, suddenly lost their jobs during the pandemic. Hence, the study found that for many, their greatest fear was that of starvation as opposed to contracting coronavirus. Income losses, food insecurities and future uncertainties were coupled with greater depression, loneliness and anxiety. Participants depended on social workers and other charitable organizations for social support, emotional support and psychological support to survive the challenges linked with homelessness. However, the study found that such support was not available during the lockdown. Lockdown regulations dictated a limited amount of physical contact and the participants were expected to communicate with social workers online which they found not helpful. A charitable organization that provided them with instrumental support such as food, clothes and toiletries was also closed, thereby exacerbating their plight. The mitigating strategy of social distancing and self-isolation, also exacerbated gender-based violence especially amongst vulnerable homeless women, who reported that they became victims of frustrated unemployed male partners. The participants alluded that even before the pandemic as homeless women, they received limited protection and support from the police department. Conclusion: The findings suggested that the unique gender experience for homeless women was exacerbated during the COVID-19 pandemic. The importance of the study was that it acknowledged that participants had feelings of uncertainty about the future, and they believed that the repercussions of the pandemic would still hit them hard even in the future. Social workers and healthcare workers should be conscientized about the vulnerabilities of homeless women, so that they may consciously remove the stigma, and take the initiative to support them. To ensure that homeless women cope with the post pandemic crisis, it is recommended that homeless women be equipped with skills and training that will make them employable or self-employed.
An exploratory study on kinship care and how it benefits children and youth in Robbinsdale, Mpumalanga
(2023-12) Mshayisa, Langa; Bhagwan, Raisuyah; Dewan, Fathima
INTRODUCTION Kinship care is one of the alternative care methods available for vulnerable children and youth who have been found to be in need of care and protection according to Section 150 of the Childrens’s Act 38 of 2005. Kinship care is offered by relatives (kin) or non-relatives (fictive kin) with close relationships with young people needing of care and protection. Unlike other nonfamilial alternative care methods, such as institutionalised care, kinship care thrives on keeping children and youth within their family environment post-removal from birth parental care. Kinship care can be formal (public) or informal (private). The difference is between the government initiated and supported kinship care or whether relatives (kinship caregivers) took it upon themselves to offer it. To kinship caregivers who offer this care under the auspices of governmental child welfare agencies, it is considered formal. On the contrary, when kinship care is only discussed and offered within families without the involvement of governmental child welfare agencies, it is considered informal. PURPOSE OF THE STUDY The study aimed to understand both the benefits and challenges of kinship care in the lives of young people in kinship care in the Robbinsdale community in Mpumalanga, South Africa. Such understanding is crucial to the betterment of this care in this context and for the benefit of the young people who are kinship care beneficiaries. METHODOLOGY The researcher used a qualitative research approach to conduct this study. Consequently, the study adopted an explorative research design. This helped the researcher obtain data that provided answers to the study’s purpose and objectives. The study setting was the Robbinsdale community in a rural part of the Mpumalanga Province, South Africa. The study had a sample of fifteen African families in which kinship care is offered. The drawing of the study sample was done through the purposive sampling technique. Subsequently, the study had twenty-one (21) participants who were interviewed through semi-structured interviews. This interviewing strategy allowed the researcher to gather rich data from participants. Data collected thereafter was analysed through the process of thematic analysis. This analysis strategy allowed the researcher to derive significant themes and sub-themes from which study findings came. The researcher adhered to the ethical considerations. FINDINGS The data collected produced six (6) significant themes from which twenty-six (26) sub-themes emerged. The six (6) significant themes were as follows: (i) kinship care, (ii) the role of African spirituality, (iii) becoming a kinship caregiver, (iv) benefits of kinship care, (v) challenges posed by kinship care and (vi) governmental support. Though there were challenges found, there were many benefits of kinship care in the lives of children and youth in kinship care as well. The benefits included, getting a parental figure(s), knowing their background, home with protection, help from the community and getting their basic needs met. The most cited challenge by participants was the lack of support by the government towards kinship care. Other challenges included negative influences, difficult behaviour by young people in kinship care and young people’s unknown paternal cultural customs. Kinship caregivers believe that the appropriate support from the South African government towards kinship care could help mitigate these challenges which are somewhat clouding the benefits of kinship care. The findings included the role played by African spirituality in the provision of kinship care in the South African context. The practice of African spirituality proved to be another benefit for young people in kinship care. The study found that African spirituality helps children and youth in kinship care grow within culturally appropriate family constellations, allowing them to be cognisant of their personal identity and preserve their cultures. Furthermore, African spirituality helps facilitate healing and the positive upbringing of children and youth in kinship care. Notwithstanding the challenges the study found, the findings showed kinship care as a much more beneficial alternative care method in the lives of children and youth in the Robbinsdale community in Mpumalanga Province. CONCLUSION The recognition of kinship care as a legal alternative care method in South Africa is of crucial importance. This recognition would help the government provide direct support for kinship care for the benefit of vulnerable children and youth in kinship care. Currently, in the South African context, kinship care in mainly informal, which restricts the amount of help and benefits young people receive in kinship care.
Exploring the use of nutritional supplementation and nutritional education in the chiropractic management of osteoarthritis amongst practicing Chiropractors in South Africa
(2023-11) Grimett, Tiffany; Abdul-Rasheed, Ashura; Padayachy, Keseri
Background Osteoarthritis (OA) is the most common form of arthritis, resulting in chronic joint pain and stiffness which may worsen overtime. Chiropractors treat all types of conditions, with osteoarthritis being one of the most common. Chiropractors provide patients with detailed plans of treatment to reduce pain and the increase movement of the affected joints; they also have the ability to provide the patient with nutritional counselling, advising the patient on which foods to avoid, suitable supplementation and the importance of physical activity for weight management. This research study focused specifically on chiropractic healthcare providers and how they implemented nutritional education with regards to osteoarthritis within their practice. It focused on how often they prescribed nutritional supplementation and also looked at the outcomes of patient treatment with and without the use of nutritional supplementation for osteoarthritis. Due to the diversity of race, culture and nutrition choices, especially in South Africa, chiropractors have to deal with more broad-spectrum patients, thereby the use of nutritional supplementation and education may vary from patient to patient. Aim of the study The aim of the study was to explore the use of nutritional supplementation and education in the management of osteoarthritis by selected practicing chiropractors in South Africa. Methodology A qualitative exploratory design was utilised in this study. Semi-structured interviews via an online platform were utilised to conduct in-depth interviews with 12 registered chiropractors practising in South Africa. The interviews were conducted in English and were then transcribed. The data were analysed using Tesch’s eight steps of thematic analysis to establish the themes and subthemes. Results There were seven key themes that arose from this study. The study highlighted the importance of including nutritional education and supplementation in conjunction to chiropractic care, noting that it does, in fact, play a role in improving the patient’s outcomes. Practitioners aimed to manage patients with a holistic approach. Using this approach to healthcare, practitioners were able to collaborate with other healthcare professionals to further improve patient outcomes. Conclusion The findings that emerged from this study indicate that the use of nutritional education and supplementation, in conjunction to chiropractic care, in the management of patients with OA, is vital. Patients showed greater improvement outcomes when the two were combined. Therefore, it is necessary that not only chiropractors but all healthcare professionals include the use of nutritional supplementation and educate the patient on the long term effects and the importance of nutrition for reduced symptoms to better manage their osteoarthritis.
The psycho-social challenges of working at the forefront of the Covid-19 pandemic : a survey of emergency care services personnel in the Eastern Cape EMS
(2023-05) Mfanafuthi Mavuso, Patrick; Bhagwan, Raisuyah; Abdullah, Naseef
Introduction The COVID-19 pandemic, which emerged in early 2020, has caused a surge in patient numbers and crippled healthcare systems. South Africa has had more than 2.9 million positive COVID-19 cases, resulting in over 89 000 deaths. Healthcare workers (HCWs) have been under insurmountable mental and psychological pressure, leading to depression, anxiety and ultimately, burnout. Emergency Medical Services (EMS) personnel play a pivotal role in managing and caring for ill and injured patients in the pre-hospital setting. These practitioners are at the forefront of the fight against COVID-19. Despite the role they play in improving the health outcomes of these patients, there is a paucity of research on the effect of COVID-19 on EMS personnel working and living in the rural areas of low-and-middle-income countries like South Africa. Gaining insight into the daily challenges faced by HCWs and the coping strategies adopted will assist EMS personnel in mitigating physical and emotional stressors, as well as long-term psychological effects. Aim of the study To investigate the psycho-social influence of working at the forefront of the COVID-19 pandemic amongst EMS personnel in the Eastern Cape. Objectives This study aimed to: I. Identify the working conditions that exacerbate the stress of working within the context of the COVID-19 pandemic; II. Ascertain the factors that reduce stress amongst EMS personnel; III. Identify the psychological stressors amongst EMS personnel in the Eastern Cape during the COVID-19 pandemic; IV. Identify the coping mechanisms/strategies used by EMS personnel in the Eastern Cape during the COVID-19 pandemic; and V. Make recommendations on providing support and improving the working conditions of EMS personnel in the Eastern Cape. Methodology The study was conducted using a quantitative, cross-sectional descriptive survey design guided by a post-positivist paradigm with a deductive approach. Data was collected from 368 participants who worked in the Eastern Cape during the start of the COVID-19 pandemic. Participants were presented with an online survey questionnaire, which was subsequently analysed using the Statistical Package for the Social Sciences (SPSS) statistics software, and the results were presented by tables, charts and descriptive summaries. Results An overwhelming 80.4% (n=296) of EMS personnel showed dedication to their work (patient care), despite working under immense pressure. The findings showed moderate agreement to different stressors, indicating that EMS personnel do not suffer from existential fears but are somewhat worried about their own risk of infection and that of their family. The main stress factors included the availability of PPE, infection and treatment protocols, recognition of their work by EMS management, and the perceived risk of infection to themselves and others. Motivational factors that encourage EMS personnel to work in future outbreaks or pandemics were not significantly related to attitudes within the context of the COVID-19 pandemic. Conclusion As a direct and immediate consequence of providing care to COVID-19-infected patients, frontline HCWs put themselves at risk of various adverse physical and emotional effects. An already stressful situation becomes extremely precarious as a result of the escalating negative impacts on mental and physical health experienced by EMS personnel, a crucial demographic, used to fight the pandemic. The findings of this study are consistent with what was already known from previous studies conducted on HCWs during previous pandemics, thereby being relatively predictable. This emphasizes the importance of basing pandemic planning and reactions on the most current and reliable data.
A work integrated learning content framework for clinical neurophysiology technology in South African universities of technology
(2024-08) Van der Walt, Christelle; Orton, Penelope Margaret; Prakaschandra, Dorcas Rosaley; Marais, S
INTRODUCTION Clinical technology (CT) is a group of seven specialist professions dealing with diagnosis and monitoring of human organ system function and diseases. Clinical neurophysiology (CN) is one of these professions and uses multi-modality test investigations of the brain, peripheral and central nervous system, and muscular system, to diagnose and monitor neurological disease. Since the origin of formal training, specialist learning in one of these categories has occurred during a period of work-integrated learning (WIL) after a combined didactic period at one of the three South African universities of technology that offer this qualification. The duration of this period has fluctuated over time. Currently this is set at 3 840 hours over a 24-month placement period as per the South African Qualifications Authority (SAQA) course registration documents. No previous investigations have been conducted to determine the industry required content of this WIL period or how the testing and monitoring modalities taught support specialist learning. No category specific training frameworks exist to aid training units at any of the current three universities offering this qualification. AIMS AND OBJECTIVES The purpose of this study was to determine the current industry requirements for graduates to integrate into Clinical Neurophysiology private practice upon graduation. This study aimed to determine the core testing modalities to include in an undergraduate clinical technology qualification and how each modality can support learning of related modalities. Related to this, this investigation also aimed to determine embedded skills, knowledge, and personal graduate attributes required for mastering of each of the core modalities. The final objective was to design a learning framework based on the interconnected learning affinity of modalities that incorporates all the required graduate skills that drive achievement of graduate level outcome skill levels as determined by industry requirements. METHODOLOGY A Delphi research study was designed to firstly investigate the historic development of the profession and training, and secondly determine the core testing modalities and related knowledge and skills a current industry aligned qualification should include. A round of unstructured interviews and desk research was undertaken to identify all modalities currently included in university of technology course documents. A total of 23 modalities were identified. This round of data gathering was followed by two Delphi questionnaires. The first questionnaire (Q1) provided clinical neurophysiologists (CNPs) currently in private practice an opportunity to select their preferred core modalities from the list of modalities identified during the first data gathering round. Participants were also able to contribute current industry required outcome skill levels and embedded skills and knowledge required to master each modality. Fifty participants identified a list of 15 modalities as potential core modalities and contributed approximately 1 600 comments on prerequisite skills and embedded knowledge and graduate attributes. The second questionnaire (Q2) reported the findings of the first and provided the 36 participants with the opportunity to evaluate the learning and prerequisite dependence or affinity of interrelated modalities. The participants also reevaluated the required outcome practice skill level for each modality and how knowledge and practical skills from Q1 drive learning of the core modalities. RESULTS At the end of the second questionnaire a total of 13 modalities were identified as core modalities that are essential to master during undergraduate WIL. It was determined that students must be able to perform, report, and interpret the results of the 13 core modalities. Dependence affinity of the 13 core modalities for learning of related modalities was confirmed and the embedded and prerequisite skills driving the mastering of each modality were combined into a learning framework. Results confirmed the historic foundational importance of electroencephalography (EEG) as a prerequisite to learning all the other core modalities. CONCLUSION This was the first study investigating industry required graduate outcome skills for an undergraduate qualification in clinical technology. Through a Delphi study 13 core outcome modalities were identified and the required outcome skills level for integrating into private practice was determined. Participant skills and knowledge contributions were drawn upon to design a driver-based learning framework that can guide the universities and training units in structuring the WIL period for most efficient clinical training time management to achieve the required graduate skills outcomes during the 3 840 clinical training hours.
Speckle tracking evaluation of right ventricular function post left-sided valve replacement
(2024-08) Dlamini, Nompilo; Prakaschandra, Dorcas Rosaley; Koshe, J J; Gojo, Mawande Khayalethu Edson
Background: The right ventricle dilates due to increased pulmonary wedge pressure caused by mitral and/or aortic valve disease, which lowers the right ventricular (RV) ejection fraction. This dilation can lead to tricuspid regurgitation (TR) with secondary right ventricular volume overload. Surgically correcting the left heart valves is thought to result in more favourable RV reverse remodelling, however, a growing number of patients have been observed in the cardiac unit at Port Elizabeth Provincial Hospital (PEPH) with worsening symptoms after left valvular correction. Due to the idea that tricuspid regurgitation (TR) would disappear after the original left-sided valve disease was corrected, surgical correction of the tricuspid valve (TV) has, up to now, been avoided in patients with secondary STR at the time of left valvular surgical correction. Much too little is known about how critical right ventricular (RV) function is and how it affects the cardiovascular patient’s prognosis. When selecting surgical procedures for the mitral valve (MV) and/or aortic valve (AO), RV performance is not the key determining factor. Aims: To determine changes in the right heart after mitral and/or aortic valve surgery, as well as to determine predictors of early signs of tricuspid regurgitation progression post-left valve surgery using two-dimensional Doppler and speckle tracking echocardiography. Study population and design: This study included 30 patients, 12 males and 18 females between the ages of 18 and 65. This was a prospective clinical study on the preoperative and postoperative echocardiographic parameters and their interaction in patients with severe mitral and/or aortic valve disease who were candidates for valve surgical correction. All echocardiographic examinations were conducted in the cardiac clinic of Port Elizabeth (Gqeberha) Hospital in the years 2020 to 2022. Subjects and methods: Participants were subjected to complete clinical examination and transthoracic echocardiography using the Ultra-Premium Aloka Prosound F75 Hitachi system, equipped with S3 transducer under very strict COVID-19 protocols. Standard 2D, M-mode, right ventricular global longitudinal strain, right ventricular free wall longitudinal strain, and Doppler echocardiography in the parasternal and apical views were recorded. Results: The population comprised 30 patients undergoing cardiac surgery for severe mitral and or aortic valve surgery. The study’s results revealed that the mean age of patients was 45.83 years with the majority being females (60%) and males at 40%. The predominant aetiology of valve diseases was degenerative valve disease (43.3%), and the most common valve disease was mitral regurgitation and aortic regurgitation, respectively at 23.3%. Tricuspid valve replacement reduced tricuspid regurgitation significantly, however, due to the small number of patients (n = 1) who progressed to significant tricuspid regurgitation further analysis was not undertaken. All correlations between tricuspid valve annulus, right ventricular systolic pressures and right ventricular diameter 6 months post-op were significant with a p-value of < 0.001. There were significant differences in left ventricular end-diastolic diameter (LVEDD) [5.46 ±.867vs 5.11 ±.850, (p=0.027)] as well as ejection fraction (EF) [65.33 ± 11.902 vs 61.50 ± 15.543, (p=0.037)] 6 months post op. There was no significant global longitudinal strain (GLS) change demonstrated in right ventricular function using speckle tracking imaging [-5.02 ± 7.400 vs -6.07 ± 9.373, p>0.005). The study demonstrated a significant decline in regional basal inferior septum (BIS) segments at 6 months follow-up [-9.67 ± 19.626 vs -4.86 ± 23.126 (p 0.034)]. The study also demonstrated a significant decrease in right ventricular function measured with TAPSE [23.20 ± 6.483 vs 19.182 ± 5.7738 (p<0.001) and FAC [60.63 ± 17.76 vs 41.33 ± 19.62 (p=0.18) 6 months post-op, with an immediate decline in mean measurements directly (72 hours) after surgery, a slight gradual mean increase was noted at 6 months follow up after surgery. A significant negative correlation was seen between RV dimensions and TAPSE 6 months post-op. There was no correlation seen between EF and GLS and TAPSE, LVEDD and GLS 72 hours post-op and again 6 months post-op (p >0.05). Conclusion: The global and/or regional systolic RV function was appropriately estimated using the 2D Doppler measurements and speckle tracking imaging. Together, these echocardiographic parameters measurements allowed for an accurate RV evaluation, improving disease diagnosis and management. Immediately following surgery, a thorough examination that includes TAPSE, S', and RVFAC assessment should be conducted. This examination should be repeated in three and six months to verify whether RV longitudinal function may have fully recovered and to enhance early management of RV failure.
The antimicrobial effectiveness of Tulbaghia violacea and Allium sativum on the in vitro growth of Candida albicans
(2024-03) Reddy, Wesley; Ross, Ashley Hilton Adrian; Pillay, Charlene
Aim This study sought to compare the antifungal potential of Tulbaghia violacea to that of Allium sativum. Mother tinctures and a respective selection of homoeopathic potencies were evaluated in terms of their inhibitory effect on the growth of Candida albicans in vitro. Methodology This experimental study employed microbiological assays to evaluate the antifungal potential of Tulbaghia violacea (wild garlic) while comparing this activity to Allium sativum (garlic) against Candida albicans in vitro. Allium sativum bulbs and fresh Tulbaghia violacea bulbs and leaves were processed into 1:2 ethanolic extracts. These were diluted into 1:10 mother tinctures in 8% ethanol and succussed to prepare respective 3CH, 5CH, 8CH, 13CH and 21CH homoeopathic potencies (CHcentesimal Hahnemannian – diluting substance by a factor of 100 followed by rigorous shaking before the next dilution). The inhibitory effect of the respective preparations was investigated using the microtitre plate assay. The absorbance of Candida albicans, in Sabouraud dextrose broth, was measured at 630 nm with a Multiskan Go microplate spectrophotometer in the presence and absence of selected test substances. The absorbance readings of the test groups were compared to the negative control (Candida albicans left untreated). Additionally, disc- and well diffusion assays were used to further explore the antifungal effectiveness by measuring the zones of inhibition in Sabouraud dextrose agar plates. Quantitative data analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 25. Descriptive statistics were used to analyse the sets of data produced from the microtitre assay. The differences between the Pre- and postincubation absorbance was analysed. Results The microtitre assay produced data, which was used for the comparative analysis of the 1:10 mother tincture, 3CH, 5CH, 8CH, 13CH and 21CH test groups indicated that the 1:10 mother tinctures were the most statistically significant test group as p = 0.006. Additionally, the analysis confirmed that the inhibitory properties of Allium sativum were better than that of Tulbaghia violacea. The pairwise comparative analysis found that all tested groups were statistically significant when compared to the negative control (Candida albicans left untreated). Both the well and disc diffusion assay did not produce measurable zones of inhibition and therefore no comparative data were obtained from this investigation. Conclusion The study found that Tulbaghia violacea mother tinctures and homoeopathic potencies were effective in inhibiting the growth of Candida albicans. It can be concluded that Tulbaghia violacea does indeed contain antifungal properties, which can be further investigated by means of in vivo testing. According to the comparative analysis Allium sativum demonstrates better antifungal effectiveness than Tulbaghia violacea.
An investigation into ambulance laryngoscopes as a potential source of infection amongst emergency medical service personnel in a private ambulance service in the eThekwini Municipality of KwaZulu-Natal
(2023-12) Pillay, Sugandran; Naguran, Sageshin; Tshabuse , F.
Background Emergency care practitioners (ECPs) provide specialised treatment and management to a great number of critically ill and injured patients in the pre-hospital setting. Overall, these patients have the potential to have a higher incidence of infectious and emerging diseases. Part of patient management is securing the patient’s airway through the placement of an ETT into the trachea. This process involves the use of a laryngoscope which is an invasive tool that comes into contact with blood and other biological agents and can provide a medium of transportation of infections if not decontaminated adequately. Disinfection and infection control is a fundamental practice in emergency medical care (EMC) that is often underrated. To date, there is no consistency and an overall lack of consensus with regards to a formalised infection control policy with specific reference to decontamination practices of the laryngoscope in the pre-hospital emergency medical care sector in KwaZulu-Natal. There are limited published research studies investigating ambulances decontamination practices regarding laryngoscope blades and handles. Purpose: This study aimed to investigate the microbial composition of ready-to-use ambulance laryngoscopes, determine the common decontamination practices, and establish the minimum concentration of disinfectants required to clean this pre-hospital equipment. Methodology: This experimental study used a descriptive design, as the purpose was to identify and quantify the microorganisms isolated from samples of laryngoscope blades and handles, and determine the most efficient disinfection agents required to render these microorganisms harmless using minimum inhibitory concentration (MIC) assay. A questionnaire was used to assess EMS personnel's decontamination practices regarding the disinfection of the equipment. The study was be conducted in a private EMS sector setting in KwaZulu-Natal province area. This service is a 24-hour private EMS, with 27 emergency care practitioners who uses laryngoscope blades and handles to help in AM. vi Results: The results presented in this study showed clearly that there was a high bacterial load found on the ambulance laryngoscope blades and handles under study. This was evident in the colony enumeration as well as the gram stain processes. Furthermore, there was a high level of potentially pathogenic species, namely, Salmonella, Shigella and Pseudomonas sp., which is of great concern. This is an indication of substandard hygiene practices IPC practices. It is evident from the results and the interpretation above that the IPC knowledge and practices regarding laryngoscope blades and handles in the selected EMS in the eThekwini District of KwaZulu-Natal is poor. Conclusion Ambulance laryngoscope blades and handles have been found to have an unsatisfactory level of pathogenic micro-organism contamination, and may be a reservoir in the transmission of potentially serious infections to patients and ambulance staff. This underlines the urgent need for the development and implementation of evidence-based ambulance IC guidelines pertaining to the airway tool. These findings should be taken into consideration and used to urgently address the problem of ambulance laryngoscope blades and handles decontamination and infection control.
Towards integrated care of the breast cancer patient : perspectives on the challenges and opportunities of medical pluralism in a disparate society
(2024-07) Ducray, Jennifer Frances; Ross, Ashley Hilton Adrian; Jinabhai, Champaklal C.
“Medical Pluralism” refers to the co-existence of many different medical systems, practices and products within a healthcare landscape. Whilst in most countries, mainstream biomedical treatment protocols dominate, many practices exist which are not routinely incorporated into these treatment protocols. For the ease of academic discourse, this large array of practices and products are often referred to collectively as “Traditional, Complementary, and Alternative Medicine” or “TCAM”. Patients with cancer, and specifically women with breast cancer, are some of the highest utilisers of TCAM as they battle the disease and mainstream treatment side-effects. Concurrent use alongside conventional oncology treatments however can hold risks, yet many patients do not disclose TCAM use to oncologists, and many oncologists do not engage in TCAM discussions with patients. “Integrative Oncology” incorporates a variety of evidence-based practices from across the pluralistic landscape, neither rejecting mainstream treatments nor accepting alternatives uncritically, and could potentially offer clarity to patients and oncologists in navigating medical pluralism. Whilst many studies have investigated patient TCAM use elsewhere in the world, there is a dearth of data on the choices and experiences of cancer patients and oncologists navigating the local pluralistic landscape. This study sought to describe aspects of current practice and lived experience of eThekwini breast cancer patients and their oncologists with respect to TCAM use. In doing so, it also sought to throw light on the incorporation of holistic or integrative practices by way of ascertaining the status of formalised Integrative Oncology in eThekwini, as well as outlining some of the challenges and opportunities for its growth in the local setting. The study utilised a mixed-methods sequential explanatory design which consisted of patient and oncologist surveys, followed by patient and oncologist interviews. Participants (316 patients and 18 oncologists) were recruited from government (GOV) and private (PVT) facilities in eThekwini by snowball and convenience sampling. Patients reported incorporating a range of lifestyle modifications and interventions as a way to gain control, combat side-effects and support the body in healing. These included dietary approaches, supplements, cannabis, exercise, meditation, yoga, psychological counselling, support groups, relaxation techniques, and prayer. Apart from spiritual support practices, frequencies of inclusion were consistently and significantly lower in the government cohort. Thirteen percent of government patients and 53% of private patients also consulted with TCAM practitioners. This included massage therapists, African traditional healers, chiropractors, homeopaths, aromatherapists, and acupuncturists. Most patients are incorporating additional practices in a self-directed fashion with varying levels of disclosure and reports of very limited to no patient practitioner discussions on TCAM. Many patients expressed the need for more information and guidance. Oncologists were divided as to the role of various TCAM inclusions. In terms of lifestyle modifications, the majority (79%) supported the role of nutrition in oncogenesis and healing, and 58% reported having a nutritionist associated with the practice. Fifty-three percent believed supplements are an important consideration in cancer management, with 79% discouraging supplement use during active mainstream treatments. All oncologists supported the vital role of exercise and 95% report raising this with their patients. Regarding TCAM practitioners, oncologists described their knowledge as “very little” or “none” for all the fields included in the survey and remain divided on the role that these practitioners can play in oncology. Oncologist reservations were rooted in previous negative experiences where patients had incorporated TCAM practices (mainly African traditional medicine); in proponents of questionable practices with unfounded claims of cure; and in a perceived lack of evidence for TCAM inclusions. Formalised Integrative Oncology is currently not evident in oncology care in eThekwini. There are, however, oncologists who strive towards a holistic model of patient care and are open to other evidence-based inclusions and collaborations. With the disparate nature of medical provision in South Africa, the government sector holds more challenges for both oncologists and patients. As such, the private sector is more suited to the growth of Integrative Oncology. Medical pluralism brings many challenges and opportunities. Empowering patients through accessible evidence-based health literacy remains a priority for them to navigate the health landscape of South Africa safely and effectively, avoiding risk whilst optimising quality of life and clinical outcomes across the cancer continuum.
An injury profile of musculoskeletal injuries in CrossFit athletes in KwaZulu-Natal
(2024-08) Simmons, Nicholas; Pillay, Julian David
Background- Musculoskeletal injuries are frequently reported amongst CrossFit athletes. This study aimed to determine an injury profile of CrossFit athletes in the KwaZulu-Natal area, to identify any associated risk factors, and explore possible treatment approaches. Currently, there is a paucity of information regarding the incidence of musculoskeletal injuries in KwaZulu-Natal. Objectives- The objectives of this study were to determine the prevalence of musculoskeletal injuries in CrossFit athletes and to identify and create a profile of musculoskeletal injuries among CrossFit athletes, including the location, nature, and severity of these injuries. Additionally, the study aimed to identify any associations between injury profile and selected risk factors for injury, such as age, gender, height, weight, and race. Finally, another objective was to investigate the type of care and management sought by CrossFit athletes for different types of injuries. Methods- The study was a quantitative-, retrospective study utilising a descriptive questionnaire administered in the form of a survey at four selected CrossFit affiliated facilities on CrossFit athletes. Results- Among the 181 participants, 29% (n=53) reported on lifetime musculoskeletal injuries. This suggests that injuries are relatively common in the sport. The most frequently reported type of injury was a strain or tear in 64.1% (n=34), with the shoulder being the most commonly affected area at 37.7% (n=20). Participants reported moderate pain levels in 49% of cases, indicating that injuries were not severe enough to result in significant discomfort, most injuries were acute (up to 3 months) and required medical attention (79.1%, n=48). The majority of injuries (73%, n=39) were caused by weightlifting, highlighting the importance of proper technique and safety measures when performing this type of exercise. Conclusion- This study sheds light on the prevalence, causes, and management of musculoskeletal injuries in CrossFit athletes. The findings emphasise the need for injury prevention strategies and proper training techniques to ensure the safety and wellbeing of individuals who participate in this sport.
Living with co-morbidities during the COVID-19 pandemic : a qualitative study of the heightened physical and psychosocial challenges emerging from the virus
(2024-08) Neerputh, Sunil; Bhagwan, Raisuyah; Haffejee, Firoza
The COVID-19 pandemic created unprecedented challenges for people with comorbidities. Those with co-morbidities faced mental and physical health consequences, and their family life, social life and healthcare were affected. The presence of co-morbidities was a compounding factor that led to deleterious consequences for this vulnerable group of people. This study sought to explore the various challenges from the experiences and perspectives of people living with comorbidities during the COVID-19 pandemic in South Africa. A qualitative research methodology was utilised in this study, with an exploratorydescriptive design, as well as non-probability and snowball sampling. Two samples were recruited namely, those affected by COVID-19 and those infected by COVID-19 post three months. Both samples had one or more co-morbidities. A total of 26 participants eventually participated. The study employed a semi-structured interview schedule to attain the required data, that allowed for a good conversational exploration into participants’ experiences during the COVID-19 pandemic. The data was analysed using thematic analysis, which yielded eight themes, all of which had sub-themes. The key findings from the study were multifactorial, as there were considerable effects on participants’ physical health, whereby an intensity of COVID-19 symptoms occurred and long-term COVID symptoms persisted for long periods of time, which resulted in a difficult journey to recovery. The COVID-19 pandemic and the virus had a substantial impact on mental health, as participants endured intense bouts of fear and anxiety with persistent mental trauma post-COVID. Additionally, issues around isolation and concurrent loneliness from lockdown measures took a toll on their health. Empirical evidence shows a worsening of co-morbidities due to declining mental well-being. Family and social lives were vastly affected by the pandemic, causing a multitude of problems relating to finance, bonding, conflicts and bereavement. Obtaining adequate healthcare was difficult during the pandemic, as participants encountered staff shortages, extended wait times, a lack of medication, the sharing and borrowing of medication and a lack of care from medical staff. Participants who were hospitalised faced further challenges that affected their healthcare and overall sense of well-being. Despite the challenges that people with co-morbidities faced, they were hopeful as they began adopting healthier eating habits, exercising and sharing responsibilities iii within the home. Having supportive family and friends proved to be a significant benefit. The lockdown also gave people an opportunity to improve familial relationships. Community and religious organisations assisted those in need and people relied on faith and spirituality for a sense of peace and comfort. The data also indicated that many individuals embraced holistic health by incorporating complementary and alternative medicine into their practices. The use of these practices enabled a sense of good physical health among the participants. This study has provided a new insight into the lives of people with co-morbidities during a period of intense turmoil. The data obtained in this study can be used as a stepping stone to further explore the long-term effects of COVID-19 on people with comorbidities who are vulnerable to the effects of disasters such as the COVID-19 pandemic, thereby improving their quality of life and health.
An interpretative phenomenological analysis of family involvement in the hospital nursing care of children with autism spectrum disorder within eThekwini District
(2024) Williams, Neil Arnold; Ngxongo, Thembelihle Sylvia Patience; Sokhela, Dudu Gloria
Autism spectrum disorder (ASD) is characterised by dramatic impairments in communication, social interaction and repetitive patterns of behaviour, resulting from a neuro-developmental disorder of the brain. Hospitalisation for children with autism spectrum disorder (ASD) can be very stressful because of sensory overload, their impaired ability to communicate, disruption of routine, a new unfamiliar environment and the illness for which the child was admitted. These factors can provoke difficult behaviour in these children such as uncontrolled crying, screaming, biting, scratching and other self-injurious behaviour. For these reasons, a nurse who is not knowledgeable about ASD often finds it very difficult to nurse a child with ASD in hospital. Nurses’ lack of knowledge about ASD results in poor nursing care of children with ASD. Literature has shown that this poor nursing care can be resolved by effectively involving parents in the care of their children. In South Africa and especially in KwaZulu-Natal there have been no studies conducted to corroborate these findings and therefore a gap exists in the literature. Aim of the study: The study aimed to develop in-depth insights into family involvement in the provision of in-hospital nursing care for children with ASD in the South African context, in order to develop a framework for the improvement of family involvement in the hospital nursing care of a child with ASD Objectives of the study: The study’s objectives were to critically assess the perceptions of professional nurses and families regarding the involvement of families in the hospital nursing care of a child with ASD; identify and describe the challenges perceived by professional nurses and families, in the involvement of families in the hospital nursing care of a child with ASD, explore participant perceptions on the range of corrective interventions and actions to overcome challenges and promote effective family involvement in the hospital nursing care of a child with ASD then develop a framework for the improvement of family involvement in the hospital nursing care of a child with ASD. Method: The study design was interpretative phenomenological analysis (IPA), which is a qualitative approach. Sampling was achieved utilising the maximum variation purposive sampling method and data were collected from ten nurses and ten families of children with ASD, using semi-structured interviews. The “Neil Williams framework for the improvement of family involvement in the hospital nursing care of a child with ASD”, was developed, utilising the Gray and Grove framework development process. Findings: The data collected were categorised into four themes, seventeen subthemes and 6 codes. The findings highlighted the nurse’s perceived lacked knowledge and time, and they were not listening to parents. Nurses had an uncaring attitude toward children with ASD. However, both nurse and family participants acknowledged the importance of family involvement in the care of a child with ASD in hospital. Family participants made several suggestions to improve family involvement in the hospital nursing care of the child with ASD. In order to overcome the identified challenges and incorporate the participants suggestions, the “Neil Williams framework for the improvement of family involvement in the hospital nursing care of a child with ASD”, was developed, utilising the empiric data from this study and the theoretical frameworks of the Neuman’s systems model, Bowen’s family systems theory and the theory of family care during critical illness. This framework was validated using the Delphi method of validation. Conclusion: The study findings confirm that nurses lack knowledge on hospital nursing care of a child with ASD, and it is important to involve family who know better about the child. This involvement can be strengthened by the empowerment of nurses and family members. This empowerment can be achieved by implementing the four components of empowerment, namely: information sharing, proximity, attitude and garnering resources. The framework developed in this study can contribute to improving nursing practice for paediatric ward nurses in the eThekwini region of KZN and may improve the in- patient experience of children with ASD and their families. It can ensure that families are meaningfully involved in the treatment of their children which may lead to improved health outcomes for children with ASD and increased positive work experience for nurses in this region, if implemented correctly.
Chiropractic manipulation and mobilization for postpartum low back pain : a systematic review
(2024) Phakathi, Londeka Nokulunga; Thandar, Yasmeen; Venketsamy, Yomika
Background: Prior research has documented empirical support for the effectiveness of chiropractic treatment for postpartum low back pain (PLBP), mostly in pregnancy but very few in postpartum. Nevertheless, the trustworthiness and calibre of the evidence from these studies has not been adequately scrutinised to authenticate their conclusions and determine whether clinical efficacy or effectiveness is present. Therefore, the objective of this study was to assess the current evidence in the literature about the therapeutic effectiveness of chiropractic manipulation and mobilisation for chronic lower back pain/pelvic girdle pain in postpartum women. Method: This study employed a qualitative evidence synthesis methodology, specifically utilising the Cochrane systematic review strategy. The literature was sourced via an electronic literature search (e.g. Google Scholar, PubMed, Medline, ProQuest Health, etc). The key search terms used were ‘low back pain’, ‘pelvic girdle pain’ together with ‘postpartum’, ‘chiropractic’, ‘manipulation’, and ‘mobilisation’. In addition to the key terms listed above, the search strategy for postpartum low back pain encompassed the following terms: ‘post-natal mechanical low back-ache’ or ‘sacroiliac syndrome/dysfunction’ or ‘sacral subluxation’ or ‘sacral pain’ or ‘lumbopelvic’ or ‘lumbar facet syndrome’. For manipulation and mobilisation, the search encompassed ‘sacral adjustment’ or ‘spinal manipulative therapy’ or ‘manual therapy’. A total of 2127 articles were identified, however 8 were suitable for inclusion. Data was extracted from each included study onto a prepared data extraction sheet. There were 4 reviewers that reviewed the 8 (4 RCTs and 4 CRs) articles included. The independent reviewers only reviewed the 4 RCTs. For Critical Appraisal and Quality of Evidence, Rev Man “Risk of Bias” was used tool for randomised controlled trials (RCTs) and for case reports (CRs), the Joanna Briggs Institute Critical Appraisal Tool (JBICAT) was selected was used. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used to rank the evidence on various levels of clinical strength in relation to treatment outcomes. Results: While 3 of the 4 RCTs demonstrated no significant evidence to support a superior effectiveness of chiropractic manipulation and mobilisation in postpartum low back pain, Pritchard (2001) showed statistically significant evidence in supporting the improvement chiropractic manipulation and mobilisation provided in this demographic. The outcomes in all 4 CRs showed large degrees of favourability to the effectiveness of chiropractic manipulation and mobilisation. However, the quality of the evidence was low to moderate at most, thus affecting the extent to which generalizability can be made, in to relation to postpartum low back pain. Conclusion: This study highlighted a dearth in literature and the need for conducting research of higher quality within this demographic. There were also discrepancies in the utilisation of the LBP term and its clinical scope. It is highly important that these discrepancies are resolved by establishing a more concrete and deliberate guideline or definition of this phrase. The production of more RCTs with larger sample sizes that include a variety of demographic characteristics (race, socioeconomic status, age, etc.), was recommended.
Systematic review of the sensitivity, specificity and validity of the active straight leg raise test in low back pain
(2024) Lee, Andrew Christopher; Korporaal, Charmaine Maria; Jack, D. A.
Background The active straight leg raise test (ASLR) is a commonly used clinical diagnostic test in a heterogenous group of conditions classified as low back pain. It may be used in a battery of tests to obtain a clinical diagnosis or to aid in the assessment of motor control in the lumbopelvic hip complex in the sagittal plane. A few variations of the ASLR exist in the literature. There is therefore a need to analyse the literature to determine to the most appropriate clinical application and interpretation of the test as the incorrect and/or ineffective application of the ASLR may influence patient outcomes. Data sources A systematic review of PubMed, Google Scholar, Cochrane Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus. Study selection All electronic or paper, English articles, which possessed the required key indexing terms and represented randomised and non-randomised controlled study designs were included. Data extraction and synthesis The blind review of the 25 articles was conducted by three independent reviewers (nine reviewers in total) using the non-randomised controlled trials (NOS) and Liddle scales. This allowed the methodological rigour of the article to be ranked. This ranking was compared to a critical appraisal of the article in order to achieve an overall decision with regards to the contribution of the article to the level of evidence for ASLR test. Results The evaluations and combined evidence were then determined for the ASLR under the heading non-pregnancy related PGP, LBP, and LPP, and various lift heights <10cm, 10-30cm, 30-60cm, full available range of motion, and unspecified range of motion. Due to study design (observational), no study exceeded level 3 evidence. Conclusion The ASLR was found to have a valid face construct, but assertions made in relation to its constructed validity in non-pregnancy related LBP is limited and conflicting. It is unclear if a positive ASLR result is from failure form closure of the public symphysis or the SIJ and if motor control is a contributing factor or product of pain.
A model to develop and promote knowledge and practice of breast self-examination among African women in rural KwaZulu-Natal province of South Africa
(2024) Sarmah, Nelisha; Sibiya, Maureen Nokuthula; Khoza, Thandokuhle Emmanuel
Background Breast self-examination (BSE) is considered one of the screening methods used for the early detection of breast cancer in addition to mammography. BSE is a safe, easy, free, and painless method used to identify any abnormalities of the breast and it is highly recommended for breast cancer screening among women in low resourced areas. Despite these recommendations, a low uptake of BSE in low middle-income countries (LMIC) is of concern. To date, a lack of knowledge, awareness, cultural influences, and socio-demographic factors have been highlighted as an influence on the uptake of BSE globally. However, much uncertainty still exists from a South African viewpoint, considering the different sociocultural backgrounds. Aim This study aims to explore and describe knowledge, perceptions, and factors that influence BSE uptake among rural African women in the KZN province of South Africa, and ultimately develop a model to develop and promote the knowledge and practice of BSE. Methodology The research was guided by the Care-Seeking Behaviour (CSB) theoretical framework. The research objectives were achieved by employing a qualitative case study design and an interpretivist paradigm. The data collection process consisted of an in-depth semi-structured one-on-one interview. The sample was selected based on a purposive sampling approach. This study was conducted in the iLembe District of KZN province of South Africa, a predominantly rural district. Study participants were African women aged 20 or older who resided in the rural iLembe District of the province of KZN. Data saturation was achieved with 22 participants. After the data were collected, they were transcribed verbatim and analysed using deductive thematic analysis. Findings In this study, several factors were found to influence the practice of BSE among rural South African women. This included, knowledge and awareness, clinical and socio-demographic influences, preventative healthcare habits, sociocultural factors, breast cancer beliefs, healthcare perception, and delayed healthcare services. In this study, the researcher noted that participants with higher levels of education were more likely to practice BSE. In addition, several participants had various traditional interpretations of breast cancer. Furthermore, there were participants who reported using complementary and self-treatment practices as a habit for health-related concerns. The findings of this study also indicate that participants perception of breast cancer and breast cancer screening may influence their willingness to participate in BSE programmes. Moreover, it was found that social support from family, friends, and community members encourage women to discuss their breast health. A lack of confidence in conventional medical methods of preventative health practices (BSE) was also attributed to clinical and socio-demographic factors and delayed access to healthcare services. Based on the findings of this study, a model was developed to promote BSE knowledge and practice among rural African women in KZN.
An investigation of rejection rates, sources thereof and methods to reduce specimen rejection
(2024) Ballim, Afsana; Mbatha, Joyce Nonhlanhla
Background Specimen rejection occurs when specimens are sent to a medical diagnostic laboratory and are deemed unsuitable for analysis based on specimen acceptability criteria. Patient care may be hindered due to rejections. Specimen rejections impact negatively on patients, healthcare workers and the diagnostic laboratory. The aim of this study was to investigate specimen rejection rates, the contributing factors, and methods to reduce the number of rejected specimens, thereby improving healthcare for the patient as well as improving the financial and quality standing of the laboratory. Materials and methods Rejection statistics were obtained for King Dinuzulu Hospital Complex (KDL) and RK Khan Hospital (RKK) for a period of six months. An investigation of the rejection rates and common causes for rejection was conducted. The information gathered from the rejection statistics was used to create training material for training workshops. Pre training and post-training questionnaires were completed to determine the effectiveness of the training. Rejection statistics were re-collected for two months post the training workshop sessions to evaluate the rejection rates for improvement. Results The initial rejection rates indicated that KDL and RKK exceeded the allowable limit of rejections (National Health Laboratory Service allowable limit < 3%). The primary reason for specimen rejections was identified as errors that occur in the pre-analytical phase, with haemolysis emerging as the predominant contributing factor. Training workshops were conducted, although the improvement in assessment score for the workshop was 49.6% (p < 0.001), the rejection statistics collected post-training workshop showed an insignificant change in overall rejection rates at KDL and RKK (p-value = 0.139 and 0.242 respectively). Conclusion Specimen rejection is a growing problem that requires mitigation. Structured training has shown to improve pre-analytical knowledge, however, it was noted that the interventions taken by offering training workshops did not reduce the rate of specimen rejections.
Assessing the burden of hepatitis B in South Africa, predicting disease prevalence and modelling the impact of hepatitis B birth dose vaccination
(2024) Moonsamy, Shelina; Prabdial-Sing, Nishi; Pillay, Pavitra
In 2016, WHO adopted a resolution to eliminate hepatitis B by 2030, targeted at reducing disease burden. In South Africa, HBV disease burden has largely been estimated from community-based or sentinel studies, thereby limiting its accuracy. Since 2009, the WHO recommended the addition of a birth dose of the HBV vaccine to current vaccine schedules to mitigate the risks of vertical transmission. This intervention is crucial to reduce disease burden, given the increased risks of developing chronic disease if contracted at birth or infancy. Despite the introduction of the HBV vaccine into their EPI schedule in 1995, South Africa is yet to fulfil this recommendation. In this study, our objective was to assess HBV disease burden in the public health sector of South Africa through meticulous analyses of an extensive national dataset spanning 2015 to 2019. Additionally, we aimed to model the potential impact of a birth dose of the HBV vaccine using country-specific HBV prevalence data obtained from our own testing conducted on women attending antenatal care in 2017. Over the five years, the national HBV prevalence was 9.02%, declining gradually each year. Overall, males had consistently higher prevalence rates than females. The observed lower infection and higher immunity rates among vaccine-eligible individuals clearly demonstrated the positive impact of the HBV vaccine. Nevertheless, HBV infection among these individuals was quite concerning, highlighting the roll-over effects of suboptimal vaccine coverage rates. The prevalence of HBsAg among pregnant women was alarmingly high at 11.24%, further compounded by the high HBeAg prevalence among these women. These findings alerted us to the increased probability of vertical transmission, representing a concerning source of disease burden in the country. Among vaccine-eligible women under 19 years old, HBsAg prevalence was surprisingly high at 8.08%, noting that these women still had approximately 30 more years of potential child-bearing. These findings pose a serious threat to achieving, or even nearing, WHO elimination goals. Using a deterministic HBV transmission model to simulate the impact of a birth dose of the HBV vaccine, we estimated more than a three-fold reduction in chronic HBV infections and HBV-related deaths, specifically when considering new cases from initiation of our model. In essence, this represents a greater than three-fold reduction in HBV disease burden. Our findings are unique for South Africa given their national representation and country-specific model inputs. Despite the introduction of the HBV vaccine in 1995, hepatitis B remained highly endemic in South Africa. Adding a birth dose to the current HBV vaccination schedule and achieving optimal vaccine coverage rates will markedly reduce country HBV burden. We therefore recommend prompt implementation of a birth dose of the HBV vaccine, together with increased efforts aimed at improving HBV vaccine coverage rates to optimal levels.
Homoeopathic perceptions of gut dysbiosis as a clinically significant obstacle to cure
(2024) Hendriks, Marizel; Ghuman, Shanaz
Echoing Hippocrates' notion that “All diseaes begin in the gut”, recent scientific research strengthens the connection between gut microbial health with overall well-being. This study delves into how South African homoeopathic practitioners address gut dysbiosis, a microbial imbalance within the gut linked to various chronic conditions. Homoeopaths interviewed for this study observed a rise in gut dysbiosis, attributing it to factors like lifestyle choices and medication use. Their treatment approach emphasizes individualized remedies and therapies tailored to each patient's unique physical, mental, and emotional symptoms. Treatment plans often incorporate dietary modifications, alongside the use of probiotics and prebiotics to support gut health. The study reveals gut dysbiosis as a significant obstacle to cure in homoeopathic treatment. The high cost of stool analysis tests restricts their use in assessing gut health, making it challenging for the interviewed homoeopaths to arrive at a diagnosis. Participants expressed a strong need for more comprehensive education on gut dysbiosis and bowel nosodes within the South African homoeopathic training curriculum. In conclusion, this study suggests that gut dysbiosis presents a clinically significant obstacle to cure in homoeopathic treatment for chronic conditions. A holistic approach combining homoeopathic remedies with dietary and lifestyle changes appears to be effective. Further research is warranted to enhance homoeopathic education on gut health and its impact on chronic diseases.

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