Theses and Dissertations

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    An approach to National Health Workforce Planning for health service delivery in South Africa
    (University of Fort Hare, 2009-12) Mahlathi, Malixole Percival; Thakhathi, D. R.
    Although South Africa educates and trains many health professionals of various categories, it continues to experience relative and critical shortages of these professionals especially at its rural health facilities. It boasts more than 15 Faculties of Health Sciences which train a variety of health professionals. In addition to training for its own purposes, it also offers training for several countries in the Southern African Development Community. The burden of disease is considered to be high and increasing, complicated by the HIV and AIDS epidemic. In the light of these challenges it is necessary that South Africa engages in careful health workforce planning as a long term approach to solve shortage of health professionals and improving the delivery of health services. This study examines the health workforce planning approaches by the various Provincial Departments of Health and the student planning approaches by the Faculties of Health Sciences of the Higher Education Institutions that train health professionals.,Thesis (PhD) -- Faculty of Health Sciences, 2009
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    Challenges hindering the implementation of quality supervision in primary health care facilities in Oliver Reginald Tambo District, Eastern Cape Province
    (University of Fort Hare, 2018) Zamxaka, Nontlantla Caroline; Mupindu, W
    The study investigated the factors that prevent quality supervision in primary health care(PHC) facilities in Oliver Reginald Tambo (O.R. Tambo) district of the Eastern Cape Province of South Africa. The motivation for this study was a concern regarding consistently poor performance by PHC facilities in the province despite regular supervisory visits. The objectives of the study were to explore practices of PHC supervisors in implementing supervision, and to assess perceptions, opinions, and attitudes of PHC supervisors and PHC operational managers with regards to PHC supervisory visits. On search methodology, qualitative approach was predominating whilst quantitative data was supplementing the study. A purposive sample of PHC supervisors and operational managers was drawn from PHC facilities which had a consistent, 100% rate of supervisory visits. The data was analysed thematically. The results revealed systemic and structural challenges that affect the implementation of quality supervision, rendering supervisory visits inefficient. These were: a high workload resulting from inconsistency in the allocation of facilities, as well as the many other responsibilities which supervisors have; a lack of knowledge and experience in supervisors; a lack of health service resources including transport; a high turnover of nurses; lack of support from the district and sub-district leadership and management; lack of collaboration, coordination and integration of activities; and delayed procurement processes resulting in a recurring lack of equipment and medical supplies. The findings of the study brought an understanding of the systemic and structural requirements that need to be made for a functioning quality supervisory system. Successful interventions require strengthening of leadership and governance, and the diligent application of the systems approach to solving problems at facility, district and provincial level. An improvement in leadership and governance should include innovative strategies to utilise the limited resources available without compromising the key objective of quality health care.,Thesis (MPH) -- Faculty of Health Sciences, 2018
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    Experiences of midwives regarding the use of pharmacological and non-pharmacological labour pain interventions in Lejweleputswa district in Free State
    (University of Fort Hare, 2019) Parkies, Limakatso Elizabeth; Murray, Daphne
    Due to the disabling effects of severe labour pains, labour pain management remains an important topic in midwifery and needs to be reviewed more often. According to studies, various pain relief options, both pharmacological and non-pharmacological, are available to help women cope with pain, but midwives did not employ these techniques adequately because of various experiences. Studies further indicate that, though the limited number of these techniques were employed they were not effective on some women. Thus, the purpose of this research study was to explore and describe midwives’ experiences on pharmacological and non-pharmacological labour pain management in the Lejweleputswa District of the Free State Province. This study employed a qualitative, descriptive, explorative, and contextual design. A purposive sampling technique was used to select the participants. The target population was midwives who work in the maternity wards of the institutions under study with three to five years’ experience in midwifery. Individual, face-face, semi-structured interviews were conducted; these were recorded for the researcher’s reference purposes, so as not to overlook important information. In addition, the researcher made use of field notes, recording in them what was heard, observed, felt, experienced, and thought during the interview. Ethical principles and trustworthiness were maintained throughout this study. Data analysis was done using Tesch’s approach to open coding in qualitative research. Confidentiality and anonymity were ensured throughout the interviews. The nine themes and 19 sub-themes that emerged during data analysis were discussed comprehensively. The findings indicate that midwives use both pharmacological and non-pharmacological methods in managing labour pain. Some methods are effective in relieving pain for certain mothers, while other methods proved ineffective. Midwives administer Pethidine and Phenergan as per doctors’ prescription; non-pharmacological methods, such as back massage, deep breathing exercises, mobilisation, and warm baths or showers are also employed. Midwives provide pharmacological methods to all women in labour, and routinely employ non-pharmacological methods. Although the midwives are willing to manage patients’ pain, they face certain challenges, such as shortage of staff, increased workload, as well as inadequate resources. This leads to inadequate provision of non-pharmacological care. In conclusion, the midwives’ experiences were that both pharmacological and non-pharmacological techniques were used for all labouring women and they had relaxing and calming effects on some women, resulting to them giving birth with ease, although for some they were not effective. In addition, the pharmacological interventions caused drowsiness to some women and babies. The findings will provide evidence-based information to the Free State Department of Health in order to assist policymakers and stakeholders in initiating and developing appropriate policies, guidelines, and interventions that can improve labour pain management. The Free State Department of Health should consider using other opioids and non-opioids in managing labour pain to broaden the scope of pain relief methods available to the midwives.,Thesis (MPH) -- Faculty of Health Sciences, 2019
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    Treatment adherence among tuberculosis patients in Nelson Mandela District, Eastern Cape Province
    (University of Fort Hare, 2019-09) Sohuma, Ntombifikile; Pinkoane, M G
    Tuberculosis (TB) morbidity and mortality rates remain high globally and are even higher in Africa. The key factor that continues to drive the burden of disease is poor compliance / adherence to treatment regimens. This study aimed to identify determinants that continue to drive poor treatment adherence among low-income communities in South Africa. Methods A cross-sectional survey was conducted, drawing on TB patients who were defaulting on treatment. An assessment tool with several socio-economic and disease-related determinants was administered to participants. Data was entered into MS Excel and analysed in SPSS version 24. Results Regarding health services factors generally, all participants agreed that health service delivery was conducted in a conducive environment and that facilities were reasonably close to their places of residence. Participants demonstrated that health workers do not provide adequate information regarding medications that patients receive. Of patients cited, 11percent indicated that they stopped medications owing to health services. When questioned, participants reported that health workers shouted at them for coming late (e.g. after lunch) and that waiting times were very long. Approximately 85percent of the study participants were more likely to adhere poorly to TB medication owing to various factors such as comorbidities and personal perceptions of wellbeing / health status. Comorbidities are high among patients, with 58percent taking other medication while on TB treatment. Self-prognosis on wellbeing is significantly high, and 44percent reported a tendency to stop medication when they were seemingly in recovery. The unemployment rate among respondents was 78percent, with limited education: 69percent had below matric. Of the respondents, 40percent showed an unsatisfactory perception of their social and economic life, 55percent were somewhat satisfied and only 5percent were very satisfied. These indicators constitute a highly vulnerable community that depends heavily on subsidised healthcare from the state. Adherence to TB treatment is mainly influenced by poverty, the health service provider–patient relationship and perceived stigma. Limited family support was noted towards the treatment of patients.,Thesis (MPH) -- Faculty of Health Sciences, 2019
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    Perceptions of patients about poor attitudes and behaviours of midwives in the maternity sections in a public hospital of East London South Africa
    (University of Fort Hare, 2019-11) Lawrence, N W; Seekoe, E
    Midwives are largely responsible for maternity care in hospitals. As such, they play a significant role in ensuring the health and well-being of pregnant women and newborn babies. To perform that duty effectively, midwives need to be professional in their conduct. However, there are reports that midwives have displayed poor attitudes and behaviour in South Africa. The main research question was “what are the perceptions of patients about attitudes and behaviours of midwives in the maternity section in a public hospital in East London, South Africa?” The aim of the study was to explore the reasons behind poor attitudes and behaviour of midwives in midwifery practice and suggest interventions that can be introduced to promote professional attitudes and behaviour by midwives in a public hospital in East London. This study used a qualitative approach to collect data. The research instrument that was used for this study was semi-structured interviews. The sample of 20 participants which was purposively selected consisted of women that have used the East London public hospital maternity section. Data was collected using coding and themes emanating from the data generated. Midwives are valued and play a very significant role in providing maternal care. Be that as it may, midwives exhibit poor attitudes and behaviours such as being rude, lack sympathy, and lack of empathy. On the other hand, midwives act professionally and are supportive of patients. There is, therefore, a need for the provision of professional etiquette training services, stress counseling, use of work development strategies and performance management systems, technical training, linkage system of traditional and modern midwives, and the use of internet platforms to increase interaction between midwives and those that need maternity care services.,Thesis (MPA) -- Faculty of Health Sciences, 2019
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    Exploring knowledge, attitudes and psychosocial experiences of health care workers regarding covid-19 in Bufalo City Municipality
    (University of Fort Hare, 2020-03) Notununu, Zintle; Murray, D
    The purpose of this study was to explore and describe the knowledge, attitude and psychosocial experiences of health care workers regarding Covid-19 in Buffalo City Municipality. Covid-19 is a disease that attacks the respiratory system and functions. It is a highly infectious disease with a lengthy 5-6 sometimes even 14-day incubation period. It is very serious condition and has killed a lot of people including the Health Care Workers A qualitative descriptive explorative contextual design was employed in this research study. The design was relevant for this study to explore and describe the knowledge, attitude, and psychosocial experiences of health workers regarding Covid-19 in Buffalo City Municipality. The non-probability sampling method was used and a convenient sampling technique was used to select the participants. Professional nurses who met the criteria and who were on duty on the day of data collection were included in the study. The researcher interviewed 15 professional nurses and stopped as the data was saturated. A semi-structured Interview guide was used as an instrument to collect data containing open-ended questions. The researcher maintained ethical principles throughout the study. Concepts of trustworthiness of the study were applied throughout the research. Tech’s eight steps approach was used to guide the data analysis process. The findings of this study indicate that health care workers have a high level of knowledge about Covid-19. They know what Covid-19 is, how it started, its signs and symptoms, how to protect themselves from it and its complications. Negative attitudes, fears were noticed from the HCWs and thus the need for psychological support was identified. Feelings of neglect and lack of motivation were also identified. Psychological support for health care workers must be provided to prevent staff burnout. Personal Protective Equipment used in the hospital premises must be left and washed in the hospital laundry to prevent the spread of infection to the families of the HCWs. It was indicated that there are health care workers who experienced chronic illnesses after being diagnosed with Covid-19. These chronic illnesses include diabetes and high blood pressure. It was brought to light that myths circulating on the social media about Covid-19 vaccines are delaying the end of Covid-19 epidemic by putting the health care workers at risk of being infected with it as they will be expected to treat patients diagnosed with Covid-19; therefore, government should develop a policy that will limit people from spreading things that they are not true and cannot prove. In conclusion, community awareness and forced vaccination are recommended to end the Covid-19 virus. Monitory incentives should be provided to motivate health care workers. Their overtime that they have worked during Covid-19 must be paid. The Department of Health and hospital managers must make sure that working conditions are improved. This includes the availability of machines to test for Covid-19. More research needs to be done to find out why some people who were diagnosed with Covid-19 end up having chronic illnesses that they never had previously.,Thesis (MPH) -- Faculty of Health Sciences, 2020
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    Barriers to exclusive breastfeeding for mothers in the Tswelopele Municipality
    (University of Fort Hare, 2020-03) Quebu, Simthandile Rebecca; Murray, Daphne
    The purpose of the study was to assess the barriers to exclusive breastfeeding (EBF) of mothers in the Tswelopele Municipality. The South Africa Demographic and Health survey reported the country’s EBF rates among children below six months of age to be at 32percent for the year 2016. The World Health Organisation endorses the promotion and protection of the practice of EBF throughout the first six months of life, and the addition of complementary foods at six months coupled with breastfeeding up to two years of age. This feeding practise is recommended as the most efficient feeding practice to save infants from various illnesses and mortality across the globe, irrespective of their mother’s HIV status and economic class. A qualitative, contextual, explorative and descriptive research design was employed for this study to achieve the research objectives. The researcher incorporated both purposive and convenience sampling in this study. Purposive sampling was used to select the clinics, and convenience sampling was used to select the participants. Mothers who had infants 6-12 months old who were accessing infant and child health services in the three public health care facilities in the Tswelopele Municipality were a target population. Individual semi-structured interviews were administered, and an audio recorder was utilized to record the interviews with the participants' consent. The researcher throughout this study verbatim transcribed the interview audio tapes, and ethical principles and trustworthiness standards were adhered to. The University of Fort Hare (Ref # 2021=06=12 QuebuS) granted ethical clearance and all participants gave formal consent to voluntarily participate in this research. Tesch's approach for data analysis to open coding in qualitative research was used to analyse the data. Sixteen (16) participants in total took part in this study and the research study was conducted during the whole month of October 2021.During the data analysis, four main themes and thirteen sub-themes emerged, all of which were thoroughly examined. The findings suggest that maternal factors such as extreme pain in the breast, maternal sickness, belief that milk supply is insufficient, lack of EBF knowledge and cultural influences are the key contributors to the success or failure of EBF practice. When mothers have difficulties with breastfeeding, their difficulties can become barriers to EBF. Furthermore, a noteworthy finding is that some participants in this study were eager to breastfeed their babies and maintain EBF for six months; however, their infants had problems that prohibited them from doing so. These issues primarily included infants who refused to breastfeed and breast milk not being tolerated by some infants, as seen by baby vomiting after feeds. It was recommended that breastfeeding education and counselling should be available to mothers and their families from prenatal to postnatal so that they have enough time to make informed infant feeding decisions. Furthermore, an open dialogue with mothers and their families on a realistic understanding of what to expect when they first breastfeed, as well as the exploration of myths, inaccurate information, and concerns can be addressed during the counselling sessions. In conclusion, health professionals should also take into account the culture of mothers, respect cultural customs linked with breastfeeding, and respectfully educate them and their families about traditions that may affect breast-feeding.,Thesis (MPH) -- Faculty of Health Sciences, 2020
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    Experiences of patients with cancer regarding decentralization of oncology services at a selected tertiary hospital in the Eastern Cape
    (University of Fort Hare, 2021-09) Jojo, Lumkile; Nkutu, N T
    Background: Cancer burden is a global public health concern. It is associated with high morbidities and mortalities worldwide. Over the past decade, there has been a constant increase in the incidence of cancer cases affecting mostly low-income countries and middle- income countries. South Africa as a middle-income country is also affected by this cancer rise. The limited access to oncology services contributed to the late presentation and late diagnosis. In the Eastern Cape, oncology services were previously offered in Port Elizabeth and East London only. Oncology unit was recently opened in Mthatha to decentralize oncology services in the province. The purpose of the study was to explore the experiences of patients with cancer regarding decentralization of oncology services at a public tertiary hospital in the Eastern Cape province of South Africa. Objectives were to describe experiences of patients with cancer regarding decentralization of oncology services at a public tertiary hospital in the Eastern Cape, and to describe the quality of oncology services provided by a public tertiary hospital in the Eastern Cape. Methods: a qualitative research approach with a descriptive, explorative, and contextual design was undertaken in this study, to get the perspective of the oncology healthcare service recipients on the decentralization of oncology services at a public tertiary hospital. An interview guide was used to get experiences of the cancer patients attending oncology clinic. Interviews were conducted to 19 participants on a one-to-one basis. With ethical consideration, all COVID-19 protocols were observed. All interviews were transcribed carefully against their audio-recordings. Field notes were also taken by the researcher on what was heard, observed, thought and experienced during the interview process. The concept of trustworthiness was used to ensure rigour throughout this study. Data was analysed by means of thematic analysis. Data was organized into themes using the Tesch’s approach to open coding in qualitative research. Results: seven themes emerged: 1) experience related to a high level of satisfaction with services provided and desired expectations, 2) waiting time, 3) availability of human and material resources, 4) attitude of health care workers, 5) appropriate treatment and care, 6) access to services, and 7) need for improved infrastructural facilities Many patients had positive experiences about decentralization of oncology services in the province. Most patients were happy about travelling short distances, a smaller number of days, using less money and the time it takes to see a doctor. They also expressed their satisfaction on the quality of oncology services rendered in the unit. The waiting times were acceptable, medicines available and staff had positive attitudes towards the patients. The study revealed that, there were complaints about infrastructure, poor hospital record keeping, and lack of resources. The themes which emanated from the recordings of the study showed that patients with cancer, attending oncology clinic at a public tertiary hospital had positive experiences in this decentralized oncology unit. The services rendered at the facility were of acceptable quality. Staff had positive attitude towards their patients. All patients were seen by the doctors within acceptable waiting time, and they all got their prescribed medication. Access to services was much improved in terms of distance, number of days travelled by patients to access the service and time taken to see the doctor for appointments. Conclusion: The hospital must improve its infrastructure, record keeping, security, and expand the services. Put more focus on cancer awareness programs.,Thesis (MPA) -- Faculty of Health Sciences, 2021
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    Knowledge, attitudes, and practices of the treatment options for dental caries among the adult patients for dental caries in Buffalo City Metropolitan Municipality, in East London, Eastern Cape, South Africa
    (University of Fort Hare, 2021-11) Veleekizhakethil, Legy; Obi, U N; Mayeye, B F
    Dentistry offers several caries-preventive measures, some of which emphasise not only patient’s responsibility to manage their disease, but also how dental professionals should manage it. Consequently, this study aimed to examine the knowledge, attitudes, and practices of adult patients towards treatment options relating to dental caries in the geographical context of Buffalo City Metropolitan Municipality, situated in the Eastern Cape Province of South Africa. Purpose Firstly, this quantitative study set out to assess the existing oral health knowledge, attitudes, and practices among an adult population visiting dental health facilities in Buffalo City Metropolitan Municipality, in East London, Eastern Cape, South Africa. Secondly, it aimed to examine the prevalence of dental caries, periodontal diseases and tooth associated diseases in this specific setting. Furthermore, the study sought to provide baseline data in order to organise a successful dental prevention programme. The data obtained will determine the layout of policies to be put forward to the Department of Health. Methodology The researcher took a quantitative approach and conducted descriptive surveys from November 2019 to March 2020. A close-ended, structured questionnaire for data collection was designed based on the aspects of knowledge, attitudes, practices and behaviour pertaining to the area of dental caries. A clinical examination of dental status was performed using dental probes, dental mirrors and tooth air-drying. All decay, and missing, filled or restored teeth due to dental caries, along with the presence of calculus, gingival, and periodontal lesions were recorded. Results Participants had an average knowledge score of 80percent with a 95percent confidence interval of (76percent; 84percent). The majority knew the importance of cleaning their teeth (88.9percent), were aware of the effects of sugary diets (80.7percent), avoided sugary foods (64.6percent), and lastly were aware of the causes of dental caries (71.3percent). However it is concerning that most had never visited a dentist, as reflected by 69.1percent of participants agreeing or strongly agreeing. At least 70percent of those who responded were satisfied with their dentists in that they ( the dentists) freely share ideas and opinions and provide advice on options for dental care. The study revealed a high prevalence of dental caries with a ratio of 6.23. Conclusions The majority of the participants affirmed the importance of visiting the dentist for a routine dental examination. In addition, the majority are aware that sugary diets are associated with dental caries. However, there is a high prevalence of dental caries among participants in this setting. Therefore, dentists should provide preventive measures, along with professional restorative and plaque removal, to curb the burden of dental caries and periodontal diseases. The type and extent of preventive measures must be adjusted according to the patient’s individual needs. Dental health professionals must collaborate with other health-care providers to promote preventive dental health.,Thesis (MPH) -- Faculty of Health Sciences, 2021
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    The impact of COVID-19 on depression, anxiety, and post-traumatic stress levels in doctors and nurses at a South African health facility
    (University of Fort Hare, 2021-12) Finger-Motsepe, Kelebogile; Van Niekerk, Rudolph Leon; Last name, First name
    Introduction: The emergence of the coronavirus disease of 2019 (Covid-19) has wrought profound and enduring transformations in global health, economic dynamics, and social interactions. However, the comprehensive quantification of the psychological repercussions of the Covid-19 pandemic remains elusive and is poised to compound the preexisting burden of mental health disorders within the general populace. Elevated transmission rates, rapid disease progression within vulnerable demographics, and the absence of definitive curative or preventive measures have collectively contributed to a heightened worldwide state of stress and anxiety. Extensive research has demonstrated that the apprehension and stress associated with Covid-19 are markedly pronounced among healthcare professionals, commonly referred to as front-line workers, in comparison to the general population. The Covid-19-related psychological distress is anticipated to act as a catalyst, exacerbating mental health conditions within high-risk groups. Aims and Objectives: This study endeavours to ascertain the prevalence and severity of depression, anxiety, and post-traumatic stress disorder (PTSD) among medical doctors and nurses employed at a regional hospital in South Africa. Methodology: A cross-sectional investigation was conducted to evaluate the presence of anxiety, depression, and stress symptoms among medical doctors and nurses working at a Regional Hospital situated in the Free State Province of South Africa. A purposive sample of 200 participants, comprising all willing doctors and nurses employed at the study site, was enrolled in the study. Findings: The participants exhibited an average age of 42 years and an average tenure of approximately 72 months at the hospital. The majority of participants were of African descent, with a male-to-female ratio of 1:2.3. Female healthcare workers reported significantly higher instances of PTSD than their male counterparts. In the aggregate, 71.4percent of doctors reported symptoms indicative of depression, 73.2percent reported anxiety-related symptoms, and 19.6percent reported PTSD-related symptoms. Among nurses, 72percent displayed clinically significant symptoms of depression, 81percent exhibited anxiety-related symptoms, and 27.7percent manifested symptoms suggestive of PTSD. A moderately robust positive correlation was discerned between PTSD and Anxiety (p = .000; r = .466) as well as PTSD and Depression (p = .000; r = .315). Additionally, a strong positive correlation was identified between Anxiety and Depression (p = .000; r = .631). A statistically significant disparity (p = .030) in anxiety levels was observed among workers in different risk-prone areas. Nurses reported substantially higher levels of anxiety (p = .039; M = 10.63, sd = 4.03) compared to doctors (M = 9.01, sd = 3.80) and administrators (M = 10.50, sd = 4.32). Moreover, both nurses (M = 27.06, sd = 13.61) and administrators (M = 33.33, sd = 14.44) exhibited significantly higher instances of PTSD (p = .003) than doctors (M = 19.96, sd = 15.03). Conclusions: The healthcare workers under scrutiny reported elevated levels of anxiety and depression attributable to the Covid-19 pandemic, although the prevalence of posttraumatic stress symptoms was comparatively lower within the hospital setting. Furthermore, this study illuminates that depressive, anxiety, and post-traumatic stress symptoms were more prevalent among nurses than doctors. Additionally, healthcare professionals operating in high-risk Covid-19 environments, such as the Covid-19 ward, demonstrated heightened levels of anxiety when juxtaposed with their counterparts stationed in low-risk Covid-19 areas within the healthcare facility.,Thesis (MPH) -- Faculty of Health Sciences, 2022
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    Backpack carriage and musculoskeletal pain among primary school learners in King Williams Town, South Africa
    (University of Fort Hare, 2022) Moni, Busisiwe; Goon, D T
    BACKGROUND: There is rising concern that kids are walking to school with too much weight on their backs. The weight of schoolchildren's backpacks is a persistent and divisive topic in the fields of education and health. Children who carry heavy backpacks are more likely to have back discomfort and musculoskeletal pain, which raises their risk of developing chronic back pain as adults. There is little research on this topic among South African school-age youngsters. The goal of the study was to find out how common low back and other musculoskeletal complaints were among primary school students who used a school bag. RESEARCH AIM: The purpose of the study was to identify the prevalence and location of musculoskeletal discomfort in primary school students in King William's Town, South Africa, and describe their link with backpack use. METHOD: In King Williams Town, Eastern Cape, South Africa, a descriptive cross-sectional survey was conducted among elementary school students between the ages of 9 and 14 years old. A systematic questionnaire and the Cornell Musculoskeletal Questionnaire were used to gather the data (body chart). Age, gender, and schoolbag details (style of backpack, carrying technique, and carrying time) were collected. The learner's waist, hip, and bag circumferences were all measured. On the data, descriptive and interferential statistics were used. FINDINGS: The study's conclusions showed that students' musculoskeletal pain was brought on by the weight of their backpacks or school bags. The majority of the students (89.8percent) complain about the difficulty they experience when lugging their heavy backpacks to class. In addition, 83.4percent of the students had bags that weighed more than 10percent of their body weight. Additionally, a sizable percentage of students (89.8percent) carry a hefty bag to school every day and report feeling fatigued while doing so (90.8percent). 90percent of the students reported feeling discomfort before, during, or after carrying their schoolbags. This pain is related with carrying a schoolbag. The majority of students (53.5percent) felt that their daily pain interferes with their ability to study. In order of severity, the majority of students report having discomfort in their shoulders (82.7percent), lower back (59.9percent), neck (47.0percent), upper back (40.7percent), and upper arm (16.4percent). CONCLUSION: According to the study, there is a link between students' musculoskeletal pain and carrying hefty backpacks or school bags. The shoulders are where musculoskeletal discomfort is most frequently felt. The study supported the findings of the majority of studies cited in the literature that most schoolchildren suffer from musculoskeletal pain because the weight of their backpacks is excessive compared to their size, weight, and age. RECOMMENDATIONS: The study produced a number of recommendations, including that the Department of Basic Education inform teachers, students, parents, guardians, and other key stakeholders about the effects of heavy backpacks or schoolbags on students' musculoskeletal pain. For students' convenience and to lighten the load on their school bags, locker rooms should be available. Teachers, parents, and guardians should also pay attention to the school bags that students are using to make sure that the weight is appropriate for their age and body size.,Thesis (MPA) -- Faculty of Health Sciences, 2022
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    Exploring socio-economic factors influencing incidences and outcome of multidrug resistance tuberculosis among patients and facility staffs in Makana Sub-District, Eastern Cape
    (University of Fort Hare, 2022-02) Cannon, Lesley-Ann ; Oladimeji, K E
    Background Drug-resistant Tuberculosis (DR-TB) is one of the main causes of global public health crisis, due to the morbidity and mortality rates associated with the disease. This DR TB is a complex illness having direct and indirect impact on finances, social functioning, and quality of life of infected individuals. Major research advances have been made in the diagnosis and treatment of DR-TB. However, minimal information exists on the socio-economic factors influencing the incidence and outcomes. This study aims to fill the gap by exploring the socio-economic factors from both the health care professional and patient perspective in particular settings to gain insights into developing context-specific strategies against the burden of DR-TB. Methodology The study applied a qualitative method to explore the socio-economic factors influencing MDR-TB through key-in-depth interviews (KIIs) and focus group discussions (FGDs). The study enrolled a total of thirty-two (32) consenting participants. The KIIs was conducted for ten (10) healthcare workers and nine (9) MDR-TB patients. Two focus group discussions were done involving seven (7) MDR TB patients and six (6) MDR-TB patients, respectively. The study targeted healthcare workers working in the MDR-TB field and TB patients with the following: GeneXpert Rifampicin resistance and patient confirmed as MDR TB. Eligible participants were selected using a purposive sampling technique from the hospitals` routine data electronic records (EDR-WEB database) and hardcopy registers (drug-resistant TB register) on MDR-TB patients enrolled in care at the study site. Informed consent was obtained from all study participants after thoroughly explaining the purpose. No personal information of participants was used. All responses from respondents were coded during analysis for autonomy and the respondents were not identifiable in any published or unpublished work following this research. The interviews were transcribed, some translated into English, where necessary, and analysed until saturation was reached. Data was coded and analysed using both thematic and content analysis technique. Results There were 3 main themes identified in the study: social factors, economic factors, and other contributing factors. 7 sub- themes were recorded under social factors and 2 subthemes under economic factors. Two independent factors that were also considered to impact MDR-TB were the attitude of healthcare workers, as well as the current COVID-19 pandemic. Conclusion MDR-TB is a major public health concern in the Makana Sub-district of the Eastern Cape. The findings of this study highlight the impact of socio- economic factors on the incidence, spread, defaulter rate and outcomes of MDR-TB. The social areas highlighted by the study participants as affecting the incidence and outcomes of MDR TB were housing and relocation, decreased immunity, stigma, patients’ attitude and lack of support, alcohol and other substance usage and prison/ incarceration. The economic factors identified by the participants were unemployment and job loss and health related expenses. Other factors are those factors contributing to the increased incidence and possible poor outcomes of MDR TB. Healthcare workers impact and attitude and the effects of the covid-19 pandemic were highlighted as additional factors influencing the incidence and outcomes of MDR TB. The management of MDR-TB requires rigorous efforts that should be directed at addressing the socio-economic factors. Therefore, future quantitative studies and important programmatic strategies should be considered to tackle the socio-economic challenges that contribute to the burden of MDR-TB infection in the Makana community.,Thesis (MPA) -- Faculty of Health Sciences, 2022
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    Safe handling, storage, and management of vaccines at selected primary health care facilities in Buffalo City Metropolitan, Eastern Cape Province
    (University of Fort Hare, 2022-04) Mazwembe-Hoho, Andiswa Zimkitha; Mangi, N; Seekoe, E; Last name, First name
    Background The World Health Organization has a standardized tool for assessing vaccine handling and management. South Africa has adopted WHO tools to suit its own conditions of supply and storage of vaccines, the WHO tool is a guideline for managing vaccines. Importantly, every person handling or supervising handling of vaccines should own this manual (s) and use it as a reference for the handling, storage, and management of vaccines and related items. Aim The aim of this study was to examine safe handling, storage, and management of vaccines by health care workers in PHC facilities of BCM Municipality. Methodology A quantitative research approach and descriptive design was used to assess the safe handling, storage, and management of vaccines in PHC facilities in BCM in EC. Results The results showed that safe handling, storage, and management of vaccines in PHC facilities in BCM does not comply fully on safe handling, storage, and management of vaccines. The overall compliance rate was 86%, and this indicated that healthcare workers have knowledge of what is required to be compliant with safe handling, storage, and management of vaccines. Conclusion Safe handling, storage, and management ovaccines in PHC facilities in BCM is conditionally compliant as the healthcare workers have moderate-to-satisfactory knowledge.,Thesis (MPH) -- Faculty of Health Sciences, 2022
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    The utilization of contraceptives amongst adolescents at Stutterheim in the Eastern Cape Province
    (University of Fort Hare, 2022-04) Ntengo-Kupula, Visisa; Nkutu, N T
    Introduction Contraception has been identified as one way in which women can prevent unwanted pregnancies. Contraceptive utilization has been proved to minimize maternal mortality by lowering the risk of pregnancy and its associated life-threatening problems. Therefore, the researcher conducted a study at Stutterheim about the “utilization of contraceptives amongst adolescents at Stutterheim in Eastern Cape Province” with the intentions to explore perceptions of adolescents on utilization of contraceptives and to determine the factors that influence that contraceptive utilization. Methods This study adopted a quantitative, descriptive cross-sectional design which involved questionnaire tools completed by 436 adolescents between the ages of 14 and 19 years at Stutterheim health facilities and the surrounding schools, regardless of whether they were sexually active or not. After obtaining ethical clearance from the University ethics Committee and permission from the Department of Health the researcher visited the gatekeepers for obtaining informed consent and data collection procedures. The researcher administered the instruments herself to ensure validity and reliability of the instrument through a pilot study. The respondents of the pilot study did not participate in the major study. Any irregularities with the data instruments were corrected accordingly. Data collection took 3 weeks to complete all the sites. The raw data was captured onto an Excel spread sheet and analysed by the researcher with the assistance of a statistician. Results The data suggests that as much as the parents discuss about sex related issues and pregnancy, they are less likely to educate their adolescent girls about contraceptives probably due to the beliefs they have, lack of knowledge and the fear of introducing them into premarital sex. The 34.4percent of participants indicated that they were scared of contraceptive rumours spreading around the community as well as the stigmatization. Conclusion Due to the results of this study the Department of Health should work together with the department of education to put into effect the optimal utilization of contraceptives amongst adolescents by adding sexual, reproductive and contraceptives health education, as a subject in the school curriculum. Department of health must also make use of main media and social media since they are influential and can be the great sources of information for campaigns and more seminars on contraceptive utilization and its benefits to the adolescents, society and the State.,Thesis (MPH) -- Faculty of Health Science, 2022
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    Linkage to care of HIV clients following diagnosis in Engcobo Sub-district, Eastern Cape
    (University of Fort Hare, 2022-04) Mthini, Sandiso; Mangi
    Background: “Linkage to care” is an essential strategy in place for the retention of HIV diagnosed clients on treatment. It is vital throughout the management and care of an HIV client. Aim of the study was to explore the effectiveness of “linkage to care” of HIV clients following the diagnosis in the Engcobo sub-district, Eastern cape. Methodology: Qualitative, explorative, descriptive study design was used to explore and describe the effectiveness of “linkage to care” of HIV clients following diagnosis in the Engcobo sub-district. The population for the study were all healthcare workers, who are involved in the program of “linkage to care” of HIV positive clients. Purposive Sampling was used to select professional nurses, Community healthcare workers, Lay counsellors, linkage officers who are involved in the linkage of HIV positive patients and the facility managers whom their facilities provide HIV care services. Interview guide was used to collect data and Tesch’s method was used to analyse data. Findings: Themes that emerged from the study were flexible time to “linkage to care”; use of different policies; administration; team activities and “linkage to care” benefits. Recommendations: Training on “linkage to care”; case management model; TIER.NET system upgrade/ linkage App development, patient information packs; standardised extended hours; transport assistance/outreach mobile services. Conclusion “Linkage to care” is a team effort, it needs collaboration and knowledge. Despite the implementation of a linkage program, there are challenges that the department of health needs to act on as addressed on researcher’s recommendations.,Thesis (MPA) -- Faculty of Health Sciences, 2022
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    Knowledge, attitude and perception of uninitiated adolescents towards customary male initiation practices in selected schools in Buffalo City Municipality, Eastern Cape
    (University of Fort Hare, 2022-07) Igaba, Nelson Kibiribiri; Oladimeji, K E; Goon, D T
    Background: Based on evidence that Voluntary Medical Male Circumcision (VMMC) significantly reduces the risk of human immunodeficiency virus- HIV transmission by 60percent, the World Health Organization (WHO) recommends implementing VMMC programs in countries with a high HIV prevalence, considering the unique sociocultural and economic dynamics of each setting. However, in South Africa (SA), multiple tribes including the AmaXhosa in the Eastern Cape (EC) province practice Customary Male Initiation (CMI) also known as Ulwaluko as a rite of passage of males from boyhood to manhood, and this involves circumcision. In recent years, this practice has been riddled with deaths of initiates, admissions to hospital, amputation of penis, assaults, drug and alcohol, and crime. Hence, this study aimed at understanding the knowledge, attitude, and perceptions of uninitiated adolescents towards the CMI practice in Buffalo City Municipality (BCM), EC to aid in developing strategies to solve current challenges. Methods: Between June and December 2021, this cross-sectional descriptive study was conducted in selected schools within BCM, in the EC, using a quantitative research approach. The study population included adolescent males aged 15 to 19 years who had not attended CMI. Applying a multistage random sampling technique, three (3)BCM towns (Bhisho, King William Town-KWT and East London-EL) and the Mdantsane township (MT) were selected and further the schools from which consenting pupils were enrolled into the study. Data was collected using a validated self-administered questionnaire which was captured on excel and analysed using STATA version 16.1. Categorical variables were summarized using percentages. Bivariate and multivariate regression was used to determine factors associated with a level of knowledge, attitude, and perception towards CMI and VMMC. The odds ratio with a 95percent confidence interval was calculated. A p–value of <0.05 was considered statistically significant. Results: Among 297 participants that responded 251 (84.51percent) were between the ages of 15-19 years and had not undergone circumcision or CMI. These were included in this analysis. Majority of participants 181 (72.11percent, 95percent CI 66.21-77.33) lacked knowledge on whether circumcision reduces risk of HIV acquisition. More than three quarters of participants 195 (77.69percent, 95percent CI 72.09-83.87) showed absence of knowledge on whether circumcision reduces risk of STIs. Close to all participants 244 (97.21percent, 95percent CI 94.25-98.67) indicated that they would choose CMI over VMMC due to cultural reason. More than three quarters of participants 193 (76.89percent, 95percent CI 71.24-81.72) agreed that CMI/Ulwaluko proves manhood. The presence of knowledge on the benefits of VMMC was positively dependent on the location where a participants lived (uOR 2.32, 95percent CI 1.09-4.97, p-value 0.029) and access to internet more than once a week (uOR 3.44, 95percent CI 1.14-10.43, p-value 0.029. The choice for CMI over VMMC was positively associated with participants living in Mdantsane Township than those living in urban areas (Coef. 1.55, 95percent CI 0.77-2.33, p-value 0.001). Conclusion: This study found lack of knowledge on benefits of VMMC, laws governing and on risks associated with CMI/Ulwaluko practices among uninitiated adolescents. The study further found that CMI/Ulwaluko was still highly regarded despite current challenges and most adolescents would choose CMI/Ulwaluko over VMMC. There is urgent need to integrate VMMC services into CMI/Ulwaluko to include health education on benefits of VMMC, infection prevention and control, male circumcision by trained medical personnel and education on laws governing CMI/Ulwaluko. These interventions should also target uninitiated adolescents.,Thesis (MPA) -- Faculty of Health Sciences, 2022
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    Colistin utilisation and clinical outcomes at a public hospital in Bloemfontein, South Africa
    (University of Fort Hare, 2022-07) Matshediso, Gaalebale Prudence; Adeniyi, O V
    Background Colistin is an antibiotic used as the last resort in the treatment of multi-drug resistant Gram-negative bacteria. Its use started in the 1950s but was decreased in the 1980s owing to its nephrotoxic side effects. The re-emergence of Colistin utilisation in 2012 in South Africa followed the emergence of multi-drug resistant Gram-negative bacteria. There is a dearth of information on the rationale use of Colistin in South Africa. Aim To describe the use of Colistin and its clinical outcomes at a tertiary hospital in Bloemfontein, South Africa. Methodology A retrospective cross-sectional study was conducted at a tertiary hospital in Bloemfontein between 2015 and 2019. Relevant data was extracted from the medical records of patients treated with Colistin. Stratified random sampling was used in selecting 50percent of the eligible medical records of patients treated with Colistin per stratum. Data was analysed using simple descriptive and inferential statistics. Results Of the total sample (N=69), the majority were neonates (43.5percent), while children constituted the lowest number of patients (18.8percent). The highest contributor to the top diagnosis, septicaemia, were neonates (44.2percent). Adherence to policy and Colistin treatment guidelines was suboptimal, more so in neonates (45.3percent) than in adults (73.7percent) and children (72.3percent). Colistin was used as a last resort in 68.1percent of the participants. Cure was achieved in 26.9percent, 46.2percent and 80percent of adults, children and neonates, respectively. The highest rate of nephrotoxicity was seen in adults (57.7percent). In the multivariate logistic regression model analysis, both adults [adjusted odds ratio (AOR)=25.54, 95percent confidence interval (CI) 2.73-238.65] and children (AOR=8.56, 95percentCI 1.06 – 69.10) had a higher risk of death than neonates. However, there was no significant difference in the odds for mortality by gender, co-morbidities, illness duration prior to admission and adherence to treatmen Conclusions This study found a suboptimal level of compliance with policy and recommended guidelines on the use of Colistin in a South African public sector tertiary hospital. In addition, there were variations in the level of compliance by age categories, with lower levels of compliance in neonates than in children and adults. The odds for mortality by gender, co-morbidities, illness duration prior to admission and adherence to treatment guidelines and policies were found to be insignificant, and age was the only predictor of mortality found in the study. The findings of the study highlight the need for improved clinical governance on antibiotic stewardship and monitoring of use of Colistin across all categories of patients in the hospital. Future studies should examine the contributing factors for suboptimal compliance, with evidence-based recommendations on the use of Colistin in the study setting as well as factors contributing to high mortality in adults.,Thesis (MPA) -- Faculty of Health Sciences, 2022
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    Infant feeding knowledge, attitudes and practices of mothers in private health facilities in Alice Town, Eastern Cape, South Africa
    (University of Fort Hare, 2022-07) Oyeniran, Aderonke Adepeju; Goon, D T
    Background and aim of the study: Within the global field of health education, it is generally accepted that the topic of breast-feeding is a crucial discussion due to its maternal, infant, and communal benefits. However, certain African countries, such as South Africa, experience certain challenges related to both predictive factors and maternal attitudes to breast-feeding. To improve public awareness and promote the implementation of breast-feeding, these factors should be investigated to highlight the importance of this practice among young mothers. Method: The study utilised a cross-sectional survey by means of a self-administered questionnaire, which was completed by the carefully chosen participants. The collected data were then analysed using a statistical package for social sciences (SPSS) (frequency, percentages, mean and standard deviation) and inferential statistics (logistic regression). The level of significance for the inferential statistics was set at 0.05. Results: A total of 377 infant mothers participated in the study with median age of 30. Most infant mothers that participated in the study were well educated with infant mother 189 having a bachelor’s degree. The findings revealed that mothers of 40 years above are 1.51 times more likely not to breastfeed exclusively compared to mothers of less than 40 years of age (95percent CI, 0.75-2.25). The odds ratio of the incidence of decision in breastfeeding for participants with breastfeeding and formula milk was 1.66 (95percent CI, 0.87-2.53). In term of family support, mothers who don’t receive family support were 3.43 times more likely no to breastfeed. The result also revealed that mothers with breast pain were 0.98 more likely not to breastfeed. Conclusion: This study concludes that infant mothers are well informed about breastfeeding. This study also revealed that factors such as infant mothers’ knowledge about breastfeeding, medical health of both mother and infant and cultural norms can go a long way in influencing the decision of mothers to breastfeeding their infant or not.,Thesis (MPH) -- Faculty of Health Sciences, 2022
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    Investigation of risky sexual behaviour amongst HIV/AIDS positive individuals on antiretroviral treatment in Buffalo City Metropolitan Municipality Eastern Cape Province, South Africa
    (University of Fort Hare, 2022-07) Pere, Mzukisi Ernest; Mayeye, B F
    Background: Human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome (AIDS) is one of the major public health concerns. Antiretroviral treatments (ART) is available immediately for HIV-positive individuals but sexually transmitted infections are on the rise. The majority of HIV positive patients on ART are engaging in unsafe sexual practices. Purpose: The aim of this study was to investigate risky sexual behaviour of people on antiretroviral treatment regarding prevention. The study was conducted on adult clients in the Buffalo City Metropolitan Municipality. Methods: A quantitative and descriptive cross-sectional design was conducted whereby 304 patients who visited Nontyatyambo Health Centre were randomly selected. Data was entered and analyzed using Statistical Package for the Social Sciences (SPSS) 24. Simple descriptive statistics such as numbers, percentages and tables were used to characterise variables. A chi-square test was used to explore associations between dependent and independent variables. Test significance, confidence intervals and p-values of all the causes and contributory factors were set at 0.05. Results: Thirty two percent reported having sex with multiple sexual partners while 19percent reported never using a condom. Forty eight percent reported having had sexually transmitted infections since starting on ART. The median age (36 years (IQR: 31, 45) vs. 35 years (IQR: 26, 40)) of those who reported STIs was higher than the median age of those who did not report STI (p=0.012). Males (57percent, p=0.049), those who were employed (55percent, p=0.048), and those who were cohabitating (68percent, 0.030) were more likely to report STI. Similarly, those who had unprotected sex with a casual partner (62percent, p<0.001), and those who did not use a condom because a partner did not like it (71percent, p=0.001) were more likely to report STIs. A significant number of 32percent of the participants reported engaging in risky sexual practices while 48percent had reported an STI. Recommendations include educational outreach programmes and capacitation of health care workers with appropriate skills and tools.,Thesis (MPH) -- Faculty of Health Sciences, 2022
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    Clinicians knowledge and perceptions of point of care testing (poct) in selected hospitals in the free state, South Africa
    (University of Fort Hare, 2022-08) Watkins, Edgar Jeffrey; Oladimeji, Elizabeth Kelechi; Last name, First name
    Point of care testing (POCT) improves access and equity to health diagnostic services in resource-limited settings like South Africa, where some health facilities do not have on-site laboratories. With recent technological advancements, most traditional laboratory tests can now be conducted on-site at primary health clinics (PHC), hospital wards and clinics. One advantage of the POCT device is that it can be used by a non-medical laboratory expert at the patient’s bed side during hospitalizations or near the patient in the doctor’s consultation rooms. This results in a shorter turnaround time for the availability of test results when compared to that from a specimen sent to a traditional clinical laboratory. Despite the benefits of POCT, many clinicians (doctors and nurses) avoid utilizing POCT for quality assurance reasons. Clinicians believe the results from a POCT device may not be as reliable as the results from tests performed by a medical laboratory scientist in the traditional clinical laboratory. This study used a concurrent mixed method research design to explore clinicians' POCT knowledge and attitudes in a subset of hospitals in the Free state of South Africa. The study population comprised of consenting medical professionals from the ten (10) selected Free State district hospitals (study sites). The findings demonstrated that hospitals in urban areas have easier access to laboratory services. There were two (2) urban study sites that had on-site laboratories which achieved faster Turn-Around-Time (TAT). The participants indicate that they are aware of POCT and routinely use it, but there are far fewer POCT tests available than laboratory tests. When diagnostic options are scarce, point-of-care testing (POCT) can provide a more accurate diagnosis than traditional methods. The improved health care provision and reduced incidence of health complications is the end result. According to the participants, having access to POCT diagnostic services has shown promise in addressing challenges that sometimes present with laboratory-based methods, particularly in settings with limited access to hospitals or when laboratories cannot be accessed. Further, clinicians argue that errors in the usage of POCT may occur due to the quality of these POCTs and improper documentation of the test results by the clinicians. Therefore, poor utilization of POCT by clinicians can be improved if implemented with pre-set strict selection goals and processes to ensure that the right POCT is selected for the right purpose that would reduce resource expenditure by the hospitals and improve patient experiences and health outcomes.,Thesis (MPH) -- Faculty of Health Sciences, 2022