School of Health Sciences

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Access to healthcare : investigating the barriers to accessing antiretroviral treatment at a public sector antiretroviral clinic in Durban, South Africa.
(2013) Kriel, Yolandie.; De la Porte, Susan.; Magula, Nombulelo Princess.
South Africa has the largest HIV/AIDS epidemic in the world and due to the rapid scale up of access to antiretroviral drugs now has the largest antiretroviral program in the world. However access to antiretroviral treatment remains a challenge and the scale up of the drug programs has caused an additional burden on an already stretched and stressed public healthcare sector. At present there are only two lines of drug regimens available to the general public that rely on the public healthcare sector for the supply of their antiretroviral drugs. Resistance to the current regimens is a major concern that is not effectively being addressed. One of the major aspects that can contribute to a rise in resistance is barriers to continually accessing antiretroviral treatment. This ethnographic investigation into the barriers to accessing antiretroviral treatment was conducted in a public health sector clinic based at a large hospital in Durban. The specific objectives of the study were to elucidate the major barriers to accessing the treatment as perceived by the patients of the clinic, to understand the structural drivers behind the barriers and to capture the patients’ reactions to these obstacles that they face on a continuous basis. Unlike most studies that focuses only on adherence this study’s focus was rather on the concept of access to healthcare and how barriers perceived by the patients influence their ability to effectively access their treatment. Thus the concept of access to healthcare is explored in detail and an argument is made for the importance of understanding and applying the holistic concept of access to healthcare within the ART setting. An ethnographic approach was adopted to conduct this study, and the study utilized a triangulation of data collection techniques including participant observation, in-depth interviews, focus groups and a questionnaire. The research was done over a period of seven months and focused on adults who were already part of a regimen for a period of at least one year. Antiretroviral treatment regimens are for life and once people start with these regimens they cannot stop. However this study found that a range of barriers exist that present obstacles for patients to continually access ART drugs. Structural violence theory provided the framework for contextualizing the specific barriers that were reported and is important in terms of situating the barriers within the larger structures that create them. What is evident is that poor healthcare related policies, stigma, discrimination, economic inequality, gender and poverty are the structural drivers behind barriers to accessing ART. By incorporating a broader understanding of access to healthcare a deeper understanding of the barriers is gained and better interventions can be created to prevent disengagement from life-long ART services.
Accessing antiretroviral treatment in the rural Eastern Cape : patients' perceptions of a decentralised pre-packing model of care and the impact on direct out-of-pocket spending.
Lines, Monique.; Suleman, Fatima.
Background: With an estimated 5.51 million HIV infected South Africans, HIV/AIDS contributes significantly to the burden of disease in the country, with far-reaching socio-economic implications particularly for poor and vulnerable groups. High out-of-pocket health expenditure associated with HIV/AIDS care has a serious impact on vulnerable individuals and is likely to severely affect the wellbeing of the affected household. Geographic inaccessibility of centralised, hospital-based antiretroviral treatment (ART) services and excessive transportation costs may contribute to patient attrition and these barriers are exacerbated in rural populations. Aim: The objectives of this study are to ascertain the out-of-pocket expenses that are incurred by patients travelling to their ART down-referral site, and compare this with the out-of-pocket expenses of those patients from the same catchment area still receiving their ART from the central hospital. The study also aims to determine whether or not the down-referral programme has impacted the patients’ economic status and improved their treatment experience. Methods: A semi-quantitative cross sectional study design was employed. Zithulele Hospital ARV Clinic and five different PHC collection points within the hospital’s catchment area were selected as the study sites. Included in the study were 44 hospital-based patients and 73 clinic-based patients registered on the Zithulele Hospital HIV Programme. Using a standard questionnaire, all socio-economic data and information related to mode of transportation and associated costs, as well as other out-of-pocket spending associated with accessing ART, was collected. Clinical data was recorded from patient medical records during the interview. Results: The average monthly household income was R1653 (R301.05 per capita) for hospital-based patients and R1617 (R392.66 per capita) for clinic-based patients. Income was predominantly sourced from either child support or pension grants. Study participants had an overall unemployment rate of 94% and, subsequently, 75% of hospital-based patients and 68.5% of clinic-based patients were living below the food poverty line of R400 per month. A higher proportion of hospital-based patients used taxis (80.5% versus 28.8%) while more clinic-based patients walked to the facility for their treatment (71.2% versus 14.6%). In terms of monthly transport costs, hospital-based patients spent on average R71.92, significantly more than the R25.81 spent by clinic-based patients. With a point estimate of 1.169, regression analysis indicated that for every one Rand increase on transport, the odds of the patient being hospital-based rather than clinic-based are 16.9% higher. There were higher levels of satisfaction recorded amongst the hospital-based group (95.5% compared to 89%) but despite this, 100% of the clinic-based patients listed their respective clinic as their preferred ART collection point. Conclusion: Decentralisation and down-referral of patients to their nearest primary healthcare clinic minimises out-of-pocket spending in rural communities while maintaining good levels of satisfaction with the healthcare service provided. It is important to consider the social, geographical and cultural context of the individuals seeking and utilizing healthcare before interventions are implemented.
Acute care in occupational therapy a package of care and the essential therapeutic equipment needed.
(2017) Chetty, Angela.; Tsoka.Gwegwen, Joyce.
ABSTRACT Introduction: Occupational therapy, together other clinical services are required by government to describe and outline their services so that minimum standards can be set, to ensure that quality care is delivered to all who use the public health service in South Africa. In KZN, where this study is focused, the vast majority of health institutions deliver acute care services at either a district, regional or tertiary level. Aligning therapeutic services to appropriate clinical service at each level will have an impact on optimal health care. Aim: This study focused on developing a package of services for occupational therapy in acute care and outlining an essential therapeutic equipment list. Methodology: A mixed methods explorative sequential study with three phases was implemented. The first phase focused on a documentation audit to determine the context, background and any relevant information on the topic. Approximately 13 documents were selected to conduct a thematic analysis and extract pertinent information to answer the research question. The second phase consisted of implementing a survey in KZN with all eligible occupational therapists to determine their opinions on existing information and generate new ideas. This survey was constructed utilizing information from the document analysis. The final phase ensured that consensus was drawn on a package of occupational therapy services and equipment list by conducting a focus group utilizing the nominal group technique. Senior experienced occupational therapists that worked in acute care constituted the expert group. Results: The documentation audit yielded a rich description of information which set the background on the survey questionnaire. A 78 % response from the survey ensured that the senior experts on the nominal focus group were well informed xii when drawing consensus on a final package of occupational therapy in acute care and the essential therapeutic equipment and assessments needed. Conclusion: This study will provide therapists with a baseline standard of care for acute care hospitals and assist them with motivating for appropriate cost effective resources to deliver effective services in KZN.
Acute stress and strain due to backpack loading among primary school pupils.
(2011) Abrahams, Sumaya.; Ellapen, Terry Jeremy.; Van Heerden, H. J.
Schoolbag carriage represents a considerable daily occupational load for children (Negrini et al., 1999). Whittfield et al., (2001) and Puckree et al., (2004) have reported that the carriage of heavy schoolbags is a suspected aetiological factor of the daily physical stress of school pupils. Methods: One hundred and eighty-seven pupils voluntarily participated in a controlled, descriptive, epidemiological retrospective study. Subjects’ biographical, epidemiological, exercise history and lifestyle information was gathered by a self-report questionnaire (adapted from Puckree et al., 2004). Subjects’ body mass, stature and mass of their schoolbags were measured using a Detecto stadiometer scale. Digital images, electromyographical muscular activity and a posture profile assessments were captured in the frontal and sagittal planes whilst the pupils were in the loaded (carrying a schoolbag) and the unloaded phases (not carrying schoolbags). These images were analyzed using biomechanical software, Dartfish. The study being retrospective in nature recorded the prevalence of schoolbag carriage musculoskeletal pain over the last 12 months. Descriptive statistical tests such as mean, mode, frequency, percentages and inferential chi-square statistical test (set at a probability of 0.05) were employed to analyze the data. Results: The result indicated that 78.99% of the cohort experience musculoskeletal pain due to schoolbag carriage (p<0.0001). The most prevalent anatomical sites of pain were the shoulders (37.04%), neck (20.37%), lumbar (11.73%) and thorax (10.49%) (p<0.0001). The mean mass of the schoolbag carried by the cohort was 5.45kg which was approximately 11.5% of their body mass. The predisposing factors of the musculoskeletal pain were the methods employed to carry the schoolbag (single strap (20.21%) versus double straps (76.6%), altered posture due to excessive schoolbag mass together with a reduced craniovertebral angle (p<0.05). Discussion & Conclusion: The excessive schoolbag mass carried by the pupils placed strain on the immature vertebral column of these pupils thus causing postural deviations which induced musculoskeletal pain and discomfort.
Addressing spirituality in group therapy : a qualitative study at a shelter for abused and vulnerable Muslim women in Durban, South African.
(2016) Soomar, Nazeemah.; Crouch, Rosemary B.
Spirituality has gained recognition as a vital factor in mental healthcare, and has been applied to major occupational therapy models. However, its clinical application is limited universally, to the possible detriment of patients. This phenomenological study aimed to explore the experiences of abused and vulnerable Muslim women on addressing spirituality in occupational therapy groupwork, including understanding a definition of spirituality, and avenues to address spirituality. An inpatient Women's centre with a spiritual ethos was identified, where patients were exposed to a series of occupational therapy groups including concepts of spirituality. Semi-structured individual interviews were conducted on 7 purposively selected participants, and followed by thematic analysis. The findings reflected through the emergence of 4 themes that addressing spirituality conforms with client-centeredness, and enhanced a sense of meaning and purpose for the participants. Strength and motivation was drawn from applying spiritual concepts in group therapy sessions, ultimately facilitating better coping and empowerment, which reflected in their daily occupation. Implications of this study extend to curriculum development, treatment and service delivery, and health promotion.
Adenosine monophosphate-activated protein kinase as a potential target for synthetic chalco-naringenin analogs and putative therapeutic applications.
(2017) Nyane, Ntsoaki Anna.; Bangalee, Varsha.
Introduction: Diabetes mellitus is a multifactorial chronic metabolic disorder that is characterized by defects in endogenous insulin secretion or action, or both, resulting in chronic hyperglycemia, a clinical hallmark of diabetes. Metformin is currently the first-line drug of choice for the treatment of type 2 diabetes (T2D), being prescribed to at least 120 million people worldwide. It exerts its antidiabetic effects by reducing hepatic glucose production and increased peripheral glucose utilization through activation of AMP-activated protein kinase (AMPK). However, despite significant gains with metformin as a monotherapy in T2D, some patients experience gastrointestinal disturbances and lactic acidosis although the latter is very rare. Moreover, some patients still fail to achieve optimum glycemic control when treated on metformin only. Naringenin, a flavonoid exerts its antidiabetic effects by inhibition of gluconeogenesis through upregulation of AMPK, hence metformin-like effects. Because of these similar pharmacological effects between naringenin and metformin, our laboratory synthesized analogs of chalco-naringenin compounds which could be more permeable to the plasma membrane and hence putatively increased pharmacological effects. Aims: To identify AMPK as a potential target of synthetic chalco-naringenin analogs and putative therapeutic applications. Methods: A novel series of 4-[(cyclopropylcarbonyl)amino] chalco-naringenin analogs, compound 5a to 5k, were synthesized and characterized by IR, 1H-NMR and 13C-NMR. In silico screening of the compounds was conducted to evaluate potential antidiabetic activity of the novel chalco-naringenin series. Compounds 2-chlorophenyl (5b) and 5k (2,3-dimethoxyphenyl) had highest binding affinity to AMPK hence were chosen for a study. C2C12 and Chang cells were cultured in dulbecco's modified eagle medium (DMEM) and eagle's minimum essential medium (EMEM) media, respectively, allowed to grow to 80% confluence, and then exposed to different concentrations. MTT assay was used to determine cell viability and chalcones were subjected for 12, 24 and 48 hours at concentrations (10-750 μM). Cells were exposed to metformin (2-10 mM), naringenin (50-500 μM) and chalcones (10-500 μM) for 48 hours and further subjected to phospho-AMPKα (Thr172) sandwich ELISA Kit to determine phosphorylation of AMPK. To measure the amount of glycogen in cells after exposure to metformin, naringenin and chalcones for 48 hours, cells were harvested (1x106 per mL) and the glycogen assay performed according to Seifter et al. (1950). Results: A chalcone series of eleven compounds were successfully synthesized using the Claisen-Schmidt reaction. The absorbance values and peaks observed on the IR spectra confirmed the different functional groups observed on the compounds. The synthesized compounds were also characterized through 13C-NMR and 1H-NMR spectroscopy. The 13C-NMR spectras indicated the presence of the CH2 group of the cyclopropylcarbonyl amide and there were certain distinct peaks on the spectras that identify carbon atoms found on the compounds. In 1H-NMR, the chemical shift for all the CH2 groups on the cycloalkane resonated around δ 1,16 – 0,80 ppm as multiplets, while the other CH multiplet resonated around δ 1,62 – 1,58 ppm. Docking scores of the chalco-naringenin series suggested a good binding affinity of these compounds to AMPK, with compound 5b showing the highest binding affinity to AMPK. Cell viability as determined by 3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide (MTT) assays were found to be dose-dependent for all compounds and compound 5k exerted reduced cell viability as compared to 5b. Furthermore, compound 5b presented with higher IC50 values compared to 5k. The effects of chalcones on AMPK phosphorylation were potentiated by co-treatment with metformin or naringenin. Metformin, naringenin and chalcone 5b significantly reduced synthesis of glycogen as compared to control (p < 0.05). Conclusions: Chalco-naringenin analogs showed potential in expression of AMPK through computational chemistry, however in the in vitro model the effects of chalcones on AMPK were potentiated by metformin and naringenin. The chalcones could further be explored for their potential on AMPK activity on primary hepatocytes and/ or in vivo studies.
Adherence to ARVs in a rural paediatric cohort.
(2015) Smith, Chanelle.; Gengiah, Tanuja Narayansamy.
Abstract available in PDF file.
Adverse drug reactions associated with antiretroviral therapy in South Africa.
(2016) Birbal, Sumeshni.; Oosthuizen, Frasia.; Ojewole, Elizabeth Bolanle.
Abstract available in PDF file.
An analysis of methods used by African Traditional Health practitioners to treat oral health conditions in Johannesburg, Gauteng.
(2020) Modisha, Mangoedi Kinder Ingridh.; Muslim, Tufayl Ahmed.; Muslim, Tufayl Ahmed.
Background African traditional medicine is widely used in South Africa. African traditional health practitioners treat patients who present with a variety of medical conditions, including oral health conditions. The aim of this study was to determine the knowledge, and practices of African traditional health practitioners regarding oral health conditions. Materials and Methods A cross-sectional survey of 11 African traditional health practitioners who consented to be interviewed in the Johannesburg area was recruited to participate in a structured questionnaire survey, followed by focus group interviews with 10 practitioners. Ethical approval was obtained from the Biomedical Research Ethics Committee (BREC ref. no 451/19). Following the collection of data from the questionnaire administration, a focus group interview was conducted. Data on the knowledge, treatment practices, and post-treatment management of four common oral conditions was collected and analysed. Results Eleven participants who consented to be interviewed, their average age was 44.1 (±8.1) years, with a range of 21-67 years, and a slight majority of female (55.5%, n=6). Ten further participants took part in focus group interviews. African traditional health practitioners were asked a series of questions, in non-dental terminology or language, related to their knowledge (causes); practise (what do you use to treat?, What advise do you give to the patient?); of four common oral health conditions. These are: sores on the lips, sores on the tongue, swollen gums and toothache. Participants reported using a variety of practices such as throwing bones, burning incense, using plants and animal product, as well as commercially manufactured products to treat and manage patients. Conclusion The results of the study reveal that there are vast differences in knowledge, management practices and treatment modalities of African traditional healthcare practitioners. Further research in the knowledge, practises and treatment of oral healthcare practitioners needs to be conducted. Mutual cooperation, collaboration and integrating African traditional health practitioners into primary oral healthcare services need to be urgently prioritised.
An analysis of perceived leadership styles and levels of job satisfaction of sport administrators employed at tertiary institutions in South Africa.
(2007) Naidoo, Padmini.; Coopoo, Yoganathan.
The leadership role of sport administrators in South Africa is of prime importance as the local sports industry in South Africa is worth in excess of R2 billion annually. The most important variable in explaining sport administrators' success becomes leadership style. Sport administrators' roles are vital to the sporting industry and therefore the degree of job satisfaction they experience is of prime importance. The key objectives of the study were to determine the different styles of leadership available in sport administration departments, to identify factors affecting the progress and status of transformation in sport administration departments, to examine the factors affecting the progress of gender equity at tertiary institutions, to identify factors which influence job satisfaction or lack of it among sport administrators and coaches employed at tertiary institutions and to determine the organizational effectiveness of tertiary institution sport departments. The questionnaire was administered to 300 coaches who had to rate their sport administrators' leadership style and 140 sport administrators. A response rate of 78% (n=109) was obtained from sport administrators and 76% (n=227) were received from coaches. The data were analysed using the computer package SPSS. From the research the following conclusions can be drawn with respect to job satisfaction and leadership among sport administrators and coaches. The overall majority of the tertiary institution sport administrators adopted a transformational style of leadership. There was a lack of transformation in the industry and gender equity in the industry. There were reasonable de grees of satisfaction in the profession, however certain variables were more pronounced than others. The study proposed the following recommendations: Those sport administrators that are still practising a more transactional and laissez-faire approach to leadership should start adopting a more transformational approach to leadership. More females need to be placed in leadership positions at tertiary institution sport departments. With regard to transformation higher management at tertiary institutions should strive to create diversity by employing individuals from other race groups to ensure transformation at institutions of higher learning. This will also serve to rectify the imbalances of our past. Management at tertiary institutions should also strike a balance with regard to gender equity. With regard to improving coaches and sport administrators' job satisfaction higher management needs to adopt a policy of open communication between staff employed at the tertiary institution sport departments and themselves.
Analysis of viral inhibitory activity of cytotoxic T. Lymphocytes targeting identical epitopes restricted by different class 1 HLA alleles from the same HLA supertype.
(2015) Ogunshola, Funsho Japhet.; Ndhlovu, Zaza Mtine.; Ndung'u, Peter Thumbi.
Human leukocyte antigen (HLA) polymorphism and the genetic diversity of human immunodeficiency virus (HIV) are the major obstacles for designing an effective HIV Cytotoxic T Lymphocytes (CTLs) based vaccine. Interestingly, recent studies have demonstrated that multiple class I alleles can recognize common epitopes “supertopes” due to the homology of amino acids within the major binding pockets of the peptide binding cleft. The implications of this for vaccine design is that a vaccine containing a small number of highly promiscuous supertopes can confer protection against a wide range of HIV variants. This notion makes supertopes immunogen design an attractive option. However, it is not clear whether supertopes presented in the context of different class I HLA alleles would induce functional equivalent CTL responses. In this study, we investigated the inhibitory activity of CTLs targeting identical epitopes presented by class I HLA alleles from the same superfamily. The viral inhibitory activity was measured using a newly developed CEM-GFP reporter T-cell line (GXR-cell) as target cell. We first compared the inhibitory activity of CTLs from 8 subjects targeting TPQDLNTML (Gag p24 residue 180-188-TL9) epitope presented by HLA-B*81:01 or B*42:01 alleles. We then assessed the inhibitory activity of the 8 subjects’ CTLs when presented with in-vivo occurring mutant (Q182S)-TL9 epitope by HLA-B*81:01 or B*42:01 alleles. Furthermore, we compared the inhibitory activity of CTLs from 4 subjects targeting ISPRTLNAW (Gag p24 residue 147-155-IW9) epitope presented by HLA-B*57:03 or B*58:01 alleles. Comparative analysis of the inhibitory activity of the 8 subjects’ CTLs showed no statistical significant difference when TL9 epitope was presented by HLA-B*81:01 or B*42:01 alleles (1:1; p-value = 0.8785, paired t test), even at low target to effector ratio (1:8; p-value = 0.4418). No statistical significant difference was observed in the inhibitory activity of the 8 subjects’ CTLs when mutant (Q182S)-TL9 epitope was presented by HLA-B*81:01 or B*42:01 alleles (1:1; p-value = 0.8042), same result was observed at low target to effector ratio (1:8; p-value = 0.9396). Comparative analysis of the inhibitory activity of the 4 subjects’ CTLs targeting identical IW9 epitopes presented by HLA-B*57:03 or B*58:01 alleles showed a trend towards significance at target to effector ratio 1:1 (1:1; p-value = 0.0924), but at low target to effector ratio, no significance difference was observed (1:8; p-value = 0.1496). In conclusion, we have demonstrated that there is no observable significant difference in the inhibitory activity of CTLs targeting wildtype TL9 or mutant (Q182S)-TL9 epitopes presented in the context of HLA-B*81:01 or B*42:01 alleles. Thus, TL9 epitope could be immunogenic for individuals expressing HLA-B*81:01 or B*42:01 alleles. We have also shown that the inhibitory activity of CTLs targeting identical IW9 epitopes presented by HLAB* 57:03 or B*58:01 alleles is comparable. Indicating that IW9 epitope could be included in immunogen design for individuals expressing HLA-B*57:03 or B*58:01 alleles. These findings are relevant for HIV vaccine approach that seeks to identify immunogenic supertopes that can be cross-presented in a broadly cross-reactive T cell based vaccine design.
An analytical study investigating noise levels in neonatal intensive care units within the public sector in the eThekwini district.
(2018) Ismail, Sabah.; Panday, Seema.
Noise is a well-documented environmental stressor in the NICU and has emerged as a public health problem. The aim of this study was to investigate noise levels and identify contributing factors to the high noise levels, in NICUs within the public sector in the eThekwini District. The study used an analytical observational research design and a purposive sampling method. Noise measurements were conducted in four hospitals with the sound level meter (CEL 450 C) placed in the centre of each NICU for 48 hours on two consecutive days of the week (Sunday and Monday). A sample of sources of noise and their frequency of occurrence were identified through direct observation in the morning, as well as a frequency analysis using one-third octave bands were conducted. Mean LAeqs were above 45dBA in all hospitals and a marginal difference between LAeqs during the morning, afternoon and night was seen in hospital D (p=0,046). A significant difference between LAeqs on Sunday and Monday was found in hospital C (p=0,028). The majority of the sources of noise were from alarms of devices and human-related noise, with the most frequently occurring sources of noise being staff conversations (30.9%), alarms (21,0%) and closing of metal pedal bins (20,0%). Multiple high frequency alarms increased the LAeq to 74,6dBA and dropping a metal object increased the LZpeak to 116,0dBA. LAeqs higher than 45dBA were seen in the mid and high frequencies (250Hz-6300Hz) specifically during the afternoon in all hospitals. The findings have implications for education and training, as well as for the development of practice and policy guidelines in NICUs.
Annual costs incurred on managing adverse drug reactions attributable to fixed-dose combination Highly Active Anti-Retroviral Therapy (HAART) in an outpatient ARV clinic in Gauteng.
(2020) Chikeya, Grace.; Bangalee, Varsha.; Oosthuizen, Frasia.
Objective The aim of the study is to identify adverse drug reactions attributable to tenofovir- and zidovudine-based fixed-dose combinations of highly active anti-retroviral therapy and, subsequently, to determine the annual costs incurred managing these adverse drug reactions and the budget implications of these costs at an outpatient anti-retroviral clinic in Mamelodi, Pretoria. Methods This retrospective cohort study reviewed de-identified clinical data for adverse drug reactions. The study was carried out at Stanza Bopape ARV Clinic in Mamelodi, Pretoria. De-identified medical charts of HIV-positive patients were analysed for clinical information and laboratory data of adult patients who started on HAART between July 2017 and June 2018. Data collection commenced in October 2018. Based on the costs and the incidence rates of adverse drug reactions observed in the analysis, a decision tree model was established to estimate the cost impact of adverse drug reaction management on the clinic¶s budget. Results A total of 469 patient files were analysed (62% female vs 38% male). The mean age at the start of anti-retroviral therapy for the cohort was 36.6yrs (95% CI 35.74-37.45) and the mean baseline CD4 count was 380 (95% CI 343-418). Incidence of adverse drug reactions to tenofovir- or zidovudine-based fixed-dose combinations of anti-retroviral therapy was found to be 24.95%. The ADRs reported with the use of TDF and AZT based HAART regimens were rash (n=45, 27%), decreased glomerular filtration rate (n=34, 21%), trouble sleeping (n=39, 21%), severe diarrhoea (n=19, 12%), nausea and vomitting (n=18, 11%), decreased heamoglobin or anaemia (n=4, 2%), headaches (n=4, 2%), dizziness (n=2, 5.3%). The study revealed that ZAR427.30 was the cost attributed to adverse drug reactions due to tenofovir-based regimens whilst ZAR467.94 was the cost attributed to adverse drug reactions due to zidovudine-based regimens, per patient, annually. Costs attributed to gastro-intestinal related adverse drug reactions were the highest in comparison to other adverse drug reactions. Estimated total cost of adverse drug reactions attributed to zidovudine-based therapy was ZAR8003.98 (US$556.40) and estimated total cost of adverse drug reactions attributed to tenofovir-based anti-retroviral therapy per annum was ZAR33 788, 23 (US$2348.80) for 1221patients initiated on antiretroviral therapy between July 2017 and June 2018. Conclusion Despite our estimated costs to the clinic, due to adverse drug reactions, being lower than similar studies, there remains a notable budget impact on a resource-limited setting.These estimates will allow for cost due to adverse drug reactions caused by tenofovir- and zidovudine-based anti-retroviral therapy to be accounted for in budgets at the antiretroviral clinic.
Anthropometric characteristics and physiological performance variables of male and female junior hockey players in KwaZulu Natal.
(1997) Amra, Mohamed.
Anthropometric measures, physiological variables and skills tests were performed on subjects selected from the provincial KwaZulu Natai Junior Hockey teams in South Africa. The main purpose of this study was to establish a data base of norms for boy and girls in the UB, U14, U16, UI8 and the U2I age groups. The tests were done at the beginning and at the end of season. The anthropometric measures included height, weight, percentage body fat and lean body mass; physiological variables included sit-ups, push-ups, sit-and-reach (flexibility), broad jump, winder and bleep tests , and the skills tests comprised a wide range of ball skill tests. As expected, anthropometric changes were observed across the age groups, due to growth. Amongst the older age groups the girls had reached height and weight values comparable to elite female players , but only the boys in the U2I had reached their adult height and were slightly taller than the elite male players. There was no significant difference in the profile between the attack and defence players in the boys, but amongst the girls the defence players tended to be heavier and taller than the attack players. In the physiological and skills tests there was no difference between positional players. In the comparison between pre and end season to determine the effectiveness of the training programmes, there was a change in the anthropometric characteristics because of growth. However, the physiological and skill tests revealed no consistent pattern of improvement in the test results from pre season to end season. This study provides the first set of norms for male and female junior hockey players in South Africa. Further studies are required to expand upon and update the data in the current study.
Anthropometric characteristics, grip strength and physical activity levels of children with physical disabilities: a case study.
(2020) Dorfling, Micaela Ashley.; Naidoo, Rowena.; Chetty, Verusia.
Physical disability impedes the completion of daily functioning and tasks in children with disability often resulting in exclusion from participating in physical activity. The problem is that a lack of physical activity results in a higher risk of non-communicable lifestyle diseases, to which an individual with physical disability is already predisposed. The participation of children with disability in sports and recreational activities promotes inclusion, minimises deconditioning, optimises physical functioning, and enhances overall well-being. Despite these benefits, children with disability are more restricted in their participation, have lower levels of fitness, and have higher levels of obesity than their peers without disabilities. Therefore, the screening and monitoring of children using simple health indicators such as anthropometry, physical activity levels and grip strength is essential to identify children who may be at risk for chronic diseases, for those who can improve their quality of life through changes in their lifestyle; and it can help raise awareness of the need to increase their participation in physical activity. Often physical activity is underestimated for children with disability, well-informed decisions with regards to types and best suited physical activity programmes are more easily formulated following identification of overall health status and individual activity preferences, such as through measurement of physical activity levels, anthropometric characteristics and hand grip strength.
Anthropometric profile and physical performance of youth players and challenges in the Ethiopian football talent identification program.
(2018) Gebreegziabher, Eyasu Merhatsidk.; Van Heerden, Jaques Johan.
The purpose of this study was to investigate the existing challenges that hinder the implementation of the talent identification program. Understand and develop basic standards to recruit talented young players based on their anthropometric and physical quality also the purpose of this study. Other purpose of the study was formulated and implement effective strategies for the coaching program. The study employed a cross-sectional study design. A homogenous group of 240 male Ethiopian football players (Age 15.6 ± 1.8 years) from 12 teams participated in this study. Sixty-one football coaches and 61 sport administrators also participated. Anthropometric assessment, speed, power, agility, endurance and flexibility tests were conducted. The data was analysed using descriptive and inferential analysis techniques. The mean and the standard deviation of results across an anthropometric profile for all players are as follows: body mass weight was 55.47kg (6.14), standing height was 1.7m (0.06), body mass index was 19.12kg/m2 (1.99), sub-scapular skinfold was 6.88mm (1.37), triceps skinfold was 5.95mm (1.51), BF(Body Fat) % was 15.53% (2.91) and LBM(Lean Body Mass) was 46.82kg (5.11). Significant weight and height differences (p≤0.05) were found between club and academy players, but not in BMI, % BF and Lean Body Mass (LBM). club players had significantly greater body mass than EFF and academy players (p≤0.05). For standing height, club and EFF players were significantly taller than players in the academy teams (p≤0.05). The mean and the standard deviation of overall fitness values for all players were as follows: 10m speed was 2.15sec (0.19), 20m speed was 3.51sec (0.29), 40m speed was 5.16sec (0.31), sit and reach flexibility was 12.94cm (7.86), vertical jump power test was 42.93cm (6.58), Illinois agility test was 17.45cm (0.83) and V̇O2 max 49.74ml/kg/min (5.42). Mean values per setting from club, academy and EFF, respectively were: 10m speed 2.08sec, 2.26s and 2.14sec (p≤0.0001); 20m speed 3.4sec, 3.7sec and 3.49sec (p≤0.0001); 40m speed 5.87sec, 5.9sec, 6.07sec (p≤0.0001). Flexibility was 11.96cm, 11.31cm and 14.96cm (p≤0.05). Club’s youth players were taller, heavier, faster and more flexible than academy and Ethiopian football federation players. Significant differences were found in age groups: 10m speed between U-14 and U-15 (p≤0.01) and U-14 and U-17 (p≤0.05), In 20m speed between U-14 group and U-16 (p≤0.01) and U-14 and U-17 (p≤0.01). Significant iv differences were also found in 40m speed between U-14 and U-15 (p≤0.05). Older age players were faster than younger ones. Anthropometrical profiles and physical performance tests may assist to identify the talented players in the country. Significant differences found per climatic altitudes and geographical locations were as follows: high altitude players’ significantly greater body mass than low altitude players (p≤0.05). Low altitude players significantly better BMI than high altitude players (p≤0.0001). For LBM, high altitude players significantly greater results than low and moderate altitude players (p≤0.005). The moderate altitude group of players performed better results than the low and high-altitudes group of players. Eastern and northern players were significantly heavier than southern and western players. Compared to southern players, Eastern and northern players were significantly taller than southern and western players. Although players from eastern, performed better in the 10m speed test than western players. Regarding the 20m speed test, eastern players performed better results than the rest three altitudes groups. A correlation matrix comparing anthropometry and physical performance indicated that: BMI was negatively related with 10m sprint (r = 0.134), 40m sprint (r = 0.232), vertical jump (r = 0.108) and agility (r = 0.123). Height was negatively related to performance in the 20m sprint (r = 0.141), 40m sprint (r = 0.201) and agility (r = 0.255). Quantitative questionnaire data related to the practice of talent identification programs in Ethiopia showed that: Most of the players (62%) have information and knowledge about a talent identification program. Most players (74%) have also experienced or passed through a talent identification program. The same was true of most players (74%) being of the opinion that they were exposed to a proper training program. Player’s knowledge and experiences; with respect to rest, water, materials and playing fields; family and coach support and test batteries found statistically significant differences (p≤0.0001) between club, academy and Ethiopian football federation settings. For the questionnaires about knowledge and experiences of coaches in the talent identification program, no statistically significant differences were found among club, academy or Ethiopian football federation settings, whereas significant differences were found with respect to experiences on upgrading of coaching knowledge related to talent v identification, in academy and Ethiopian football federation (p≤0.05) TIP (Talent Identification Program) settings. For the questionnaires related to problems and solutions of talent identification program, statistically significant differences in opinion were found among club, academy and Ethiopian football federation settings, but opinions about incorporation of talent identification programs in training courses were not significantly different. In terms of setting up programs to evaluate the level of performances of the players, not all settings were in the affirmative. For the implementation or application of talent identification programs, statistically significant differences in opinion were found across club, academy and Ethiopian football federation (p≤0.0001) settings. However, no differences were found fin terms of using a manual to identify player’s talent. For the questions about availability of materials and equipment for the TIP (Talent Identification Program) statistically significant differences in opinion were found among coaches in clubs and the Ethiopian football federation, while only those in the Ethiopian football federation TIP felt that testing materials are appropriate. For all questionnaires about administrators’ knowledge and experiences of talent identification, statistically significant differences were found in all groups. Questions on knowledge about TIP and facilitating refreshment courses for the coaches on talent identification were not statistically difference. For the questions about problems and solutions for the talent identification program, opinions varied statistically whereas opinions regarding their team’s conducting talent identification program and motivation of the players were similar. For the questionnaires about implementation responsibility of talent identification programs, statistically significant differences were found among the club, academy and Ethiopian football federation settings. For the questionnaires about manpower and materials for the talent identification program, statistically significant opinions were found among all the club, academy and Ethiopian football federation TID settings. For open-ended questions, all responses were investigated by using the detective qualitative data computer software package (NVIVO). The themes identified focussed on problems, solutions and suggestions for the operation of the Ethiopian football talent identification program. Under the three themes, focus nodes were identified as being the vi system, knowledge and experience, hard-work, training, monitoring and support, manpower, while facilities and equipment were also mentioned. The football talent identification program in Ethiopia is not an optimally functioning system. The improvement of the system is the first essential element for the talent identification program. This research has shown the need for a new systematic structure to be established for the talent identification program. Scarcity of knowledge and experience, also affects the talent identification program. Education and training were offered as keys to a solution.
Anti-diabetic and anti-dyslipidaemic effects of grapefruit juice.
Ngubane, Sanelisiwe Precious.; Owira, Peter Mark Oroma.
Background Hypoglycaemic effects of grapefruit juice in diabetic rats have been previously reported. The mechanisms by which grapefruit juice lowers blood glucose are not known. This study aimed to investigate the hypoglycaemic and anti-dyslipidaemic effects of grapefruit juice, as well as to elucidate the possible mechanism/s of action of this juice. Materials and Methods Male Wistar Rats (Rattusnovergicus) of 200-300 g body weight (BW) were randomly divided into five groups (n=6). Animals in group 1 were treated with 3.0 ml/kg of water for 60 days, by oral gavage. Groups 2, 4 and 5 were rendered diabetic by a single intraperitoneal injection of 60 mg/kg BW of streptozotocin. Group 5 was further treated with 4.0 U/kg of insulin (subcutaneously, twice daily), while groups 3 and 4 were orally treated with 3.0 ml/kg of GFJ. Fasting blood glucose and glucose tolerance tests were done in all the groups. Plasma insulin levels were also measured. Hepatic glycogen content, glucokinase and glucose-6-phosphatase (G6Pase) activities were measured in homogenised liver tissues. Plasma lipid levels were measured and hepatic enzymes (Acetyl-Coenzyme Aacetyl Transferase (ACAT) and 3-Hydroxy-3-Methyl-Glutaryl-CoA (HMG-CoA reductase) expression was determined. Results Diabetic rats showed significantly reduced weight gain, but higher water consumption in comparison to the controls. Fasting blood glucose was significantly higher in the diabetic group compared to controls, but were significantly (p<0.05) attenuated in GFJ-treated diabetic group, compared to the control. Diabetic rats exhibited significantly impaired glucose tolerance compared to controls, which was, however, improved in GFJ-treated groups in comparison to the diabetic non-treated group. GFJ treatment did not improve fasting plasma insulin in diabetic animals. Glucokinase activity and hepatic glycogen concentrations were significantly increased by GJF treatment, but G6Pase was alternatively suppressed by GFJ treatment. HDL-C levels were significantly increased in GFJ treated diabetic animals. Liver ACAT and HMG-CoA reductase enzyme expression were significantly suppressed in GFJ treated diabetic animals in comparison to the non-treated diabetic animals. Conclusion The findings show that GFJ has both hypoglycaemic and anti-dyslipidaemic effects. Although it not insulinotrophic, GFJ improves glucose intolerance in diabetic animals by supressing hepatic gluconeogenesis. Furthermore, GFJ improved plasma lipid profiles and supressed the liver expression of ACAT and HMG-CoA reductase enzymes.
Anti-diabetic and anti-dyslipidemic effects of Naringin.
(2015) Cobongela, Sinazo Zezethu Zongeziwe.; Owira, Peter Mark Oroma.
The incidence of diabetes is expected to dramatically increase over the next decade. Dyslipidemia is the greatest risk factor of coronary heart diseases in patients with diabetes. Antidiabetic and anti-dyslipidemic effects of naringin were investigated in type 1 diabetes. Male Sprague-Dawley rats (n = 7) were treated daily with 3.0 ml/kg body weight (BW) of water (group 1), naringin (50 mg/kg BW) (groups 2, 4 and 7, respectively), regular insulin (4 U/kg BW, subcutaneously, twice daily) (group 3 and 7), and simvastatin (20 mg/kg BW) in group 6. On treatment day 45, halothane overdose was used to sacrifice the animals and blood samples were collected via cardiac puncture for plasma insulin and lipid profile analysis. Rat livers were excised, rinsed in normal saline and stored at -80⁰C for glycogen content analysis. Group 3, 4, 5, 6 and 7 exhibited weight loss, polydipsia and hyperglycemia after injection with 60 mg/kg body weight of streptozotocin. Naringin with or without insulin significantly prevented weight loss in diabetic animals compared to non-treated diabetic animals. Insulin with/without naringin, but not naringin, significantly lowered fasting blood glucose levels in diabetic rats. Naringin with/without insulin significantly improved hepatic glycogen content compared to nontreated diabetic rats. Naringin with/without insulin significantly increased the plasma insulin levels in diabetic animals compared to non-treated diabetic animals. Plasma total cholesterol, triglycerides, very low density lipoprotein, low density lipoprotein cholesterol concentrations were significantly higher in non-treated diabetic rats compared to non-diabetic controls. High density lipoprotein cholesterol was significantly higher in non-treated diabetic rats compared to non-diabetic control. Naringin with/without insulin improved lipid profile in diabetic animals, whereas simvastatin decreased only total cholesterol and triglycerides compared to non-treated diabetic animals. Naringin with/without insulin significantly decreased coronary risk index in diabetic animals compared to non-treated diabetic animals. Atherogenic index was significantly decreased by insulin or naringin with/without insulin in diabetic rats compared to non-treated rats. Naringin is not hypoglycemic but improves coronary risk index and atherogenic index in type 1 diabetes. However, naringin with insulin showed synergistic effects. This study was conducted to investigate the effect of naringin on blood glucose regulation dyslipidemia in type 1 diabetes. The results showed that naringin is not hypoglycemic, however, it improved fasting plasma insulin and hepatic glycogen. Naringin also showed anti-dyslipidemic effects by decreasing the antherogenic lipids and increasing the high density lipoprotein cholesterol. The findings suggests that naringin can be used as a dietary supplement to ameliorate diabetic dyslipidemia.
Antibiotic prescribing in treatment of non-severe paediatric Community Acquired Pneumonia at Limbe Health Centre, Blantyre.
(2018) Matambo, Ernest.; Solomon, Vernon Philip.; Småbrekke, Lars.; Katundu, Kondwani.
Introduction Pneumonia is one of the diseases with high child mortality worldwide. Appropriate antibiotic treatment is vital for treatment success and minimising emergence of antibiotic resistance. Adherence of prescribers to guidelines in the treatment of non-severe Community Acquired Pneumonia (CAP) is one aspect that can optimise treatment outcome and help mitigate emergence of antibiotic resistance. This study was conducted to investigate antibiotic prescribing patterns of clinical officers and medical assistants in the treatment of non-severe paediatric CAP at Limbe Health Centre (LHC). Materials and methods The study was conducted at LHC. Prescriptions of 53 children aged 2-59 months diagnosed and treated for non-severe CAP were reviewed for analysis of demographic and treatment data. Data collection was conducted from March to May 2017. Prescribed antibiotics by medical assistants and clinical officers were compared using Fischer’s exact test. Correctly and incorrectly prescribed antibiotic daily doses in the two groups of prescribers were compared using Chi-square test. In addition, we also analysed demographic and academic qualification data for prescribers. Results The 53 prescriptions included were either for cotrimoxazole (n=29), amoxicillin (n=19) or erythromycin (n=5). There was no significant difference in choice of antibiotic for the treatment of non-severe paediatric CAP between medical assistants and clinical officers (p=0.2). Based on age or weight of the participant, distribution of correctly and incorrectly prescribed daily doses was not significantly different in the two groups of prescribers (p>0.5). Of the 53 participants, 30 (57%) were under-dosed. Ten participants were under-dosed by 33%, while 20 participants were under-dosed by 34-50% of the recommended antibiotic daily dose. Participants were either prescribed a 5-day (n=51) or a 3-day (n=2) antibiotic treatment. Conclusion Amoxicillin, cotrimoxazole and erythromycin were prescribed for the treatment of non-severe paediatric CAP at LHC. More than half of the included patients were under-dosed. Antibiotic treatment for paediatric CAP at LHC was either for 3 or 5 days. Understanding antibiotic prescribing patterns is necessary in designing interventions aimied at improving antibiotic treatment and curbing the emergence of antibiotic resistance.
Antibiotic prophylaxis in a primary level hospital: a medicines use evaluation to assess compliance in caesarean sections.
(2016) Govender, Seshnee.; Gray, Andrew Lofts.
Introduction: Caesarean section births are the most important known common factor that has been linked with post-partum bacterial infections. According to the current Standard Treatment Guidelines, the prophylactic dose in surgical prophylaxis is a single dose of cefazolin, equal to the standard therapeutic dose, and given as a single stat dose prior to surgery. Multiple-dose regimes are associated with higher costs compared to a single-dose regime, not just in terms of acquisition costs but also in terms of staff time. Aim: To contribute to the rational use of antibiotics, through the application of a medicines use evaluation in a district hospital. Methods: A retrospective Medicine Use Evaluation (MUE) was carried out at Heidelberg Hospital in Gauteng. The quantitative data was collected over a 3 month study period in which the medical records of 120 female patients who delivered through Caesarean section was captured using the Medicine Use Evaluation data sheet. The qualitative phase involved structured interviews with medical officers to establish reasons for non-compliance. A total of 7 medical officers participated in the interviews. Results: None of the 120 patients received the stipulated regimen as recommended in The Standard Treatment Guidelines. Patients either received: 1 day of cefazolin, administered every 8 hours intravenously (83/120, 69.2%) or 3 days’ of cefazolin administered every 8 hours (37/120, 30.8%). Every HIV-uninfected woman (83/120, 69.2%) received 3 doses of cefazolin, whereas every HIV-infected woman received 9 doses of cefazolin and metronidazole intravenously. All patients also received 5 days’ of oral antibiotics on discharge. Eighty-five percent of patients did not have a justifiable reason for receiving a full therapeutic course. Discussion: Clear evidence was provided that the administration of antibiotic prophylaxis for Caesarean section deliveries at Heidelberg Hospital was irrational. Using MUE methods, the study identified different elements of non-compliance with the national recommendations. The study did not provide any justifications for the therapeutic use of antibiotics in patients without established or suspected infections post-operatively. Recommendations: The Standard Treatment Guidelines should provide unambiguous recommendations for the use of prophylaxis in women undergoing Caesarean sections in addition to the management of women suspected of having an established infection, and who deserve a full therapeutic course of antibiotics.

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