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Knowledge, Attitudes and Perceptions Towards HIV Testing Among IsiXhosa-Speaking Men in The Zithulele Catchment Area of The Rural Eastern Cape Province, South Africa

  • Authors: Scotcher, Philippa Claire
  • Date: 2021-10
  • Subjects: HIV infections
  • Language: English
  • Type: Masters theses , text
  • Identifier: http://hdl.handle.net/11260/6842 , vital:51017
  • Description: BACKGROUND South Africa carries the largest burden of Human Immunodeficiency Virus (HIV) in the world, with over 7.9 million people infected and over 70 000 HIV-related deaths in 2019. Men are 25% more likely to die from Acquired Immune Deficiency Syndrome (AIDS) compared to women, even though women are more likely to be infected. Despite these numbers, only 24.1% of HIV-positive men compared to 64.8% of HIV-positive women were aware of their status. Statistics indicate that men in South Africa are not testing for HIV until it is too late. In order to focus efforts on the prevention of HIV transmission, there is a need to understand why men are not accessing HIV testing and treatment services earlier. This study aims to explore the knowledge, attitudes, and perceptions towards HIV testing of isiXhosa-speaking men in the Zithulele catchment area of the rural Eastern Cape. METHODS This was a qualitative study using the phenomenological approach. It was conducted among a purposive sample of isiXhosa-speaking men from the Zithulele catchment area, in the OR Tambo district of the Eastern Cape Province. Ten semi-structured interviews and one focus group were conducted in isiXhosa. Interviews were audiorecorded, transcribed, and translated into English. The interviews were thematically analysed using an inductive approach. RESULTS Participants from the study had a good understanding of HIV and HIV transmission. They perceived HIV infection as a death sentence, a consequence of immoral behaviour and an indication of failure as man. Reluctance to test for HIV was due to the perception that testing hastens the onset of symptoms and death, whereas disclosure of an HIV-positive status was described as difficult due to the fear of stigmatization. Some of the barriers to accessing HIV testing services included masculine norms, the belief that sickness is equated with weakness, a perceived lack of confidentiality at health facilities and how female-dominated clinics were not male-friendly spaces. Suggestions to improve HIV testing among men included improving targeted education, home-based testing services and utilizing traditional meetings to address men. CONCLUSION The findings of this study may suggest that healthy men in the Zithulele catchment area of the rural Eastern Cape are not accessing HIV testing and treatment services. The reasons behind this reluctance include false beliefs around HIV and testing, the fear of discrimination, disruption of masculine norms and reluctance to access care at female-dominated health facilities. Further research is needed to explore ways to reach, educate and encourage men to test earlier for HIV. , Thesis (Masters) -- Faculty of Health Sciences, 2021
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Assessing South African Medical Interns’ Experience and Confidence in Managing Obstetric Emergencies

  • Authors: Miller, Andrew
  • Date: 2021-02
  • Subjects: Obstetrical emergencies
  • Language: English
  • Type: Masters theses , text
  • Identifier: http://hdl.handle.net/11260/6882 , vital:52352
  • Description: Background: Medical doctors in South Africa are required to complete a two-year internship at training hospitals, including a four-month rotation in obstetrics and gynaecology. Following this, doctors are allocated to community service posts; many of which are at district and primary level facilities where supervision is limited. The latest triennial Saving Mothers Report identified district hospitals as the second leading site for maternal deaths of all causes. District hospital were also the leading site for maternal deaths secondary to obstetric haemorrhage and the most likely site for the lack of a skilled doctor to be identified as a factor in deaths associated with caesarean delivery. Methods: This cross-sectional descriptive study aimed to describe the self-perceived readiness of medical interns completing their training to independently manage obstetric emergencies, based on the ESMOE modules in the HPCSA internship logbook. The research assessed medical interns in the last three months of their training, using a self-administered online questionnaire, with data collection between October and December 2019. Cluster sampling of interns at training facilities throughout the country resulted in a total of 182 respondents from 17 hospitals in seven provinces in the country, with an overall response rate of 34.1%. Results: Most interns had experience with, and confidence in, the management of miscarriage and hypertension in pregnancy. However, gaps in labour ward management, pregnancy related sepsis and surgical skills were identified. Only 42.3% of respondents were confident in their ability to diagnose obstructed labour, 26.3% had performed an assisted delivery, 39.0% were confident in their knowledge of the indications and contraindications of assisted deliveries and 35.7% had been involved in the delivery of a baby with shoulder dystocia. Regarding pregnancy related sepsis, 54.4% had experience with managing a wound abscess and 29.7% were confident managing puerperal endometritis. While 78.0% felt confident to perform a caesarean section, only 28.6% had performed uterine compression sutures for uterine atony at caesarean section. Additionally, there was a statistically significant variation in scores between training hospitals. Conclusion: A gap exists between the shortcomings in district hospital obstetric services, the prioritisation of placement of community service doctors at primary care and district hospitals, and the self-perceived readiness of medical interns completing their training to safely manage obstetric emergencies. This highlights the importance of clinical support for junior doctors at district hospitals and standardisation of intern training at accredited facilities across the country. , Thesis (Masters) -- Faculty of Health Sciences, 2021
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Outcomes of Drug Resistant Tuberculosis in Two Rural District Hospitals, Eastern Cape Province, South Africa

  • Authors: Lotz, John-D Knipe
  • Date: 2021-02
  • Subjects: Medicinal plants
  • Language: English
  • Type: Masters theses , text
  • Identifier: http://hdl.handle.net/11260/6834 , vital:51018
  • Description: Tuberculosis (TB) is still rampant in South Africa, and drug resistant tuberculosis (DR-TB) forms a significant part of this burden on both the health care system and economy. A number of interventions have recently been introduced to help curb the growing epidemic of DR-TB, including increasing access to novel and repurposed drugs, decentralisation of care, and a new shorter (9-11 month) treatment regimen recently endorsed by the World Health Organization (WHO). Significantly, this new regimen has now also become injectable-free (also known as an all-oral regimen). However, at the time of implementation in 2017, the shorter regimen was yet to be proven effective in a programmatic setting in South Africa. This is a retrospective cohort study to describe the outcomes in patients on short and long DR-TB treatment regimens, over five years, at two treatment sites in a rural setting in the Eastern Cape province of South Africa. It is the hope that elucidation of factors involved in affecting outcomes in DR-TB may direct future interventions in these two facilities, and the wider DR-TB program in South Africa , Thesis (Masters) -- Faculty of Health Sciences, 2021
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An Investigation on the Clinical Experiences of Newly Qualified Professional Nurses in Hospital Facilities of the Alfred Nzo District Municipality in the Eastern Cape

  • Authors: Hloba, Siyathemba Prince
  • Date: 2021-00
  • Subjects: Nurse practitioners
  • Language: English
  • Type: Masters theses , text
  • Identifier: http://hdl.handle.net/11260/7942 , vital:55856
  • Description: The study aimed to explore and describe the clinical experiences of newly qualified professional nurses in hospital facilities of the Alfred Nzo District Municipality in the Eastern Cape. The newly qualified professional nurses may face difficulties in the hospital facilities when it comes to the execution of duties. The newly qualified professional nurses are expected to display knowledge, skills and to have a positive effect on patients, the relatives of patients and their colleagues to alleviate diseases. This challenge may create emotional distress if newly qualified professional nurses receive inadequate guidance from the senior staff members of the hospital facility. The objectives of this study were to explore and describe the clinical experiences of newly qualified professional nurses, to explore how the newly qualified professional nurses were affected emotionally by clinical experiences and to explore the support system to enhance the performance of the newly qualified professional nurses. A qualitative, explorative, descriptive and contextual design was used to explore and describe the experiences of the newly qualified professional nurses in hospital facilities of the Alfred Nzo District Municipality in the Eastern Cape. A purposive sampling of newly qualified professional nurses, with less than two years of experience after completing the community service in the clinical practice, was used. The data were collected through face-to-face and semi-structured interviews. The interviews were conducted until the data were saturated. A pilot study was done before the main study to prove the adequacy and suitability of the methods to conduct the main study. The participants‟ interviews and results of the pilot study were incorporated into the interviews and results of the main study. Tesch‟s method of thematic analysis and an independent coder were used to analyse the data and to draw meaning from the content. The study used Guba and Lincoln‟s criteria of measures to ensure trustworthiness, which included credibility, confirmability, dependability and transferability. Ethical standards were maintained throughout the study as the researcher complied with ethical principles, namely, respect for persons, beneficence, justice and autonomy. The key considerations to curb the spread of the Covid-19 pandemic, as stipulated by the World Health Organisation, were followed during the data collection. On data interpretation, three themes were developed with eight subthemes on the first theme, two subthemes on the second theme and three subthemes on the third theme. The research findings revealed that the participants experienced negative attitudes from colleagues and multidisciplinary team members. The shortage of staff and resources made participants feel ineffective in their work environment. Clinical exposure to different units and procedures in various units added value to the development of the participants. The recommendations were made with regards to three divisions. They were the hospital facilities‟ personnel, future nursing research personnel and nursing schools personnel. In hospital facilities, the recommendations included that all novice professional nurses should be made aware of the emotional impact at work. An annual plan for workshops and in-service training should be implemented. Professional counselling is required for the novice professionals who were exposed to Covid-19 isolation units. A need to increase staff coverage in the clinical units was identified as the workload is too big. Management is encouraged to be more sensitive about the newly employed nurses‟ challenges in their facilities and the most experienced nurses are encouraged to mentor and coach the novice nurses. In the future nursing research, recommendations included that more studies need to be conducted in South Africa and the Eastern Cape province to verify the findings of this research. A specific research study that will focus on the supportive needs of nurses in clinical facilities should be done institutionally to provide evidence-based practice. The research culture on the nurses‟ experiences in clinical facilities needs to become a norm. In nursing schools, the recommendations motivated that the nursing students should be exposed to all clinical units before completing the training xiv course. Further studies need to be conducted to evaluate the balance between theory and clinical learning on duly performance. The nursing education institutions should use quality improvement suggestion boxes for students to consider their experiences and opinions about their learning. Key words : clinical experiences, newly qualified professional nurses, Alfred Nzo district municipalities , Thesis (Masters) -- Faculty of Health Sciences, 2021
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Women’s perceptions, beliefs and lived experiences of postpartum intrauterine contraception at a District Hospital in the Eastern Cape Province of South Africa – a qualitative study

  • Authors: Gibson, Dylan
  • Date: 2021-00
  • Subjects: Postpartum contraception
  • Language: English
  • Type: Masters theses , text
  • Identifier: http://hdl.handle.net/11260/6833 , vital:51015
  • Description: Background There is a significant unmet need for family planning in South Africa where long acting reversible contraceptives (LARC), including intrauterine contraceptive devices (IUCD) are underutilised. The situation is no different in the Amathole District in the Eastern Cape where high rates of unintended pregnancies continue to be a problem. The postpartum period presents a unique opportunity for providing effective contraception. It has been established that immediate post-placental insertion of a copper IUCD is a safe, effective method that has the potential to reduce unintended pregnancy rates. A Post placental intrauterine contraceptive device (PPIUCD) refers to an IUCD that is placed into the uterine fundus immediately after delivery of the placenta after caesarean or vaginal delivery. The understanding of women’s perceptions, beliefs and lived experiences of the PPIUCD in this community has the potential to improve uptake of this method. The aim of the study was to fully explore the phenomenon of postpartum intrauterine contraception as a means of family planning at Madwaleni District Hospital in the Amathole District within the Eastern Cape, South Africa. Methods A qualitative, phenomenological study design was used in gathering data through a combination of three focus group discussions and in-depth individual interviews with three different groups of peripartum women. Data was collected from perinatal women at three snapshots in time, namely prior to labour, during the postpartum admission and at 12 weeks postpartum with the aim to fully explore the phenomenon of post-placental IUCD use in the study population. III Results The data was analysed using the framework method and five themes were derived iteratively from the text. These themes included the perceptions of perinatal women towards a PPIUCD, the origins of these perceptions, the reasons why women would or would not choose the method for themselves and lastly, the experiences of those women who chose the method. The findings of this study showed that PPIUCD was a novel method in this community and that misinformation, largely driven by deficiencies in antenatal counselling, led to hesitancy to adopt the method. These deficiencies extended to those women who consented to a PPIUCD insertion at caesarean section who did not fully understand what they had consented to. Despite this, women were open to a more effective, convenient contraceptive and the overall experiences of those women who chose to use a PPIUCD was positive. Conclusions Post-placental IUCD insertion was a relatively new method in the study population. Deficiencies in antenatal contraceptive counselling created uncertainty and scepticism which in turn contributed to low uptake of the method among perinatal women. Despite this, there was a strong desire amongst perinatal women to access effective, convenient family planning and prevent future unwanted pregnancies. The overall experiences of women who did choose the method was positive. This suggested that with the right counselling and support, there would be an increase in uptake of PPIUCD in the population. Recommendations from this study include the need to explore healthcare workers perspectives on this topic, to further explore the lived experience of PPIUCD users over a longer period of time and to explore the effectiveness of various antenatal counselling strategies to equip women to make peripartum contraceptive choices. , Thesis (Masters) -- Faculty of Health Sciences, 2021
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Evaluating the Prevention of Mother to Child Transmission (PMTCT) of HIV Services in the Eastern Cape: subtitle if needed. If no subtitle follow instructions in manual

  • Authors: Sigovana, Khuthala
  • Date: 2019
  • Language: English
  • Type: Masters theses , text
  • Identifier: http://hdl.handle.net/11260/3176 , vital:43182
  • Description: Abstract text To effectively reduce HIV transmission to newborns requires a reduction of HIV prevalence among pregnant women and a full understanding of its epidemiology. There is however, a literature gap: few recent HIV studies focus on women attending antenatal care in rural areas in South Africa. A Cross-sectional study of women attending antenatal care in four Primary Care facilities was conducted. An interviewer-administered questionnaire to collect information on socio-demographic characteristics and medical history was used. Binomial logistic regression analyses were used to determine factors associated with HIV and to estimate the prevalence ratio (PR). The 95% confidence interval (CI) is used for precision of estimates; p≤0.05 for statistical significance. A total of 343 participants were recruited. Most participants (n = 341 or 99.42%; CI: 97.91 – 99.93) knew their HIV status. The antenatal HIV prevalence was 38.19% (CI: 33.17 – 43.48). Participants older than 40 years were 3.99 and 3.81 times more likely to be HIV positive compared to teenagers (PR = 3.99; CI: 1.11 – 14.30; pstxvalue = 0.034) and those in the 20-29 age group (PR = 3.81; CI: 1.07 – 13.60; pstxvaluevalue = 0.039) respectively; and this was statistically significant. Unemployed participants were 34% (PR = 1.34; CI: 1.16 – 1.55; p-value less than 0.0001) and 41 percent (PR = 1.41; CI: 1.23 – 1.61; p-value less than 0.0001) more likely to be HIV positive when compared to tertiary students and self-employed individuals respectively. The antenatal HIV prevalence remains high and is increasing in this population. However, findings suggest a changing and maturing epidemic. , Thesis (MMED) -- Faculty of Health Sciences, 2019
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Exploring Teacher Assessment Practices in The General Education and Training Level in Junior Secondary Schools in Mthatha Education District

  • Authors: Novukela, Cawe Sandys
  • Date: 2019
  • Language: English
  • Type: Masters theses , text
  • Identifier: http://hdl.handle.net/11260/3460 , vital:43409
  • Description: Diabetes mellitus is one of the largest and most important public health emergencies of our time that has resulted in human suffering and huge financial implications for organisations, governments and individuals (IDF Atlas, 2015). Furthermore there is growing evidence that a number of employees are overstretched in their work environments and this has resulted in stress and burnout (McCormack and Cotter, 2013). This study investigated the effects of diabetes mellitus on burnout among WSU employees as well as the prevalence of diabetes mellitus and burnout. A mixed method research design using quantitative and qualitative approaches was employed in order to explore the effects of diabetes on burnout as well as the prevalence of diabetes and burnout at WSU. A cross-sectional survey was used to gather quantitative data and semi-structured interviews were used for the qualitative data collection. A total number of 169 participants were involved in this study. This included 154 participants and 15 participants who were selected for the quantitative and qualitative respectively using random sampling technique and purposive sampling method. The quantitative data was analysed using Stata version 13. The study findings indicated that the prevalence of diabetes at WSU was 16% and 57% participants were burned out. It was further found that the majority of participants (58%) who were diabetic also suffered from burnout. The relationship between diabetes and burnout was found to be significant. Qualitative data analysis involved coding data and analysing the emerging themes to form the basis of the findings. The results of the study found an emerging problem of high level of burnout and also a significant number of employees who were diabetic. A combination of these two conditions poses a challenge to the continued uninterrupted functioning of WSU. It is recommended that the university should educate its employees about diabetes and burnout as well as create an environment that promotes healthy lifestyle. A model has been developed that could help deal with diabetes and burnout. , Thesis - Faculty of Health Sciences, 2019
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Determinants of Type 2 diabetes mellitus among HIV/AIDS patients on antiretroviral drugs in the OR Tambo District, South Africa

  • Authors: Bam, Nokwanda Edith
  • Date: 2018
  • Subjects: HIV/AIDS Diabetes mellitus (DM) -- Patients Antiretroviral drugs -- South Africa -- Eastern Cape
  • Language: English
  • Type: Thesis , Doctoral , PhD Health Sciences
  • Identifier: http://hdl.handle.net/11260/1476 , vital:35976
  • Description: Type 2 diabetes mellitus (DM) is a frequent adverse effect of antiretroviral drugs for those who are on ARVS. People with type 2 DM can suffer multiple complications that hinder the quality of life. In South Africa research has shown significant increase in neuropathy, heart and kidney diseases among patients living with type 2 DM and HIV/AIDS compared to DM without HIV. Accessed knowledge lacked consistency on the predictors of DM in HIV/AIDS patients with regards to the type of ARVS with higher risks of DM. Research needed to be done to find the determinants of type 2 DM in HIV/AIDS context. The purpose of this study was to describe the determinants of type 2 DM among HIV/AIDS patients on ARVS in the OR Tambo District, SA in order to develop intervention strategies to mitigate the long-term effects of type 2 DM. A quantitative research methodology using a case control retrospective study was used. A sample of 177 (33%) cases with HIV/AIDS and type 2 DM was selected using a one stage stratified sampling with allocation proportional to size of each stratum of the four sub-districts of OR Tambo District. Two non-diabetic patients with HIV/AIDS were selected as controls per case unpaired and totalled up to 354 (67%) controls. A self-administration questionnaire adopted from the WHO (2011) STEPwise surveillance tool for chronic diseases was used for data collection. Stata (standard version 13.0, Stata Corp., Lakeway Drive USA) was used for data management and analysis. Findings of the study revealed determinants of type 2 DM grouped as the socio-demographic determinants; tertiary education and marital status, levels of physical activities; lack of vigorous activity and sport, types of diets; high fruits and vegetables and healthy eating out at restaurants, arterial blood pressure; lack of routine BP check and known HPT and types of ARVS used in HIV/AIDS therapy. Compared with patients who received FDC, the risk of type 2 DM was 43 times and 22 higher when a tri-therapy regimen contained Ritonavir and Lopinavir respectively . The majority of DM patients (n=177) were diagnosed type 2 DM after ARVS at n=108 (61%). In managing the diabetic patients a shift from a single disease to multiple-chronic disease focus is required to mitigate the complex drug interactions that exist in the control of NCDs such as HIV/AIDS, DM, HPT and other long-term diseases. The HIV/AIDS and type 2 DM awareness and care intervention strategy is recommended as healthy lifestyle, monitoring of side effects and drug interactions, enhanced FDC roll out and elimination of unsafe ARVS to improve the health outcomes of type 2 DM patients in an HIV/AIDS context in OR Tambo District.
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The perceptions of Nursing service and Operational Managers on the role of nursing sub-professionals in the Health Service System at Mhlontlo Municipality

  • Authors: Mpini, Minah Malakiwe
  • Date: 2018
  • Subjects: Health service management -- South Africa -- Eastern Cape Nursing sub-professional
  • Language: English
  • Type: Thesis , Masters , M Nursing
  • Identifier: http://hdl.handle.net/11260/1341 , vital:32258
  • Description: South Africa is experiencing a serious shortage of nurses, especially nursing sub-professionals. The Eastern Cape Province is among the provinces with highest percentage of vacancies for nurses in all nursing categories. Nursing shortage has compromised South African health care services as health services are mostly supported by this group of health professionals. As a result of this shortage, rural health services have for a long time depended on the nursing sub-professionals to perform basic nursing services. This category is however also decreasing, which makes it difficult for nursing professionals to cope with the amount of work. South African rural health centres put pressure on professional nurses to do some of the health care activities that are meant to be done by medical doctors. The aim of the study was to explore the role and value of nursing sub-professionals in the health care system as viewed by the nursing managers. A qualitative exploratory study was conducted to get the perceptions of nursing service managers and operational managers on the role and value of nursing sub-professionals in the health service. A purposive sample of 23 participants was selected and interviewed. Most of the participants viewed the retention of nursing sub-professionals as crucial in the health service system. The participants saw sub-professionals as playing a vital role in the health services as the latter have a scope of practice that enables them to work independently. The reasons they put forth in support of their retention include reduction of litigations, easing the work load of professional nurses, sometimes performing non-nursing duties during crisis periods, reduction in the waiting time for patients/clients, and enabling professional nurses to perform more sophisticated professional duties which include management. Few managers viewed the existence of sub-professional nurses as increasing the work of nursing professionals. They felt that nursing sub-professionals worked under the supervision of nursing professionals. This, according to them, resulted in more work for nursing professionals who had to check and/or repeat what had been done in the name of supervision.
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Assessing the risk factors of Coronary heart disease among rural adults in the Joe Gqabi District: Eastern Cape

  • Authors: Tetana, Thando
  • Date: 2016
  • Subjects: Cardiovascular disease Coronary heart disease -- South Africa -- Eastern Cape Coronary heart disease--Risk factors
  • Language: English
  • Type: Thesis , Masters/Doctoral , M Sc Public Health
  • Identifier: http://hdl.handle.net/11260/1440 , vital:35587
  • Description: Cardiovascular disease (CVD) such as coronary heart disease (CHD) is a contributing factor to a large percentage of mortalities and morbidities worldwide including in affluent South African setting. In the Eastern Cape of Province, South Africa, there is no extensive data reported on Coronary Heart Disease (CHD) determinants and risk factors. The present study sought to assess the risk factors and determinants of CHD. This case (n=50) control (n=50) study matched for sex and age, was conducted among Xhosa adults from rural and semi urban/ township areas of Joe Gqabi District, Eastern Cape Province of South Africa. Non modifiable, environmental, lifestyle, and psychological factors were investigated using univariate analysis and multivariate logistic regression analysis. Depression, alcohol excessive intake, family history of CHD were the CHD univariate risk factors. The independent risk factors of CHD were uncontrolled systolic hypertension (Odds Ratio (OR)=95; 95% Confidence Interval 16.9-128; In front of a multifactorial disease driven by interactions of socio determinants and traditional risk factors, urgent programmes of education, clinical management and health promotion for adequate diet, physical activity, adherence and compliance to medication and are needed to curb epidemic proportions of CVD risk factors.
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Challenges faced by professional nurses in implementing the six Ministerial priority standards of care in a Health care institution in O R Tambo Region in the Eastern Cape province

  • Authors: Kula, Nokuseni
  • Date: 2016
  • Subjects: Health care standards -- Hospital
  • Language: English
  • Type: Thesis , Masters , M Cur
  • Identifier: http://hdl.handle.net/11260/699 , vital:27770
  • Description: The objective of this research study was to describe and explore challenges faced by professional nurses in implementing six ministerial priority standards of care in selected units of an identified institution in O.R. Tambo region. Nurses are trained and employed to provide nursing care to patients according to scope of practice set by their statutory body (South African Nursing Council). Setting of standards forms part of quality improvement in nursing care and standards need to be monitored and evaluated (Muller 2006:206). In South Africa, the Minister of Health has identified six priority areas to fast-track improvement and ensure quality in health services. These priority areas are as follows: attitudes and values of health workers, cleanliness of the facility, waiting times, patient safety and security, infection prevention and control, and availability of medicines (National Health Plan: Strategic plan 2010/2013). Standard of nursing care in OR Tambo region according to available statistics, is lower than the expected ministerial standards, regardless of continued monitoring and evaluation. Staff attitudes is an ongoing problem, long queues, linen shortages, low standards of cleanliness as well as shortage of medication remain a challenge in health care institutions. This study is a qualitative, descriptive, exploratory, and contextual study that explored challenges faced by professional nurses in implementing the six ministerial priority standards of care. A purposive sampling of 10 professional nurses, meeting the selection criteria was utilised. In depth, semi structured interviews were used as a method of data collection. A digital voice recorder was used to record the interviews and consent from participants was obtained. Ethical considerations were adhered to. The interview question was: “What challenges are you facing in implementing expected standards of care with reference to the six ministerial priority standards of care?” Data was analysed using content thematic analysis approach. An independent coder with a Master’s degree and studying towards a doctorate helped with coding the results of the interviews. The Theory for Health Promotion in nursing as propounded by Botes (2006) was used to analyse the findings. The approach used was based on the external environment and its dimensions – social, physical and intellectual. v The findings of the research revealed the following themes: Lack of resources, demotivation of nurses, attitude of nurses, lack of monitoring and evaluation, environment and overcrowding, lack of patient safety, negligence, availability of policy and procedure manuals, and incompetency of health care professionals. The findings of this study revealed that nurses faced many challenges with regard to improving the standard of nursing care. According to Botes (2006), the purpose of nursing research is functional by nature, it provides guidelines for practice. Therefore in this study, a description of guidelines to improve nursing care has been done. Trustworthiness of the findings was ensured by utilising Lincoln and Guba’s model of trustworthiness. Limitations of the research are highlighted and recommendations for further and related studies are made.
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Experiences of R425 newly qualified professional Nurses during their first year of practice in 3 selected hospitals in the Eastern Cape

  • Authors: Qwaqwa, Nomathamsanqa P
  • Date: 2016
  • Subjects: Student nurses practice -- Hospitals
  • Language: English
  • Type: Thesis , Masters , M Cur
  • Identifier: http://hdl.handle.net/11260/677 , vital:27767
  • Description: Transition of the newly qualified nurses from an educational focus to professional practitioner has long been identified as a conflicted time of critical personal and professional adjustment and staggering reality shock. This study explored the experiences of newly qualified R425 professional nurses during their first year of practice in the Eastern Cape Province at three selected hospitals. The study followed a qualitative, exploratory, descriptive design using a phenomenological approach. The sample included newly qualified professional nurses in their first year of employment. Convenience sampling was used to select the participants. Data collection was conducted by means of semi-structured interviews from ten (n=10) participants. Each interview took about 45 minutes. Ethical codes of research were followed. Data was coded manually and analyzed using content analysis Four themes and seven subthemes emerged from the data collected The findings revealed positive experiences such as sense of belonging and feelings of independence; negative experiences such as feelings of rejection, as well as management challenges The study identified challenges which impacted on the performance of new nurses, namely shortage of human and material resources and inadequate support in the working environment Recommendation: Introducing mandatory education by service institutions on transition as well as extended, sequential and structured orientation and mentoring programs for newly qualified professional nurses as this will assist them in their career development Managers to use different strategies in enhancing quality environments in order to reduce frustration for these newly qualified nurses.
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The Anti-hypertensive Properties of T. officinale on L-Name-induced Hypertensive Rats

  • Authors: Aremu, Olukayode Olasunkanmi
  • Date: 2016
  • Subjects: Hypertension Anti-hypertensive
  • Language: English
  • Type: Thesis , Masters , M Sc
  • Identifier: http://hdl.handle.net/11260/1045 , vital:30434
  • Description: Medicinal plants have long been used in folkloric medicine in various parts of the world. Presence of phenolic compounds has been attributed to their medicinal properties. Despite various medicinal uses, scientific claims of anti-hypertensive activities are still deficient. Therefore, hydroethanolic (70% ethanol) extracts of the leaf and root parts of T. officinale (TOL and TOR respectively) were investigated for anti-hypertensive antioxidant, diuretic activities, and effects on lipid profile in L-Name-induced hypertensive Wistar rats. Phytochemical screening of TOL and TOR was assessed by known standardized method. Acute toxicity profile of the plant was also evaluated by Lorke’s method. Total phenolic and flavonoid contents were assessed using Folin Ciocalteau and Aluminium chloride colorimetric methods; while, 2, 2-diphenyl-1-picrylhydrazyl (DPPH), 2, 2’–azino-bis-3-ethylbenzthiazoline-6-sulphonic acid (ABTS)and ferric antioxidant reducing power (FRAP) protocols were used for their radical scavenging and total antioxidant capacities respectively. Spontaneously hypertensive rats were used for acute antihypertensive study while for the 21 days antihypertensive study, hypertension was induced by administering L-Name (40 mg/kg) for 4 weeks and, CODA 8 Non-invasive tail cuff machine was used to measure blood pressure. With the aid of a semi-auto chemistry analyzer, lipid profile of Taraxacum officinale (TO) was determined using Biosinol reagents. TOL and TOR also significantly reduced systolic, diastolic and mean arterial blood pressures up until 4 hours with the leaf part most active in single dose study using SHR model. TOL and TOR also significantly lowered systolic, diastolic and mean arterial blood pressures with the leaf part most active in 21 days study using and L-Name-induced HTN models. However, these plant extracts did not have a diuretic effect, but seems to exert its antihypertensive effects by modulating NO production and possibly bioavailability, by acting via an endothelium-dependent pathway. This study validates the traditional use of the leaf part of the plant as an antihypertensive agent.
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The experiences of non-psychiatric trained nurses caring for mental health care users on 72 hour observations in a listed Hospital in the O R Tambo District

  • Authors: Dubo, Siyabonga
  • Date: 2016
  • Subjects: Mental Health care -- Hospital
  • Language: English
  • Type: Thesis , Masters , M Cur
  • Identifier: http://hdl.handle.net/11260/688 , vital:27769
  • Description: Nurses are an integral part of the health care system and their job encompasses a wide range of responsibilities including the promotion of health, prevention of illness and care for physically, mentally ill and disabled people. Nurses have a mandate to be responsible and accountable to the public they serve. For these reasons, it is crucial that nurses possess attitudes that allow them to provide optimal care in a supportive manner for patients. Despite the fact that considerable research on the experiences of nurses caring for the mentally ill in general hospitals has been done globally, none has been conducted in the Eastern Cape, South Africa. Additionally, no studies could be obtained from anywhere in the world on the experiences of non-psychiatric trained nurses caring for mental health care users on 72 hour observations. Studies indicated that nurses have different experiences when caring for mental health care users. It was therefore considered necessary to find out how non-psychiatric trained nurses perceive the caring of mental health care users during the 72 hour observations. The research design used to explore and describe their experiences was qualitative, descriptive, explorative, phenomenological and contextual in character. Semi-structured interviews were conducted with eight (8) participants who were purposively selected. This was done after necessary permission from the Department of Health and informed consent from the research participants. Steps were taken throughout the course of the study to ensure trustworthiness. Data were analysed using Tesch’s methods and the services of an independent coder were used. The results indicate that there are different experiences with regard to the caring for mental health care users during the 72 hour observations. The major themes identified are: feelings experienced by these nurses, lack of knowledge, challenges and strategies used for coping with a violent user, need for support from security staff and lack of policies. v Guidelines as a supportive action are suggested. From the results of the study recommendations are made in the areas of nursing education, nursing practice and nursing research. It is concluded that for non-psychiatric trained nurses to provide optimal care to mental health care users, the nurses need knowledge and skills in order to facilitate the promotion, maintenance and restoration of mental health of these patients as an integral part of health.
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Comparison between Endothelin, Nitric Oxide and their Association to Blood Pressure and Body Composition in HIV Patients, in Mthatha

  • Authors: Zono, Sinethemba
  • Date: 2015
  • Language: English
  • Type: Masters theses , text
  • Identifier: http://hdl.handle.net/11260/2909 , vital:43105
  • Description: Background: Dysfunction of the vascular endothelium is an early finding in the progression of cardiovascular disease and is closely related to clinical events in patients with obesity and hypertension. Vascular function is mediated by nitric oxide (NO) and endothelin (ET-1) which serve as natural counterparts. The aim of the study was to determine the physiological effects of HIV infection, blood pressure and body composition on the changes of ET-1 and NO and association between ET-1 and NO. Methods and results: This was a descriptive and comparative study. A Quota sample method was used. The study population consisted of 154 participants categorized into the following groups: 57 HIV negative participants (A), 40 HIV positive not on treatment participants and 57 HIV positive on treatment participants. Enzyme immunoassay kit was used for the quantitative determination of ET-1 and Nitrate/nitrite colorimetric assay kit was used for the determination of NO. Anthropometric measurements, body composition were determined. Hemodynamic measurements were also taken into account. Results: Resting metabolism, waist circumference (WC) and hip circumference had low mean levels in both HIV positives groups compared to HIV negative group. On lipid profiles visceral fat (VF), whole fat (WF) had low mean levels but skeletal muscle fat (SMF) showed the highest mean levels in both HIV positive groups. All the blood pressures between HIV groups were on a normal range scale. Mean values of endothelin and nitric oxide are increased in HIV positive not on ART and HIV (+) on ART compared with the HIV negative group. Conclusion: NO, ET-1, ART and HIV itself were associated with the pathogenesis of endothelial dysfunction in persons with HIV infection. Elevated endothelial markers namely ET-1 and NO can lead to improvement of endothelium dependent relaxation to some extent but not completely. Although these markers have deleterious effect on the endothelium but can also serve as up-regulator of hypertension. Key words: HIV-infection, antiretroviral therapy, endothelial dysfunction, Endothelin1 (ET-1), nitric oxide (NO), blood pressures (BPs). , Thesis (MSc) -- Faculty of Health Sciences, 2015
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The evaluation of continuous quality improvement amongst the Community Health Centers of Lukhanji sub-district, of Chris Hani District Municipality, Eastern Cape

  • Authors: Qotoyi, Ntombesitatu
  • Date: 2015
  • Subjects: Health Standard Compliance Health Care -- Quality improvement Community health centrers -- South Africa -- Eastern Cape
  • Language: English
  • Type: Thesis , Masters/Doctoral , MSc Nursing
  • Identifier: http://hdl.handle.net/11260/1465 , vital:35973
  • Description: Continuous Quality Improvement is a system that seeks to improve the provision of services with an emphasis on future results (Tomey, 2009). It is a process that involves evaluation, actions and mindset to strive constantly for excellence (Sullivan, 2012). Evaluation of quality in health care has evolved into a dynamic and modern science which plays a significant role in patient safety, quality assurance (QA), benchmarking and continuous quality improvement (CQI). Improved quality has a positive impact on patient and staff satisfaction, improving the efficiency and effectiveness of healthcare provision in both the public and private sector, eventually leading to increased trust in the health system (Whittaker, Burns, Doyle and Fenney, 1998). The purpose of this study was to explore and describe the factors that influence continuous quality improvement amongst the Community Health Centers of Lukhanji sub district, of Chris Hani District Municipality, Eastern Cape. The standards of the community health centers were assessed against the National Core Standards of the South African National Department of Health. Donabedian‟s tripartite model (1988) which addresses three elements of quality assessment, namely structure, process and outcome, led this study. A quantitative, descriptive design was adapted, using National Core Standard checklists and assessment questionnaires to collect data from two community health centers. Respondents were sampled through simple random sample. Data were collected through staff and patient interviews, document reviews, patient record assessment and observations. The raw data were transferred to the District Health Information System (DHIS) Assessment Questionnaire CHC/CDC programme which generated the results into colour coded tables (dashboard view). According to DHIS software version: 1.4.1.12 data base version: 19 June 2013 each community health center is listed in the DHIS programme for each district to capture data. The researcher consolidated and interpreted the results according to the expected level of performance and compliance as per the South African Office of the Health Standard Compliance. The results highlighted a need for improvement in the six priority areas for the Community Health Centers (CHCs) to reach the acceptable performance of 80% and above. CHC A scored 85% in availability of medicines and supplies however CHC B obtained 68 %. For cleanliness both CHCs obtained 54% which need more than 20% effort to reach the acceptable performance of 80%. In patient safety CHC A obtained 48% whilst CHC B had a score of 36%. For infection prevention and control CHC A scored 61% and CHC B obtained 53%. In the assessment of positive and caring attitudes CHC A had a score of 77% whereas CHC B obtained 40% indicative of noncompliance. In waiting time measures CHC A was compliant with a score of 82% however CHC B had a score of 71%. The results of this study indicated that there is a need for the CHCs to put systems in place to strengthen PHC effectiveness and ensure patient safety. The results and recommendations would assist in service delivery and continuous quality improvement in the community health centers.
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The integration of previously hospital based Antiretroviral sites into Primary Health Care clinics in Lukhanji sub district of Chris Hani District Municipality

  • Authors: Pakade, Nonkoliso
  • Date: 2015
  • Subjects: HIV/AIDS -- Antiretroviral(ARV) -- Eastern Cape -- South Africa Human Immune Virus(HIV) -- Antiretroviral therapy(ART) treatment
  • Language: English
  • Type: Thesis , Masters/Doctoral , MSc Nursing
  • Identifier: http://hdl.handle.net/11260/1431 , vital:35585
  • Description: The first country to take note of HIV/AIDS was United States of America in the report published by Atlanta based Centers for Disease Control (CDC) and Prevention (Barnett and Whiteside, 2006). In the past years ARV program was largely hospital-based where clients were assessed by doctors, discussed with multidisciplinary team which involved social workers, dieticians and pharmacists before initiated on treatment. The integration of ARV services into PHC was one of the strategies proposed to increase access to treatment for people living with HIV/AIDS (WHO, 2010). The study sought to describe the integration of previously hospital based ARV sites into PHC clinics in Lukhanji sub-district of Chris Hani Health District in Eastern Cape. A qualitative research design was followed and a phenomenological approach was used to examine the experiences of clients who previously took ARV treatment at Frontier hospital and were transferred to take treatment at Ezibeleni, Ilinge, Philani and Sada clinics. An interview guide was used for data collection. Participants were sampled through purposive sampling. The study was composed of four focus groups for clients with a total of forty (18 males and 22 females) and 10 professional nurses for semi structured individual interviews. In the analysis of data, the collected data from voice recordings were transcribed verbatim and translated from isiXhosa to English. The researcher immersed herself into the data, re read, and themes and sub-themes emerged. Related topics to each other were grouped together in order to reduce the number of categories and to create themes. The similar categories were grouped and analyzed. Findings indicated that integration of ART sites into PHC clinics was a strategy put in place to increase accessibility and availability of ARV treatment to all communities. Both participants stated that integration brought services nearer to people and caused much relief from spending more money for travelling long distances. Ambulance delays were reported by both participants as the major challenge in the referral system between clinics and the hospital. Other challenges facing integration of ART services into PHC clinics included long waiting times caused by shortage of staff in the clinics, lack of consulting rooms for nurses and waiting areas for clients. Also lack of other health care professionals including social workers, dieticians, and psychologists was mentioned. The recommendations made by the researcher on the conclusion of this study addressed all the challenges mentioned by participants. The aim was to increase accessibility and availability of ART services to all the communities.
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Molecular characterization, antibiograms and activity of medicinal plants against streptococcus pneumoniae and haemophilus influenzae isolates from clinical samples of patients in the Eastern Cape province, South Africa

  • Authors: Morobe, Isaac Christopher
  • Date: 2015-00
  • Subjects: Medicinal plants
  • Language: English
  • Type: Master's/Doctoral theses , text
  • Identifier: http://hdl.handle.net/11260/6469 , vital:46340
  • Description: H. influenzae and S. pneumoniae are important causes of community acquired respiratory tract infections including, pneumonia, acute sinusitis, otitis media, meningitis, bacteremia, sepsis, osteomyelitis, pericarditis, septic arthritis, endocarditis, peritonitis, cellulitis and brain abscesses. The ability to effectively treat bacterial infections has been compromised in recent years due to the acquisition of antibiotic resistance, particularly to β-lactam drugs. The increasing trends in antibiotic resistance have prompted incessant searches aimed at unraveling new effective sources for the management of microbial infections. Plant derived antimicrobial compounds that have no or minimal toxicity to host cells are considered candidates for developing new antimicrobial drugs. Safety is therefore critical in the development and formulation of such antimicrobials. In addition to studies on the structural elucidation of active compounds of selected medicinal plants and determination of their toxicity levels, concerted investigations on the molecular landscape of the designated bacteria, including genes coding for resistance and virulence, the phylogenetic profiles of isolates from different sources and the abilities of isolates to withstand the normal bactericidal activities of human serum samples from different blood groups are critical for a thorough understanding of the management, pathogenetic and clinico- epidemiological trajectories of the pathogens. Therefore, the aims of the various studies were to characterize local H. influenzae and S. pneumoniae isolates by serological and molecular methods; ascertain the antibiotic susceptibility profiles of isolates in order to provide updated data and guide clinicians and other health care workers on the empiric management of patients; determine genes coding for virulence and phylogenetic relatedness of isolates of H. influenzae and S. pneumoniae from diverse sources; ascertain the bactericidal activity of human serum samples from different blood groups against H. influenzae and S. pneumoniae and also to determine the activity of active compounds and toxicity levels of selected medicinal plants. In order to achieve these goals, relevant samples were collected and screened using an array of microbiological, serological, molecular and phytochemical methods, which would be espoused in the relevant chapters, presented hereunder. Key findings of the various chapters including their contributions to knowledge are highlighted. The studies are presented in eight chapters and each chapter, with the exception of chapter one (General Introduction and Literature Review) consists of an introduction, materials and methods, results, discussions, conclusions and references. Each chapter is therefore designed as a publishable unit. Chapter 1 gives an account of the background to the study and the literature review. The morphology, cultural characteristics, laboratory diagnosis, pathogenesis, antibiogram and clinical manifestations of H. influenzae and S. pneumoniae were reviewed. Furthermore, the activities of medicinal plants and their various applications in the management of infections in different countries, including their possible active compounds and toxicity levels were also explored in order to provide a suitable background for the study. Similar reviews were undertaken for molecular aspects of both pathogens as well as the activities of human serum samples against microbial infections. In Chapter 2 the prevalence and antibiotic resistance profiles of H. influenzae and, S. pneumoniae isolates from clinical samples of patients in Mthatha, Eastern Cape Province were investigated. Clinical samples were obtained randomly from individuals attending different hospitals in Mthatha district. Samples were analysed using the Kirby Bauer disk diffusion test (antibiotic susceptibility testing) and MIC breakpoints were determined using E-test strips. From a total of 475 clinical samples tested, 323 (68.0%) were positive for both H. influenzae and S. pneumoniae. Most of the positive isolates were obtained from children under 9 years. Out of 323 isolates, 187 (57.89%) were positive for H. influenzae and 136 (42.1%) were positive for S. pneumoniae. From 10 hospitals selected for sampling in this study, Mthatha General Hospital recorded the highest number of isolates, 42 (25.15%) and 31 (22.79%) of H. influenzae and S. pneumoniae positive isolates respectively, followed by Nelson Mandela Academic Hospital 33 (19.76%) and 26 (19.12%) respectively while ST. Patricks 8 (4.79%) recorded the least number of isolates for H. influenzae and Khotsong 4 (2.94%) recorded the least number of isolates for S. pneumoniae. Antibiotic susceptibility tests revealed Amoxicillin (MIC50, 0.125μg/ml) and Vancomycin (MIC50,0.12μg/ml) as the most effective antibiotics against S. pneumoniae isolates and Co-amoxiclav (MIC50,0.3µg/ml) and Cefuroxime (MIC50,0.15µg/ml) against H. influenzae isolates. These data highlight the need for education and to consider predominant resistance when choosing empiric therapies to treat bacterial infections. Chapter 3 was designed to investigate the virulence factors of H. influenzae and S. pneumoniae isolates from clinical specimens of patients with respiratory tract infections in Mthatha district, the Eastern Cape Province. PCR and sequencing methods were used to verify the genetic determinants responsible for virulence in H. influenzae and S. pneumoniae strains. Results indicated that, of the 187 H. influenzae isolates studied, 26 (13.9%) were typeable, positive by genotypic determination, while 161 (86.1%) were non typeable (NTHi) strains. On the other, out of the 136 S. pneumoniae isolates 24 (17.6%) were typeable while 112 (82.4%) were non typeable strains. All isolates tested contained the metS2 gene for both H. influenzae and S. pneumoniae. The phylogenetic clusters identified by maximum-parsimony analysis were also compared to the results of 16S rRNA sequences. Twenty five percent of none typeable strains were typed by 16S rRNA sequencing. The phylogenetic tree yielded 7.7% H. influenzae similarities while S. pneumoniae yielded 25% similarities with other typeable strains. The presence of genes coding for virulence in this study suggest a significant contribution of genes encoding for virulence to antimicrobial resistance among respiratory tract organisms studied. This study underlines the importance of understanding the virulence composition and diversity of pathogens for enhanced clinico-epidemiological monitoring and health care delivery. The findings will also provide a genetic foundation for future research into mechanisms of pathogenesis of H. influenzae and S. pneumoniae and may accelerate the development of safe and effective vaccines to prevent and control diseases caused by H. influenzae and S. pneumoniae. In Chapter 4, cytotoxic effects and safety profiles of extracts of active medicinal plants from the OR Tambo District Municipality in the Eastern Cape of South Africa were carried out. The most prominent families of medicinal plants (Solanacea and Euphorbiaceae) were used. Extracts of nine South African medicinal plants were screened for cytotoxic activities against MAGI CC5+ cells using MTT assay. Results indicated that nine plant extracts (methanolic and aqueous) used in the MTT assay revealed Herb 2 (Cyanthula inculata) as the most potent extract identified with activity of 1.4 Cc50 values of 25.6 mg/mL and induced over 50% of cell deaths, followed by herb 3 (Croton grattismus) and Herb 4 (Cassine trasvaalensis) with activity of 0.2 Cc50 values of 3.7 mg/mL each. The herbs that induced the least cell death, were herbs 5 (Capris tomentosa) and 7 (Hypoxis hemerocallidea), with the activity of 0.05 Cc50 values of 0.9 mg/mL each. Of the nine plant extracts 2(22%) exhibited minimal toxicity on MAGI cells and 7(77.8%) exhibited 50% toxicity. Two (22%) of the methanolic extracts exhibited anti-HIV1 IIIB activities and against Mycobacterium tuberculosis (TB) only one medicinal plant extract (Lysium inerme) exhibited 29% activity. Cytotoxicity tests will provide comprehensive reference data bases for the profiling and eventual considerations of medicinal plants as potential templates for drug designs and medical applications. In chapter 5 Chemical Components of the volatile and non-volatile extractives of Croton species and their microbial activities were screened. Isolation of the essential oils from the leaves of Croton pseudopulchellus and C. gratissimus from the Eastern Cape and KwaZulu-Natal Provinces in South Africa were performed using an all glass Clevenger apparatus according to the British Pharmacopeia method. The minimum inhibitory concentrations of the oils were assessed against the seven different standard strains of bacteria: H. influenzae, Bacillus pimitus, Staphylococcus aureus, S. pneumoniae, Escherichia coli, Klebsiella pneumoniae, Serratia marcescens and Entarobacter cloacae using micro dilution technique on a 96 well microtitre plate. Results showed golden to very light yellow oils obtained with percentage yield of 1.03 -1.25 respectively (w/w). Analysis of the oils was performed using Gas Chromatography and Gas Chromatography/Mass Spectrophotometry. The leaf oil of Croton pseudopulchellus had germacrene (24.2%),β-phellandrene (17.4%), myrcene (13.4%) and β-caryophyllene (11.4%) as the prominent compounds identified in the oil. The chemical composition of the leaf oil of C. gratissimus was characterized by sabinene (14.6%), β-phellandrene (12.3%), α-phellandrene (10.7%), α-pinene (6.0%) and germacrene D (5.9%). Chemical profiles of the essential oils of Croton species reported in literatures are specific to their geographical location. The oils from C. pseudopulchellus and C. grattisimus were found to have significant antibacterial activities and therefore could be used as natural antimicrobial agents for the treatment of several infectious diseases caused by pathogenic and antibiotic resistant organisms. Chapters 6 and 7 were designed to isolate two bioactive compounds from the stem bark of Lycium inerme and the leaves of Croton grattisimus and were screened for their biological activities against H. influenzae and S. pneumoniae. A qualitative phytochemical screening and bioassay of the plants extracts was carried out. Antimicrobial screening was by broth microdilution and bioautography. Bioassay results showed that compounds with Rf –values between 0.67 to 0.80 were very active against H. influenzae and S. pneumoniae. However, the most active of these compounds was observed at 0.70 for H. influenzae and 0.69 for S. pneumoniae from the dichloromethane extract. Column chromatography, Preparative Thin Layer Chromatography (PTLC) and Sephadex LH20 were used for isolation, sample clean-up and purification of this extract. Two active compounds: a coumarin (7-hydroxy-6-methoxy-coumarin) and two triterpenoids, Ursolic acid (3-oxo-19-hydroxyl-6-methoxylpomolic acid) and Moronic acid (3-oxoolean-12-en-28-oic acid) were isolated from the dichloromethane fraction. The presence of Coumarins and Terpenoids in this herb was observed from the TLC fingerprints. NMR spectroscopic methods were used for the structural elucidation of the active compounds while the GC-MS was used to determine the presence of essential oils from volatile samples obtained from the leaves of C. grattisimus and L. inerme. C. grattisimus extracts possess strong free radicals with scavenging, antimicrobial and antifungal activities; therefore, further studies are needed to determine their efficacies in vivo or clinical usefulness. L. inerme stem bark can therefore be used as a source of alternative medicine or new pharmaceutical and health care product or as a starting material for synthesis of drugs. In chapter 8, general conclusions and perspectives of various parts of the findings were captured. The multi-drug resistance was observed among the emerging respiratory tract bacterial pathogens. It was recommended that measures should be put in place to control the spread of drug resistance in pathogens through improved and standardized laboratory practices, proper and regular surveillance to help guide against the indiscriminate use of antibiotics in empirical treatment. The recognition but cautious use of medicinal plants as alternative sources of therapies and a probable means to solve the emerging resistance problem was recommended. Improved standard of hygiene in hospital settings and the communities is important to prevent the spread of infections. The thesis provides a novel reference document on the genes coding for resistance, antibiograms and phylogenetic profiles of local isolates of H. influenzae and S. pneumoniae as well as the activities, active compounds and toxicity levels of medicinal plants investigated in an endeavour to effectively understand the possible therapeutic, molecular and epidemiological trends in respect of the designated pathogens. , Thesis (Phd) -- Faculty of Health Sciences, 2015
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Degradation of Paracetamol and other constituents in Perfalgan®: subtitle if needed. If no subtitle follow instructions in manual

  • Authors: Curran,Catherine
  • Date: 2014
  • Language: English
  • Type: Masters theses , text
  • Identifier: http://hdl.handle.net/11260/3165 , vital:43181
  • Description: Abstract text. 5.1 Background Paracetamol (acetaminophen) is useful for the treatment of mild to moderate pain as well as being opiate–sparing. In recent years the problem of poor solubility of paracetamol in water has been overcome and an intravenous formulation of paracetamol developed. In South Africa this is marketed by Bristol-Myers Squibb as Perfalgan®. Each 500 mg or 1g ampoule of Perfalgan® is recommended for single use only and is to be discarded once opened (Medicines.org, n.d.). This is most likely due to concerns about degradation of paracetamol or other ingredients in the solution once exposed to air and sterility issues. However in South Africa where this drug is expensive, some centers use one ampoule for multiple cases over the course of 12-24 hours. No obvious clinical adverse effects have been reported. 5.2 Objective of study The aim of this study was to examine the practice of using a single vial of Perfalgan® in divided doses over the course of a day for different patients by way of assessing the stability of Perfalgan® on exposure to air. The study has three components, namely: 1. In vitro assessment of paracetamol levels on exposure to air and stressors over time. 2. In vitro assessment of levels of the excipients, namely mannitol and cysteine on exposure to air and stressors over time. 3. Assessment of the lipid permeability of paracetamol in Perfalgan® on exposure to air and stressors over time. C Curran 2014 Degradation of paracetamol and other constituents in Perfalgan® 8 5.3 Methodology High performance liquid chromatography (HPCL-UV) was used to determine the concentration of paracetamol and the presence of degradation products in samples taken at set time periods following exposure of Perfalgan® to air and stressors. Initial work was done using pure paracetamol to determine optimal measurement conditions prior to analysing Perfalgan®. The concentrations of the additives and their degradation products were measured using nuclear magnetic resonance (1 H NMR). Appreciable changes in these could indicate a safety hazard or decreased bioavailability. Finally ultraviolet spectroscopy was performed to assess samples at a wider spectrum of wavelengths, instead of the single wavelength used in HPLC. This was used to assess for degradation products which absorb at different wavelengths and therefore may be missed if HPLC was used alone. Ultraviolet spectroscopy was also used to test bioavailability of the drug via the octanol:water partition coefficient under stressed and unstressed conditions. 5.4 Results The paracetamol in Perfalgan® did not degrade on exposure to air over 24 hours. Neither did it degrade on exposure to acid, alkali, oxidative or heat stress. The HPLC retention time was constantly between 3.17-3.29 minutes. 1 H NMR revealed no change in the formulation of Perfalgan® except for the conversion of the oxygen scavenger cysteine to cystine. The octanol:water partition coefficient likewise stayed constant and was in agreement with the value of 0.46-0.49 quoted in the literature (International Programme on Chemical Safety, 2008; McNeil Consumer Healthcare, 2010). 5.5 Conclusion The paracetamol in Perfalgan® did not degrade on exposure to air and other stressors over 24 hours. The formulation as Perfalgan® was likewise found to be stable. The drug retained its lipid permeability over this period. , Thesis (MMED) -- Faculty of Health Sciences, 2014
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An intervention study to develop a male circumcision health promotion programme at Libode Rural Communities in the Eastern Cape Province, South Africa

  • Authors: Douglas, Mbuyiselo
  • Date: 2013
  • Subjects: Circumcision Health promotion Penis surgery South Africa -- Libode
  • Language: English
  • Type: Thesis , Doctoral , Ph D
  • Identifier: vital:18476 , http://hdl.handle.net/11260/d1007187
  • Description: The purpose of this study was to develop an intervention health promotion programme to prevent circumcision related health problem such as sepsis, botched circumcision, dehydration, penile amputation and reduce the number of deaths. The intervention programme was aimed at promoting a safe male circumcision practice affecting boys aged 12-18 years at Libode rural communities in Eastern Cape Province of South Africa. This was achieved through a mixed method design using both quantitative and qualitative approaches utilizing sequential transformative strategy to allow for the convergence of multiple perspectives of the traditional male circumcision in Libode. The study was conducted in 22 schools of the rural communities of Libode because most of the participants are still attending school. Frequencies and percentages were used to analyse the quantitative data, utilizing the Statistical Package for Social Sciences (SPSS). A total of 1036 participants, AmaXhosa circumcised young men (abafana) and uncircumcised boys (amakhwenkwe) participated in the cross-sectional survey, quantitative phase of the study. Qualitative phase of this study was composed of 7 focus group discussions with a total of 84 circumcised and uncircumcised male participants and 10 key informants’ interviews were conducted. In analysis qualitative data, the researcher found the most descriptive words for each topic and turned them into categories or sub-themes. Topics that related to each other were then grouped in order to reduce the number of categories and to create themes. The similar categories of data were grouped and analysed using Tesch’s method. Findings indicated that traditional circumcision is performed during winter and summer holidays in order to cater for the boys who are attending schools. The circumcision age at Libode ranges from 12 and 18 years of age which is against the Health Standards in Traditional Circumcision Act (Act No. 6 of 2001). Although the participants were aware of the complications of male circumcision in Libode, there was a high preference for traditional circumcision (92.3% of participants) to hospital circumcision. The participants were of the view that the benefits of traditional circumcision outweigh the complications or challenges related to traditional circumcision. They wanted to be socially accepted and wanted to learn about manhood values in the traditional circumcision which are values that cannot be achieved through the hospital based circumcision. As male circumcision initiation is seasonal and the intervention programme needed to be approved by different stakeholders, the testing of intervention programme could not happen before the programme was approved by all the stakeholders.
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