Acute toxicity study and prevention of Nω-nitro-L-arginine methyl ester-induced hypertension by Osteopermum imbricatum
- Tata, Charlotte, M, Gwebu, Ephraim, T, Olukayode O Aremu, Nkeh-Chungag, Benedicta, N, Oyedeji, Adebola, O, Oyedeji, Opeopluwa, O, Sewani-Rusike, Constance, R
- Authors: Tata, Charlotte, M , Gwebu, Ephraim, T , Olukayode O Aremu , Nkeh-Chungag, Benedicta, N , Oyedeji, Adebola, O , Oyedeji, Opeopluwa, O , Sewani-Rusike, Constance, R
- Date: June-2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/4915 , vital:44303 , https://www.ajol.info/index.php/tjpr/article/view/174343
- Description: Purpose:To determine the phytochemical content, toxicity and hypertension prevention effects of Osteospermum imbricatum leaf and root extracts.Methods:Phytochemical screening of leaf and root extracts of O. imbricatum was performed by colorimetric procedure. Acute toxicity of leaf and root extracts was conductedin two phases; phase I consisted of three groups of mice (n = 3) for each dose level of 10, 100 and 1000 mg/kg while phase II had three mice that received 1600, 2900 or 5000 mg/kg. Wistar rats were grouped into 7 groups that were co-treated with L-NAME and normal saline or L-NAME and hydroethanolic leaf extract (150 and 300 mg/kg) or L-NAME and hydroethanolic root extract (150 and 300 mg/kg) or L-NAME and amlodipine (5 mg/kg) or normal saline only for 4 weeks. Treatment was carried out via the oral route while blood pressure was measured weeklyfor 4 weeks by non-invasive tail cuff method.Results:The phytochemical profile of the leaf and root extracts revealed the presence of phenols, terpenoids, flavonoids, glycosides, tannins, steroids and saponins. Both the leaf and root extracts were toxic at 5000 mg/kg with an LD50of 3807.89 mg/kg. In the fourth week of the study, only the leaf extract significantly (p less 0.01) prevented the progression of L-NAME induced hypertension; systolic and diastolic blood pressure of the group treated with L-NAME and leaf extract (300 mg/kg) were 183 ± 1 and 140 ± 1 mmHg, respectively, compared to the group that was treated with L-NAME and normal saline which produced systolic and diastolic BP values of 213 ± 3 and 172 ± 4 mmHg, respectively. The extracts, especially OIR300, exhibited diuretic effects in the second and third week of study by promoting excretion of 16 and 19 ml urine, respectively, compared to 11 and 14 ml for LN group.Conclusion:The results suggest that O. imbricatum is moderately toxic at a high dose and contains a wide range of phytochemicals which offer partial protection against the development of nitric oxide deficiency hypertension.
- Full Text:
- Authors: Tata, Charlotte, M , Gwebu, Ephraim, T , Olukayode O Aremu , Nkeh-Chungag, Benedicta, N , Oyedeji, Adebola, O , Oyedeji, Opeopluwa, O , Sewani-Rusike, Constance, R
- Date: June-2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/4915 , vital:44303 , https://www.ajol.info/index.php/tjpr/article/view/174343
- Description: Purpose:To determine the phytochemical content, toxicity and hypertension prevention effects of Osteospermum imbricatum leaf and root extracts.Methods:Phytochemical screening of leaf and root extracts of O. imbricatum was performed by colorimetric procedure. Acute toxicity of leaf and root extracts was conductedin two phases; phase I consisted of three groups of mice (n = 3) for each dose level of 10, 100 and 1000 mg/kg while phase II had three mice that received 1600, 2900 or 5000 mg/kg. Wistar rats were grouped into 7 groups that were co-treated with L-NAME and normal saline or L-NAME and hydroethanolic leaf extract (150 and 300 mg/kg) or L-NAME and hydroethanolic root extract (150 and 300 mg/kg) or L-NAME and amlodipine (5 mg/kg) or normal saline only for 4 weeks. Treatment was carried out via the oral route while blood pressure was measured weeklyfor 4 weeks by non-invasive tail cuff method.Results:The phytochemical profile of the leaf and root extracts revealed the presence of phenols, terpenoids, flavonoids, glycosides, tannins, steroids and saponins. Both the leaf and root extracts were toxic at 5000 mg/kg with an LD50of 3807.89 mg/kg. In the fourth week of the study, only the leaf extract significantly (p less 0.01) prevented the progression of L-NAME induced hypertension; systolic and diastolic blood pressure of the group treated with L-NAME and leaf extract (300 mg/kg) were 183 ± 1 and 140 ± 1 mmHg, respectively, compared to the group that was treated with L-NAME and normal saline which produced systolic and diastolic BP values of 213 ± 3 and 172 ± 4 mmHg, respectively. The extracts, especially OIR300, exhibited diuretic effects in the second and third week of study by promoting excretion of 16 and 19 ml urine, respectively, compared to 11 and 14 ml for LN group.Conclusion:The results suggest that O. imbricatum is moderately toxic at a high dose and contains a wide range of phytochemicals which offer partial protection against the development of nitric oxide deficiency hypertension.
- Full Text:
Adult binge drinking: rate, frequency and intensity in Buffalo City Metropolitan Municipality, South Africa
- Owolabi, Eyitayo Omolara, Goona, Daniel Ter, Adeniyi, Oladele Vincent, Seekoea, Eunice
- Authors: Owolabi, Eyitayo Omolara , Goona, Daniel Ter , Adeniyi, Oladele Vincent , Seekoea, Eunice
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/4944 , vital:44305 , https://doi.org/10.1080/20786190.2017.1382970
- Description: This study was conducted to explore views about the execution of powers and functions of the police in the light of related challenges. This study made use of data from a total of 83 adult participants (a survey involving 73 individuals, and 10 in-depth interviews), including males and females of diverse occupational backgrounds from Bindura and Mount Darwin policing districts in Zimbabwe. A closed-ended, mostly Likert-scale-based questionnaire was used to collect data about the prevalent forms of police abuse of powers and functions, while an in-depth interview guide was provided to harvest information qualitatively. Findings reveal that police officers abuse their powers through unlawful arrests, arbitrary search and seizure, excessive use of force, unlawful methods of investigation, and ill treatment of detainees. Though not as prevalent as other forms of abuse, malicious criminal prosecution and partisan policing were also cited.K EYWOR DS: powers, abuse, function, police, Zimbabwe
- Full Text:
- Authors: Owolabi, Eyitayo Omolara , Goona, Daniel Ter , Adeniyi, Oladele Vincent , Seekoea, Eunice
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/4944 , vital:44305 , https://doi.org/10.1080/20786190.2017.1382970
- Description: This study was conducted to explore views about the execution of powers and functions of the police in the light of related challenges. This study made use of data from a total of 83 adult participants (a survey involving 73 individuals, and 10 in-depth interviews), including males and females of diverse occupational backgrounds from Bindura and Mount Darwin policing districts in Zimbabwe. A closed-ended, mostly Likert-scale-based questionnaire was used to collect data about the prevalent forms of police abuse of powers and functions, while an in-depth interview guide was provided to harvest information qualitatively. Findings reveal that police officers abuse their powers through unlawful arrests, arbitrary search and seizure, excessive use of force, unlawful methods of investigation, and ill treatment of detainees. Though not as prevalent as other forms of abuse, malicious criminal prosecution and partisan policing were also cited.K EYWOR DS: powers, abuse, function, police, Zimbabwe
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Cloud computing adoption: Strategies for Sub-Saharan Africa SMEs for enhancing competitiveness
- Authors: Adane, Martin
- Date: 2018
- Subjects: business intelligence small businesses business planning Article
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6862 , vital:51101 , xlink:href="https://doi.org/10.1080/20421338.2018.1439288"
- Description: Small and medium-sized enterprises (SMEs) need to design and implement strategies for adopting new technologies as a competitive tool for maintaining their competitive advantage and cloud computing is at its peak. Since its emergence, there has been a surge in the adoption of cloud computing with research into its adoption primarily concentrated on bigger firms. However, a major characteristic of cloud computing is the anticipated possibilities it holds for SMEs. This paper primarily explores cloud computing adoption strategies for SMEs operating in Sub-Saharan Africa. Using a mixed method approach, a sample of 261 respondents and 11 SMEs was respectively used for the quantitative and qualitative stages of the research. The results reveal that, even though SMEs have their unique expectations for adopting cloud computing, they were of the consensus that elements of an adoption strategy should include adoption goals, a roadmap, and considerations. The paper makes specific recommendations to SMEs to develop adoption strategies that meet their specific needs if they expect cloud computing to play a stronger role to support more strategic initiatives to grow their businesses and improve customer experience.
- Full Text:
- Authors: Adane, Martin
- Date: 2018
- Subjects: business intelligence small businesses business planning Article
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6862 , vital:51101 , xlink:href="https://doi.org/10.1080/20421338.2018.1439288"
- Description: Small and medium-sized enterprises (SMEs) need to design and implement strategies for adopting new technologies as a competitive tool for maintaining their competitive advantage and cloud computing is at its peak. Since its emergence, there has been a surge in the adoption of cloud computing with research into its adoption primarily concentrated on bigger firms. However, a major characteristic of cloud computing is the anticipated possibilities it holds for SMEs. This paper primarily explores cloud computing adoption strategies for SMEs operating in Sub-Saharan Africa. Using a mixed method approach, a sample of 261 respondents and 11 SMEs was respectively used for the quantitative and qualitative stages of the research. The results reveal that, even though SMEs have their unique expectations for adopting cloud computing, they were of the consensus that elements of an adoption strategy should include adoption goals, a roadmap, and considerations. The paper makes specific recommendations to SMEs to develop adoption strategies that meet their specific needs if they expect cloud computing to play a stronger role to support more strategic initiatives to grow their businesses and improve customer experience.
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Connecting with home, keeping in touch: physical and virtual mobility across stretched families in sub-Saharan Africa
- Porter, Gina, Hampshire, Kate, Abane, Albert, Munthali, Alister, Robson, Elsbeth, Tanle, Augustine, Owusu, Samuel, de Lannoy , Ariane, Bango , Andisiwe
- Authors: Porter, Gina , Hampshire, Kate , Abane, Albert , Munthali, Alister , Robson, Elsbeth , Tanle, Augustine , Owusu, Samuel , de Lannoy , Ariane , Bango , Andisiwe
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5240 , vital:44414 , https://www.cambridge.org/core/journals/africa/article/connecting-with-home-keeping-in-touch-physical-and-virtual-mobility-across-stretched-families-in-subsaharan-africa/937D8F364AEC4397912B1F0BD9A26285
- Description: There is a long history of migration among low-income families in sub-SaharanAfrica, in which (usually young, often male) members leave home to seek theirfortune in what are perceived to be more favourable locations. While the physicaland virtual mobility practices of such stretched families are often complex andcontingent, maintaining contact with distantly located close kin is frequently ofcrucial importance for the maintenance of emotional (and possibly material)well-being, both for those who have left home and for those who remain. Thisarticle explores the ways in which these connections are being reshaped by increas-ing access to mobile phones in three sub-Saharan countries–Ghana, Malawi andSouth Africa–drawing on interdisciplinary, mixed-methods research fromtwenty-four sites, ranging from poor urban neighbourhoods to remote ruralhamlets. Stories collected from both ends of stretched families present a worldin which the connectivities now offered by the mobile phone bring a differentkind of closeness and knowing, as instant sociality introduces a potential substi-tute for letters, cassettes and face-to-face visits, while the rapid resource mobiliza-tion opportunities identified by those still at home impose increasing pressures onmigrant kin
- Full Text:
- Authors: Porter, Gina , Hampshire, Kate , Abane, Albert , Munthali, Alister , Robson, Elsbeth , Tanle, Augustine , Owusu, Samuel , de Lannoy , Ariane , Bango , Andisiwe
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5240 , vital:44414 , https://www.cambridge.org/core/journals/africa/article/connecting-with-home-keeping-in-touch-physical-and-virtual-mobility-across-stretched-families-in-subsaharan-africa/937D8F364AEC4397912B1F0BD9A26285
- Description: There is a long history of migration among low-income families in sub-SaharanAfrica, in which (usually young, often male) members leave home to seek theirfortune in what are perceived to be more favourable locations. While the physicaland virtual mobility practices of such stretched families are often complex andcontingent, maintaining contact with distantly located close kin is frequently ofcrucial importance for the maintenance of emotional (and possibly material)well-being, both for those who have left home and for those who remain. Thisarticle explores the ways in which these connections are being reshaped by increas-ing access to mobile phones in three sub-Saharan countries–Ghana, Malawi andSouth Africa–drawing on interdisciplinary, mixed-methods research fromtwenty-four sites, ranging from poor urban neighbourhoods to remote ruralhamlets. Stories collected from both ends of stretched families present a worldin which the connectivities now offered by the mobile phone bring a differentkind of closeness and knowing, as instant sociality introduces a potential substi-tute for letters, cassettes and face-to-face visits, while the rapid resource mobiliza-tion opportunities identified by those still at home impose increasing pressures onmigrant kin
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Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa
- Longo–Mbenza, Benjamin, K Ekoru, GAV Murphy, EH Young, H Delisle, CS Jerome , F Assah, JPD Nzambi, JBK On'Kin , F Buntix, MC Muyer, DL Christensen, CS Wesseh, A Sabir, C Okafor, ID Gezawa, F Puepet, O Enang, T Raimi, E Ohwovoriole, OO Oladapo, P Bovet, W Mollentze, N Unwin, WK Gray, R Walker K Agoudavi, S Siziya, J Chifamba, M Njelekela, CM Fourie, S Kruger, AE Schutte, C Walsh, D Gareta, A Kamali, J Seeley, SA Norris NJ Crowther, D Pillay, P Kaleebu, AA Motala and MS Sandhu on behalf of the African Partnership for Chronic Disease Research (APCDR)
- Authors: Longo–Mbenza, Benjamin , K Ekoru, GAV Murphy, EH Young, H Delisle, CS Jerome , F Assah, JPD Nzambi, JBK On'Kin , F Buntix, MC Muyer, DL Christensen, CS Wesseh, A Sabir, C Okafor, ID Gezawa, F Puepet, O Enang, T Raimi, E Ohwovoriole, OO Oladapo, P Bovet, W Mollentze, N Unwin, WK Gray, R Walker K Agoudavi, S Siziya, J Chifamba, M Njelekela, CM Fourie, S Kruger, AE Schutte, C Walsh, D Gareta, A Kamali, J Seeley, SA Norris NJ Crowther, D Pillay, P Kaleebu, AA Motala and MS Sandhu on behalf of the African Partnership for Chronic Disease Research (APCDR)
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5389 , vital:44560 , https://www.nature.com/articles/ijo2017240
- Description: BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cutpoints for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5–83.8 cm) and 81.0 cm (95% CI 79.2–82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63–65) than in men (53%, 95% CI 51–55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4–2.9, for men and 2.2, 95% CI 2.0–2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.
- Full Text:
- Authors: Longo–Mbenza, Benjamin , K Ekoru, GAV Murphy, EH Young, H Delisle, CS Jerome , F Assah, JPD Nzambi, JBK On'Kin , F Buntix, MC Muyer, DL Christensen, CS Wesseh, A Sabir, C Okafor, ID Gezawa, F Puepet, O Enang, T Raimi, E Ohwovoriole, OO Oladapo, P Bovet, W Mollentze, N Unwin, WK Gray, R Walker K Agoudavi, S Siziya, J Chifamba, M Njelekela, CM Fourie, S Kruger, AE Schutte, C Walsh, D Gareta, A Kamali, J Seeley, SA Norris NJ Crowther, D Pillay, P Kaleebu, AA Motala and MS Sandhu on behalf of the African Partnership for Chronic Disease Research (APCDR)
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5389 , vital:44560 , https://www.nature.com/articles/ijo2017240
- Description: BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cutpoints for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5–83.8 cm) and 81.0 cm (95% CI 79.2–82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63–65) than in men (53%, 95% CI 51–55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4–2.9, for men and 2.2, 95% CI 2.0–2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.
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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.
- Full Text:
- 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.
- Full Text:
Factors affecting adherence to antiretroviral therapy among pregnant women in theEastern Cape, South Africa
- Adeola, H A, Adeniyi, Oladele Vincent, Ajayi, Anthony Idowu, Goon, Daniel Ter, Owolabi, Eyitayo Omolara, Eboh, Alfred, Lambert, John
- Authors: Adeola, H A , Adeniyi, Oladele Vincent , Ajayi, Anthony Idowu , Goon, Daniel Ter , Owolabi, Eyitayo Omolara , Eboh, Alfred , Lambert, John
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5272 , vital:44427 , https://neuro.unboundmedicine.com/medline/citation/29653510/Factors_affecting_adherence_to_antiretroviral_therapy_among_pregnant_women_in_the_Eastern_Cape_South_Africa_
- Description: Background:Context-specific factors influence adherence to antiretroviral therapy (ART) among pregnant womenliving with HIV. Gaps exist in the understanding of the reasons for the variable outcomes of the prevention ofmother-to-child transmission (PMTCT) programme at the health facility level in South Africa. This study examinedadherence levels and reasons for non-adherence during pregnancy in a cohort of parturient women enrolled in thePMTCT programme in the Eastern Cape, South Africa.Methods:This was a mixed-methods study involving 1709 parturient women in the Eastern Cape, South Africa. Weconducted a multi-centre retrospective analysis of the mother-infant pair in the PMTCT electronic database in 2016.Semi-structured interviews of purposively selected parturient women with self-reported poor adherence (n= 177)were conducted to gain understanding of the main barriers to adherence. Binary logistic regression was used todetermine the independent predictors of ART non-adherence.Results:A high proportion (69.0%) of women reported perfect adherence. In the logistic regression analysis, afteradjusting for confounding factors, marital status, cigarette smoking, alcohol use and non-disclosure to a family memberwere the independent predictors of non-adherence. Analysis of the qualitative data revealed that drug-related side-effects, being away from home, forgetfulness, non-disclosure, stigma and work-related demand were among the mainreasons for non-adherence to ART.Conclusions:Non-adherence to the antiretroviral therapy among pregnant women in this setting is associated withlifestyle behaviours, HIV-related stigma and ART side-effects. In order to eliminate mother-to-child transmission of HIV,clinicians need to screen for these factors at every antenatal clinic visit.Keywords:Adherence, Non-adherence, HIV, Antiretroviral therapy, Elimination of mother-to-child transmission,Prevention of mother-to-child transmission, Stigma, South Africa
- Full Text:
- Authors: Adeola, H A , Adeniyi, Oladele Vincent , Ajayi, Anthony Idowu , Goon, Daniel Ter , Owolabi, Eyitayo Omolara , Eboh, Alfred , Lambert, John
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5272 , vital:44427 , https://neuro.unboundmedicine.com/medline/citation/29653510/Factors_affecting_adherence_to_antiretroviral_therapy_among_pregnant_women_in_the_Eastern_Cape_South_Africa_
- Description: Background:Context-specific factors influence adherence to antiretroviral therapy (ART) among pregnant womenliving with HIV. Gaps exist in the understanding of the reasons for the variable outcomes of the prevention ofmother-to-child transmission (PMTCT) programme at the health facility level in South Africa. This study examinedadherence levels and reasons for non-adherence during pregnancy in a cohort of parturient women enrolled in thePMTCT programme in the Eastern Cape, South Africa.Methods:This was a mixed-methods study involving 1709 parturient women in the Eastern Cape, South Africa. Weconducted a multi-centre retrospective analysis of the mother-infant pair in the PMTCT electronic database in 2016.Semi-structured interviews of purposively selected parturient women with self-reported poor adherence (n= 177)were conducted to gain understanding of the main barriers to adherence. Binary logistic regression was used todetermine the independent predictors of ART non-adherence.Results:A high proportion (69.0%) of women reported perfect adherence. In the logistic regression analysis, afteradjusting for confounding factors, marital status, cigarette smoking, alcohol use and non-disclosure to a family memberwere the independent predictors of non-adherence. Analysis of the qualitative data revealed that drug-related side-effects, being away from home, forgetfulness, non-disclosure, stigma and work-related demand were among the mainreasons for non-adherence to ART.Conclusions:Non-adherence to the antiretroviral therapy among pregnant women in this setting is associated withlifestyle behaviours, HIV-related stigma and ART side-effects. In order to eliminate mother-to-child transmission of HIV,clinicians need to screen for these factors at every antenatal clinic visit.Keywords:Adherence, Non-adherence, HIV, Antiretroviral therapy, Elimination of mother-to-child transmission,Prevention of mother-to-child transmission, Stigma, South Africa
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Feasibility and acceptability of conducting HIV vaccine trials in adolescents in South Africa: : Going beyond willingness to participate towards implementation
- Authors: Chandia, Jimmy
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5498 , vital:44586 , http://www.samj.org.za/index.php/samj/article/view/12260
- Description: Background. HIV/AIDS remains a leading cause of death in adolescents (aged 15 - 25 years), and in sub-Saharan Africa HIV-related deaths continue to rise in this age group despite a decline in both adult and paediatric populations. This is attributable in part to high adolescent infection rates and supports the urgent need for more efficacious prevention strategies. In particular, an even partially effective HIV vaccine, given prior to sexual debut, is predicted to significantly curb adolescent infection rates. While adolescents have indicated willingness to participate in HIV vaccine trials, there are concerns around safety, uptake, adherence, and ethical and logistic issues. Objectives. To initiate a national, multisite project with the aim of identifying obstacles to conducting adolescent HIV vaccine trials in South Africa (SA). Method. A simulated HIV vaccine trial was conducted in adolescents aged 12 - 17 years across five SA research sites, using the already licensed Merck human papillomavirus vaccine Gardasil as a proxy for an HIV vaccine. Adolescents were recruited at community venues and, following a vaccine discussion group, invited to participate in the trial. Consent for trial enrolment was obtained from a parent or legal guardian, and participants aged 16 - 17 years were eligible only if sexually active. Typical vaccine trial procedures were applied during the five study visits, including the administration of vaccination injections at study visits 2, 3 and 4. Results. The median age of participants was 14 years (interquartile range 13 - 15), with 81% between the ages of 12 and 15 years at enrolment. Overall, 98% of screened participants opted to receive the vaccine, 588 participants enrolled, and 524 (89%) attended the final visit. Conclusions. This trial showed that adolescents can be recruited, enrolled and retained in clinical prevention trials with parental support. While promising, these results were tempered by the coupling of sexual-risk eligibility criteria and the requirement for parental/guardian consent, which was probably a barrier to the enrolment of high-risk older adolescents. Further debate around appropriate consent approaches for such adolescents in HIV prevention studies is required.
- Full Text:
- Authors: Chandia, Jimmy
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5498 , vital:44586 , http://www.samj.org.za/index.php/samj/article/view/12260
- Description: Background. HIV/AIDS remains a leading cause of death in adolescents (aged 15 - 25 years), and in sub-Saharan Africa HIV-related deaths continue to rise in this age group despite a decline in both adult and paediatric populations. This is attributable in part to high adolescent infection rates and supports the urgent need for more efficacious prevention strategies. In particular, an even partially effective HIV vaccine, given prior to sexual debut, is predicted to significantly curb adolescent infection rates. While adolescents have indicated willingness to participate in HIV vaccine trials, there are concerns around safety, uptake, adherence, and ethical and logistic issues. Objectives. To initiate a national, multisite project with the aim of identifying obstacles to conducting adolescent HIV vaccine trials in South Africa (SA). Method. A simulated HIV vaccine trial was conducted in adolescents aged 12 - 17 years across five SA research sites, using the already licensed Merck human papillomavirus vaccine Gardasil as a proxy for an HIV vaccine. Adolescents were recruited at community venues and, following a vaccine discussion group, invited to participate in the trial. Consent for trial enrolment was obtained from a parent or legal guardian, and participants aged 16 - 17 years were eligible only if sexually active. Typical vaccine trial procedures were applied during the five study visits, including the administration of vaccination injections at study visits 2, 3 and 4. Results. The median age of participants was 14 years (interquartile range 13 - 15), with 81% between the ages of 12 and 15 years at enrolment. Overall, 98% of screened participants opted to receive the vaccine, 588 participants enrolled, and 524 (89%) attended the final visit. Conclusions. This trial showed that adolescents can be recruited, enrolled and retained in clinical prevention trials with parental support. While promising, these results were tempered by the coupling of sexual-risk eligibility criteria and the requirement for parental/guardian consent, which was probably a barrier to the enrolment of high-risk older adolescents. Further debate around appropriate consent approaches for such adolescents in HIV prevention studies is required.
- Full Text:
How good are our guidelines? Four years of experience with the SAMJ’s AGREE II review of submitted clinical practice guidelines
- Kredo, Tamara, Wiseman, Roger, Gray, Andy, Parrish, Andy, Miot, Jacqui, Jamaloodien, Khadija, Blockman, Marc
- Authors: Kredo, Tamara , Wiseman, Roger , Gray, Andy , Parrish, Andy , Miot, Jacqui , Jamaloodien, Khadija , Blockman, Marc
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5296 , vital:44431 , http://10.7196/SAMJ.2018.v108i11.13646
- Description: The South African Medical Journal (SAMJ) is an established source of clinical practice guidelines (CPGs) serving the local healthcare community. CPGs link professional societies and clinicians by guiding best practice through the collation and interpretation of the best available evidence. Not only are CPGs important in standardising the quality of patient care, but they also assist with medicine selection and resource allocation decisions, adjudicating medicolegal claims, and promoting equity by influencing medicine access and health system organisation.[1] In 2014, the SAMJ appointed an editorial subcommittee to review CPGs submitted for publication.[2] This was in response to several concerns, including the global shift in CPG quality requirements, the potential effect of poor-quality CPGs on healthcare quality and cost, and the challenges South African (SA) CPG developers face in meeting new standards. This editorial reflects on the SAMJ CPG review subcommittee’s experience over the past 4 years and describes the value of more robust CPG development.
- Full Text:
- Authors: Kredo, Tamara , Wiseman, Roger , Gray, Andy , Parrish, Andy , Miot, Jacqui , Jamaloodien, Khadija , Blockman, Marc
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5296 , vital:44431 , http://10.7196/SAMJ.2018.v108i11.13646
- Description: The South African Medical Journal (SAMJ) is an established source of clinical practice guidelines (CPGs) serving the local healthcare community. CPGs link professional societies and clinicians by guiding best practice through the collation and interpretation of the best available evidence. Not only are CPGs important in standardising the quality of patient care, but they also assist with medicine selection and resource allocation decisions, adjudicating medicolegal claims, and promoting equity by influencing medicine access and health system organisation.[1] In 2014, the SAMJ appointed an editorial subcommittee to review CPGs submitted for publication.[2] This was in response to several concerns, including the global shift in CPG quality requirements, the potential effect of poor-quality CPGs on healthcare quality and cost, and the challenges South African (SA) CPG developers face in meeting new standards. This editorial reflects on the SAMJ CPG review subcommittee’s experience over the past 4 years and describes the value of more robust CPG development.
- Full Text:
Inhibition of NOS- like activity in maize alters the expression of genes involved in H2O2 scavenging and glycine betaine biosynthesis
- Phillips, Kyle, Majola, Anelisa, Gokul, Arun, Keyster, Marshall, Ludidi, Ndiko, Egbichi, Ifeanyi
- Authors: Phillips, Kyle , Majola, Anelisa , Gokul, Arun , Keyster, Marshall , Ludidi, Ndiko , Egbichi, Ifeanyi
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5256 , vital:44425 , https://www.nature.com/articles/s41598-018-31131-z#citeas
- Description: Nitric oxide synthase-like activity contributes to the production of nitric oxide in plants, which controls plant responses to stress. This study investigates if changes in ascorbate peroxidase enzymatic activity and glycine betaine content in response to inhibition of nitric oxide synthase-like activity are associated with transcriptional regulation by analyzing transcript levels of genes (betaine aldehyde dehydrogenase) involved in glycine betaine biosynthesis and those encoding antioxidant enzymes (ascorbate peroxidase and catalase) in leaves of maize seedlings treated with an inhibitor of nitric oxide synthase-like activity. In seedlings treated with a nitric oxide synthase inhibitor, transcript levels of betaine aldehyde dehydrogenase were decreased. In plants treated with the nitric oxide synthase inhibitor, the transcript levels of ascorbate peroxidase-encoding genes were down-regulated. We thus conclude that inhibition of nitric oxide synthase-like activity suppresses the expression of ascorbate peroxidase and betaine aldehyde dehydrogenase genes in maize leaves. Furthermore, catalase activity was suppressed in leaves of plants treated with nitric oxide synthase inhibitor; and this corresponded with the suppression of the expression of catalase genes. We further conclude that inhibition of nitric oxide synthase-like activity, which suppresses ascorbate peroxidase and catalase enzymatic activities, results in increased H2O2 content.Background:Context-specific factors influence adherence to antiretroviral therapy (ART) among pregnant womenliving with HIV. Gaps exist in the understanding of the reasons for the variable outcomes of the prevention ofmother-to-child transmission (PMTCT) programme at the health facility level in South Africa. This study examinedadherence levels and reasons for non-adherence during pregnancy in a cohort of parturient women enrolled in thePMTCT programme in the Eastern Cape, South Africa.Methods:This was a mixed-methods study involving 1709 parturient women in the Eastern Cape, South Africa. Weconducted a multi-centre retrospective analysis of the mother-infant pair in the PMTCT electronic database in 2016.Semi-structured interviews of purposively selected parturient women with self-reported poor adherence (n= 177)were conducted to gain understanding of the main barriers to adherence. Binary logistic regression was used todetermine the independent predictors of ART non-adherence.Results:A high proportion (69.0%) of women reported perfect adherence. In the logistic regression analysis, afteradjusting for confounding factors, marital status, cigarette smoking, alcohol use and non-disclosure to a family memberwere the independent predictors of non-adherence. Analysis of the qualitative data revealed that drug-related side-effects, being away from home, forgetfulness, non-disclosure, stigma and work-related demand were among the mainreasons for non-adherence to ART.Conclusions:Non-adherence to the antiretroviral therapy among pregnant women in this setting is associated withlifestyle behaviours, HIV-related stigma and ART side-effects. In order to eliminate mother-to-child transmission of HIV,clinicians need to screen for these factors at every antenatal clinic visit.Keywords:Adherence, Non-adherence, HIV, Antiretroviral therapy, Elimination of mother-to-child transmission,Prevention of mother-to-child transmission, Stigma, South Africa
- Full Text:
- Authors: Phillips, Kyle , Majola, Anelisa , Gokul, Arun , Keyster, Marshall , Ludidi, Ndiko , Egbichi, Ifeanyi
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5256 , vital:44425 , https://www.nature.com/articles/s41598-018-31131-z#citeas
- Description: Nitric oxide synthase-like activity contributes to the production of nitric oxide in plants, which controls plant responses to stress. This study investigates if changes in ascorbate peroxidase enzymatic activity and glycine betaine content in response to inhibition of nitric oxide synthase-like activity are associated with transcriptional regulation by analyzing transcript levels of genes (betaine aldehyde dehydrogenase) involved in glycine betaine biosynthesis and those encoding antioxidant enzymes (ascorbate peroxidase and catalase) in leaves of maize seedlings treated with an inhibitor of nitric oxide synthase-like activity. In seedlings treated with a nitric oxide synthase inhibitor, transcript levels of betaine aldehyde dehydrogenase were decreased. In plants treated with the nitric oxide synthase inhibitor, the transcript levels of ascorbate peroxidase-encoding genes were down-regulated. We thus conclude that inhibition of nitric oxide synthase-like activity suppresses the expression of ascorbate peroxidase and betaine aldehyde dehydrogenase genes in maize leaves. Furthermore, catalase activity was suppressed in leaves of plants treated with nitric oxide synthase inhibitor; and this corresponded with the suppression of the expression of catalase genes. We further conclude that inhibition of nitric oxide synthase-like activity, which suppresses ascorbate peroxidase and catalase enzymatic activities, results in increased H2O2 content.Background:Context-specific factors influence adherence to antiretroviral therapy (ART) among pregnant womenliving with HIV. Gaps exist in the understanding of the reasons for the variable outcomes of the prevention ofmother-to-child transmission (PMTCT) programme at the health facility level in South Africa. This study examinedadherence levels and reasons for non-adherence during pregnancy in a cohort of parturient women enrolled in thePMTCT programme in the Eastern Cape, South Africa.Methods:This was a mixed-methods study involving 1709 parturient women in the Eastern Cape, South Africa. Weconducted a multi-centre retrospective analysis of the mother-infant pair in the PMTCT electronic database in 2016.Semi-structured interviews of purposively selected parturient women with self-reported poor adherence (n= 177)were conducted to gain understanding of the main barriers to adherence. Binary logistic regression was used todetermine the independent predictors of ART non-adherence.Results:A high proportion (69.0%) of women reported perfect adherence. In the logistic regression analysis, afteradjusting for confounding factors, marital status, cigarette smoking, alcohol use and non-disclosure to a family memberwere the independent predictors of non-adherence. Analysis of the qualitative data revealed that drug-related side-effects, being away from home, forgetfulness, non-disclosure, stigma and work-related demand were among the mainreasons for non-adherence to ART.Conclusions:Non-adherence to the antiretroviral therapy among pregnant women in this setting is associated withlifestyle behaviours, HIV-related stigma and ART side-effects. In order to eliminate mother-to-child transmission of HIV,clinicians need to screen for these factors at every antenatal clinic visit.Keywords:Adherence, Non-adherence, HIV, Antiretroviral therapy, Elimination of mother-to-child transmission,Prevention of mother-to-child transmission, Stigma, South Africa
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Literary representations of Zimbabwean migrants’ lives in selected texts
- Authors: Mpofu, Tarisai
- Date: 2018
- Subjects: Human rights -- Zimbabwe , Homelessness in literature , African diaspora in literature
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/3402 , vital:43340
- Description: It has been nearly two decades since Zimbabwe has been engulfed in both political and economic crises which have had untold hardships to the majority of ordinary people. As the hardships worsened it pushed Zimbabweans to migrate to “greener pastures” as a survival strategy. Due to the sheer numbers of people who left the country, migration became a social phenomenon in the country that even literary writers also explored. It is the purpose of this study to analyse literary reactions to migration in Zimbabwe from the turn of the new millennium to date, with particular reference to selected Zimbabwean fiction in the form of the short story and novel. The dissertation examines how Zimbabwean literature represents life in Zimbabwe in the context of this economic malaise that emerged after the year 2000 and the resultant lives of migrants who left the country as a result of this political and economic crisis. Similar to the majority of African literatures, Zimbabwean literature emerges from specific historical events and this study therefore sought to describe literary representations of people’s responses to the crisis and the life of Zimbabwean migrants in the margins of host communities. This study reveals the intricate relationship between literary responses and the conditions that most migrants found themselves in especially as they fled the country and what obtained in host countries. , Thesis (MA) -- Faculty of Humanities, Social Sciences and Law, 2018
- Full Text:
- Authors: Mpofu, Tarisai
- Date: 2018
- Subjects: Human rights -- Zimbabwe , Homelessness in literature , African diaspora in literature
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/3402 , vital:43340
- Description: It has been nearly two decades since Zimbabwe has been engulfed in both political and economic crises which have had untold hardships to the majority of ordinary people. As the hardships worsened it pushed Zimbabweans to migrate to “greener pastures” as a survival strategy. Due to the sheer numbers of people who left the country, migration became a social phenomenon in the country that even literary writers also explored. It is the purpose of this study to analyse literary reactions to migration in Zimbabwe from the turn of the new millennium to date, with particular reference to selected Zimbabwean fiction in the form of the short story and novel. The dissertation examines how Zimbabwean literature represents life in Zimbabwe in the context of this economic malaise that emerged after the year 2000 and the resultant lives of migrants who left the country as a result of this political and economic crisis. Similar to the majority of African literatures, Zimbabwean literature emerges from specific historical events and this study therefore sought to describe literary representations of people’s responses to the crisis and the life of Zimbabwean migrants in the margins of host communities. This study reveals the intricate relationship between literary responses and the conditions that most migrants found themselves in especially as they fled the country and what obtained in host countries. , Thesis (MA) -- Faculty of Humanities, Social Sciences and Law, 2018
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Perceptions of school based support teams about providing support to Foundation Phase Teachers in two Butterworth Primary Schools, Eastern Cape
- Authors: Luningo, Mziwonke
- Date: 2018
- Subjects: School based support--Teams Foundation phase--Teachers--Eastern Cape Education support--Primary schools
- Language: English
- Type: Thesis , Doctoral , D Ed
- Identifier: http://hdl.handle.net/11260/1410 , vital:34373
- Description: The policy on Inclusive Education acknowledges that all children can learn if they are given the necessary support. In order to achieve this goal, the Department of Education (DoE) introduced the establishment of SBSTs whose main function is to support teaching and learning in schools. This study used interpretive paradigm to explore perceptions of SBST about providing support to foundation phase (FP) teachers and to interpret what they said. Nonetheless, there seemed to be challenges on how to support learners experiencing barriers to learning among the members of the SBST. The aim of this study was to explore the perceptions of the School-Based Support Teams (SBSTs) about providing support to the foundation phase teachers in two Butterworth Primary Schools in the Eastern Cape. This study used the qualitative mode of inquiry and a case study as a research design. Semi-structured interviews using one on one, observations and document analysis were used to collect the data from the SBSTs about their perceptions of providing support to the FP teachers. Purposeful sampling was used where two mainstream primary schools were conveniently selected with six SBST participants from each school, making a total of six participants. Twelve SBST members were interviewed. Data were analysed and common themes emerged. The findings revealed that the SBSTs did not have enough knowledge and skills to support the FP teachers. Some of the challenges they cited included inadequate training, lack of communication, overcrowding and lack of support from the parents. In an attempt to alleviate the above-raised challenges, a model was proposed. These are some of the recommendations that resulted from the findings: all schools should have SBSTs, they should be composed of all the important stakeholders as proposed by the DoE, frequent SBST meetings should be held and further recommendations are made.
- Full Text:
- Authors: Luningo, Mziwonke
- Date: 2018
- Subjects: School based support--Teams Foundation phase--Teachers--Eastern Cape Education support--Primary schools
- Language: English
- Type: Thesis , Doctoral , D Ed
- Identifier: http://hdl.handle.net/11260/1410 , vital:34373
- Description: The policy on Inclusive Education acknowledges that all children can learn if they are given the necessary support. In order to achieve this goal, the Department of Education (DoE) introduced the establishment of SBSTs whose main function is to support teaching and learning in schools. This study used interpretive paradigm to explore perceptions of SBST about providing support to foundation phase (FP) teachers and to interpret what they said. Nonetheless, there seemed to be challenges on how to support learners experiencing barriers to learning among the members of the SBST. The aim of this study was to explore the perceptions of the School-Based Support Teams (SBSTs) about providing support to the foundation phase teachers in two Butterworth Primary Schools in the Eastern Cape. This study used the qualitative mode of inquiry and a case study as a research design. Semi-structured interviews using one on one, observations and document analysis were used to collect the data from the SBSTs about their perceptions of providing support to the FP teachers. Purposeful sampling was used where two mainstream primary schools were conveniently selected with six SBST participants from each school, making a total of six participants. Twelve SBST members were interviewed. Data were analysed and common themes emerged. The findings revealed that the SBSTs did not have enough knowledge and skills to support the FP teachers. Some of the challenges they cited included inadequate training, lack of communication, overcrowding and lack of support from the parents. In an attempt to alleviate the above-raised challenges, a model was proposed. These are some of the recommendations that resulted from the findings: all schools should have SBSTs, they should be composed of all the important stakeholders as proposed by the DoE, frequent SBST meetings should be held and further recommendations are made.
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Perspectives about the execution of police powers and functions in the republic of Zimbabwe
- Mugari, Ishmael, Obioha, Emeka, E
- Authors: Mugari, Ishmael , Obioha, Emeka, E
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/4928 , vital:44304 , http://cjssp.uni-corvinus.hu/index.php/cjssp/article/view/220
- Description: This study was conducted to explore views about the execution of powers and functions of the police in the light of related challenges. This study made use of data from a total of 83 adult participants (a survey involving 73 individuals, and 10 in-depth interviews), including males and females of diverse occupational backgrounds from Bindura and Mount Darwin policing districts in Zimbabwe. A closed-ended, mostly Likert-scale-based questionnaire was used to collect data about the prevalent forms of police abuse of powers and functions, while an in-depth interview guide was provided to harvest information qualitatively. Findings reveal that police officers abuse their powers through unlawful arrests, arbitrary search and seizure, excessive use of force, unlawful methods of investigation, and ill treatment of detainees. Though not as prevalent as other forms of abuse, malicious criminal prosecution and partisan policing were also cited.K EYWOR DS: powers, abuse, function, police, Zimbabwe
- Full Text:
- Authors: Mugari, Ishmael , Obioha, Emeka, E
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/4928 , vital:44304 , http://cjssp.uni-corvinus.hu/index.php/cjssp/article/view/220
- Description: This study was conducted to explore views about the execution of powers and functions of the police in the light of related challenges. This study made use of data from a total of 83 adult participants (a survey involving 73 individuals, and 10 in-depth interviews), including males and females of diverse occupational backgrounds from Bindura and Mount Darwin policing districts in Zimbabwe. A closed-ended, mostly Likert-scale-based questionnaire was used to collect data about the prevalent forms of police abuse of powers and functions, while an in-depth interview guide was provided to harvest information qualitatively. Findings reveal that police officers abuse their powers through unlawful arrests, arbitrary search and seizure, excessive use of force, unlawful methods of investigation, and ill treatment of detainees. Though not as prevalent as other forms of abuse, malicious criminal prosecution and partisan policing were also cited.K EYWOR DS: powers, abuse, function, police, Zimbabwe
- Full Text:
Point-of-care and lung ultrasound incorporated in daily practice
- Neethling, E, Roodt, F, Beck, C, Swanevelder, J L C
- Authors: Neethling, E , Roodt, F , Beck, C , Swanevelder, J L C
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5248 , vital:44424 , http://www.samj.org.za/index.php/samj/article/view/12293
- Description: Point-of-care ultrasound (POCUS) is a fast-growing clinical utility and is becoming an essential clinical skill for all practitioners attending to critically ill patients. Ultrasound equipment is now smaller, more affordable and readily available in clinical work areas. POCUS is performed by a non-cardiologist physician at the patient’s bedside as an adjunct to the physical examination. It is easily taught, non-invasive and allows for real-time clinical information. Bedside use of ultrasound imaging aids with rapid diagnosis of severe and life-threatening pathological conditions. It can be repeated, may change clinical management, and impact on patient outcome. POCUS has a broad clinical use, including, but not limited to, focused assessed transthoracic echocardiography (FATE), lung ultrasound imaging, extended focused assessment with sonography for trauma (e-FAST), vascular access and regional blocks. It may also be extended to detect endotracheal intubation and the estimation of intracranial pressure. Assessment of cardiac pathology by POCUS, performed by a novice examiner, has been shown to compare with the gold standard of an expert. Training is paramount. The physician should know his limitations and always relate the information back to the clinical scenario and context. By incorporating POCUS as part of our armamentarium and into our daily medical practice, we might see it reach its full clinical potential, optimising patient care and improving patient outcomes.
- Full Text:
- Authors: Neethling, E , Roodt, F , Beck, C , Swanevelder, J L C
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5248 , vital:44424 , http://www.samj.org.za/index.php/samj/article/view/12293
- Description: Point-of-care ultrasound (POCUS) is a fast-growing clinical utility and is becoming an essential clinical skill for all practitioners attending to critically ill patients. Ultrasound equipment is now smaller, more affordable and readily available in clinical work areas. POCUS is performed by a non-cardiologist physician at the patient’s bedside as an adjunct to the physical examination. It is easily taught, non-invasive and allows for real-time clinical information. Bedside use of ultrasound imaging aids with rapid diagnosis of severe and life-threatening pathological conditions. It can be repeated, may change clinical management, and impact on patient outcome. POCUS has a broad clinical use, including, but not limited to, focused assessed transthoracic echocardiography (FATE), lung ultrasound imaging, extended focused assessment with sonography for trauma (e-FAST), vascular access and regional blocks. It may also be extended to detect endotracheal intubation and the estimation of intracranial pressure. Assessment of cardiac pathology by POCUS, performed by a novice examiner, has been shown to compare with the gold standard of an expert. Training is paramount. The physician should know his limitations and always relate the information back to the clinical scenario and context. By incorporating POCUS as part of our armamentarium and into our daily medical practice, we might see it reach its full clinical potential, optimising patient care and improving patient outcomes.
- Full Text:
Potential latitudinal variation in orodigestive tract cancers in Africa
- Adeola, H A, Adefuye, A O, Jimoh, S A
- Authors: Adeola, H A , Adefuye, A O , Jimoh, S A
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5280 , vital:44428 , http://www.samj.org.za/index.php/samj/article/view/12259
- Description: Background. Previous studies have alluded to a causal relationship between pathological entities and geographical variations, but there is a paucity of studies from Africa discussing the effect of latitudinal variation on orodigestive cancers in this region. It seems plausible that the burden of orodigestive cancer would differ as a result of variations in diet, cultural habits, climate and environmental conditions down the length of Africa. Objectives. To analyse regional variations in prevalence, incidence and mortality data in the global cancer statistics database (GLOBOCAN 2012) curated by the World Health Organization and the International Agency for Research on Cancer. Basic descriptive statistical tools were used to depict regional variations in cancer morbidity and mortality. Methods. Data on 13 African countries between longitude 20⁰ and 30⁰ east and latitude 35⁰ north and 35⁰ south were examined for variation in age-standardised orodigestive cancer prevalence, incidence and mortality. Possible regional causes for orodigestive tract cancer development were investigated. Data on lip and oral cavity, oesophageal, gastric, colorectal, liver, gallbladder and pancreatic cancers in the 13 countries were compared. Results. Our empirical findings from this preliminary study support the notion that the incidence and prevalence of orodigestive cancers vary within Africa. This effect may be due to environmental, economic, political and possibly genetic factors. Conclusions. Considering the heterogeneity of the above factors across Africa, disbursement of funding for cancer research and therapy in Africa should be focused in terms of regional variations to make best use of the fiscal allocation by African governments, non-governmental organisations and international agencies.
- Full Text:
- Authors: Adeola, H A , Adefuye, A O , Jimoh, S A
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5280 , vital:44428 , http://www.samj.org.za/index.php/samj/article/view/12259
- Description: Background. Previous studies have alluded to a causal relationship between pathological entities and geographical variations, but there is a paucity of studies from Africa discussing the effect of latitudinal variation on orodigestive cancers in this region. It seems plausible that the burden of orodigestive cancer would differ as a result of variations in diet, cultural habits, climate and environmental conditions down the length of Africa. Objectives. To analyse regional variations in prevalence, incidence and mortality data in the global cancer statistics database (GLOBOCAN 2012) curated by the World Health Organization and the International Agency for Research on Cancer. Basic descriptive statistical tools were used to depict regional variations in cancer morbidity and mortality. Methods. Data on 13 African countries between longitude 20⁰ and 30⁰ east and latitude 35⁰ north and 35⁰ south were examined for variation in age-standardised orodigestive cancer prevalence, incidence and mortality. Possible regional causes for orodigestive tract cancer development were investigated. Data on lip and oral cavity, oesophageal, gastric, colorectal, liver, gallbladder and pancreatic cancers in the 13 countries were compared. Results. Our empirical findings from this preliminary study support the notion that the incidence and prevalence of orodigestive cancers vary within Africa. This effect may be due to environmental, economic, political and possibly genetic factors. Conclusions. Considering the heterogeneity of the above factors across Africa, disbursement of funding for cancer research and therapy in Africa should be focused in terms of regional variations to make best use of the fiscal allocation by African governments, non-governmental organisations and international agencies.
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Practice intentions at entry to and exit from medical schools aspiring to social accountability: findings from the Training for Health Equity Network Graduate Outcome Study
- Iputo, Jehu, Sarah Larkins , Karen Johnston, John C. Hogenbirk, Sara Willems, Salwa Elsanousi, Marykutty Mammen, Kaatje Van Roy, Jehu Iputo , Fortunato L. Cristobal , Jennene Greenhill, Charlie Labarda11 and Andre-Jacques Neusy
- Authors: Iputo, Jehu , Sarah Larkins , Karen Johnston, John C. Hogenbirk, Sara Willems, Salwa Elsanousi, Marykutty Mammen, Kaatje Van Roy, Jehu Iputo , Fortunato L. Cristobal , Jennene Greenhill, Charlie Labarda11 and Andre-Jacques Neusy
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5415 , vital:44567 , https://pubmed.ncbi.nlm.nih.gov/30424760/
- Description: Background: Understanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the practice intentions of entry and exit cohorts of medical students across low and high income settings and the correlation of student characteristics with these intentions. Methods: The Training for Health Equity Network (THEnet) Graduate Outcome Study (GOS) is an international prospective cohort study tracking learners throughout training and ten years into practice as part of the longitudinal impact assessment described in THEnet’s Evaluation Framework. THEnet is an international community of practice of twelve medical schools with a social accountability mandate. Data presented here include cross-sectional entry and exit data obtained from different cohorts of medical students involving eight medical schools in six countries and five continents. Binary logistic regression was used to create adjusted odds ratios for associations with practice intent. Results: Findings from 3346 learners from eight THEnet medical schools in 6 countries collected between 2012 and 2016 are presented. A high proportion of study respondents at these schools come from rural and disadvantaged backgrounds and these respondents are more likely than others to express an intention to work in underserved locations after graduation at both entry and exit from medical school. After adjusting for confounding factors, rural and low income background and regional location of medical school were the most important predictors of intent to practice in a rural location. For schools in the Philippines and Africa, intention to emigrate was more likely for respondents from high income and urban backgrounds.
- Full Text:
- Authors: Iputo, Jehu , Sarah Larkins , Karen Johnston, John C. Hogenbirk, Sara Willems, Salwa Elsanousi, Marykutty Mammen, Kaatje Van Roy, Jehu Iputo , Fortunato L. Cristobal , Jennene Greenhill, Charlie Labarda11 and Andre-Jacques Neusy
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5415 , vital:44567 , https://pubmed.ncbi.nlm.nih.gov/30424760/
- Description: Background: Understanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the practice intentions of entry and exit cohorts of medical students across low and high income settings and the correlation of student characteristics with these intentions. Methods: The Training for Health Equity Network (THEnet) Graduate Outcome Study (GOS) is an international prospective cohort study tracking learners throughout training and ten years into practice as part of the longitudinal impact assessment described in THEnet’s Evaluation Framework. THEnet is an international community of practice of twelve medical schools with a social accountability mandate. Data presented here include cross-sectional entry and exit data obtained from different cohorts of medical students involving eight medical schools in six countries and five continents. Binary logistic regression was used to create adjusted odds ratios for associations with practice intent. Results: Findings from 3346 learners from eight THEnet medical schools in 6 countries collected between 2012 and 2016 are presented. A high proportion of study respondents at these schools come from rural and disadvantaged backgrounds and these respondents are more likely than others to express an intention to work in underserved locations after graduation at both entry and exit from medical school. After adjusting for confounding factors, rural and low income background and regional location of medical school were the most important predictors of intent to practice in a rural location. For schools in the Philippines and Africa, intention to emigrate was more likely for respondents from high income and urban backgrounds.
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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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- 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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Vulnerabilities of Coastal Tourism destinations to climate change related incidents: a case study selected holiday resorts along the wildcoast, Eastern Cape, South Africa
- Authors: Van Der Byl, Athina
- Date: 2018
- Subjects: Coastal Tourism destinations -- Wildcoast Wildcoast -- Holiday resorts -- South Africa -- Eastern Cape Climate change -- Tourism
- Language: English
- Type: Thesis , Masters , M Sc
- Identifier: http://hdl.handle.net/11260/1337 , vital:32259
- Description: Climate change is a global phenomenon with major impacts on coastlines, leaving coastal areas vulnerable to conditions such as sea level rise, flooding as well as storm surges, which results in increased damage to or loss of coastal property and infrastructure. The study examined the vulnerability of the Eastern Cape’s Wild Coast resorts to climate change related impacts. Both qualitative and quantitative methods aided by questionnaires and GIS mapping were used to identify vulnerable settlements as well as their impacts. A meta analysis of the identified vulnerabilities was studied and strategies employed to reduce the impacts was also done. Results indicated that almost 80% of the Wild Coast resorts occur within the low-lying areas of the coast and these areas were mostly affected by impacts such as sea level rise, heavy rainfall and floods accompanied by storm surges. Another alarming challenge faced by the King Sabata Dalindyebo Municipality was controlling unplanned developments within these low-lying zones of the coast. Therefore, it is recommended that relevant departments provide awareness through various platforms such as workshops, programmes and campaigns to ensure that people understand the risk of climate change on low-lying areas as well as mainstreaming climate change in long term development planning. This study highlights a need for monitoring of coastal environments vulnerable to the impact of climate change along a South African coastline.
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- Authors: Van Der Byl, Athina
- Date: 2018
- Subjects: Coastal Tourism destinations -- Wildcoast Wildcoast -- Holiday resorts -- South Africa -- Eastern Cape Climate change -- Tourism
- Language: English
- Type: Thesis , Masters , M Sc
- Identifier: http://hdl.handle.net/11260/1337 , vital:32259
- Description: Climate change is a global phenomenon with major impacts on coastlines, leaving coastal areas vulnerable to conditions such as sea level rise, flooding as well as storm surges, which results in increased damage to or loss of coastal property and infrastructure. The study examined the vulnerability of the Eastern Cape’s Wild Coast resorts to climate change related impacts. Both qualitative and quantitative methods aided by questionnaires and GIS mapping were used to identify vulnerable settlements as well as their impacts. A meta analysis of the identified vulnerabilities was studied and strategies employed to reduce the impacts was also done. Results indicated that almost 80% of the Wild Coast resorts occur within the low-lying areas of the coast and these areas were mostly affected by impacts such as sea level rise, heavy rainfall and floods accompanied by storm surges. Another alarming challenge faced by the King Sabata Dalindyebo Municipality was controlling unplanned developments within these low-lying zones of the coast. Therefore, it is recommended that relevant departments provide awareness through various platforms such as workshops, programmes and campaigns to ensure that people understand the risk of climate change on low-lying areas as well as mainstreaming climate change in long term development planning. This study highlights a need for monitoring of coastal environments vulnerable to the impact of climate change along a South African coastline.
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Fundal pressure during the second stage of labour
- Hofmeyr, Georges Justus, Vogel, Joshua. P, Cuthbert, Anna, Singata, Mandisa
- Authors: Hofmeyr, Georges Justus , Vogel, Joshua. P , Cuthbert, Anna , Singata, Mandisa
- Date: 03-2017
- Subjects: South Africa Pregnancy Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5766 , vital:44640 , https://DOI:10.1002/14651858.CD006067.pub3
- Description: Background Fundal pressure during the second stage of labour (also known as the 'Kristeller manoeuvre') involves application of manual pressure to the uppermost part of the uterus directed towards the birth canal, in an attempt to assist spontaneous vaginal birth and avoid prolonged second stage orthe need for operative birth. Fundal pressure has also been applied using an inflatable belt. Fundal pressure is widely used, however methods of its use vary widely. Despite strongly held opinions in favour of and against the use of fundal pressure, there is limited evidence regarding its maternal and neonatal benefits and harms. There is a need for objective evaluation of the eGectiveness and safety of fundal pressure in the second stage of labour. Objectives To determine if fundal pressure is eGective in achieving spontaneous vaginal birth, and preventing prolonged second stage or the need for operative birth, and to explore maternal and neonatal adverse eGects related to fundal pressure. Search methods We searched Cochrane Pregnancy and Childbirth's Trials Register (30 November 2016) and reference lists of retrieved studies. Selection criteria Randomised and quasi-randomised controlled trials of fundal pressure (manual or by inflatable belt) versus no fundal pressure in women in the second stage of labour with singleton cephalic presentation. Data collection and analysis Two or more review authors independently assessed potential studies for inclusion and quality. We extracted data using a pre-designed form. We entered data into Review Manager 5 soAware and checked for accuracy. Main results Nine trials are included in this updated review. Five trials (3057 women) compared manual fundal pressure versus no fundal pressure. Four trials (891 women) compared fundal pressure by means of an inflatable belt versus no fundal pressure. It was not possible to blind women and staG to this intervention. We assessed two trials as being at high risk of attrition bias and another at high risk of reporting bias. All other trials were low or unclear for other risk of bias domains. Most of the trials had design limitations. Heterogeneity was high for the majority of outcomes. Manual fundal pressure versus no fundal pressure Manual fundal pressure was not associated with changes in: spontaneous vaginal birth within a specified time (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.71 to 1.28; 120 women; 1 trial; very low-quality evidence), instrumental births (RR 3.28, 95% CI 0.14 to 79.65; 197 women; 1 trial), caesarean births (RR 1.10, 95% CI 0.07 to 17.27; 197 women; 1 trial), operative birth (average RR 0.66, 95% CI 0.12 to 3.55; 317 women; 2 studies; I2 = 43%; Tau2 = 0.71; very low-quality evidence), duration of second stage (mean diGerence (MD) -0.80 minutes, 95% CI -3.66 to 2.06 minutes; 194 women; 1 study; very low-quality evidence), low arterial cord pH in newborn babies (RR 1.07, 95% CI 0.72 to 1.58; 297 women; 2 trials; very low-quality evidence), or Apgar scores less than seven at five minutes (average RR 4.48, 95% CI 0.28 to 71.45; 2759 infants; 4 trials; I2 = 89%; Tau2 = 3.55; very low-quality evidence). More women who received manual fundal pressure had cervical tears than in the control group (RR 4.90, 95% CI 1.09 to 21.98; 295 women; 1 trial). No neonatal deaths occurred in either of the two studies reporting this outcome (very low-quality evidence). No trial reported the outcome severe maternal morbidity or death. Fundal pressure by inflatable belt versus no fundal pressure Fundal pressure by inflatable belt did not reduce the number of women havinginstrumental births (average RR 0.73, 95% CI 0.52 to 1.02; 891 women; 4 trials; I2 = 52%; Tau2 = 0.05) or operative births (average RR 0.62, 95% CI 0.38 to 1.01; 891 women; 4 trials; I2 = 78%; Tau2 = 0.14; very low-quality evidence). Heterogeneity was high for both outcomes. Duration of second stage was reported in two trials, which both showed that inflatable belts shortened duration of labour in nulliparous women (average MD -50.80 minutes, 95% CI -94.85 to -6.74 minutes; 253 women; 2 trials; I2 = 97%; Tau2 = 975.94; very low-quality evidence). No data on this outcome were available for multiparous women. The inflatable belt did not make any diGerence to rates of caesarean births (average RR 0.56, 95% CI 0.14 to 2.26; 891 women; 4 trials; I2 = 70%; Tau2 = 0.98), low arterial cord pHin newborn babies (RR 0.47, 95% CI 0.09 to 2.55; 461 infants; 1 trial; low-quality evidence), or Apgar scores less than seven atfive minutes (RR 4.62, 95% CI 0.22 to 95.68; 500 infants; 1 trial; very low-quality evidence). Third degree perinealtears were increased in the inflatable belt group (RR 15.69, 95% CI 2.10 to 117.02; 500 women; 1 trial). Spontaneous vaginal birth within a specified time, neonatal death, andsevere maternal morbidity or death were not reported in any trial. Authors' conclusions There is insuGicient evidence to draw conclusions on the beneficial or harmful eGects of fundal pressure, either manually or by inflatable belt. Fundal pressure by an inflatable belt during the second stage of labour may shorten duration of second stage for nulliparous women, and lower rates of operative birth. However, existing studies are small and their generalizability is uncertain. There is insuGicient evidence regarding safety for the baby. There is no evidence on the use of fundal pressure in specific clinical settings such as inability of the mother to bear down due to exhaustion or unconsciousness. There is currently insuGicient evidence for the routine use of fundal pressure by any method on women in the second stage of labour. Because of current widespread use of the procedure and the potential for use in settings where other methods of assisted birth are not available, further good quality trials are needed. Further evaluation in other groups of women (such as multiparous women) will also be required. Future research should describe in detail how fundal pressure was applied and consider safety of the unborn baby, perineal outcomes, longer-term maternal and infant outcomes and maternal satisfaction.
- Full Text:
- Authors: Hofmeyr, Georges Justus , Vogel, Joshua. P , Cuthbert, Anna , Singata, Mandisa
- Date: 03-2017
- Subjects: South Africa Pregnancy Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5766 , vital:44640 , https://DOI:10.1002/14651858.CD006067.pub3
- Description: Background Fundal pressure during the second stage of labour (also known as the 'Kristeller manoeuvre') involves application of manual pressure to the uppermost part of the uterus directed towards the birth canal, in an attempt to assist spontaneous vaginal birth and avoid prolonged second stage orthe need for operative birth. Fundal pressure has also been applied using an inflatable belt. Fundal pressure is widely used, however methods of its use vary widely. Despite strongly held opinions in favour of and against the use of fundal pressure, there is limited evidence regarding its maternal and neonatal benefits and harms. There is a need for objective evaluation of the eGectiveness and safety of fundal pressure in the second stage of labour. Objectives To determine if fundal pressure is eGective in achieving spontaneous vaginal birth, and preventing prolonged second stage or the need for operative birth, and to explore maternal and neonatal adverse eGects related to fundal pressure. Search methods We searched Cochrane Pregnancy and Childbirth's Trials Register (30 November 2016) and reference lists of retrieved studies. Selection criteria Randomised and quasi-randomised controlled trials of fundal pressure (manual or by inflatable belt) versus no fundal pressure in women in the second stage of labour with singleton cephalic presentation. Data collection and analysis Two or more review authors independently assessed potential studies for inclusion and quality. We extracted data using a pre-designed form. We entered data into Review Manager 5 soAware and checked for accuracy. Main results Nine trials are included in this updated review. Five trials (3057 women) compared manual fundal pressure versus no fundal pressure. Four trials (891 women) compared fundal pressure by means of an inflatable belt versus no fundal pressure. It was not possible to blind women and staG to this intervention. We assessed two trials as being at high risk of attrition bias and another at high risk of reporting bias. All other trials were low or unclear for other risk of bias domains. Most of the trials had design limitations. Heterogeneity was high for the majority of outcomes. Manual fundal pressure versus no fundal pressure Manual fundal pressure was not associated with changes in: spontaneous vaginal birth within a specified time (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.71 to 1.28; 120 women; 1 trial; very low-quality evidence), instrumental births (RR 3.28, 95% CI 0.14 to 79.65; 197 women; 1 trial), caesarean births (RR 1.10, 95% CI 0.07 to 17.27; 197 women; 1 trial), operative birth (average RR 0.66, 95% CI 0.12 to 3.55; 317 women; 2 studies; I2 = 43%; Tau2 = 0.71; very low-quality evidence), duration of second stage (mean diGerence (MD) -0.80 minutes, 95% CI -3.66 to 2.06 minutes; 194 women; 1 study; very low-quality evidence), low arterial cord pH in newborn babies (RR 1.07, 95% CI 0.72 to 1.58; 297 women; 2 trials; very low-quality evidence), or Apgar scores less than seven at five minutes (average RR 4.48, 95% CI 0.28 to 71.45; 2759 infants; 4 trials; I2 = 89%; Tau2 = 3.55; very low-quality evidence). More women who received manual fundal pressure had cervical tears than in the control group (RR 4.90, 95% CI 1.09 to 21.98; 295 women; 1 trial). No neonatal deaths occurred in either of the two studies reporting this outcome (very low-quality evidence). No trial reported the outcome severe maternal morbidity or death. Fundal pressure by inflatable belt versus no fundal pressure Fundal pressure by inflatable belt did not reduce the number of women havinginstrumental births (average RR 0.73, 95% CI 0.52 to 1.02; 891 women; 4 trials; I2 = 52%; Tau2 = 0.05) or operative births (average RR 0.62, 95% CI 0.38 to 1.01; 891 women; 4 trials; I2 = 78%; Tau2 = 0.14; very low-quality evidence). Heterogeneity was high for both outcomes. Duration of second stage was reported in two trials, which both showed that inflatable belts shortened duration of labour in nulliparous women (average MD -50.80 minutes, 95% CI -94.85 to -6.74 minutes; 253 women; 2 trials; I2 = 97%; Tau2 = 975.94; very low-quality evidence). No data on this outcome were available for multiparous women. The inflatable belt did not make any diGerence to rates of caesarean births (average RR 0.56, 95% CI 0.14 to 2.26; 891 women; 4 trials; I2 = 70%; Tau2 = 0.98), low arterial cord pHin newborn babies (RR 0.47, 95% CI 0.09 to 2.55; 461 infants; 1 trial; low-quality evidence), or Apgar scores less than seven atfive minutes (RR 4.62, 95% CI 0.22 to 95.68; 500 infants; 1 trial; very low-quality evidence). Third degree perinealtears were increased in the inflatable belt group (RR 15.69, 95% CI 2.10 to 117.02; 500 women; 1 trial). Spontaneous vaginal birth within a specified time, neonatal death, andsevere maternal morbidity or death were not reported in any trial. Authors' conclusions There is insuGicient evidence to draw conclusions on the beneficial or harmful eGects of fundal pressure, either manually or by inflatable belt. Fundal pressure by an inflatable belt during the second stage of labour may shorten duration of second stage for nulliparous women, and lower rates of operative birth. However, existing studies are small and their generalizability is uncertain. There is insuGicient evidence regarding safety for the baby. There is no evidence on the use of fundal pressure in specific clinical settings such as inability of the mother to bear down due to exhaustion or unconsciousness. There is currently insuGicient evidence for the routine use of fundal pressure by any method on women in the second stage of labour. Because of current widespread use of the procedure and the potential for use in settings where other methods of assisted birth are not available, further good quality trials are needed. Further evaluation in other groups of women (such as multiparous women) will also be required. Future research should describe in detail how fundal pressure was applied and consider safety of the unborn baby, perineal outcomes, longer-term maternal and infant outcomes and maternal satisfaction.
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