Browsing by Author "Adams, Shahieda"

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    The Correlates of Post-Traumatic Stress Disorder in Ambulance Personnel and Barriers Faced in Accessing Care for Work-Related Stress
    (2022-02-11) Ntatamala, Itumeleng; Adams, Shahieda
    We investigated factors associated with increased risk for post-traumatic stress disorder (PTSD) in ambulance personnel and the barriers faced in accessing support for work-related stress (WRS). A cross-sectional study of 388 ambulance personnel used self-administered questionnaires to assess for PTSD and level of occupational stressors: Impact of Event Scale-Revised, Emergency Medical Services (EMS) Critical Incident Inventory, EMS Chronic Stress Questionnaire, SF-36 Quality of Life and the Connor–Davidson Resilience Scale. The prevalence of PTSD in the study population was 30%. The participants were predominantly female (55%), with a median age of 38 (IQR; 31–44) years. PTSD was associated with smoking (OR = 1.76, 95% CI: 1.05–2.95), illicit drug use (OR = 16.4, 95% CI: 1.87–143.86) and problem drinking (OR = 3.86, 95% CI: 1.80–8.23). A self-reported mental health condition (OR = 3.76, 95% CI: 1.96–7.21), being treated for a medical condition (OR = 1.95, 95% CI: 1.22–3.11), exposure to critical incident stress (OR = 4.27, 95% CI: 2.24–8.15) and chronic WRS (OR = 4.46, 95% CI: 1.93–10.31) were associated with PTSD risk. Barriers to seeking help included concerns that services were not confidential and the negative impact on the participant’s career. The increased levels of WRS, strong associations with substance use and barriers to accessing care offer starting points for workplace interventions to reduce the impact of PTSD in ambulance personnel.
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    Health-Related Quality of Life (HRQoL) of Residents with Persistent Lower Respiratory Symptoms or Asthma Following a Sulphur Stockpile Fire Incident
    (Multidisciplinary Digital Publishing Institute, 2022-03-02) Adams, Shahieda; Rajani, Mayuri; Baatjies, Roslynn; Omar, Faieza; Jeebhay, Mohamed Fareed
    Background: This study evaluated health-related quality of life (HRQoL) in residents with persistent lower respiratory symptoms (PLRS) or asthma six years after exposure to sulphur dioxide vapours emanating from an ignited sulphur stockpile. Methods:A cross-sectional study was carried out, using interview data collected at three time points (prior to, one- and six-years post incident), medical history, respiratory symptoms and HRQOL using the Medical Outcomes Study Form 36 (SF-36). Results: A total of 246 records, 74 with and 172 without PLRS or asthma, were analysed. The mean age was 42 (SD:12) years in the symptomatic group and 41 (SD:13) years in the asymptomatic group. Mean SF-36 scores were significantly lower for the symptomatic group in the Physical Functioning (24 vs. 39), Role—Physical (33 vs. 48) and General Health (GH) domains (24 vs. 37). Symptomatic residents experienced a significant decline in their Role—Physical (OR = 1.97; CI 1.09, 3.55) and GH (OR = 3.50; CI 1.39, 8.79) at year 6 compared to asymptomatic participants. Residents with co-morbid reactive upper airways dysfunction syndrome demonstrated stronger associations for GH (OR = 7.04; CI 1.61, 30.7) at year 1 and at year 6 (OR = 8.58; CI 1.10, 65.02). Conclusions:This study highlights the long-term adverse impact on HRQoL among residents with PLRS or asthma following a sulphur stockpile fire disaster.
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    Obstructive Lung Disease among tobacco farmers in Malawi
    (2020) Moyo, Yotam Mgonjetsi; Adams, Shahieda; Jeebhay, Mohamed
    Introduction and aim Tobacco farmers are exposed to toxic workplace hazards such as nicotine and pesticides in addition to known agriculture related hazards like dust, and ergonomic factors. Nicotine and pesticide exposure have been linked to the development of chronic respiratory diseases. This study was aimed at determining the prevalence of obstructive lung disease among tobacco farmers in Malawi and its association to nicotine and pesticide exposure. Methods A cross-sectional study was conducted comprising of 279 current workers across four flue-cured tobacco farms in rural Zomba district of Malawi during a tobacco growing season. The assessment involved the use of a modified ECRHS questionnaire and questions on pesticides and nicotine exposure. Voluntary HIV testing was offered to individuals who did not know their HIV status. Health outcomes assessment involved the use of both symptom and spirometry-based diagnoses of obstructive lung disease. The data was analyzed using STATA 14 computer software and included bivariate and multivariate logistic regression analysis. Results The study had predominantly male participants (68%) with a total mean age of 37.7 years, majority (73%) of whom had attained primary education or higher, with 20% being current smokers. Participants had a mean employment duration of 7.3 years and 62% indicated that they worked mainly with tobacco while 57% were involved in pesticides application. HIV prevalence was 16%. The prevalence of current asthma (ECRHS) was 20% whilst for asthma score≥2 it was 23%. The prevalence of chronic bronchitis, work related ocular nasal symptoms and work- related chest symptoms were 17%, 20% and 29%, respectively. Airflow Limitation measured as FEV1 < LLN was 14% (NHANES and sample reference). The prevalence of moderate to severe obstruction was 4%. The prevalence of green tobacco sickness (a proxy for nicotine exposure) in the past year was 26% with an average of 3 episodes within that period. Most workers were exposed to pesticides with 72% reporting exposure during spraying of pesticides while 83% reported re-entry into fields soon after spraying. The main pesticide in use was organophosphates (18%). The majority (51%) of participants reported use of organophosphate pesticides at home. In multivariate analysis nicotine exposure and associated tasks were significantly associated with all respiratory outcomes (OR range 1.78-7.26). Pesticide application was positively associated with all the symptom-based respiratory outcomes (OR 1.96- 2.62) except for work related chest symptoms. Exposure during spraying was significantly associated with asthma score≥2 (OR 2.09, CI 1.01-4.31), current asthma (OR 2.57, CI 1.22-5.40), and work related ocular nasal symptoms (OR 2.43, CI 1.17- 5.04) while pesticide drift was associated with current asthma (OR 2.62, CI 1.00-6.86) and work related ocular nasal symptoms (OR 3.00, CI 1.18-7.62). In spirometry-based outcomes duration of pesticide exposure was significantly associated with FEV1/FVC< LLN (OR 5.11, CI 1.57-16.66), FEV1/FVC< 70% (OR 4.58, CI 1.17-17.98) and moderate to severe obstruction (OR 13.25, CI 1.69-103.93). Nicotine exposure was not significantly associated with spirometry-based outcomes. Conclusion In conclusion, this study showed that tobacco farmers in Malawi have a higher prevalence of asthma and chronic bronchitis compared to the general population or tobacco farmers in other settings. Additionally, exposure to nicotine and pesticides is strongly associated with the prevalence of obstructive lung diseases among these farmers.
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    Predictors of discordant latent tuberculosis infection test results amongst South African health care workers
    (BioMed Central, 2019-02-08) Adams, Shahieda; Ehrlich, Rodney; Baatjies, Roslynn; Dendukuri, Nandini; Wang, Zhuoyu; Dheda, Keertan
    Background The tuberculin skin test (TST) and interferon-gamma-release-assays (IGRAs) are utilized in screening programmes for presumed latent tuberculosis infection (LTBI) in health care workers (HCWs). However, inter-test comparison yields high rates of discordance, which is poorly understood. The aim of the study was therefore to identify factors associated with discordance amongst HCWs in a TB and HIV endemic setting. Methods 505 HCWs were screened for LTBI in South Africa using the TST and two IGRA assays (QuantiFERON-TB-Gold-In-Tube (QFT-GIT) and TSPOT.TB). Factors associated with discordance were analyzed using a multinomial logistic regression model. Results TST-IGRA discordance was negatively associated with longer duration of employment for both TSPOT.TB (OR = 0.92; 95% confidence interval (CI) 0.85–0.99) and QFT-GIT (OR = 0.90; 95% CI 0.84–0.96). Marked test discordance occurred in HIV-infected individuals who were more likely to have TSPOT.TB + ve / TST-ve discordance (OR 4.44; 95% CI 1.14–17.27) or TSPOT.TB + ve / QFT-GIT-ve test discordance (OR 5.72; 95% CI 1.95–16.78). Those engaged in home care were less likely to have QFT-GIT + ve/TSPOT.TB -ve / discordance (OR 0.32; 95% CI 0.10–0.95). Conclusion The marked TST-IGRA and IGRA-IGRA discordance in HIV-infected individuals suggest greater sensitivity of TSPOT.TB in immunocompromised persons or potential greater reactivity of TSPOT.TB in this population.
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    Predictors of obstructive lung disease among seafood processing workers along the west coast of the Western Cape of South Africa
    (2007) Adams, Shahieda; Jeebhay, Mohamed Fareed
    Introduction: This study examined the patterns and the prevalence of obstructive lung disease (asthma and COPD) and associated risk factors (age, gender, atopy, smoking history, allergic history, previous history of lung disease, occupational exposures, seafood intake) in a working population of seafood processing workers along the West coast of the Western Cape of South Africa. Materials and method: A cross-sectional study was conducted 643 currently employed workers in two fish processing plants working fish canning and fishmeal processing. A modified version of the European Community Respiratory Health Survey (ECRHS) questionnaire was used. Skin prick tests (SPT) used extracts of common airborne allergen. Lung function spirometry and methacholine challenge tests (tidal breathing method) conducted using Vitallograph S-model bellows volume-time spirometers according to ATS guidelines. Serum omega-3 and omega-6 fatty acid levels also analysed to examine the association between dietary fatty acids and asthma outcomes. Multivariate regression models were developed for asthma outcomes after adjusting for age, gender, sex and atopic status whilst the models were adjusted for age, gender and smoking history for COPD outcomes.
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    Predictors of post-traumatic stress disorder among ambulance personnel in the western cape province
    (2021) Ntatamala, Itumeleng Mmoko Theophelus; Adams, Shahieda
    Objective: To determine the factors associated with an increased risk for PTSD in ambulance personnel and the barriers faced in accessing support for work related stress (WRS). Methods: A cross-sectional study of voluntary participants comprising 388 ambulance personnel was conducted. Participants completed self-administered questionnaires: Impact of Event Scale-Revised (IES-R), EMS Critical Incident Inventory (CII), EMS Chronic Stress Questionnaire (EMSCSQ), SF-36 Quality of Life questionnaire (SF-36) and Connor-Davidson Resilience Scale (CD-RISC) which were used to assess PTSD and level of occupational stressors. Results: The prevalence of PTSD in the study population was 30%. Participants were predominantly female (55%), median age 38 (IQR; 31 - 44) years with a professional qualification (83%). Those with PTSD were more likely current smokers (OR=1.76, 95% CI: 1.05 - 2.95), current illicit drug users (OR=16.4, 95% CI: 1.87 - 143.86) and problem drinkers (OR=3.86, 95% CI: 1.80 - 8.23). A self-reported mental health condition (OR=3.76, 1.96 - 7.21), being treated for a medical condition (OR=1.95, 1.22 - 3.11), exposure to chronic WRS (OR=1.05, 1.04 - 1.07) and high critical incident stress score (OR=1.03, 1.02 - 1.04) were positively associated with PTSD risk. Barriers to seeking help for WRS included concerns that services were not confidential, and that the participant's career would be negatively affected. Conclusion: The PTSD prevalence in ambulance personnel is considerably higher than that found in previous studies conducted among this occupational group in the Western Cape. Identified risk factors should inform interventions designed to support ambulance personnel and a greater focus on addressing barriers to accessing care is needed.
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    A study to evaluate immunodiagnostic tests for tuberculosis infection and determinants of TB infection in a population of health care workers in the Western Cape of South Africa
    (2015) Adams, Shahieda; Dheda, Keertan; Ehrlich, Rodney
    Background: Health care workers are at increased risk of acquiring latent tuberculosis infection (LTBI). The emergence of interferon - gamma release assays (IGRAs) for the diagnosis of LTBI, presents an opportunity for improved estimation of TB infection prevalence and incidence. Their utility in settings with high background prevalence TB and HIV infection is unknown. Major aims of the study were to: * Evaluate the prevalence and factors associated with TB infection using both tuberculin skin test (TST) and IGRA assays in a sample of health care workers. * Evaluate change in interval test response over one year to determine annual risk of infection and determinants associated with test conversion. Methods: Participants completed a questionnaire on occupational and environmental characteristics including a TB symptom screen and underwent chest radiograph and rapid HIV test. Three tests for latent TB infection were administered: TST, QuantiFERON - TB Gold In - Tube (QFT - GIT) and a T - SPOT.TB test. All tests were repeated one year later. Results: The prevalence of TB infection at baseline was 84%, 65% and 60% as measured by TST, QFT - GIT and T - SPOT.TB. There was only fair agreement between TST and IGRAs. HIV positive status was significantly associated with having a TST negative / T - SPOT.TB positive discordant test response (OR=4.72). TST had superior sensitivity than IGRAs for the diagnosis of LTBI. In primary level staff a positive TST outcome, was negatively associated with HIV positive status (OR=0.41). Long employment duration was positively associated with TST (OR=4.17) and QFT - GIT (OR= 2.42) positivity. Involvement in sputum collection (OR=3.25) and home - based care of TB patients (OR= 4.14) was associated with a positive IGRA test. The conversion rate for TST and IGRAs was 38% and 22%, respectively. Reversion rates ranged from 1 % - 16 % and was lowest for TST. Factors associated with conversion (for IGRAs) included employment sector, counselling of TB patients and a baseline positive TST. Conclusion: The annual rate of TB infection was very high pointing to occupational exposure as a contributory factor. TST had superior sensitivity than IGRAs for LTBI diagnosis but poor uptake on serial testing. IGRAs had excellent uptake but its clinical utility was negatively influenced by high rates of reversion.
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    The burden and cost of sickness absenteeism amongst healthcare workers at a teaching hospital in South Africa. A cross-sectional study.
    (2022) Khan, Muhamed Adil; Adams, Shahieda; Cleary, Susan
    A high burden of sickness-related absenteeism (SRA) amongst healthcare workers (HCWs) may impact health service delivery. The burden is known in high-income settings but not well evaluated in low and middle income (LMIC) settings and absent within a South African context. To determine the prevalence, associated medical conditions and cost of SRA amongst HCWs in a LMIC setting, we evaluated Human Resource (HR) absence records from a teaching hospital in South Africa over a 3 year period. Of the 3,543 HCW employed during the study period, 78% (n = 2,748) had at least 1 SRA episode. The overall SRA prevalence was 2.63%. The mean duration of absence was 2.25 days per episode and the mean frequency was 2.65 episodes per annum. Conditions of the musculoskeletal system (40.1%) were the most commonly reported, followed by acute infections of the upper respiratory tract (13.2%) and other respiratory conditions (6.2%). The total direct cost SRA was US$5,105,061.78 over the study period and the mean direct SRA cost per person was US$1,857.74 per episode. The results demonstrate a higher SRA burden compared with studies in similar settings and prompts further research into the causative factors and targeted risk mitigation strategies.
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    The epidemiology of tuberculosis in health care workers in South Africa: a systematic review
    (BioMed Central, 2016-08-20) Grobler, Liesl; Mehtar, Shaheen; Dheda, Keertan; Adams, Shahieda; Babatunde, Sanni; van der Walt, Martie; Osman, Muhammad
    Background: In South Africa, workplace acquired tuberculosis (TB) is a significant occupational problem among health care workers. In order to manage the problem effectively it is important to know the burden of TB in health care workers. This systematic review describes the epidemiology of TB in South African health care workers. Methods: A comprehensive search of electronic databases [MEDLINE, EMBASE, Web of Science (Social Sciences Citation Index/Science Citation Index), Cochrane Library (including CENTRAL register of Controlled Trials), CINAHL and WHO International Clinical Trials Registry Platform (ICTRP)] was conducted up to April 2015 for studies reporting on any aspect of TB epidemiology in health care workers in South Africa. Results: Of the 16 studies included in the review, ten studies reported on incidence of active TB disease in health care workers, two report on the prevalence of active TB disease, two report on the incidence of latent TB infection, three report on the prevalence of latent TB infection and four studies report on the number of TB cases in health care workers in various health care facilities in South Africa. Five studies provide information on risk factors for TB in health care workers. All of the included studies were conducted in publicly funded health care facilities; predominately located in KwaZulu-Natal and Western Cape provinces. The majority of the studies reflect a higher incidence and prevalence of active TB disease in health care workers, including drug-resistant TB, compared to the surrounding community or general population. Conclusions: There is relatively little research on the epidemiology of TB in health care workers in South Africa, despite the importance of the issue. To determine the true extent of the TB epidemic in health care workers, regular screening for TB disease should be conducted on all health care workers in all health care facilities, but future research is required to investigate the optimal approach to TB screening in health care workers in South Africa. The evidence base shows a high burden of both active and latent TB in health care workers in South Africa necessitating an urgent need to improve existing TB infection, prevention and control measures in South African health care facilities.
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    The Prevalence And Determinants Of Burnout In Medical Doctors At Public Hospitals In Gqeberha During The Covid-19 Pandemic: A Cross-Sectional Study
    (2023) Khan, Saajida; Adams, Shahieda
    Introduction: Burnout has been defined as “a syndrome that results from chronic workplace stress” which has been unsuccessfully managed and has previously been documented in doctors. The COVID-19 pandemic has increased the occupational challenges faced by doctors in hospitals, potentially increasing their risk for burnout. Aim: This study aimed to determine the prevalence and determinants of burnout amongst medical doctors at public hospitals in Gqeberha (South Africa) during the COVID-19 pandemic. Methods: A cross-sectional study was conducted on 260 doctors employed at three public hospitals in Gqeberha. Participants voluntarily completed self-administered electronic questionnaires: Oldenburg Burnout Inventory, selected subscales of the NIOSH Generic Job Stress Questionnaire, the Connor-Davidson Resilience Scale 10 to assess burnout, job stress and resilience as well as questions related to challenges associated with the COVID-19 pandemic. Results: The burnout prevalence amongst the study participants was 78%. Most of the participants were female (58%) and young, with 43% in the 20-29 age-group. Medical Interns formed the dominant occupational group (32%) with an average of 2 years of service (IQR = 1-5) and 96% were in full-time employment. Burnout was significantly associated with being a medical intern or community service medical officer (OR=6.72, 1.71-26.40), being in the lowest income band (OR= 10.78, 2.55-45.49) as well as in those using alcohol to manage workrelated stress (OR=3.01, 1.12-8.04). Burnout was furthermore significantly associated with experiencing high conflict at work (OR=5.04, 1.92-13.20) and high role ambiguity (OR=4.49,1.98-10.18). Participants with low job satisfaction (OR=27.82, 6.27-123.45), low support at work (OR=9.99, 3.66-27.23), medium job satisfaction (OR= 5.38, 2.65- 10.93) and medium support at work (OR=3.39, 1.71-6.73) were also at increased risk of burnout. Medium (OR=0.28, 0.10-0.80) and high resilience (OR=0.08, 0.03-0.25) vi were found to be significantly protective against burnout. Factors related to COVID-19 infection and workplace interventions were not significantly associated with burnout. Conclusion: The prevalence of burnout amongst medical doctors in Gqeberha during the COVID-19 pandemic was high. Factors associated with burnout include conflict at work, role ambiguity and role conflict, job satisfaction, support at work and resilience. Given the strong associations with job stress factors and burnout, the management of burnout and mitigation should focus on interventional measures that are implemented at an organisational level.