1
|
Hlongwa M, Basera W, Nicol E. Comparing PrEP initiation rates by service delivery models among high risk adolescent boys and young men in KwaZulu-Natal, South Africa: findings from a population-based prospective study. BMC Public Health 2024; 24:1151. [PMID: 38658900 PMCID: PMC11043044 DOI: 10.1186/s12889-024-18660-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 04/18/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy that can reduce the risk of HIV acquisition by more than 90% if taken consistently. Although South Africa has been implementing PrEP since 2016, initially for selected population groups before expanding access to more people, there is a dearth of research focused on PrEP among adolescent boys and young men (ABYM), despite them experiencing high rates of HIV infection. To address this gap, we compared PrEP initiation rates by service delivery points (SDPs) among ABYM in KwaZulu-Natal, South Africa. METHODS We conducted a population-based prospective study in 22 SDPs from July 2021 to July 2022 in KwaZulu-Natal, South Africa. Sexually active ABYM aged 15-35 years who tested HIV negative were recruited at purposively selected PrEP SDPs (i.e., healthcare facilities, secondary schools and Technical Vocational Education and Training (TVET) colleges, and community-based youth zones). We collected baseline quantitative data from each participant using self-administered electronic questionnaires built into REDCap, including demographic information such as age, sex, employment status and level of education, as well as PrEP initiation outcomes. We extracted data from REDCap and exported it to Stata version 17.0 for analysis, and then eliminated discrepancies and removed duplicates. We described baseline characteristics using summary and descriptive statistics (median, interquartile range [IQR] and proportions) and reported PrEP initiation proportions overall and by SDPs. RESULTS The study included 1104 ABYM, with a median age of 24 years (interquartile range (IQR): 21-28)). Almost all participants were black African (n = 1090, 99%), with more than half aged 15-24 years (n = 603, 55%) and 45% (n = 501) aged 25-35 years. The majority (n = 963; 87%) had attained a secondary level of education. Overall PREP initiation rate among adolescent boys and young men was low: among 1078 participants who were eligible for PrEP, 13% (n = 141) were started on PrEP. Among the participants who were initiated on PrEP, over three quarters (78%, n = 58) were initiated from high schools, compared with community-based youth zones (40%, n = 37), TVET colleges (26%, n = 16) and healthcare facilities (4%, n = 30). CONCLUSIONS This study provided evidence suggesting that expanding PrEP services to non-traditional settings, such as high schools, TVET colleges, and community-based organizations, may have a potential to increase PrEP access among ABYM in South Africa.
Collapse
Affiliation(s)
- Mbuzeleni Hlongwa
- Public Health, Societies and Belonging, Human Sciences Research Council, Pretoria, South Africa.
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Wisdom Basera
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
2
|
Kisepa MM, Zharare EG, Zimudzi C, Akweni AL. Morphological diversity and fruit production of wild Salacia kraussii ( Celastraceae) on the Northern Coast of KwaZulu-Natal, South Africa. Heliyon 2024; 10:e25332. [PMID: 38404900 PMCID: PMC10884428 DOI: 10.1016/j.heliyon.2024.e25332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
This study aimed to assess morphological diversity within Salacia kraussii, a fruit and medicinal wild plant species, based on morphological features and compared the fruit production among morphological types (morphotype) that naturally occur on the northern coast of KwaZulu-Natal. Following one species plant survey, a description of the qualitative morphological features revealed that S. kraussii individuals mainly differed in their leaf shapes, having elliptic, oblong, or obovate leaves. That led us to the identification of three morphotypes, namely Salacia kraussii 'elliptic', Salacia kraussii 'oblong' and Salacia kraussii 'obovate'. The analysis of variance (one-way ANOVA) of plant quantitative features indicated that plant height, stem diameter, branch number, leaf number and area, and fruit number were significantly different between plants from different sites (p-values < 0.05) and morphotypes (p-values < 0.01). Generally, S. kraussii grows in KwaZulu-Natal as a suffrutex with many stems and exhibits short plant height, small stem diameter, branches, and little foliage per stem. The average fruit number recorded per plant stem was likewise few. Plants growing in Sikhalasenkosi (site1) dominated in average plant height (35.58 cm), leaf number (45), number of branches (4), and number of fruits (5). Plants with elliptic leaves constantly dominated in average plant height (34.45 cm), foliage (36 leaves of 16.29 cm2 each), number of branches (4), and number of fruits (5). A few plants exhibited a strong vegetative vigor and produced more than 20 fruits. There was a highly positive correlation (CC = 0.8) between plant height and leaf number, branch number and leaf number, and branch number and fruit number. However, a negative correlation (CC = -0.1) was recorded between the leaf area and stem diameter. Overall, the study showed wide morphological diversity and fruit production within and between populations of S. kraussii, on the northern coast of KwaZulu-Natal.
Collapse
Affiliation(s)
- Merveille Mukaya Kisepa
- Department of Agriculture, Faculty of Sciences, Agriculture and Engineering, University of Zululand, South Africa
- Faculté des Sciences Agronomiques, Université de Kikwit, Democratic Republic of the Congo
| | - Elijah Godfrey Zharare
- Department of Agriculture, Faculty of Sciences, Agriculture and Engineering, University of Zululand, South Africa
| | | | - Arindo Lukawu Akweni
- Department of Agriculture, Faculty of Sciences, Agriculture and Engineering, University of Zululand, South Africa
- Faculté des Sciences Agronomiques, Université de Kikwit, Democratic Republic of the Congo
| |
Collapse
|
3
|
Mabona M, Zwane T, Raman J, Kuonza L, Mhlongo B, Phafane P. Evaluation of the malaria case surveillance system in KwaZulu-Natal Province, South Africa, 2022: a focus on DHIS2. Malar J 2024; 23:47. [PMID: 38350921 PMCID: PMC10865712 DOI: 10.1186/s12936-024-04873-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/08/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND South Africa set a target to eliminate malaria by 2023, with KwaZulu-Natal (KZN) Province the malaria-endemic province closest to achieving this goal. Objective two of the National Malaria Elimination Strategic Plan (NMESP) focused on strengthening surveillance systems to support the country's elimination efforts. Regular evaluations of the malaria surveillance systems against the targets of the NMESP objective are crucial in improving their performance and impact. This study aimed to assess whether the malaria surveillance system in KwaZulu-Natal Province meets the NMESP surveillance objective and goals. METHODS A mixed-methods cross-sectional study design was used to evaluate the malaria surveillance system, focusing on the District Health Information System 2 (DHIS2). The study assessed the data quality, timeliness, simplicity, and acceptability of the system. Key personnel from KZN's Provincial malaria control programme were interviewed using self-administered questionnaires to evaluate their perception of the system's simplicity and acceptability. Malaria case data from January 2016 to December 2020 were extracted from the DHIS2 and evaluated for data quality and timeliness. RESULTS The survey respondents generally found the DHIS2-based surveillance system acceptable (79%, 11/14) and easy to use (71%, 10/14), stating that they could readily find, extract, and share data (64%, 9/14). Overall data quality was good (88.9%), although some variables needed for case classification had low completeness and data availability. However, case notifications were not timely, with only 61% (2 622/4 329) of cases notified within 24 h of diagnosis. During the 5-year study period, the DHIS2 captured 4 333 malaria cases. The majority of cases (81%, 3 489/4 330) were categorized as imported, and predominately in males (67%, 2 914/4 333). CONCLUSION While the malaria surveillance system in KZN Province largely met the NMESP surveillance strategic goals, it failed to achieve the overarching surveillance objective of 100% notification of cases within 24 h of diagnosis. The majority of reported cases in KZN Province were classified as imported, emphasizing the importance of complete data for accurate case classification. Engaging with healthcare professionals responsible for case notification and disseminating aggregated data back to them is needed to encourage and improve notification timeliness.
Collapse
Affiliation(s)
- Maxwell Mabona
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa.
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa.
| | - Thembekile Zwane
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Jaishree Raman
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
- Wits Research Institute for Malaria Control, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- UP Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Lazarus Kuonza
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Babongile Mhlongo
- KwaZulu-Natal Provincial Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Poncho Phafane
- KwaZulu-Natal Provincial Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa
- Division of Public Health Surveillance, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| |
Collapse
|
4
|
Moyo RC, Sigwadhi LN, Carries S, Mkhwanazi Z, Bhana A, Bruno D, Davids EL, Van Hout MC, Govindasamy D. Health-related quality of life among people living with HIV in the era of universal test and treat: results from a cross-sectional study in KwaZulu-Natal, South Africa. HIV Res Clin Pract 2023; 25:2298094. [PMID: 38217525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
BACKGROUND The World Health Organisation's (WHO) key population-based strategy for ending the human immunodeficiency virus (HIV) epidemic is universal HIV test and treat (UTT) along with pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP). Despite the successful scale-up of the UTT strategy in sub-Saharan Africa (SSA), the quality of life (QoL) of people living with HIV (PLHIV) remains sub-optimal. Poor QoL in PLHIV may threaten the UNAIDS 95-95-95 programme targets. Monitoring QoL of PLHIV has become a key focus of HIV research among other outcomes so as to understand health-related QoL (HRQoL) profiles and identify interventions to improve programme performance. This study aimed to describe HRQoL profiles and identify their predictors in PLHIV in KwaZulu Natal, South Africa. METHODS We conducted a secondary data analysis of a cross-sectional survey conducted between May and June 2022 among PLHIV (n = 105) accessing HIV services at an outpatient clinic in KwaZulu-Natal, South Africa. Socio-demographic, HRQoL (EQ-5D-5L index scores), clinical data, depressive symptoms (CES-D-10), and viral load data were collected from all participants. We examined predictors of HRQoL using generalised linear models controlling for age and sex. RESULTS The mean age of the participants was 45 years (SD = 13). The proportion of participants with disabilities and comorbidities were 3% and 18%, respectively. Depressive symptoms were present in 49% of the participants. Participant's mean EQ-5D-5L index score was 0.87 (SD = 0.21) and ranged from 0.11 to 1.0. The mean general health state (EQ-VAS) was 74.7 (SD = 18.8) and ranged from 6 to 100. Factors that reduced HRQoL were disability (β = -0.607, p ≤ 0.001), comorbidities (β = - 0.23, p ≤ 0.05), presence of depressive symptoms (β = -0.10, p ≤ 0.05), and old age (β = -0.04, p ≤ 0.05). Factors that increased HRQoL were a good perceived health state (β = 0.147, p ≤ 0.001) and availability of social support (β = 0.098, p ≤ 0.05). CONCLUSION A combination of old age (60 years and above), any disability and comorbidities had a considerable effect on HRQoL among PLHIV. Our findings support the recommendation for an additional fourth UNAIDS target that should focus on ensuring that 95% of PLHIV have the highest possible HRQoL. Psycho-social support interventions are recommended to improve the HRQoL of PLHIV.
Collapse
Affiliation(s)
- Reuben Christopher Moyo
- Faculty of Medicine and Family Health, Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town, South Africa
| | - Lovemore N Sigwadhi
- Faculty of Medicine and Family Health, Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town, South Africa
| | - Stanley Carries
- Health Systems Research Unit, South African Medical Research Council, Durban, South Africa
| | - Zibuyisile Mkhwanazi
- Health Systems Research Unit, South African Medical Research Council, Durban, South Africa
| | - Arvin Bhana
- Health Systems Research Unit, South African Medical Research Council, Durban, South Africa
| | - Davide Bruno
- Health Systems Research Unit, South African Medical Research Council, Durban, South Africa
| | - Eugene L Davids
- Optentia Research Unit, Faculty of Humanities, North-West University, Vanderbijlpark, South Africa
| | | | - Darshini Govindasamy
- Health Systems Research Unit, South African Medical Research Council, Durban, South Africa
| |
Collapse
|
5
|
Francois KLA, Msomi N, Govender K, Gounder L, Moodley P, Parboosing R, Chetty I, Xaba L, Khan A. Seroprevalence of SARS-CoV-2 immunoglobulin G in HIV-positive and HIV-negative individuals in KwaZulu-Natal, South Africa. Afr J Lab Med 2023; 12:2065. [PMID: 37434993 PMCID: PMC10331028 DOI: 10.4102/ajlm.v12i1.2065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/29/2023] [Indexed: 07/13/2023] Open
Abstract
Background KwaZulu-Natal ranked second highest among South African provinces for the number of laboratory-confirmed cases during the second wave of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The seroprevalence of SARS-CoV-2 among certain vulnerable groups, such as people living with HIV in KwaZulu-Natal, is unknown. Objective The study aimed to determine the prevalence of SARS-CoV-2 immunoglobulin G (IgG) in HIV-positive versus HIV-negative patients. Methods This was a retrospective analysis of residual clinical blood specimens unrelated to coronavirus disease 2019 (COVID-19) submitted for diagnostic testing at Inkosi Albert Luthuli Central Hospital, Durban, from 10 November 2020 to 09 February 2021. Specimens were tested for SARS-CoV-2 immunoglobulin G on the Abbott Architect analyser. Results A total of 1977/8829 (22.4%) specimens were positive for SARS-CoV-2 antibodies. Seroprevalence varied between health districts from 16.4% to 37.3%, and was 19% in HIV-positive and 35.3% in HIV-negative specimens. Seroprevalence was higher among female patients (23.6% vs 19.8%; p < 0.0001) and increased with increasing age, with a statistically significant difference between the farthest age groups (< 10 years and > 79 years; p < 0.0001). The seroprevalence increased from 17% on 10 November 2020 to 43% on 09 February 2021 during the second wave. Conclusion Our results highlight that during the second COVID-19 wave in KwaZulu-Natal a large proportion of people living with HIV were still immunologically susceptible. The reduced seropositivity in people with virological failure further emphasises the importance of targeted vaccination and vaccine response monitoring in these individuals. What the study adds This study contributes to data on SARS-CoV-2 seroprevalence before and during the second wave in KwaZulu-Natal, South Africa, which has the highest HIV prevalence globally. Reduced seropositivity was found among people living with HIV with virological failure, highlighting the importance of targeted booster vaccination and vaccine response monitoring.
Collapse
Affiliation(s)
- Kerri-Lee A Francois
- Discipline of Virology, Faculty of Health Sciences, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Nokukhanya Msomi
- Discipline of Virology, Faculty of Health Sciences, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Kerusha Govender
- Discipline of Virology, Faculty of Health Sciences, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Lilishia Gounder
- Discipline of Virology, Faculty of Health Sciences, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Pravi Moodley
- Discipline of Virology, Faculty of Health Sciences, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Raveen Parboosing
- Discipline of Virology, Faculty of Health Sciences, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
- Department of Medical Virology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Indrani Chetty
- Discipline of Virology and National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Lunga Xaba
- Discipline of Virology and National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Aabida Khan
- Discipline of Virology, Faculty of Health Sciences, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| |
Collapse
|
6
|
Mlaba PC, Ginindza TG, Hlongwana KW. The Prevalence of Compassion Fatigue among Oncology Healthcare Professionals in Three Public Healthcare Facilities in Kwazulu-Natal, South Africa. Int J Environ Res Public Health 2023; 20:5412. [PMID: 37048026 PMCID: PMC10093869 DOI: 10.3390/ijerph20075412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/15/2023] [Accepted: 04/04/2023] [Indexed: 06/19/2023]
Abstract
Compassion fatigue (CF) is a serious global challenge among healthcare professionals dealing with diseases with poor health outcomes in clinical settings. Chronic exposure to the suffering of others is inevitable in the oncology setting and remains one of the main contributors to CF. Therefore, this study determined the prevalence of CF among oncology healthcare professionals (OHPs) in three public healthcare facilities in KwaZulu-Natal, South Africa. This cross-sectional descriptive study was conducted among 73 OHPs using the Professional Quality of Life Scale version 5 questionnaire, and the data were analysed using the Statistical Package for Social Sciences. More than half (56.2%) of the participants reported average scores for CF, with 43.8% of them scoring low. The participants from Inkosi Albert Luthuli Central Hospital had the highest CF mean score (26.8) compared to those from Addington Hospital (21.2) and Greys Hospital (22.9). Female OHPs had a higher mean score (24.3) for CF, compared to their male counterparts (20.6). The CF scores were positively correlated with older age and longer work experience of the OHPs. The prevalence of CF among OHPs was average, compared to those reported by other local and international studies. Nevertheless, these results cannot be taken lightly, given the straining effects of unmanaged CF on the healthcare system generally and on patient care in particular. The results of this study can potentially contribute to policy development and the planning of intervention strategies towards the effective management of CF among OHPs.
Collapse
Affiliation(s)
- Phindile C. Mlaba
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Khumbulani W. Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
| |
Collapse
|
7
|
Lubuzo B, Hlongwana K, Ginindza T. Model for Achieving a Coordinated Access to Lung Cancer Care in Selected Public Health Facilities in KwaZulu-Natal, South Africa: Protocol for a Qualitative Study. JMIR Res Protoc 2023; 12:e34341. [PMID: 36867453 PMCID: PMC10024215 DOI: 10.2196/34341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Timely delivery of high-quality cancer care to all patients is barely achieved in South Africa and many other low- and middle-income countries, mainly due to poor care coordination and access to care services. After health care visits, many patients leave facilities confused about their diagnosis, prognosis, options for treatment, and the next steps in their care continuum. They often find the health care system disempowering and inaccessible, thereby making access to health care services inequitable, with the resultant outcome of increased cancer mortality rates. OBJECTIVE The aim of this study is to propose a model for cancer care coordination interventions that can be used to guide and achieve coordinated access to lung cancer care in the selected public health care facilities in KwaZulu-Natal. METHODS This study will be conducted through a grounded theory design and an activity-based costing approach that will include health care providers, patients, and their caregivers. The study participants will be purposively selected, and a nonprobability sample will be selected based on characteristics, experiences of the health care providers, and the objectives of the study. With the study's objectives in mind, communities in Durban and Pietermaritzburg were selected as study sites, for the study along with the 3 public health facilities that provide cancer diagnosis, treatment, and care in the province. The study involves a range of data collection techniques, namely, in-depth interviews, evidence synthesis reviews, and focus group discussions. A thematic and cost-benefit analysis will be used. RESULTS This study receives support from the Multinational Lung Cancer Control Program. The study obtained ethics approval and gatekeeper permission from the University's Ethics Committee and the KwaZulu-Natal Provincial Department of Health, as it is being conducted in health facilities in KwaZulu-Natal province. As of January 2023, we had enrolled 50 participants, both health care providers and patients. Dissemination activities will involve community and stakeholder dissemination meetings, publications in peer-reviewed journals, and presentations at regional and international conferences. CONCLUSIONS This study will provide comprehensive data to inform and empower patients, professionals, policy architects, and related decision makers to manage and improve cancer care coordination. This unique intervention or model will address the multifactorial problem of cancer health disparities. If successful, this study will affect the design and implementation of coordination programs to promote optimal cancer care for underserved patients. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34341.
Collapse
Affiliation(s)
- Buhle Lubuzo
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Khumbulani Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Themba Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
8
|
Munsense IM, Tsoka-Gwegweni JM. Perceived Health System Challenges of Implementing Cross-Border Malaria Preventive Measures at Ports of Entry in KwaZulu-Natal. Ann Glob Health 2023; 89:29. [PMID: 37124936 PMCID: PMC10144057 DOI: 10.5334/aogh.3992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/16/2023] [Indexed: 05/02/2023] Open
Abstract
Background Cross-border movements, especially from a malaria-endemic neighbour, contribute to importation of malaria, as they provide favourable conditions for malaria transmission in the receiving country. In the KwaZulu-Natal (KZN) province of South Africa (SA), the uMkhanyakude district is one of the endemic malaria areas where the borders are characterised by frequent cross-border movements of travellers coming into the province, mostly from Mozambique. Many studies have suggested that regional efforts through the implementation of cross-border measures are needed in both the high- and low-endemic countries to effectively address imported malaria. The implementation of cross-border measures to prevent imported malaria has led to a significant decline in malaria cases in KZN and SA; however, those measures are subjected to various challenges. Objective This study sought to determine the health system challenges of implementing cross-border preventive measures for imported malaria at the Kosi Bay, Kwaphuza and Golela ports of entry in KZN. Methods This inquiry consisted of a mixed methods approach, of which the qualitative component is reported here. In-depth interviews were conducted with four purposively selected health officers working at the legal and illegal ports of entry of the KZN province. Data were coded manually and then analysed using thematic data and descriptive analyses. Results This study identified operational and prevention challenges. The related operational challenges included travellers' non-disclosure and refusal, uncontrolled cross-border movements and poor coverage as well as shortage of staff. The prevention challenges included lack of novelty in the existing cross-border preventive measures, insecurity and illegal migration. Concerning travellers' non-disclosure and refusal to cooperate, these issues occur at the legal ports of entry of Kosi Bay and Golela, where travellers were less cooperative in disclosing their health-related information to health border officers. They were more eager to cross and attend to their business. The findings revealed a lack of new ideas in the existing cross-border measures for the prevention of imported malaria, which some scientists considered as the reason for the failure of the elimination efforts in SA. Because of the porous borders and the shortage of staff to cover all the uncontrolled entries, travellers constantly crossed without any hindrances. Porous borders exposed the people living at the border areas and travellers to insecurity, promoted criminal activities and encouraged illegal migration. Conclusion Cross-border malaria preventive measures are meant to contribute to decreased travel-related disease. Failure to attain this purpose must be carefully examined and mitigation strategies implemented. The study revealed the challenges of implementing cross-border measures at the KZN ports of entry of Kosi Bay, Kwaphuza and Golela. The challenges occurred at the operational and prevention levels, which, if not effectively addressed, could impede the decrease of imported malaria in the malaria-endemic district of KZN and SA in general.
Collapse
Affiliation(s)
- Ida M. Munsense
- Department of Public Health Medicine, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | | |
Collapse
|
9
|
Thibane Z, Soni S, Phali L, Mdoda L. Factors impacting sugarcane production by small-scale farmers in KwaZulu-Natal Province-South Africa. Heliyon 2023; 9:e13061. [PMID: 36711268 PMCID: PMC9879781 DOI: 10.1016/j.heliyon.2023.e13061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Sugarcane is an important crop on a global scale, due to its numerous dietary and commercial applications. Smallholder sugarcane production is an important sector in developing countries, especially South Africa as it enhances livelihoods and job creation. Hence, this study is carried out to understand the challenges and factors which are contributing to the decline of smallholder sugarcane production. Therefore, the paper aims to investigate challenges and factors affecting sugarcane production by smallholder farmers in the KwaZulu-Natal Province of South Africa. The study employed a quantitative research design and data was collected through the use of secondary data. Descriptive statistics and a production function analysis were used for analysis. Results show that labour costs, drought stress, lack of finance, and high transaction costs are the major limiting constraints in sugarcane production. Empirical results reveal that variable input costs affect the sugarcane production of smallholder farmers. The study recommends the use of fertilizer and mechanical maintenance by smallholder farmers to enhance sugarcane productivity.
Collapse
Affiliation(s)
- Zimi Thibane
- Discipline of Agricultural Economics, School of Agriculture, Earth and Environmental Sciences, University of KwaZulu-Natal, P/Bag X01, Scottsville, Pietermaritzburg, 3209, South Africa
| | - Siphelele Soni
- Discipline of Agricultural Economics, School of Agriculture, Earth and Environmental Sciences, University of KwaZulu-Natal, P/Bag X01, Scottsville, Pietermaritzburg, 3209, South Africa
| | - Lerato Phali
- Discipline of Agricultural Economics, School of Agriculture, Earth and Environmental Sciences, University of KwaZulu-Natal, P/Bag X01, Scottsville, Pietermaritzburg, 3209, South Africa
| | - Lelethu Mdoda
- Discipline of Agricultural Economics, School of Agriculture, Earth and Environmental Sciences, University of KwaZulu-Natal, P/Bag X01, Scottsville, Pietermaritzburg, 3209, South Africa
| |
Collapse
|
10
|
Nwoko OE, Manyangadze T, Chimbari MJ. Spatial distribution, abundance, and infection rates of human schistosome-transmitting snails and related physicochemical parameters in KwaZulu-Natal (KZN) province, South Africa. Heliyon 2022; 9:e12463. [PMID: 36793949 PMCID: PMC9922783 DOI: 10.1016/j.heliyon.2022.e12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/08/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
This study investigated the spatial distribution, abundance, and infection rates of human schistosome-transmitting snails and related physicochemical parameters and environmental factors in 11 districts in KwaZulu-Natal (KZN) province, South Africa, from December 2020-February 2021. Snail sampling was carried out in 128 sites by two people for 15 min using scooping and handpicking methods. Geographical information system (GIS) was used to map surveyed sites. In situ measurements of physicochemical parameters were recorded, while remote sensing was used to obtain measurements for climatic factors required to achieve the study's objective. Cercarial shedding and snail-crushing methods were used to detect snail infections. Kruskal-Wallis test was used to test the differences in snail abundance among snail species, districts, and habitat types. A negative binomial generalized linear mixed model was used to identify the physicochemical parameters and environmental factors influencing the abundance of snail species. A total of 734 human schistosome-transmitting snails were collected. Bu. globosus were significantly more abundant (n = 488) and widely distributed (found in 27 sites) compared to B. pfeifferi (n = 246) found in 8 sites. Bu. globosus and B. pfeifferi had infection rates of 3.89% and 2.44%, respectively. Dissolved oxygen and normalized difference vegetation index showed a statistically positive relationship, while normalized difference wetness index showed a statistically negative relationship with the abundance of Bu. globosus. However, there was no statistically significant relationship between B. pfeifferi abundance, physicochemical parameters, and climatic factors. Our study described the current distribution, abundance, and infection status of human schistosome-transmitting snails in KZN province, which will contribute to informing control measure policies for schistosomiasis.
Collapse
Affiliation(s)
- Onyekachi Esther Nwoko
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa,Corresponding author.
| | - Tawanda Manyangadze
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa,Geography Department, Faculty of Science and Engineering, Bindura University of Science Education, Bag 1020, Bindura, Zimbabwe
| | - Moses John Chimbari
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa,Department of Behavioural Science, Medical and Health Sciences, Great Zimbabwe University, P.O Box 1235, Masvingo, Zimbabwe
| |
Collapse
|
11
|
Omonijo AO, Mukaratirwa S. Knowledge and practices on consumption of free-range chickens in selected rural communities of KwaZulu-Natal, South Africa, with focus on zoonotic transmission of Toxoplasma gondii and Toxocara spp. Trop Anim Health Prod 2022; 55:9. [PMID: 36527523 DOI: 10.1007/s11250-022-03393-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022]
Abstract
Chickens are a host to a variety of pathogens of zoonotic importance and this depends more on the husbandry system practiced. Toxoplasma gondii and Toxocara spp which are more prevalent in free-range chickens (FRC) can be acquired by humans via the ingestion of raw or undercooked meat (muscle) and/or viscera contaminated with infective stages of T. gondii and Toxocara spp. This study aimed to assess knowledge and practices on the household consumption of FRC meat and viscera by rural communities in KwaZulu-Natal (KZN) province, South Africa, as a risk factor in the transmission of zoonotic pathogens with special emphasis on T. gondii and Toxocara spp. A cross-sectional study was conducted on twenty (20) randomly selected households in four selected communities located on the northern coast (Gingindlovu and Ozwathini) and southern coast (uMzinto and Shongweni) of KZN province using a semi-structured questionnaire. To determine the presence of selected zoonotic pathogens in FRC, birds were purchased from randomly selected households in the study localities for sacrifice. Brain tissues were collected and subjected to molecular detection of T. gondii using TOX4 and TOX5 primers while other tissues and organs that were collected were subjected to molecular detection of Toxocara spp using Nem 18S primers. Questionnaire data were analyzed using the statistical package for social sciences (SPSS) version 25.0. Descriptive and chi-square statistics were used to assess knowledge and practices related to FRC consumption and zoonosis transmission. Molecular results showed four positive samples for T. canis from Gingindlovu (n = 1), uMzinto (n = 1), and Shongweni (n = 2). The role of FRC consumption in zoonosis transmission is discussed.
Collapse
Affiliation(s)
- Adejumoke Oluwatosin Omonijo
- Department of Animal and Environmental Biology, Faculty of Science, Federal University Oye - Ekiti, Oye - Ekiti, Ekiti State, Nigeria. .,School of Life Sciences, College of Agriculture, Engineering and Science, Westville Campus, University of KwaZulu-Natal, Durban, South Africa.
| | - Samson Mukaratirwa
- School of Life Sciences, College of Agriculture, Engineering and Science, Westville Campus, University of KwaZulu-Natal, Durban, South Africa.,One Health Center for Zoonoses and Tropical and Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, KN0101, Saint Kitts and Nevis
| |
Collapse
|
12
|
Hlongwa M, Jama NA, Mehlomakulu V, Pass D, Basera W, Nicol E. Barriers and Facilitating Factors to HIV Treatment Among Men in a High-HIV-Burdened District in KwaZulu-Natal, South Africa: A Qualitative Study. Am J Mens Health 2022; 16:15579883221120987. [PMID: 36066024 PMCID: PMC9459474 DOI: 10.1177/15579883221120987] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Despite enormous increases in the proportion of people living with HIV accessing treatment in sub-Saharan Africa, major gender disparities persist, with men experiencing lower rates of testing, linkage to treatment, and retention in care. In this study, we investigated the barriers and facilitating factors to HIV treatment among men in uThukela, a high-HIV-burdened district in KwaZulu-Natal province, South Africa. We conducted a qualitative study including nine Black African male participants who were recruited from 18 health care facilities in uThukela District, KwaZulu-Natal province. In-depth interviews were conducted with participants who linked to care and those who did not link to care at 3-month post HIV diagnosis. We used Atlas.ti for thematic analysis. Data were coded and linked to broader themes emerging across interviews. The median age was 40 years (interquartile range [IQR]: 31-41). This study identified the following key themes which emerged as barriers to HIV treatment among men in uThukela District: lack of emotional readiness, perceived medication side effects, fear of treatment non-adherence, perceived stigma and confidentiality concerns, and poor socioeconomic factors. We identified the following enabling factors to HIV treatment among men: fear of HIV progressing, acceptance of status, disclosure, support from family and friends, positive testing experience, and accessibility of antiretroviral treatment. This study revealed barriers and enabling factors to HIV treatment among men. These factors are important to inform the design of targeted intervention strategies aimed at improving linkage and retention to HIV treatment among men.
Collapse
Affiliation(s)
- Mbuzeleni Hlongwa
- Burden of Disease Research Unit, South
African Medical Research Council, Cape Town, South Africa,School of Nursing and Public Health
Medicine, University of KwaZulu-Natal, Durban, South Africa,Mbuzeleni Hlongwa, Burden of Disease
Research Unit, South African Medical Research Council, P.O. Box 19070,
Tygerberg, Cape Town 7505, South Africa.
| | - Ngcwalisa Amanda Jama
- Burden of Disease Research Unit, South
African Medical Research Council, Cape Town, South Africa,School of Public Health, University of
the Western Cape, Bellville, South Africa
| | - Vuyelwa Mehlomakulu
- Burden of Disease Research Unit, South
African Medical Research Council, Cape Town, South Africa
| | - Desiree Pass
- Burden of Disease Research Unit, South
African Medical Research Council, Cape Town, South Africa
| | - Wisdom Basera
- Burden of Disease Research Unit, South
African Medical Research Council, Cape Town, South Africa,School of Public Health and Family
Medicine, University of Cape Town, Cape Town, South Africa
| | - Edward Nicol
- Burden of Disease Research Unit, South
African Medical Research Council, Cape Town, South Africa,Division of Health Systems and Public
Health, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
13
|
Omoyeni O, Tsoka-Gwegweni J. Knowledge, attitudes and practices of cervical cancer screening among rural women in KwaZulu-Natal, South Africa. Pan Afr Med J 2022; 42:188. [PMID: 36212930 PMCID: PMC9508371 DOI: 10.11604/pamj.2022.42.188.26172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/01/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION cervical cancer continues to be a major cause of morbidity and mortality among women in the developing world. Despite the national cervical cancer screening programme, findings show low levels of knowledge and practices of cervical cancer screening among rural women in South Africa (SA). The purpose of this study was to determine the knowledge, attitudes and practices of cervical cancer screening among rural women in KwaZulu-Natal, SA. METHODS an observational cross-sectional study was performed. The study was conducted at three rural clinics. A systematic sampling technique was used to select 283 women, aged 18-65 years. Data were collected using a standardised structured self-administered questionnaire. Data were analysed using descriptive and analytic statistics. RESULTS findings showed a high level of awareness of cervical cancer (93.3%, n=264) and the Pap smear test (95.1%, n=269). Knowledge of cervical cancer-associated factors, symptoms, screening methods and treatment was poor (28.0%, n=79). An overwhelming majority (81.8%, n=231) displayed a positive attitude towards cervical cancer screening. The practice of cervical cancer screening was fairly good (66.8%, n=189). The results showed that socio-demographics were not statistically significantly associated with knowledge of cervical cancer and cervical cancer screening. CONCLUSION despite the inadequate knowledge of women, attitudes towards cervical cancer and screening were generally positive. Health care practitioners are encouraged to focus not only on creating awareness but also on improving knowledge so as women will not only undergo screening but appreciate the importance of cervical cancer screening.
Collapse
Affiliation(s)
- Oluwatosin Omoyeni
- Department of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Joyce Tsoka-Gwegweni
- Department of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa,,Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa,Corresponding author: Joyce Tsoka-Gwegweni, Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
| |
Collapse
|
14
|
Mbeje NP, Ginindza T, Jafta N. Epidemiological Study of Risk Factors for Lung Cancer in KwaZulu-Natal, South Africa. Int J Environ Res Public Health 2022; 19:6752. [PMID: 35682333 PMCID: PMC9180813 DOI: 10.3390/ijerph19116752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 12/24/2022]
Abstract
The high incidence cancer rates are due to factors such as behavior, occupational exposures, genetics, environmental pollution and infections. The aim of this study was to identify risk factors associated with lung cancer among patients seen in the public health facilities in KwaZulu-Natal, South Africa. In this case-control study, 75 cases and 159 controls were interviewed using a structured close-ended questionnaire. Logistic regression showed a positive association between lung cancer and tobacco smoking (OR = 2.86, 95% CI: 1.21-6.77) and exposure to passive smoke (OR = 3.28, 95% CI: 1.48-7.30). When adjusted for other covariates, tobacco smoking and passive smoke were still positively associated with increased risk of lung cancer. Alcohol consumption (aORs ranging from 2.79 to 3.35) and history of lung disease (aORs ranging from 9.91 to 12.1) were statistically significantly associated with lung cancer. Our study suggests that tobacco smoke exposure is the major cause of lung cancer, and increased exposure to occupational and environmental carcinogenic substances, alcohol consumption and history of lung disease increase the risk of lung cancer. Based on our findings, policy development and planning of prevention strategies incorporating smoking legislations, occupational health and safety are essential in South Africa.
Collapse
Affiliation(s)
- Noluthando P. Mbeje
- Cancer and Infectious Diseases Epidemiology Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa; (T.G.); (N.J.)
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Themba Ginindza
- Cancer and Infectious Diseases Epidemiology Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa; (T.G.); (N.J.)
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Nkosana Jafta
- Cancer and Infectious Diseases Epidemiology Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa; (T.G.); (N.J.)
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu–Natal, Durban 4041, South Africa
| |
Collapse
|
15
|
Bhagwan R, Ashokcoomar P. An exploratory study of the experiences and challenges faced by advanced life support paramedics in the milieu of neonatal transfers. Health SA 2021; 26:1562. [PMID: 34858641 PMCID: PMC8603084 DOI: 10.4102/hsag.v26i0.1562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 08/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background The safe transfer of critically ill neonates is important for their survival. This calls for greater preparedness on the part of paramedics to effect these transfers safely. Aim To understand the experiences and the challenges faced by advanced life support (ALS) paramedics during neonatal transfers. Setting The study setting consisted of advanced life support paramedics from urban and rural areas in KwaZulu-Natal. It comprised of a network of district hospitals as well air and ground transfer facilities, both public and private. Method Using a qualitative research approach, the study sought the views of ALS paramedics who were involved in neonatal transfers in KwaZulu-Natal. A purposive sample of n = 8 ALS paramedics was selected. Data were collected using in-depth semi-structured interviews. The data were analysed through the process of thematic analysis. Results The study found that paramedics faced multiple complex challenges related to neonatal transfers. Poor pre-transfer preparation of the neonate, equipment related challenges, lack of clinical support available during transfers and pressure to effect inappropriate transfers were some of the challenges they faced. These challenges coupled with insufficient education and the lack of sub-speciality programmes to capacitate, rendered them unprepared to deal with neonatal transfers effectively. Conclusion Emergency medicine needs to provide greater attention towards preparing all stakeholders for successful neonatal transfers. Contribution The findings provide recommendations for a programme that will limit risks involved with, and support the inter-healthcare facility transfer of critically ill neonates in South Africa.
Collapse
Affiliation(s)
- Raisuyah Bhagwan
- Department of Community Health Studies, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Pradeep Ashokcoomar
- Department of Emergency Medical Care, KwaZulu-Natal Department of Health's Emergency Medical Services College, Durban, South Africa
| |
Collapse
|
16
|
Kyegombe N, Stoebenau K, Chimbindi N, Zuma T, Shahmanesh M, Seeley J, Wamoyi J. Measuring transactional sex in different contexts: How do tools to measure this practice perform in rural South Africa? African Journal of AIDS Research 2021; 20:329-335. [PMID: 34905457 DOI: 10.2989/16085906.2021.2012213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Adolescent girls and young women across sub-Saharan Africa are at disproportionate risk of HIV infection compared to their male counterparts. Transactional sex has been identified as an important proximate risk for infection in this population. Definitions and measures of transactional sex vary, necessitating improved measures to better estimate prevalence across settings, over time, and to understand the mechanisms through which transactional sex increases HIV risk. This article describes the results of cognitive interviews in rural KwaZulu-Natal in South Africa to evaluate the performance of an improved measure of transactional sex.Methods: Data were collected between May and June 2017 with sexually active adolescent girls and young women (n = 10) and men (n = 10) drawn from a general population sample. Two questions were tested. Audio-recorded interviews were conducted in isiZulu using a structured tool. Matrices were used to summarise the data across participants which were then compared using constant comparative techniques.Results: Participants captured the instrumental nature of transactional sex relationships clearly and understood that the questions were about relationships that were primarily motivated by benefit. However, despite prior qualitative research in this setting describing transactional sex as widely practised, only one male participant answered either question in the affirmative in this face-to-face interview. This implies a judgement placed on relationships that are deemed as having been motivated mainly by exchange, perhaps compelling people to under-report such relationships.Conclusion: Participants' unwillingness to answer in the affirmative highlights the importance of understanding the research context and the possible social and historical influences which may influence how survey questions are answered. This has implications for measurement development, and highlights the need for measures that can be responsive to contextual differences. Further research is needed for refinements to measurement approaches in this and other settings.
Collapse
Affiliation(s)
- Nambusi Kyegombe
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kirsten Stoebenau
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, USA
| | - Natsayi Chimbindi
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
| | - Thembelihle Zuma
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
| | - Maryam Shahmanesh
- Institute for Global Health, University College London, United Kingdom
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joyce Wamoyi
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| |
Collapse
|
17
|
Ntombela NP, Kharsany ABM, Soogun A, Yende-Zuma N, Kohler HP, McKinnon LR. Prevalence and Risk Factors for HIV Infection Among Heterosexual Men Recruited from Socializing Venues in Rural KwaZulu-Natal, South Africa. AIDS Behav 2021; 25:3528-37. [PMID: 33575900 DOI: 10.1007/s10461-021-03182-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 02/07/2023]
Abstract
Young heterosexual men have low uptake of HIV prevention and treatment services and represent an important key population that may require novel strategies. We recruited 1271 heterosexual men, 12 years and older from socializing venues such as "shebeens", transport hubs, "spaza" shops, and community centers in rural KwaZulu-Natal, South Africa. Participants completed a questionnaire and were tested for HIV serostatus. Generalized estimating equations (GEE) with exchangeable covariance structure estimated factors independently associated with prevalent HIV infection. Median age was 25 years [Interquartile range (IQR) 21-29]. HIV prevalence was 15.5% [95% confidence interval (CI) 11.0-21.9] and increased significantly by age. Factors associated with higher odds of HIV infection were being 25 years and older [adjusted odds ratio (aOR) 4.82, 95% CI 3.47-6.69; p < 0.001), not completing high school (aOR 1.60, 95% CI 1.39-1.85; p < 0.001), not using condoms at first sex (aOR 1.43, 95% CI 1.20-1.70; p < 0.001), consuming alcohol (aOR 1.63, 95% CI 1.15-2.31; p = 0.006) or substances (aOR 1.37, 95% CI 1.31-1.44; p < 0.001), and absence of medical circumcision (aOR 2.05, 95% CI 1.71-2.44; p < 0.001). Risk was lower among those testing for HIV in last 12 months (aOR 0.54, 95% CI 0.36-0.80; p = 0.002). Greater effort is needed to implement innovative programs within settings that are easily accessible and where heterosexual men are likely to be.
Collapse
|
18
|
Mlaba PC, Ginindza TG, Hlongwana KW. The social burden experienced by families caring for members living with cancer in KwaZulu-Natal, South Africa. Afr J Prim Health Care Fam Med 2021; 13:e1-e10. [PMID: 34797113 PMCID: PMC8603144 DOI: 10.4102/phcfm.v13i1.2955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cancer is a global public health problem and it affects people in different ways. Family caregivers (FCs) play an essential role in caring for patients with cancer, and thus, they experience many caregiver burdens that go unnoticed. AIM This research study explored the social burden that families experience in providing care to their family members living with cancer. SETTING This study was conducted in Durban and Pietermaritzburg, cities located in KwaZulu-Natal, South Africa. METHODS This was a qualitative study using the interpretative phenomenological approach that was ideal for understanding FCs subjective perspectives on their cancer caregiving experience. Data saturation were reached at 20 in-depth interviews. RESULTS Two major themes culminated from the data analysis; dynamics of a cancer diagnosis and psychosocial impact of a cancer diagnosis with respective sub-themes. Themes centred around the relational impact of a cancer diagnosis with FCs experiencing a shift in this dynamic and a disturbance to normality in social life. Social support systems were found to play a meaningful role in mitigating the impact of a cancer diagnosis with financial, psychosocial and educational support considered essential needs. CONCLUSION Cancer caregiving is a challenging task that also presents opportunities for strengthening family bonds as they evolve in new paths. A family-centred care approach is recommended as a form of social support with further collaboration with health care providers for guided patient care. If the needs of FCs are addressed accordingly through health care policies and interventions, FCs may be able to provide better care and support for their family members with cancer and thus positively impact cancer survivorship.
Collapse
Affiliation(s)
- Phindile C Mlaba
- Department of Public Health Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban.
| | | | | |
Collapse
|
19
|
Chimukangara B, Lessells RJ, Singh L, Grigalionyte I, Yende-Zuma N, Adams R, Dawood H, Dlamini L, Buthelezi S, Chetty S, Diallo K, Duffus WA, Mogashoa M, Hagen MB, Giandhari J, de Oliveira T, Moodley P, Padayatchi N, Naidoo K. Acquired HIV drug resistance and virologic monitoring in a HIV hyper-endemic setting in KwaZulu-Natal Province, South Africa. AIDS Res Ther 2021; 18:74. [PMID: 34656129 PMCID: PMC8520607 DOI: 10.1186/s12981-021-00393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background Introduction of tenofovir (TDF) plus lamivudine (3TC) and dolutegravir (DTG) in first- and second-line HIV treatment regimens in South Africa warrants characterization of acquired HIV-1 drug resistance (ADR) mutations that could impact DTG-based antiretroviral therapy (ART). In this study, we sought to determine prevalence of ADR mutations and their potential impact on susceptibility to drugs used in combination with DTG among HIV-positive adults (≥ 18 years) accessing routine care at a selected ART facility in KwaZulu-Natal, South Africa. Methods We enrolled adult participants in a cross-sectional study between May and September 2019. Eligible participants had a most recent documented viral load (VL) ≥ 1000 copies/mL after at least 6 months on ART. We genotyped HIV-1 reverse transcriptase and protease genes by Sanger sequencing and assessed ADR. We characterized the effect of ADR mutations on the predicted susceptibility to drugs used in combination with DTG. Results From 143 participants enrolled, we obtained sequence data for 115 (80%), and 92.2% (95% CI 85.7–96.4) had ADR. The proportion with ADR was similar for participants on first-line ART (65/70, 92.9%, 95% CI 84.1–97.6) and those on second-line ART (40/44, 90.9%, 95% CI 78.3–97.5), and was present for the single participant on third-line ART. Approximately 89% (62/70) of those on first-line ART had dual class NRTI and NNRTI resistance and only six (13.6%) of those on second-line ART had major PI mutations. Most participants (82%) with first-line viraemia maintained susceptibility to Zidovudine (AZT), and the majority of them had lost susceptibility to TDF (71%) and 3TC (84%). Approximately two in every five TDF-treated individuals had thymidine analogue mutations (TAMs). Conclusions Susceptibility to AZT among most participants with first-line viraemia suggests that a new second-line regimen of AZT + 3TC + DTG could be effective. However, atypical occurrence of TAMs in TDF-treated individuals suggests a less effective AZT + 3TC + DTG regimen in a subpopulation of patients. As most patients with first-line viraemia had at least low-level resistance to TDF and 3TC, identifying viraemia before switch to TDF + 3TC + DTG is important to avoid DTG functional monotherapy. These findings highlight a need for close monitoring of outcomes on new standardized treatment regimens. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-021-00393-5.
Collapse
|
20
|
Motlana MK, Ginindza TG, Mitku AA, Jafta N. Spatial Distribution of Cancer Cases Seen in Three Major Public Hospitals in KwaZulu-Natal, South Africa. Cancer Inform 2021; 20:11769351211028194. [PMID: 34285460 PMCID: PMC8261849 DOI: 10.1177/11769351211028194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Noncommunicable diseases (NCDs) like cancer are posing a challenge in the
health system especially in low- and middle-income countries (LMICs). In
South Africa, cancer is under-reported due to the lack of a comprehensive
cancer surveillance system. The limited knowledge on the extent of cancer
burden has led to inaccurate allocation of public health resources. The aim
of this study was to describe cancer incidence and spatial distribution of
cancer cases seen at 3 main public oncology facilities in KwaZulu-Natal. Methods: In this retrospective study, cases of cancer observed from year 2015 to 2017
were extracted from medical records. The crude incidence rate was estimated
for the total cancer cases and for different type of cancer reported over
that period. Age-standardised incidence rates (ASR) per 100 000 was
calculated per year using age groups and sex according to the district
population data of KwaZulu-Natal. The comparisons of cancer diagnosed
incidences were made between 11 districts using the ASR. Choropleth spatial
maps and Moran’s Index were used to assess the ASR cancer spatial
distribution along with geographical patterns among the districts. One
sample chi-square test was used to assess the significant increase/decrease
over time. Results: The study lost numerous cases due to incompleteness. A total of 4909 new
cases were diagnosed with cancer during 2015 to 2017, 62% of which were
female. Both uMgungundlovu and eThekwini districts had the highest ASR among
district municipalities of KwaZulu-Natal for both male and female (83.6 per
100 000 per men year for men, 158.2 per 100 000 women per year, and 60.1 per
100 000 men per year and 96.9 per 100 000 women per year, respectively).
Random distribution of reported cancer cases in KwaZulu-Natal was observed
with a high concentration being in and around 2 metropolitan districts.
Spatial variation showed a significant difference from year to year between
the districts with the random spatial distribution. Overall, there was a
significant decline of cancer incidences observed from 2015 to 2017
(P < .05) in the province. Conclusion: The overall cancer incidence in the study shows that female cancers (breast
and cervical) are still on the rise and still need to be given priority as
they were most prevalent in KwaZulu-Natal. Spatial analysis (choropleth
maps) was used to show a pattern of higher concentration of cancer incidence
in the north-western parts of the province.
Collapse
Affiliation(s)
- Mpho Ktn Motlana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Themba G Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Aweke A Mitku
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Department of Statistics, Science College, Bahir Dar University, Bahir Dar, Ethiopia
| | - Nkosana Jafta
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
21
|
Kandala NB, Nnanatu CC, Dukhi N, Sewpaul R, Davids A, Reddy SP. Mapping the Burden of Hypertension in South Africa: A Comparative Analysis of the National 2012 SANHANES and the 2016 Demographic and Health Survey. Int J Environ Res Public Health 2021; 18:5445. [PMID: 34069668 DOI: 10.3390/ijerph18105445] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/18/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022]
Abstract
This study investigates the provincial variation in hypertension prevalence in South Africa in 2012 and 2016, adjusting for individual level demographic, behavioural and socio-economic variables, while allowing for spatial autocorrelation and adjusting simultaneously for the hierarchical data structure and risk factors. Data were analysed from participants aged ≥15 years from the South African National Health and Nutrition Examination Survey (SANHANES) 2012 and the South African Demographic and Health Survey (DHS) 2016. Hypertension was defined as blood pressure ≥ 140/90 mmHg or self-reported health professional diagnosis or on antihypertensive medication. Bayesian geo-additive regression modelling investigated the association of various socio-economic factors on the prevalence of hypertension across South Africa’s nine provinces while controlling for the latent effects of geographical location. Hypertension prevalence was 38.4% in the SANHANES in 2012 and 48.2% in the DHS in 2016. The risk of hypertension was significantly high in KwaZulu-Natal and Mpumalanga in the 2016 DHS, despite being previously nonsignificant in the SANHANES 2012. In both survey years, hypertension was significantly higher among males, the coloured population group, urban participants and those with self-reported high blood cholesterol. The odds of hypertension increased non-linearly with age, body mass index (BMI), waist circumference. The findings can inform decision making regarding the allocation of public resources to the most affected areas of the population.
Collapse
|
22
|
Mutabazi UP, Brysiewicz P. Descriptive survey of women's childbirth experiences in two state hospitals in KwaZulu-Natal. Curationis 2021; 44:e1-e7. [PMID: 33970005 PMCID: PMC8111629 DOI: 10.4102/curationis.v44i1.2164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Giving birth is one of the most important events in a woman’s life and is a highly individualistic and unique experience. Objectives The study aimed to describe women’s childbirth experiences in two state hospitals in KwaZulu-Natal. Method A non-experimental, quantitative, descriptive survey of low-risk mothers was conducted in two state hospitals by using the Childbirth Experience Questionnaire (CEQ). Results With a response rate of 96%, 201 questionnaires were completed and returned. The highest mean score of the four dimensions of the CEQ was for the dimension of Professional Support (3.1). The results of the individual dimension items scoring the highest positive response were: I felt that I handled the situation well (147; 74%) (Own Capacity); I felt very well cared for by my midwife (165; 82%) (Professional Support); 151 respondents (76%) scored the item My impression of the team’s medical skill made me feel secure as the highest positive experience (Perceived Safety); and I felt I could have a say in the choice of pain relief (105; 52%) (Participation). The relationship between demographic variables (age, level of education, parity, antenatal clinic attendance, induction of labour, augmentation and duration of labour) and respondents’ scores of the CEQ dimensions was calculated, and only the dimension of Perceived Safety and duration of labour (≥ 12 hours) were found to be significant (p = 0.026). Conclusion From the women perspectives, the study results described childbirth experience as multi-dimensional experience and subjective. Both positive and negative experiences coexisted in all dimensions of the CEQ, with the dimension of Professional Support scoring the highest positive response. To maintain a positive birth experience, the study suggests that women should be involved and equipped with knowledge on the process of childbirth.
Collapse
|
23
|
Orton PM, Sokhela DG, Nokes KM, Perazzo JD, Webel AR. Factors related to functional exercise capacity amongst people with HIV in Durban, South Africa. Health SA 2021; 26:1532. [PMID: 34007474 PMCID: PMC8111642 DOI: 10.4102/hsag.v26i0.1532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/16/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND People with HIV (PWH), who engage in regular physical activity, have improved fitness, muscular strength, body composition, health-related quality of life and mental health symptoms, but PWH have amongst the lowest physical activity levels of those with any chronic health condition. Furthermore, there is scant evidence examining these relationships in PWH in Africa. AIM To address these critical gaps, this cross-sectional descriptive research study examined the relationships between demographic, HIV-related, anthropometric factors, neighbourhood walkability and physical activity, amongst PWH in Durban, South Africa. SETTING Respondents (N = 100) were receiving primary healthcare in six eThekwini nurse-run municipal clinics. METHODS Self-reported socio-demographic data were collected, and HIV-related medical data were extracted from respondent's medical charts. Height and weight were measured to calculate the body mass index (BMI, kg/m2); neighbourhood walkability was measured on the Neighbourhood Environment scale; and physical activity, specifically functional exercise capacity, was measured by the 6-min walk test (6MWT). RESULTS On average, respondents were black African, female, approximately 38 years old and unemployed; men were of normal weight whilst women were overweight. Only 65% of the respondents reached the age- and sex-predicted distance during the 6MWT. Correlational analyses did not reveal any significant relationships between the functional exercise capacity and socio-demographic, HIV-related factors or anthropometric measures. CONCLUSION South African PWH do not reach their predicated walking distance on the 6MWT. Engaging community agencies to promote walking as both a means of transportation and leisure physical activity may decrease the risks of a sedentary lifestyle and improve progression towards recommended physical activity targets.
Collapse
Affiliation(s)
- Penelope M Orton
- Department of International Education and Partnerships, Durban University of Technology, Durban, South Africa
| | - Dudu G Sokhela
- Department of Nursing, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Kathleen M Nokes
- Department of Nursing, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
- Department of Nursing, City University of New York (CUNY) Graduate Center, New York, United States of America
| | - Joseph D Perazzo
- Department of Nursing, University of Cincinnati, Cincinnati, United States of America
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Faculty of Health Sciences, Case Western Reserve University, United States of America
| |
Collapse
|
24
|
Dimitriades ME, Pillay K. Dietary management practices for type 1 diabetes mellitus by dietitians in KwaZulu-Natal. Health SA 2021; 26:1506. [PMID: 33936786 PMCID: PMC8063549 DOI: 10.4102/hsag.v26i0.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/20/2021] [Indexed: 12/04/2022] Open
Abstract
Background In South Africa, 5% – 15% of diabetics have type 1 diabetes mellitus (T1DM). Dietitians are an important part of the diabetes management team; however, there is a lack of published data on the dietary management practices for T1DM by dietitians. Aim The aim of this study was to determine the dietary management practices for T1DM by dietitians in KwaZulu-Natal (KZN). Setting This study was conducted in KZN. Methods A cross-sectional, descriptive study was conducted using a self-administered electronic questionnaire. Results Of the 69 dietitians who participated, 58% (n = 40) used the American Diabetes Association (ADA) guidelines to manage T1DM; just under 35% (n = 24) spent over an hour with new cases; and 87% (n = 60) used face-to-face consultations for follow-up. Dietitians used the glycaemic index, portion control using the healthy eating plate, carbohydrate counting using nutritional labels and household measures and carbohydrate awareness to manage T1DM (p < 0.05). Dietitians also used the healthy eating plate (71%; n = 49) (p < 0.05) and household measures (73.9%; n = 51) (p < 0.05) to manage T1DM. Time constraints, the literacy level of the patient, available resources and language barriers all played a role in determining the dietary management practices used (p < 0.05). Conclusion Most dietitians in KZN used the ADA dietary guidelines to manage T1DM, which highlights the need for South African dietary guidelines for the management of T1DM. Dietitians used a variety of different dietary methods to manage T1DM in practice. This suggests that dietitians are flexible in how they manage T1DM with no one particular method being used. A variety of factors also influenced which dietary management practices were chosen.
Collapse
Affiliation(s)
- Megan E Dimitriades
- Department of Dietetics and Human Nutrition, College of Agriculture, Engineering and Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Kirthee Pillay
- Department of Dietetics and Human Nutrition, College of Agriculture, Engineering and Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| |
Collapse
|
25
|
Gumede DM, Taylor M, Kvalsvig JD. Engaging future healthcare professionals for rural health services in South Africa: students, graduates and managers perceptions. BMC Health Serv Res 2021; 21:220. [PMID: 33706769 DOI: 10.1186/s12913-021-06178-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 02/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background The shortage of healthcare professionals (HCP) negatively affects health services in rural areas in many parts of the world, as is the case in South Africa. Innovative programs designed to improve the recruitment strategies for health system in a rural area are essential. They need support with a scholarship and mentorship programme for young people from rural areas to study for health science degrees, with the aim that they would take up a post at the hospital in their community, once qualified. This paper reports the perceptions and experiences of the students and graduates sponsored by the foundation, and those of managers from the facilities where the students were ultimately placed, in order to gauge whether such a programme can make a sustainable contribution to address the shortage of health personnel in rural areas and to what extent this is happening. Methods The authors used qualitative methods, combining semi-structured in-depth interviews and focus groups and the data were analyzed thematically. Results The results provide information on students interviewed who appreciated the financial and socio-emotional support that they received. On the other hand, graduates value the availability of jobs in their home community on completion of their studies. The managers reported the success of the programme in increasing the number of healthcare personnel at the hospitals, and the increased range of available medical services. Since the graduates are familiar with the language and culture of their patients the managers considered that they are better able to assist them. Conclusions The system was well thought-out and achieved its goal of improving health services in an underdeveloped rural area of South Africa. More could be achieved if other government services in the area were simultaneously improved and if the system were replicated elsewhere. The students and graduates from rural areas are involved on sustaining health services in rural areas while rural managers support the programme and make suggestions for improvement and to promote the program in other regions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06178-w.
Collapse
|
26
|
Blose SB, Deoraj S, Padia S, Pillay K, Reddy K, Chetty V. Healthcare professionals' perceptions of community-based rehabilitation in KwaZulu-Natal, South Africa. Afr J Prim Health Care Fam Med 2021; 13:e1-e9. [PMID: 33567846 PMCID: PMC7876970 DOI: 10.4102/phcfm.v13i1.2461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/20/2020] [Accepted: 09/27/2020] [Indexed: 11/30/2022] Open
Abstract
Background People with disabilities (PWDs) continue to experience challenges with access to healthcare. Community-based rehabilitation (CBR) is an approach that advocates for equal opportunities and social inclusion of PWDs to enhance their quality of daily life. Healthcare professionals are crucial in the implementation of CBR. However, little is known about the perception of healthcare professionals on this approach to rehabilitation in South Africa. Aim This study sought to explore perceptions of healthcare professionals on CBR in the province of KwaZulu-Natal, South Africa. Setting This study was located across four public healthcare facilities spanning districts to tertiary levels care in KwaZulu-Natal, situated in rural and peri-urban areas. Methods An explorative qualitative approach using focus group discussions was used to collect data from healthcare professionals employed at these public hospitals in the province. Twenty-five healthcare workers participated in four focus group discussions, with four to eight participants per group. Data were transcribed and analysed using thematic analysis. Results The findings revealed four dominant themes, namely, the CBR conundrum, CBR enablers, perceived impediments to CBR implementation and a proposal for the implementation of CBR. Conclusion Continual promotion of, as well as education and training on, CBR for healthcare professionals, was understood as an imperative for the development and roll-out of CBR programmes in South African communities. Excellent communication about CBR programmes was described as key to ensuring social inclusion, quality of life and access to services for PWDs.
Collapse
Affiliation(s)
- Sithembiso B Blose
- Department of Physiotherapy, Faculty of Health Sciences, University of KwaZulu-Natal, Durban.
| | | | | | | | | | | |
Collapse
|
27
|
Naicker M, Singh R, van der Westhuizen D, Tinarwo P, Abbai NS. Lack of resistance to macrolides in Mycoplasma genitalium detected in South African pregnant women. S Afr J Infect Dis 2021; 36:209. [PMID: 34549049 PMCID: PMC8447758 DOI: 10.4102/sajid.v36i1.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/21/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Azithromycin regimens have been considered first-line treatment for Mycoplasma genitalium (M. genitalium), a sexually transmitted infection (STI) associated with adverse pregnancy outcomes. However, recent years have seen rapid emergence of macrolide resistance in M. genitalium as a result of widespread administration of azithromycin. Currently, there are limited data on macrolide resistance in pregnant women from KwaZulu-Natal (KZN), South Africa. This study investigated the prevalence of M. genitalium and emerging patterns of macrolide resistance in pregnant women from KZN. METHODS This was a sub-study of a larger study which involved laboratory-based detection of STIs in pregnant women. In the main study, pregnant women provided urine samples for detection of STIs. For this study, deoxyribose nucleic acid (DNA) extracted from stored urine was used to determine emerging macrolide resistance by amplification of the 23S ribosomal ribonucleic acid (rRNA) gene of M. genitalium by polymerase chain reaction (PCR) and sequencing of amplicons to identify mutations associated with resistance. The Allplex™ MG & AziR assay was used as a confirmatory assay. RESULTS The prevalence of M. genitalium in pregnant women was 5.9% (13 out of 221). Sequencing of PCR amplicons did not reveal the presence of the A2059G and A2058G mutations associated with macrolide resistance. These findings were confirmed by the Allplex™ MG & AziR assay. CONCLUSION Despite the lack of resistance to macrolides in this study population, continued antimicrobial resistance surveillance for M. genitalium in pregnant women is important because azithromycin is now part of the South African national STI syndromic management guidelines for vaginal discharge syndrome.
Collapse
Affiliation(s)
- Meleshni Naicker
- School of Clinical Medicine Research Laboratory, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ravesh Singh
- Department of Medical Microbiology, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Microbiology, National Health Laboratory Services, KwaZulu-Natal Academic Complex, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | | | - Partson Tinarwo
- Department of Biostatistics, College of Health Sciences, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - Nathlee S Abbai
- School of Clinical Medicine Research Laboratory, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
28
|
Hlongwa M, Kalinda C, Peltzer K, Hlongwana K. Factors associated with modern contraceptive use: a comparative analysis between younger and older women in Umlazi Township, KwaZulu-Natal, South Africa. Womens Health (Lond) 2021; 17:17455065211060641. [PMID: 34798800 PMCID: PMC8606954 DOI: 10.1177/17455065211060641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Unplanned pregnancy continues to be a global reproductive and public health concern among women. This study aimed to investigate whether factors associated with modern contraceptive use differ by age-group among young and older women of reproductive age. METHODS This was a cross-sectional study conducted among 433 women of reproductive age, with the median age of 25 years (interquartile range: 21-28), and aged between 18 and 49. Data were collected from 10 public health care clinics in Umlazi Township, KwaZulu-Natal, using a structured questionnaire. Data were coded, entered into Epi Data Manager and exported to Stata for analysis. A Pearson's chi-square test and logistic regression models were employed to assess the level of the association between the predictor and outcome variables, and the p-value of 0.05 or lower was considered statistically significant. RESULTS Most women in the sample (n = 351, 81%) had obtained a secondary level of education, while 53% (n = 230) were unemployed and 89% (n = 387) were single. We found that women with secondary level of education (AOR: 2.89, 95% CI: 0.99-5.38) or a tertiary level of education (AOR 3.80, 95% CI: 1.07-3.53) were more likely to use contraceptive methods compared to women with lower education. Women who experienced unplanned pregnancy (AOR 0.51, 95% CI: 0.22-3.79) were more likely to use contraceptives. Women aged 25-49 years who experienced pregnancy, whether planned (AOR 3.87, 95% CI: 1.08-3.89) or unplanned (AOR 3.60, 95% CI: 2.15-4.19), were more likely to use a contraceptive method. Results showed that the level of education (p = 0.942) and whether one experienced unplanned pregnancy (p = 0.913) were not significant predictors of contraceptive use among women aged 18-24 years. CONCLUSION Concerted educational efforts to addressing existing barriers deterring women from accessing contraception among young women are necessary. Different groups of women should be targeted with family planning interventions specific to their needs.
Collapse
Affiliation(s)
- Mbuzeleni Hlongwa
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Mbuzeleni Hlongwa, Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa.
| | - Chester Kalinda
- University of Global Health Equity, Bill and Joyce Cummings Institute of Global, Kigali, Rwanda
| | - Karl Peltzer
- Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa
- Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Khumbulani Hlongwana
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
29
|
Chikafu H, Chimbari MJ. Levels and Correlates of Physical Activity in Rural Ingwavuma Community, uMkhanyakude District, KwaZulu-Natal, South Africa. Int J Environ Res Public Health 2020; 17:ijerph17186739. [PMID: 32947853 PMCID: PMC7559597 DOI: 10.3390/ijerph17186739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/27/2020] [Accepted: 07/05/2020] [Indexed: 01/25/2023]
Abstract
Physical activity, among others, confers cardiovascular, mental, and skeletal health benefits to people of all age-groups and health states. It reduces the risks associated with cardiovascular disease and therefore, could be useful in rural South Africa where cardiovascular disease (CVD) burden is increasing. The objective of this study was to examine levels and correlates of physical activity among adults in the Ingwavuma community in KwaZulu-Natal (KZN). Self-reported data on physical activity from 392 consenting adults (female, n = 265; male, n = 127) was used. We used the one-sample t-test to assess the level of physical activity and a two-level multiple linear regression to investigate the relationship between total physical activity (TPA) and independent predictors. The weekly number of minutes spent on all physical activities by members of the Ingwavuma community was 912.2; standard deviation (SD) (870.5), with males having 37% higher physical activity (1210.6 min, SD = 994.2) than females (769.2, SD = 766.3). Livelihood activities constituted 65% of TPA, and sport and recreation contributed 10%. Participants without formal education (20%), those underweight (27%), and the obese (16%) had low physical activity. Notwithstanding this, in general, the Ingwavuma community significantly exceeded the recommended weekly time on physical activity with a mean difference of 762.1 (675.8–848.6) minutes, t (391) = 17.335, p < 0.001. Gender and age were significant predictors of TPA in level 1 of the multiple regression. Males were significantly more active than females by 455.4 min (β = −0.25, p < 0.001) and participants of at least 60 years were significantly less active than 18–29-year-olds by 276.2 min (β = −0.12, p < 0.05). Gender, marital status, and health awareness were significant predictors in the full model that included education level, employment status, body mass index (BMI), and physical activity related to health awareness as predictors. The high prevalence of insufficient physical activity in some vulnerable groups, notably the elderly and obese, and the general poor participation in sport and recreation activities are worrisome. Hence we recommend health education interventions to increase awareness of and reshape sociocultural constructs that hinder participation in leisure activities. It is important to promote physical activity as a preventive health intervention and complement the pharmacological treatment of CVDs in rural South Africa. Physical activity interventions for all sociodemographic groups have potential economic gains through a reduction in costs related to the treatment of chronic CVD.
Collapse
|
30
|
Olofinbiyi OB, Dube M, Mhlongo EM. A perception survey on the roles of nurses during triage in a selected public hospital in Kwazulu-Natal Province, South Africa. Pan Afr Med J 2020; 37:9. [PMID: 32983327 PMCID: PMC7501752 DOI: 10.11604/pamj.2020.37.9.22211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/03/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION triage is gradually becoming an autonomous nursing role essential to patients' safety and the efficient delivery of emergency care. The increased need for more holistic and advanced care during triage makes the role of nurses during triage highly indispensable. However, several studies have shown that nurse-led triage has been so successful over the years in most African countries and in other developing countries. South African Triage Scale (SATS) is an example of triage tool that was designed in such a way that the lowest cadre nurse can successfully implement. The success recorded by this tool made most African countries and some other developing countries adopt the tool. The study was designed to explore the roles of nurses during triage in a selected public hospital in KwaZulu-Natal province. METHODS this study utilized a quantitative approach, in which a non-experimental survey involving convenience sampling technique was chosen as the most suitable sampling technique for the study. Recognition-primed decision model formed the framework of the study. Ethical clearance was obtained from University of KwaZulu-Natal Ethics Review Board and ethics principles were observed during the study. RESULTS the result of the study indicated that majority (100%) of the respondents perceived that nurses have lots of roles to perform during triage. They further unveiled that it is highly paramount for nurses to manage the waiting room and control overcrowding in the unit. CONCLUSION the study draws on the need for qualified and experienced nurses to be in charge of these roles in order to reduce the mortality and morbidity rates that usually occur during triage administration.
Collapse
Affiliation(s)
| | - Makhosazane Dube
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Euphemia Mbali Mhlongo
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
| |
Collapse
|
31
|
Kharsany ABM, McKinnon LR, Lewis L, Cawood C, Khanyile D, Maseko DV, Goodman TC, Beckett S, Govender K, George G, Ayalew KA, Toledo C. Population prevalence of sexually transmitted infections in a high HIV burden district in KwaZulu-Natal, South Africa: Implications for HIV epidemic control. Int J Infect Dis 2020; 98:130-137. [PMID: 32562845 PMCID: PMC7484252 DOI: 10.1016/j.ijid.2020.06.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) and Human immunodeficiency virus (HIV) share a complex bidirectional relationship, however, population prevalence and the association between the presence of STIs and HIV in a high HIV burden district in KwaZulu-Natal, South Africa is not known. METHODS A total of 9812 participants aged 15-49 years were enrolled in a cross-sectional population-based household survey. Participants completed a structured questionnaire and provided first-pass urine (males) or self-collected vulvo-vaginal swabs (females) for the detection of STIs. RESULTS Prevalence of herpes simplex virus type-2 (HSV-2) was 57.8%, syphilis was 1.6%, Neisseria gonorrhoeae was 2.8%, Chlamydia trachomatis was 7.1%, Trichomonas vaginalis was 9.0%, Mycoplasma genitalium was 5.5% and HIV was 36.3%. HIV positive status was associated with an increased probability of having M. genitalium (aPR = 1.49, 95% CI 1.02-2.19) among males and syphilis (aPR = 2.54, 95% CI 1.32-4.86), N. gonorrhoeae (aPR = 2.39, 95% CI 1.62-3.52), T. vaginalis (aPR = 1.70, 95% CI 1.43-2.01) and M. genitalium (aPR = 1.60, 95% CI 1.15-2.22) among females. HIV viral load ≥400 copies per mL was associated with an increased probability of N. gonorrhoeae (aPR = 1.91, 95% CI 1.36-2.70), C. trachomatis (aPR = 1.52, 95% CI 1.12-2.05) and M. genitalium (aPR = 1.83, 95% CI 1.27-2.63). CONCLUSIONS The high prevalence of STIs and the association between STIs and HIV, and HIV viral load underscores the public health implications of sustained transmission risk of STIs and HIV. These findings highlight the urgent need for expanding STI surveillance and implementing interventions to monitor and reduce the STI burden.
Collapse
Affiliation(s)
- Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; School of Laboratory Medicine & Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa.
| | - Lyle R McKinnon
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Lara Lewis
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Cherie Cawood
- Epicentre AIDS Risk Management (Pty) Limited, Cape Town, South Africa
| | - David Khanyile
- Epicentre AIDS Risk Management (Pty) Limited, Cape Town, South Africa
| | - Domiciled Venessa Maseko
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service (NICD/NHLS), Johannesburg, South Africa
| | - Tawni C Goodman
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Sean Beckett
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | | | - Carlos Toledo
- Centers for Disease Control and Prevention (CDC), Atlanta, United States
| |
Collapse
|
32
|
Singaram S, Naidoo M. The physical impact of long bone fractures on adults in KwaZulu-Natal. S Afr J Physiother 2020; 76:1393. [PMID: 32935065 PMCID: PMC7479430 DOI: 10.4102/sajp.v76i1.1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 05/06/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Limb fractures are increasingly common in low-income and middle-income countries due to an increase in motor vehicle and other accidents. Fractures may often lead to physical impairment that affects an individual's ability to carry out tasks. OBJECTIVES To assess the physical impact of long bone fractures on adults in KwaZulu-Natal. METHOD A standardised questionnaire pertaining to activities at home and leisure was used to establish patient-reported outcomes at nine public hospitals. English-speaking and isiZulu-speaking participants who had sustained a single long bone fracture in the preceding 4 to 12 weeks at the time of data collection were included. The following activities were evaluated: walking, running, exercising, driving, performing household chores, writing, answering telephones, texting on a cell phone, bathing, using crockery and preparing meals. RESULTS A total of 821 participants completed the questionnaire. Ninety-three per cent had closed long bone fractures and 69 per cent were lower limb fractures. Fifty-seven per cent of the fractures were caused by a fall. Female participants (p = 0.19) with lower limb fractures were more likely to have greater difficulty in performing tasks and participants 60 years of age and older (p = 0.001) were significantly more likely to have difficulty performing tasks. CONCLUSION These findings illustrate the daily limitations in patients' everyday activities at home, leisure and in activities such as driving. CLINICAL IMPLICATIONS This study highlights the difficulty that some individuals, particularly women and individuals 60 years of age and older, face in performing daily tasks after experiencing a long bone fracture.
Collapse
Affiliation(s)
- Sevani Singaram
- Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Mergan Naidoo
- Department of Family Medicine, Medical School, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
33
|
Hlongwa M, Peltzer K, Hlongwana K. Risky sexual behaviours among women of reproductive age in a high HIV burdened township in KwaZulu-Natal, South Africa. BMC Infect Dis 2020; 20:563. [PMID: 32738895 PMCID: PMC7395408 DOI: 10.1186/s12879-020-05302-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite several intervention programmes in South Africa, risky sexual behaviours among women of reproductive age remain a public health concern, making them vulnerable to unintended pregnancies and/or sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection. The aim of this study was to investigate the predictors of risky sexual behaviours among women of reproductive age in a high HIV-burden township in KwaZulu-Natal, South Africa. METHODS In a cross-sectional study, 471 women of reproductive age (18-49 years, mean: 25.83) in 10 public health clinics in Umlazi Township, responded to a structured questionnaire. Data were coded, entered into Epi Data Manager and exported to Stata for analysis. A Pearson Chi-square tests and logistic regression models (bivariate and multivariate) were employed to assess the level of the association between the predictor and outcome variables and the p-value < 0.05 was considered statistically significant. RESULTS More than half (51.80%) of the women were aged 18-24 years and only a handful (18.26%) had a tertiary qualification. The majority were single (88.96%) and the unemployed accounted for 53.50%. This study found that women who had talked about condoms with their partner in the past 12 months were more likely (p = < 0.0001) to have used condoms during their last sexual intercourse. Older women (p = 0.035) were more likely to have used a condom at last sex, compared to younger women. However, women who were exposed to physical partner violence (hitting and/or slapping), those who had been diagnosed with HIV and those whose sexual partners were diagnosed with HIV, did not show a significant association with condom use at last sex. CONCLUSION Exposure to physical partner violence and poor partner discussions about condoms are key deterrents to condom usage. Holistic interventions are required in order to address the risky behaviours, and consequently reduce sexually transmitted infections and/or unintended pregnancies.
Collapse
Affiliation(s)
- Mbuzeleni Hlongwa
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Karl Peltzer
- HIV/AIDS/STIs and TB Research Programme, Human Sciences Research Council, Cape Town, South Africa
- Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa
| | - Khumbulani Hlongwana
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
34
|
Abstract
Background Despite significant gains in the HIV epidemic in South Africa, with reduction in mortality and elimination of vertical transmission, national HIV prevalence remains high, with women rather than men continuing to bear higher burden of the disease. Population subgroups, through ignorance, disbelief or recklessness, continue to engage in risky sexual behaviour. A substantial proportion of minibus taxi drivers engage in risky sex, seldom seeing themselves at risk for STIs or HIV/AIDS. These taxi drivers have been linked with so-called taxi queens, with whom they engage in transactional and intergenerational relationships. Objectives The study explored condom use and condom negotiation strategies among taxi drivers and taxi queens in Kwa- Zulu-Natal, South Africa. Methods Applying explorative qualitative design, we conducted focus group discussion and individual interviews among participants who were purposively recruited in KwaZulu-Natal. Result Qualitative data analysis revealed that condom use and negotiation are sources of conflict for the participants. In addition, the strategies employed by participants to ensure condom usage are not always sustainable and are likely to be problematic due to a variety of complex factors. Conclusion Our study concludes by recommending a nested public health response that takes cognizance of factors that promote sustainable condom use strategies among this population subgroup.
Collapse
Affiliation(s)
- Gugu G Mchunu
- School of Nursing and Public Health, University of Kwazulu-Natal, South Africa
- Corresponding author: Gugu G Mchunu, School of Nursing and Public Health, University of Kwazulu-Natal, South Africa. 5th Floor, Desmond Clarence Building, Howard College Campus, University of Kwazulu-Natal, Durban. 4041.
| | | | | |
Collapse
|
35
|
Raman J, Gast L, Balawanth R, Tessema S, Brooke B, Maharaj R, Munhenga G, Tshikae P, Lakan V, Mwamba T, Makowa H, Sangweni L, Mkhabela M, Zondo N, Mohulatsi E, Nyawo Z, Ngxongo S, Msimang S, Dagata N, Greenhouse B, Birkholtz LM, Shirreff G, Graffy R, Qwabe B, Moonasar D. High levels of imported asymptomatic malaria but limited local transmission in KwaZulu-Natal, a South African malaria-endemic province nearing malaria elimination. Malar J 2020; 19:152. [PMID: 32295590 PMCID: PMC7161075 DOI: 10.1186/s12936-020-03227-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/06/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND KwaZulu-Natal, one of South Africa's three malaria endemic provinces, is nearing malaria elimination, reporting fewer than 100 locally-acquired cases annually since 2010. Despite sustained implementation of essential interventions, including annual indoor residual spraying, prompt case detection using malaria rapid diagnostics tests and treatment with effective artemisinin-based combination therapy, low-level focal transmission persists in the province. This malaria prevalence and entomological survey was therefore undertaken to identify the drivers of this residual transmission. METHODS Malaria prevalence as well as malaria knowledge, attitudes and practices among community members and mobile migrant populations within uMkhanyakude district, KwaZulu-Natal were assessed during a community-based malaria prevalence survey. All consenting participants were tested for malaria by both conventional and highly-sensitive falciparum-specific rapid diagnostic tests. Finger-prick filter-paper blood spots were also collected from all participants for downstream parasite genotyping analysis. Entomological investigations were conducted around the surveyed households, with potential breeding sites geolocated and larvae collected for species identification and insecticide susceptibility testing. A random selection of households were assessed for indoor residual spray quality by cone bioassay. RESULTS A low malaria prevalence was confirmed in the study area, with only 2% (67/2979) of the participants found to be malaria positive by both conventional and highly-sensitive falciparum-specific rapid diagnostic tests. Malaria prevalence however differed markedly between the border market and community (p < 0001), with the majority of the detected malaria carriers (65/67) identified as asymptomatic Mozambican nationals transiting through the informal border market from Mozambique to economic hubs within South Africa. Genomic analysis of the malaria isolates revealed a high degree of heterozygosity and limited genetic relatedness between the isolates supporting the hypothesis of limited local malaria transmission within the province. New potential vector breeding sites, potential vector populations with reduced insecticide susceptibility and areas with sub-optimal vector intervention coverage were identified during the entomological investigations. CONCLUSION If KwaZulu-Natal is to successfully halt local malaria transmission and prevent the re-introduction of malaria, greater efforts need to be placed on detecting and treating malaria carriers at both formal and informal border crossings with transmission blocking anti-malarials, while ensuring optimal coverage of vector control interventions is achieved.
Collapse
Affiliation(s)
- Jaishree Raman
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa. .,Wits Research Institute for Malaria, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa. .,UP Institute for Sustainable Malaria Control, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa.
| | - Laura Gast
- Clinton Health Access Initiative, Pretoria, Gauteng, South Africa
| | - Ryleen Balawanth
- Clinton Health Access Initiative, Pretoria, Gauteng, South Africa
| | - Sofonias Tessema
- Department of Medicine, University of California-San Francisco, San Francisco, USA
| | - Basil Brooke
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa.,Wits Research Institute for Malaria, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Rajendra Maharaj
- UP Institute for Sustainable Malaria Control, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa.,Office of Malaria Research, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa
| | - Givemore Munhenga
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa.,Wits Research Institute for Malaria, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Power Tshikae
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Vishan Lakan
- Office of Malaria Research, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa
| | - Tshiama Mwamba
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa.,Wits Research Institute for Malaria, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Hazel Makowa
- Department of Biochemistry, Genetics and Microbiology, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Lindi Sangweni
- KwaZulu-Natal Provincial Malaria Control Programme, Jozini, KwaZulu-Natal, South Africa
| | - Moses Mkhabela
- KwaZulu-Natal Provincial Malaria Control Programme, Jozini, KwaZulu-Natal, South Africa
| | - Nompumelelo Zondo
- KwaZulu-Natal Provincial Malaria Control Programme, Jozini, KwaZulu-Natal, South Africa
| | | | - Zuziwe Nyawo
- KwaZulu-Natal Provincial Malaria Control Programme, Jozini, KwaZulu-Natal, South Africa
| | - Sifiso Ngxongo
- KwaZulu-Natal Provincial Malaria Control Programme, Jozini, KwaZulu-Natal, South Africa
| | - Sipho Msimang
- KwaZulu-Natal Provincial Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Nicole Dagata
- Clinton Health Access Initiative, Pretoria, Gauteng, South Africa
| | - Bryan Greenhouse
- Department of Medicine, University of California-San Francisco, San Francisco, USA
| | - Lyn-Marie Birkholtz
- Department of Biochemistry, Genetics and Microbiology, University of Pretoria, Pretoria, Gauteng, South Africa
| | - George Shirreff
- Clinton Health Access Initiative, Pretoria, Gauteng, South Africa
| | - Rebecca Graffy
- Clinton Health Access Initiative, Pretoria, Gauteng, South Africa
| | - Bheki Qwabe
- KwaZulu-Natal Provincial Malaria Control Programme, Jozini, KwaZulu-Natal, South Africa
| | - Devanand Moonasar
- UP Institute for Sustainable Malaria Control, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa.,Malaria Vector Borne and Zoonotic Diseases, National Department of Health, Pretoria, Gauteng, South Africa
| |
Collapse
|
36
|
van Rooyen H, Makusha T, Joseph P, Ngubane T, Kulich M, Sweat M, Coates T. Zwakala Ndoda: a cluster and individually randomized trial aimed at improving testing, linkage, and adherence to treatment for hard-to reach men in KwaZulu-Natal, South Africa. Trials 2019; 20:798. [PMID: 31888701 DOI: 10.1186/s13063-019-3908-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/15/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Men in sub-Saharan Africa are less likely than women to get tested for HIV, less likely to present for treatment, less likely to be maintained in treatment, more likely to have detectable viral load, more likely to transmit HIV with unprotected intercourse, and more likely to progress to AIDS and die sooner from HIV. The ultimate objective of this research is to provide evidence-based strategies to improve HIV testing and treatment of HIV-infected men. METHODS This study is being conducted in the Greater Edendale Area and Vulindlela region in KwaZulu-Natal, South Africa. It is a two-stage design of a cluster-randomized trial and an individual randomized trial to test how structural and individual-level interventions address the demand-side factors that affect HIV testing and treatment for hard-to reach, high-risk men. It combines male-focused mobilization, community-based mobile HIV testing services, and a small incentive to determine if the strategies singly and in combination can result in more men diagnosed with HIV, and more men linked to and maintained in care with undetectable viral load. DISCUSSION A priority for sub-Sahara Africa is developing and evaluating novel and cost-effective strategies for identifying hard-to-reach groups such as men, linking them to HIV testing and care services, and maintaining them in care to the point of viral suppression. We propose a combination prevention intervention that addresses men's individual, interpersonal, and structural barriers to testing and care. This includes male-led mobilization to encourage uptake of testing and treatment, male-focused testing venues, male-only counselors, developing counseling models that are flexible and responsive to men, and strategies for adhering to clinic visits without missing work and navigating the healthcare system. By thoughtfully combining male-focused mobilization, and testing and addressing some of the barriers to male engagement with health facilities, this study hopes to add to the growing evidence base about how to reach, test, link, and maintain a hard-to-reach group such as men in HIV treatment and care services. TRIAL REGISTRATION ClinicalTrials.gov, NCT03794245. Registered on 4 January 2019.
Collapse
|
37
|
Naidoo K, Van Wyk J. What the elderly experience and expect from primary care services in KwaZulu-Natal, South Africa. Afr J Prim Health Care Fam Med 2019; 11:e1-e6. [PMID: 31714116 PMCID: PMC6852327 DOI: 10.4102/phcfm.v11i1.2100] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/08/2019] [Accepted: 07/12/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND People aged 60 years and above are predicted to outnumber those aged under 5 years in South Africa for the first time by 2040. This will put increased demands on the health system to address geriatric health needs. However, data on geriatric populations in sub-Saharan Africa are scarce. Health policymakers need to be informed of the expectations of the elderly people regarding health services, especially at primary care level. AIM The aim of this study was to explore the experiences and expectations of people aged 60 years and above regarding ageing and health services, and the factors that might improve the quality of primary care services for geriatric patients. SETTING The study was conducted at three public health primary care facilities in KwaZulu-Natal province, South Africa: one in a rural setting, one in a peri-urban and one in an urban setting. METHODS This qualitative study involved a purposive sample of 28 participants, aged 60 years and above. Four focus group discussions were conducted in either isiZulu or English, depending on the preference of the participants. Data were analysed thematically using an inductive approach. RESULTS Nineteen of the 28 participants were women. Five key findings emerged from the study: (1) long waiting times - participants were distressed by lengthy waiting times, (2) illness-centred care - participants felt that they were seen as diseases to be treated, (3) lack of caring - health providers were perceived to lack compassion, (4) pill burden - participants experienced adverse effects of prescribed medication and (5) need for priority care - participants wanted a separate queue for the elderly. CONCLUSION Health systems and health professions educators should consider the need for patient-centred and integrated care for geriatric populations. Further research is required on the unmet needs of geriatric people in the community.
Collapse
Affiliation(s)
- Keshena Naidoo
- Department of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban.
| | | |
Collapse
|
38
|
Sacolo-Gwebu H, Chimbari M, Kalinda C. Prevalence and risk factors of schistosomiasis and soil-transmitted helminthiases among preschool aged children (1-5 years) in rural KwaZulu-Natal, South Africa: a cross-sectional study. Infect Dis Poverty 2019; 8:47. [PMID: 31202273 PMCID: PMC6571117 DOI: 10.1186/s40249-019-0561-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 05/28/2019] [Indexed: 02/17/2023] Open
Abstract
Background Despite efforts to control neglected tropical diseases (NTDs), schistosomiasis and soil-transmitted helminthiases remain widely prevalent in sub-Saharan Africa. Recent data suggest that these infections are prevalent among preschool aged children (PSAC) in poor communities. Evidence of schistosomiasis and soil-transmitted helminths (STH) infection patterns and prevalence among PSAC is essential for effective treatment and control programmes. The aim of the study was to determine the prevalence, intensity and risk factors of schistosomiasis and STH infection among PSAC in the Ingwavuma area of uMkhanyakude District, South Africa. Methods A cross-sectional study was conducted among 1143 PSAC aged 1–5 years in 34 preschools and early childhood development (ECD) centres. Data on risk factors was collected using a semi-structured questionnaire. A Kruskal–Wallis test was used to compare the differences in infection intensity with age. Pearson Chi-square test and multivariate logistic regression were performed to assess the association between PSAC infection status, sociodemographic, household, water and sanitation variables and hygiene practices of PSAC and their caregivers. Results We observed a low prevalence of Schistosoma haematobium (1.0%) and S. mansoni (0.9%). The prevalence of Ascaris lumbricoides (18.3%) was high compared to Trichuris trichiura (1.2%), hookworms (1.6%) and Taenia (6.4%). The odds of schistosome infection were lowest among PSAC under younger (15–24 years) caregivers (0.1, 95% CI: 0.02–0.54) and those who used tap water (0.3, 95% CI: 0.09–0.78) for domestic purposes. Schistosome infection was however higher among PSAC who bathed in river water (17.4, 95% CI: 5.96–51.04). STH infection on the other hand was lowest among PSAC who did not play in soil (0.1, 95% CI: 0.51–0.28), were from households that used tap water for domestic purposes (0.5, 95% CI: 0.27–0.80) and PSAC under the care of younger (25–35 years) caregivers (0.3, 95% CI: 0.10–0.75). The risk of STH infection was highest among PSAC who did not wash their hands with soap (3.5, 95% CI: 1.04–11.67) and PSAC whose nails were not trimmed (3.6, 95% CI: 1.75–7.26). Conclusions The findings show low prevalence and infection intensity of schistosomiasis and STH infection except A. lumbricoides among PSAC. Factors predicting schistosomiasis and STH infection among PSAC were related to caregivers’ age, educational status, water and hygiene practices. STH infection was exclusively associated with PSAC playing and handwashing habits. These findings highlight the need to include PSAC caregivers in schistosomiasis and STH prevention and control programmes. Electronic supplementary material The online version of this article (10.1186/s40249-019-0561-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Hlengiwe Sacolo-Gwebu
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard Campus, Durban, South Africa.
| | - Moses Chimbari
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard Campus, Durban, South Africa
| | - Chester Kalinda
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard Campus, Durban, South Africa.,University of Namibia, Katima Mulilo Campus, Winela Road, Box 1096, Katima Mulilo, Namibia
| |
Collapse
|
39
|
Latif AA, Ntantiso L, De Beer C. African animal trypanosomosis (nagana) in northern KwaZulu-Natal, South Africa: Strategic treatment of cattle on a farm in endemic area. ACTA ACUST UNITED AC 2019; 86:e1-e6. [PMID: 31170783 PMCID: PMC6556924 DOI: 10.4102/ojvr.v86i1.1639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 01/02/2019] [Accepted: 01/09/2019] [Indexed: 11/04/2022]
Abstract
African animal trypanosomosis (AAT) is caused by several species of the genus Trypanosoma, a parasitic protozoan infecting domestic and wild animals. One of the major effects of infection with pathogenic trypanosome is anaemia. Currently, the control policies for tsetse and trypanosomosis are less effective in South Africa. The only response was to block treat all infected herds and change the dip chemical to one which controls tsetse flies during severe outbreaks. This policy proved to be less effective as demonstrated by the current high level of trypanosome infections in cattle. Our objective was to study the impacts of AAT (nagana) on animal productivity by monitoring the health of cattle herds kept in tsetse and trypanosomosis endemic areas before and after an intervention that reduces the incidence of the disease. The study was conducted on a farm in northern KwaZulu-Natal which kept a commercial cattle herd. There was no history of any cattle treatment for trypanosome. All cattle were generally in poor health condition at the start of the study though the herd received regular anthelminthic treatment. A treatment strategy using two drugs, homidium bromide (ethidium) and homidium chloride (novidium), was implemented. Cattle were monitored regularly for 13 months for herd trypanosomosis prevalence (HP), herd average packed cell volume (H-PCV) and the percentage of the herd that was anaemic (HA). A total of six odour-baited H-traps were deployed where cattle grazed from January 2006 to August 2007 to monitor the tsetse population. Glossina brevipalpis Newstead and Glossina austeni Newstead were collected continuously for the entire study period. High trypanosomes HP (44%), low average H-PCV (29.5) and HA (24%) were rerecorded in the baseline survey. All cattle in the herd received their first treatment with ethidium bromide. Regular monthly sampling of cattle for the next 142 days showed a decline in HP of 2.2% – 2.8%. However, an HP of 20% was recorded by day 220 and the herd received the second treatment using novidium chloride. The HP dropped to 0.0% and HA to 0.0% by day 116 after the second treatment. The cow group was treated again by day 160 when the HP and HA were 27.3% and 11%, respectively. The same strategy was applied to the other two groups of weaners and the calves at the time when their HP reached 20%. Ethidium and novidium treatment protected cattle, that were under continuous tsetse and trypanosomosis challenge, for up to 6 months. Two to three treatments per year may be sufficient for extended protection. However, this strategy would need to be included into an integrated pest management approach combining vector control for it to be sustainable.
Collapse
Affiliation(s)
- Abdalla A Latif
- School of Life Sciences, University of KwaZulu-Natal, Westville, Durban.
| | | | | |
Collapse
|
40
|
Nyide SP, Brysiewicz P, Bruce J, Clarke DL. A retrospective audit of nursing-related morbidity recorded in a state hospital in KwaZulu-Natal. Curationis 2019; 42:e1-e5. [PMID: 31038327 PMCID: PMC6489142 DOI: 10.4102/curationis.v42i1.1969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/23/2018] [Accepted: 11/01/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Health care professionals are expected to deliver safe and effective health services; however there is increased realisation that adverse events in the health system are a major cause of preventable morbidity and mortality. OBJECTIVES To conduct a retrospective audit of nursing-related morbidities in a state hospital in KwaZulu-Natal, South Africa. METHOD A retrospective audit of nursing-related morbidities documented by the surgical service was carried out using the Hybrid Electronic Medical Registry data for a period of 3 years - 01 November 2013 to 31 October 2016. RESULTS There were a total of 12 444 admissions to surgical service during the study period, with 461 nursing-related morbidities reported. There was an increase in the number of documented nursing-related morbidities noted during November 2015 to October 2016, with 79% of all reported nursing-related morbidities documented during this period. A total of 54% of nursing-related morbidities were associated with males (n = 248) and 46% (n = 213) with females. The most commonly documented nursing-related morbidity was drugs/medication (n = 167, 36%) with the second most common being adjunct management (n = 130, 28%). CONCLUSION The study has identified the most commonly documented nursing-related morbidities in the surgical service of a state hospital. The findings of the study could provide direction for further research and educational initiatives.
Collapse
Affiliation(s)
- Spumelelo P Nyide
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban.
| | | | | | | |
Collapse
|
41
|
Mulqueeny DM, Taylor M. Does the public antiretroviral treatment programme meet patients' needs? A study at four hospitals in eThekwini, KwaZulu-Natal, South Africa. Afr J Prim Health Care Fam Med 2019; 11:e1-e11. [PMID: 30843416 PMCID: PMC6407438 DOI: 10.4102/phcfm.v11i1.1824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/07/2018] [Accepted: 08/31/2018] [Indexed: 01/26/2023] Open
Abstract
Background Patients play a major role in the success of any antiretroviral treatment (ART) programme. Hence, their needs should be articulated on a regular basis for interventional processes to promote adherence, retention and quality care. Aim This study investigated whether patients’ needs were being met, described which needs were met, which were not and how such needs could be met. Setting The study took place at four ART clinics in eThekwini district public hospitals. Methods This study formed part of a larger study that utilised a sequential mixed-methods design. However, only the qualitative component is documented herein. Twelve HIV-infected patients engaged in in-depth interviews (three patients from each of the four hospitals). A socio-ecological framework divided responses into four categories, namely, the individual, interpersonal, institutional and policy. Each category presented (1) patients’ needs that are being met, (2) needs that are not being met, (3) recommendations on how they can be met and (4) researchers’ observations. Results All 12 patients reported that all their needs were not being met. They further shared their met needs, unmet needs and made recommendations for meeting their unmet needs. These needs varied per antiretroviral clinic because of unique processes at each institution. Conclusion To adequately address the needs of HIV-infected patients, it is imperative for all stakeholders involved in the public ART programme to gain an understanding of what constitutes ‘patients’ needs’. The results reflect patients’ willingness to be involved in their care, treatment and interventional strategies to adequately meet their needs.
Collapse
|
42
|
Naidoo U, Ennion L. Barriers and facilitators to utilisation of rehabilitation services amongst persons with lower-limb amputations in a rural community in South Africa. Prosthet Orthot Int 2019; 43:95-103. [PMID: 30044179 DOI: 10.1177/0309364618789457] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: Persons with disabilities who reside in rural areas experience challenges accessing and utilising health services and rehabilitation. Due to the high prevalence of diabetes mellitus in rural regions, the risk of having a lower-limb amputation is increasing. Comprehensive rehabilitation is vital to mitigate the negative impact that a lower-limb amputation has on a person. OBJECTIVE: To explore the barriers and facilitators to accessing rehabilitation experienced by persons with lower-limb amputations in a rural setting. STUDY DESIGN: A qualitative descriptive approach was used to collect and analyse data. METHODS: Data were collected from 11 conveniently sampled participants from three sub-district hospitals in the rural iLembe district, Kwa-Zulu Natal, South Africa. Data were collected using semi-structured interviews to explore the barriers and facilitators perceived by persons with lower-limb amputations in a rural region. RESULTS: The three main barriers identified in this study were environmental factors, financial constraints and impairments. These barriers negatively impacted the participant's utilisation of rehabilitation. The two main facilitators identified were environmental facilitators and personal factors which aided participant's utilisation of rehabilitation. CONCLUSION: Access to rehabilitation was mainly hindered by the challenges utilising transport to the hospital, while self-motivation to improve was the strongest facilitator to utilising rehabilitation. CLINICAL RELEVANCE Rehabilitation is essential in preparation for prosthetic fitting. If a person cannot access rehabilitation services, they will remain dependent on caregivers. Highlighting the challenges to utilisation of rehabilitation in rural areas can assist to reduce these barriers and improve the functional status of persons with lower-limb amputations.
Collapse
Affiliation(s)
- Ugendrie Naidoo
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Liezel Ennion
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
43
|
Adeyinka GC, Moodley B, Birungi G, Ndungu P. Quantitative analyses of selected polychlorinated biphenyl (PCB) congeners in water, soil, and sediment during winter and spring seasons from Msunduzi River, South Africa. Environ Monit Assess 2018; 190:621. [PMID: 30269295 DOI: 10.1007/s10661-018-6993-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 09/20/2018] [Indexed: 06/08/2023]
Abstract
The lack of information and the need for knowledge on the organic pollutants within the area of KwaZulu-Natal together with the global problem of water supply have prompted our investigation into the analyses of eight polychlorinated biphenyl (PCB) congeners in the Msunduzi River of KwaZulu-Natal, South Africa. Soil, sediment, and water samples were collected at ten different sites along the river during winter and spring seasons. Soil and sediment samples were extracted using ultra sonication with dichloromethane while water samples were liquid-liquid extracted using dichloromethane. All sample extracts were cleaned-up using a multi-layer silica gel column and analyzed with gas chromatography-mass spectrometry. Quality assurance measures were also determined. The percentage recoveries for water were 53-128 for all the PCBs analyzed, while sediment recoveries ranged between 69 and 105%. The highest total concentrations of the PCBs in sediment were 214.21-610.45 ng/g dw at the Du Toit sampling site and 30.86-444.43 ng/g dw basis at the wastewater treatment inlet for winter and spring, respectively. Soil PCB concentrations were 76.53-397.75 ng/g dw at the Msunduzi Town sampling site and 20.84-443.49 ng/g (dry weight) at the Du Toit sampling site for winter and spring, respectively. In addition, high PCB concentrations were found in effluent of the wastewater treatment inlet compared to other sampling sites, which ranged between 0.68-22.37 and 2.53-35.69 ng/mL for winter and spring seasons, respectively. In all the sampling sites selected for this study, Du Toit afforded the highest PCB concentration levels and the lowest was after chlorination at the Darvill wastewater treatment plant. The results presented are new and it is the first study of organic pollutants such as PCBs that has been carried out on this river.
Collapse
Affiliation(s)
- Gbadebo Clement Adeyinka
- School of Chemistry and Physics, College of Agriculture, Engineering and Sciences, University of KwaZulu-Natal, Private Bag X54001, Westville, Durban, 4000, South Africa
| | - Brenda Moodley
- School of Chemistry and Physics, College of Agriculture, Engineering and Sciences, University of KwaZulu-Natal, Private Bag X54001, Westville, Durban, 4000, South Africa.
| | - Grace Birungi
- Chemistry Department, Faculty of Science, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Patrick Ndungu
- School of Chemistry and Physics, College of Agriculture, Engineering and Sciences, University of KwaZulu-Natal, Private Bag X54001, Westville, Durban, 4000, South Africa
- Department of Applied Chemistry, Doornfontein Campus, University of Johannesburg, P.O. Box 17011, Doornfontein, Johannesburg, 2028, South Africa
| |
Collapse
|
44
|
Abstract
BACKGROUND The South African public health sector embarked on a National Telemedicine System implementation program in 1999 and although unsuccessful, the Province of KwaZulu-Natal subsequently implemented teledermatology in 2003, with two currently active services (synchronous and asynchronous). Although sustained these have not been scaled-up to meet the needs of all hospitals in the Province. A recent teledermatology scale-up design requirements elicitation process within KwaZulu-Natal confirmed the need for a framework, and identified requirements through key stakeholders, programme observations, the literature, and experts. This study aimed to identify and characterise existing teledermatology or related eHealth scale-up frameworks, determine whether any met the previously elicited scale-up framework requirements, and were suitable for use in the KwaZulu-Natal public health sector. METHODS A structured literature search was performed of electronic databases (Scopus, Science Direct, IEEE, PubMed, and Google Scholar) seeking proposed or developed teledermatology or related scale-up frameworks. Global public health publications were also hand-searched. The teledermatology or telemedicine, telehealth or eHealth related scale-up frameworks identified were critiqued against the previously elicited teledermatology scale-up framework requirements to determine their suitability for use. RESULTS No specific teledermatology scale-up framework was found. Seven related scale-up frameworks were identified, although none met all the previously identified teledermatology scale-up framework requirements. The identified frameworks were designed for specific scale-up phases and lacked a more holistic and comprehensive approach. CONCLUSIONS There is an evidenced-based need for the development of a health sector aligned, holistic framework that meets the identified teledermatology scale-up framework requirements. The findings of this paper will inform development of such a framework.
Collapse
Affiliation(s)
- Laticha Elizabeth Marolana Walters
- Department of TeleHealth, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Council for Scientific and Industrial Research (CSIR), Meraka Institute, Pretoria, South Africa
| | - Richard Ernest Scott
- Department of TeleHealth, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- NT Consulting - Global e-Health Inc., Calgary, Canada
| | - Maurice Mars
- Department of TeleHealth, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
45
|
Walters LEM, Scott RE, Mars M. A Teledermatology Scale-Up Framework and Roadmap for Sustainable Scaling: Evidence-Based Development. J Med Internet Res 2018; 20:e224. [PMID: 29925492 PMCID: PMC6031901 DOI: 10.2196/jmir.9940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 11/13/2022] Open
Abstract
Background The objectives of South Africa’s electronic health (eHealth) strategy recognize the value proposition that telemedicine practices hold for rural and urban referrals, but a lack of accepted and formalized scale-up has impeded realization of benefits. While both synchronous and asynchronous teledermatology exist, these remain localized and not scaled-up. Skin pathology is often the first sign of an HIV/AIDS infection, which remains a major cause of morbidity and mortality in South Africa. It is essential to replace the current inefficient dermatology referral process with a swift, organized, and efficacious one. Objective The objective of this study is to present an evidenced-based teledermatology scale-up framework (TDSF) and implementation roadmap (TDSF-IR). Methods A qualitative method with a design science research process model was used which consisted of 5 phases: (1) Awareness, which confirmed the need for an evidence-based TDSF and supporting TDSF-IR; (2) Suggestion, where a proposal was delivered on how to develop a TDSF and TDSF-IR; (3) Development, where we identified recommended design requirements and used these to identify and critique existing teledermatology or related scale-up frameworks; (4) Evaluation and validation, where we assessed outputs of the development phase against the design requirements and validated by confirming the veracity of the TDSF and TDSF-IR (validation involved 4 key senior teledermatology stakeholders using a questionnaire with a 5-point Likert scale); and (5) Conclusion, where validation results were used to finalize and communicate the TDSF and TDSF-IR to users. Results The study identified 5 TDSF components: eHealth building blocks, eHealth strategic objectives and budget, scale-up continuum periods, scale-up drivers, and scale-up phases. In addition, 36 subcomponents were identified. Each was further characterized and described to enable design of the final evidence-based TDSF. An implementation roadmap (TDSF-IR) was also prepared as a guide for an implementer with step-by-step instructions for application of the TDSF. For the validation study of the TDSF and supporting TDSF-IR, 4 purposively selected key senior teledermatology management stakeholders were asked if they found it useful as a guide to assist the South African public health system with teledermatology scale-up. The mean (SD) of Likert-scale rating was 4.0 (0.53) where 4=Agree and 33 of 36 responses were either agree or strongly agree. Conclusions This study developed a TDSF and supporting roadmap (TDSF-IR) that are evidence-based. The proposed approach and described tools could be adapted to assist with ensuring scale-up and sustainability for other eHealth practices in other locations.
Collapse
Affiliation(s)
- Laticha Elizabeth Marolana Walters
- Department of TeleHealth, University of KwaZulu-Natal, Durban, South Africa.,Meraka Institute, Council for Scientific and Industrial Research, Pretoria, South Africa
| | - Richard Ernest Scott
- Department of TeleHealth, University of KwaZulu-Natal, Durban, South Africa.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,NT Consulting - Global e-Health Inc, Calgary, AB, Canada
| | - Maurice Mars
- Department of TeleHealth, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
46
|
Sibiya MN, Ngxongo TSP, Beepat SY. The influence of peer mentoring on critical care nursing students' learning outcomes. Int J Workplace Health Manag 2018; 11:130-142. [PMID: 30166994 PMCID: PMC6091654 DOI: 10.1108/ijwhm-01-2018-0003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to explore the influence of peer mentoring on critical care nursing students' learning outcomes in critical care units. Design/methodology/approach A qualitative exploratory research design was used to conduct the study. Ten critical care nursing students were recruited from critical care units in the five private and two public hospitals. Descriptions of their experiences were gained through individual face-to-face interviews. Findings The study reinforces peer mentoring as a vital strategy in helping the critical care nursing students to attain their learning outcomes. However, peer mentoring was not consistent in all hospitals and there were no structured support systems to ensure that peer mentoring was formalized. Making peer mentoring a vital component in the registered nurses core competencies would enable efficiency and guarantee the viability of peer mentoring. Research limitations/implications Mentors for the critical care nursing students were not included in the study. Practical implications The study identified a need for incorporating a formalized mentorship programme into the core competencies of all qualified critical care nurses, the unit mentor to familiarise themselves with the prescribed learning objectives of the critical care nursing student and an allocation of supernumerary time for the critical care nursing student and mentors to allow for formal mentoring responsibilities to take place. Originality/value The study reinforces peer mentoring as a vital strategy in helping the critical care nursing students to attain their learning outcomes and conscietises registered nurses of their responsibility as mentors.
Collapse
|
47
|
Mashamba-Thompson TP, Sartorius B, Drain PK. Operational assessment of point-of-care diagnostics in rural primary healthcare clinics of KwaZulu-Natal, South Africa: a cross-sectional survey. BMC Health Serv Res 2018; 18:380. [PMID: 29843711 PMCID: PMC5975682 DOI: 10.1186/s12913-018-3207-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/15/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) called for new clinical diagnostic for settings with limited access to laboratory services. Access to diagnostic testing may not be uniform in rural settings, which may result in poor access to essential healthcare services. The aim of this study is to determine the availability, current usage, and need for point-of-care (POC) diagnostic tests among rural primary healthcare (PHC) clinics in South Africa's KwaZulu-Natal (KZN) province. METHODS We used the KZN's Department of Health (DoH) clinic classification to identify the 232 rural PHC clinics in KZN, South Africa. We then randomly sampled 100 of 232 rural PHC clinics. Selected health clinics were surveyed between April to August 2015 to obtain clinic-level data for health-worker volume and to determine the accessibility, availability, usage and need for POC tests. Professional healthcare workers responsible for POC testing at each clinic were interviewed to assess the awareness of POC testing. Data were survey weighted and analysed using Stata 13. RESULTS Among 100 rural clinics, the average number of patients seen per week was 2865 ± 2231 (range 374-11,731). The average number of POC tests available and in use was 6.3 (CI: 6.2-6.5) out of a potential of 51 tests. The following POC tests were universally available in all rural clinics: urine total protein, urine leukocytes, urine nitrate, urine pregnancy, HIV antibody and blood glucose test. The average number of desired POC diagnostic tests reported by the clinical staff was estimated at 15 (CI: 13-17) per clinic. The most requested POC tests reported were serum creatinine (37%), CD4 count (37%), cholesterol (32%), tuberculosis (31%), and HIV viral load (23%). CONCLUSION Several POC tests are widely available and in use at rural PHC clinics in South Africa's KZN province. However, healthcare workers have requested additional POC tests to improve detection and management of priority disease conditions. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT02692274.
Collapse
Affiliation(s)
- T P Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor, George Campbell Building, Science Drive, Howard College Campus, Durban, 4001, South Africa.
| | - B Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor, George Campbell Building, Science Drive, Howard College Campus, Durban, 4001, South Africa
| | - P K Drain
- International Clinical Research Center, Department of Global Health, University of Washington, Seattle, USA.,Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, USA.,Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
48
|
Sekwadi PG, Ravhuhali KG, Mosam A, Essel V, Ntshoe GM, Shonhiwa AM, McCarthy K, Mans J, Taylor MB, Page NA, Govender N. Waterborne outbreak of gastroenteritis on the KwaZulu-Natal Coast, South Africa, December 2016/January 2017. Epidemiol Infect 2018; 146:1318-25. [PMID: 29781418 DOI: 10.1017/S095026881800122X] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
An unexpected increase in gastroenteritis cases was reported by healthcare workers on the KwaZulu-Natal Coast, South Africa, January 2017 with >600 cases seen over a 3-week period. A case-control study was conducted to identify the source and risk factors associated with the outbreak so as to recommend control and prevention measures. Record review identified cases and controls and structured-telephonic interviews were conducted to obtain exposure history. Stool specimens were collected from 20 cases along with environmental samples and both screened for enteric pathogens. A total of 126 cases and 62 controls were included in the analysis. The odds of developing gastroenteritis were 6.0 times greater among holiday makers than residents (95% confidence interval (CI) 2.0-17.7). Swimming in the lagoon increased the odds of developing gastroenteritis by 3.3 times (95% CI 1.06-10.38). Lagoon water samples tested positive for norovirus (NoV) GI.6, GII.3 and GII.6, astrovirus and rotavirus. Eleven (55%) stool specimens were positive for NoV with eight genotyped as GI.1 (n = 2), GI.5 (n = 3), GI.6 (n = 2), and GI.7 (n = 1). A reported sewage contamination event impacting the lagoon was the likely source with person-to-person spread perpetuating the outbreak. Restriction to swimming in the lagoon was apparently ineffective at preventing the outbreak, possibly due to inadequate enforcement, communication and signage strategies.
Collapse
|
49
|
Naidoo K, Yende-Zuma N, Augustine S. A retrospective cohort study of body mass index and survival in HIV infected patients with and without TB co-infection. Infect Dis Poverty 2018; 7:35. [PMID: 29690932 PMCID: PMC5937835 DOI: 10.1186/s40249-018-0418-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 04/05/2018] [Indexed: 12/05/2022] Open
Abstract
Background High early morbidity and mortality following antiretroviral therapy (ART) initiation has been a distinguishing feature of ART programmes in resource limited settings (RLS) compared to high-income countries. This study assessed how well body mass index (BMI: kg/m2) correlated with survival among HIV infected patients with and without TB co-infection. Methods We retrospectively evaluated clinical data from 1000 HIV infected patients, among whom 389 were also co-infected with TB, between January 2008 and December 2010, in KwaZulu-Natal, South Africa. Results Among 948 patients eligible for analysis, 15.7% (149/948) were underweight (< 18.50), 55.9% (530/948) had normal BMI (≥18.50–24.90), 18.7% (177/948) were overweight (25.00–29.00) and 9.7% (92/948) were obese (≥30.00). Irrespective of TB status, underweight patients, had significantly higher risk of death compared to those with normal BMI at baseline (aHR = 2.9; 95% CI: 1.5–5.7; P = 0.002). Conclusions Irrespective of TB co-infection, low BMI correlated with mortality in HIV infected patients. Trial registration UKZN Biomedical Research Ethics Committee Reference number E 248/05, 23 September 2005. Electronic supplementary material The online version of this article (10.1186/s40249-018-0418-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor Doris Duke Medical Research Institute, Private Bag X7, Durban, Congella, 4013, South Africa. .,MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor Doris Duke Medical Research Institute, Private Bag X7, Durban, Congella, 4013, South Africa.,MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Stanton Augustine
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor Doris Duke Medical Research Institute, Private Bag X7, Durban, Congella, 4013, South Africa
| |
Collapse
|
50
|
Kabuyaya M, Chimbari MJ, Mukaratirwa S. Infection status and risk factors associated with urinary schistosomiasis among school-going children in the Ndumo area of uMkhanyakude District in KwaZulu-Natal, South Africa two years post-treatment. Int J Infect Dis 2018; 71:100-106. [PMID: 29679769 DOI: 10.1016/j.ijid.2018.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/31/2018] [Accepted: 04/03/2018] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To assess the efficacy of praziquantel in children infected with Schistosoma haematobium over a 2-year period in the Ndumo area of uMkhanyakude District, South Africa. METHODS This cohort study enrolled 173 school-going children in September 2017 who had participated in a baseline survey conducted in 2015 in the Ndumo area. Questionnaire interviews were conducted to collect information on the risk factors related to the transmission of schistosomiasis. The filtration technique was performed to detect Schistosoma haematobium eggs in urine. Infection intensity was classified as light or heavy. The Chi-square test was used to assess the associations between variables at the 95% confidence level, and p=0.05 was considered significant. RESULTS Of the 173 participants screened 2 years post-treatment, 10 were infected. Six of these were new infection cases, while four were cases of re-infection. The intensity of infection had decreased significantly (p=0.001) at the time of the follow-up survey compared to the baseline survey. However, no significant difference was found among the risk factors for schistosomiasis 2 years later. CONCLUSIONS The prevalence of S. haematobium had decreased significantly in the cohort at 2 years post praziquantel treatment, during a period of persistent drought in the area. Risk factors that were significantly associated with schistosomiasis at baseline were no longer significantly associated at 2 years following treatment.
Collapse
Affiliation(s)
- Muhubiri Kabuyaya
- Discipline of Public Health Medicine, University of KwaZulu-Natal, P.O. Box Durban, 4041, Durban, South Africa.
| | - Moses John Chimbari
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Samson Mukaratirwa
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa.
| |
Collapse
|